If you have been unsuccessfully battling depression, you are not alone. At least 40 percent of all alcoholics in the United States are affected. I say ‘at least’ because our Health Recovery Center study found that almost two-thirds of our clients are depressed at entry. In fact, most alcoholics I have treated suffered from some degree of depression.
It is tempting to pin the blame for hopelessness and despair on the external events that can be triggered by alcoholism, such as the deterioration of a marriage or the loss of employment. To be sure, some of the depression alcoholics report is a result of the negative course life can take when you drink too much. You will be relieved to learn that this type of situational depression is self-limiting and will pass when your life begins to improve. Counseling or group therapy can be of enormous value here. But depression among alcoholics usually runs much deeper than the situational variety I have just described.
Depression often has biochemical roots that stem from the destructive effect of alcohol on the normal chemisty of the brain. Research has verified the relationship between biochemistry and depression. Autopsies of people who have committed suicide have revealed biochemical disruptions that may be unique to suicidal depression. In this chapter you will learn to recognize the warning signs of this tragedy in the making.
No amount of counseling or psychotherapy can help people who suffer from biochemically induced depression. I learned this the hard way: watching my son fight the deep sadness and feelings of hopelessness that descended upon him as his depression worsened. The counseling he received was excellent, but words have no power to reverse the biochemical disruption caused by alcoholism and drugs. In fact, therapy’s focus on the unhappy or unsatisfactory external events marring the lives of such seriously depressed people only creates more misery.
My search for an explanation for Rob’s suicide led me to studies that confirmed the connections between brain biochemistry and depression and offered methods of repair that succeed far more reliably than any form of talk therapy. I learned that there is no single biochemical glitch that explains all depression. At my clinic, we treat seven different sources of depression affecting alcoholics. In this article, you will learn which of the seven may underlie your depression, (in some cases, two or more may be to blame). You will also learn how to overcome your particular chemical problem or problems. This may mean taking more nutrients. It may require further changes in your diet. Or you may need drug treatment to correct a medical condition that can precipitate depression. First, of course, you’ll have to confirm that you are depressed. Then you can evaluate the severity of your case.
How Can You Tell if You are Depressed?
Although two-thirds of the clients at my clinic are severely depressed when they enter the program, many do not realize they are affected. Men in particular are inclined to attribute the feelings induced by depression to other causes. Some blame their inability to handle stress well. Others reject being labeled depressed because of the social stigma often unjustly attached to this condition. Some are simply so overwhelmed by alcoholic symptoms that their depression is masked. Even so, depression is not difficult to spot if you know that certain behaviors are red flags to the condition:
- Withdrawal from activity; isolating yourself
- Continual fatigue, lethargy
- Lack of motivation, boredom, loss of interest in life
- Feeling helpless, immobilized
- Sleeping too much; using sleep to escape reality
- Insomnia, particularly early morning insomnia (waking very early and being unable to get back to sleep)
- Lack of response to good news
- Loss of appetite or binge eating
- Ongoing anxiety
- Silent and unresponsive around people
- An “I don’t care” attitude
- Easily upset or angered, lashing out at others
- Inability to concentrate
- Listening to mood music persistently
- Self-destructive behavior
- Suicidal thoughts or plans
How to Tell if Your Depression is Psychological or Biochemical
Biochemical depression has certain symptoms that distinguish it from the depression stemming from negative life events. You have reason to suspect that you are biochemically depressed if any of the markers listed below describes your depression:
- You have been depressed for along time despite changes in your life
- Talk therapy has little or no effect; in fact, psychological probing–questions like “Why do you hate your father?”–leave you as confused as Alice at the Mad Hatter’s tea party
- You don’t react to good news
- You awaken very early in the morning and can’t get back to sleep
- You cannot trace the onset of your depression to any event in your life
- Your moods may swing between depression and elation over a period of months in a regular rhythm (this suggests bipolar, or manic-depressive, disorder)
- Heavy drinking makes your depression worse
How Serious Is Your Depression?
As important as identifying the cause of your depression is determining the depth of your feelings. If you often have suicidal thoughts, please confide in your physician and a close friend or relative. You will recover, but in your present state you need the support of someone you trust. Share this information and together do the detective work needed to discover what is responsible for your continued depression.
The Seven Kinds of Alcoholic Depression
- Neurotransmitter depletion
- Unavailability of prostaglandin E1
- Vitamin/mineral deficiency
- Food and chemical allergies
- Candida-related complex
[These may not only affect alcoholics but any of us who suffer from depression.] Where do you fit in? Let’s begin with the most likely biochemical scenario.
Neurotransmitter Depletion and Depression
Neurotransmitters are the natural chemicals that facilitate communication between brain cells. These substances govern our emotions, memory, moods, behavior, sleep, and learning abilities. Neurotransmitters are manufactured in the brain from the amino acids we extract from foods, and their supply is entirely dependent on the presence of these precursor amino acids. Alcohol destoys these essential precursor amino acids which is probably why alcoholics seem so emotionally muddled and depressed. Without adequate amino-acid conversion, neurotransmitters are no longer produced in sufficient amounts; this deficiency causes “emotional” symptoms, including depression.
The two major neurotransmitters involved in preventing depression are serotonin (converted from the amino acid L- tryptophan) and norepinephrine (also know as noradrenaline, converted from the amino acids L- phenylalanine and L-tyrosine). You can resupply the vital neurotransmitter precursors and reverse depression by taking daily amino-acid supplements. Your symptoms will determine which amino acid you will take for depression: L-tryptophan if your symptoms are sleeplessness, anxiety, or irritability; L-tyrosine or L-phenylalanine if your symptoms are lethargy, fatigue, sleeping too much, or feelings of immobility.
Tryptophan to Serotonin
The amino-acid tryptophan found in large amounts in milk and turkey is the nutrient needed to form serotonin, which controls moods, sleep, sex drive, appetite, and pain threshold. Eating disorders and violent behavior have also been traced to serotonin depletion. Replacing serotonin can lift depression and end insomnia. In one notable study, a medical researcher in Holland demonstrated that a combination of tryptophan (2 grams nightly) and vitamin B6 (125 milligrams three time a day) could restore patients with anxiety type depression to normal in four weeks. Depression accompanied by anxiety and sleep disturbances is most likely to respond to tryptophan.
How to Take Tryptophan
Until the U.S. Food and Drug Administration prohibited the manufacture and sale of tryptophan in the United States in the fall of 1980, we used it for ten years at the clinic without any ill effects. This amino acid has also been widely used in England and Canada. Last year, however, a number of deaths and illnesses in the United States were traced to batches of tryptophan manufactured in Japan. In response, the FDA removed tryptophan from the U.S. market. At the time of this writing, the ban remains in effect. I want to caution you against using any tryptophan purchased before the FDA barred its sale. I am confident that eventually tryptophan will again be freely available in this country. At that point, you can purchase a fresh supply. Here are guidelines for its use:
- Tryptophan alone will not be converted to sertonin. To insure that it is properly used, you must also take vitamin C and vitamin B6 (see table below)
- Tryptophan is converted to niacin before its final conversion into serotonin. If your body is deficient in niacin, the tryptophan you take will supply you with niacin, not serotonin. For this reason, it is a good idea to take a B-complex vitamin daily. This will give you both vitamin B6 and niacin and allow the tryptophan to be converted to serotonin.
Of all the amino acids, tryptophan is least able to cross the blood-brain barrier. It must pass this biological hurdle in order to be converted to serotonin. Always take your tryptophan on an empty stomach.
Safety and Side Effects
Orthomolecular physicians have safely used tryptophan in doses of one to six grams daily. Since it is not stored in the body, it cannot accumulate to toxic levels. However, taking high levels of tryptophan can produce some side effects:
- Drowsiness the next morning
- Bizarre or strange dreams (rare)
- Increased blood pressure in persons over age sixty who already have high blood pressure
- Aggressiveness (this rare side effect can occur in the absence of sufficient supplies of the nutrients needed for normal conversion of tryptophan to serotonin.)
Formula for Depression Due to Serotonin Depletion
|L-Tryptophan*||500 mg||2 to 8 capsules per day in divided doses (1 or 2 midmorning, 1 or 2 midafternoon, 2 to 4 at bedtime) on an empty stomach|
|Vitamin B6||50 mg||1 capsule 3 times per day|
|Vitamin C||1000 mg||1 capsule per day|
|Niacin||500 mg||1 capsule per day (non-time released)|
*Use tryptophan only if the FDA lifts the current ban on its sale.
Who Should Not Take Tryptophan
- Anyone who takes an MAO (monoamine oxidase) inhibitor for depression; do not take tryptophan until ten days after giving up MAO inhibitors
- Anyone with severe liver disease (a damaged liver cannot properly metabolize tryptophan or any other amino acid)
- Pregnant women (you may be able to take five hundred to a thousand milligrams of tryptophan, but only with the approval and supervision of your physician)
Tyrosine to Norepinephrine
The amino acid tyrosine, found in large amounts in cheeses, has an amazing effect on depression. A number of studies have found that it can succeed where antidepressant drugs fail. In the brain, tyrosine is converted into the neurotransmitter norepinephrine, which has been described as the brain’s version of adrenaline. You can appreciate the power of norepinephrine when you realize that the effect produced by cocaine comes from the drug’s ability to activate norepinephrine while inhibiting serotonin. This chemical reaction causes the brain to race until the supply of norepinephrine is depleted. The crash leaves addicts exhausted, depressed, extremely irritable, and craving more cocaine. Large doses of tyrosine can reduce withdrawal symptoms and prevent serious depression among cocaine addicts. We have used tyrosine at the Health Recovery Center for the past few years with no adverse effects. The usual dose is three to six grams per day, taken on an empty stomach. You must take vitamins B6 and C to facilitate conversion of tyrosine to norepinephrine (see table below).
L-Phenylalanine to Norepinephrine
As an alternative to tyrosine, you can take the amino acid L- phenylalanine, which also can be converted into norepinephrine. A number of studies have confirmed L-phenylalanine’s amazing antidepressant effects. In one, this potent amino acid was found as effective an antidepressant as the drug imipramine (Tofranil). L-phenylalanine has one important advantage over tyrosine in treating depression. It can be converted to a substance called 2-phenylethylamine or 2-PEA. Low brain levels of 2-PEA are responsible for some depression (before it converts to tyrosine, which then converts to norepinephrine). If you are affected, L-phenylalanine will be better for you than tyrosine. The only way to find out is by trial and error. I recommend that you start by taking L-phenylalanine. If you find that it makes your thoughts rush (an effect that is often described as the brain “racing”), you don’t need 2-PEA and should switch to tyrosine. The only other disadvantage to taking L-phenylalanine is its slight potential for raising blood pressure.
There is also some evidence that excess L-phenylalanine can cause headaches, insomnia, and irritability. For these reasons, it is important to start with a low dose. L-Phenylalanine doses can range from 500 milligrams to 1500 milligrams daily taken on an empty stomach. Overdose symptoms are headaches, insomnia, and irritability.
Formula for Depression Due to Norepinephrine Depletion
|L-Tyrosine||500 mg||4 to 10 capsules per day in 2 or 3 equal doses on an empty stomach|
|OR — L-Phenylalanine||500 mg||1 to 3 capsules per day in equal doses on an empty stomach|
|Vitamin B6||50 mg||1 capsule 3 times per day|
|Vitamin C||1000 mg||1 capsule per day|
Who Should Not Take Tyrosine or L-Phenylalanine
- Anyone with high blood pressure should avoid phenylalanine or take very low doses (one hundred milligrams) at first and monitor blood pressure as dosage is increased.
- No one taking an MAO inhibitor for depression should take either tyrosine or L-phenylalanine
- No one with severe liver damage should take any amino acid.
- Do not take any amino acids during pregnancy except with the approval and supervision of your physician.
- No one with PKU (phenylketonuria) should use L-phenylalanine.
- No one with schizophrenia should take either amino acid (except with a physician’s approval and under their supervision.)
- No one with an overactive thyroid or malignant melanoma should take either amino acid.
- If you are being treated for any serious illness, consult your doctor before taking these amino acids.
Another biochemical cause of depression is a genetic inability to manufacture enough prostaglandin E1 (PGE1), an important brain metabolite derived from essential fatty acids (EFAs). The problem is the result of an inborn deficiency in omega-6 essential fatty acid. Alcohol stimulates temporary production of PGE1 and lifts the depression.
If you have been depressed since childhood, your introduction to alcohol was probably an extreme relief. But this relief is short-lived. When you stop drinking, PGE1 levels fall again and depression returns. To banish it, you turn again to alcohol. Thus a deadly spiral begins toward alcoholism.
During the last fifteen years, researchers have learned to restore normal PGE1 levels in alcoholics and eliminate both the depression and the need to drink for relief. A substance called gamma-linolenic acid (GLA) is easily converted to PGE1. I have seen some amazing recoveries from depression within three weeks of GLA treatment. Take the case of Colleen, a high school English teacher:
As her college years passed, Colleen’s alcohol consumption escalated. She needed to drink more and more to get the lift she sought. She also began to experience deep depressions in the days following heavy drinking. After college, she began teaching high school English. Controlling her depression with alcohol became a real balancing act. Eventually, her drinking came to the attention of her peers and her students. Colleen was appalled at the idea that she was a problem drinker. She decided to prove she could live without alcohol. The next ten years were some of the most miserable of her life. She joined AA and sought psychiatric help for her severe depression. Sadly, no antidepressant drug relieved her misery. It was hard to keep teaching, hard to keep living.
Her depression had reached the suicidal stage when she reasoned that alcohol could put an end to her despair. Her decision to resume drinking didn’t take much reflection. Predictably, her alcohol intake began to escalate rapidly. This time, no one sympathized. Her principal ordered her to treatment. Three weeks after completing an inpatient program, she was back at employment and drinking again to medicate her depression. A second round of treatment left her temporarily dry and depressed. Colleen was on a merry-go-round she couldn’t get off. When she called the Health Recovery Center, she was crying, “I have alienated everyone because I won’t stay sober, but being drunk feels better than being depressed.”
I often think someone up there does watch over people, it seems more than coincidence that Colleen found her way to one of the few treatment centers in the country that would run tests and restore her chemistry to normal. Within three weeks, her depression had vanished. She no longer needed nor craved alcohol.
Colleen’s was a classic case of chronic depression caused by too little PGE1. Although alcohol blocks production of additional amounts of this metabolite, its active effect is to enhance what little is available in the brain. Eventually, a no-win situation develops and alcohol becomes the only way to prevent depression. The solution, of course, is to provide the brain with the PGE1 needed to reverse the depression. If your body can’t do this normally, you can correct the problem by taking gamma linolenic acid (GLA) in the form of Efamol ( a trade name for oil of evening primrose). The formula for EFA deficient depression (see table below) includes three supportive nutrients in addition to Efamol: zinc, needed for formation of gamma-linolenic acid (GLA); vitamin B6 for metabolism of cis-linolenic acid; and vitamin C, to increase production of PGE1. When you take GLA and its co-factors, depression magically lifts and won’t return as long as you continue to take the formula. Colleen now uses this natural substance daily instead of alcohol, and her world has brightened up permanently.
Do You Have an EFA Deficiency? In his book “Essential Fatty Acids and Immunity in Mental Health, Charles Bates, Ph.D., provides a list of factors that suggest an essential fatty acid deficiency:
- Ancestry that is one-quarter or more Celtic, Irish, Scandinavian, native American, Welsh, or Scottish.
- A tendency to abuse alcohol or feel that it affects you differently from others; trouble with alcohol in your teenage years.
- Anxiety or depression during hangovers
- Depression among close relatives
- A family history of alcoholism, depression, suicide, schizophrenia, or other mental illness.
- Depression that persists while you are abstinent from alcohol.
- A personal or family history of Crohn’s disease, hepatic cirrhosis, cystic fibrosis, Sjogren-Larsson syndrome, atopic eczema.
- A personal or family history of ulcerative colitis, irritable bowel syndrome, premenstrual syndrome, scleroderma, diabetes, or benign breast disease.
- Experiencing an emotional lift from certain foods or vitamins.
- Winter depressions that lighten in the spring.
Formula for Depression due to EFA Deficiency
|Efamol||500 mg||3 capsules, 3 times per day with meals (9 per day); can be reduced to 6 per day after 1 month|
|Zinc picolinate||20 mg||1 capsule with food|
|Vitamin B6||50 mg||1 capsule 3 times per day|
|Vitamin C||1000 mg||1 capsule per day|
|Niacin||100 mg||1 capsule with food daily|