Exit

Health Condition

Depression

About This Condition

Depression is a condition characterized by unhappy, hopeless feelings. It can be a response to stressful events, hormonal imbalances, biochemical abnormalities, or other causes.

Mild depression that passes quickly may not require any diagnosis or treatment. However, when depression becomes recurrent, constant, or severe, it should be diagnosed by a licensed counselor, psychologist, social worker, or doctor. Diagnosis may be crucial for determining appropriate treatment. For example, depression caused by low thyroid function can be successfully treated with prescription thyroid medication. Suicidal depression often requires prescription antidepressants. Persistent mild to moderate depression triggered by stressful events is often best treated with counseling and not necessarily with medications.

When depression is not a function of external events, it is called endogenous. Endogenous depression can be due to biochemical abnormalities. Lifestyle changes, nutritional supplements, and herbs may be used with people whose depression results from a variety of causes, but these natural interventions are usually best geared to endogenous depression.

Symptoms

A diagnosis of depression requires at least five of the following symptoms.

  • Depressed mood.
  • Diminished interest or pleasure in all or most activities, most of the day, nearly every day.
  • Significant weight loss or gain when not dieting (e.g., more than 5% of body weight in a month).
  • Insomnia or excessive sleeping nearly every day.
  • Agitation or depression in voluntary muscle movements nearly every day.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive and inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate, or indecisiveness nearly every day.
  • Recurrent thoughts of death (not just fear of death), recurrent suicidal ideation without a plan, or a suicide attempt or specific plan to commit suicide.

Other Therapies

Psychological counseling is an essential component of therapy.

References

1. Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord 1998;48:149-55.

2. Maes M, Smith R, Christophe A, et al. Fatty acid composition in major depression: decreased omega 3 fractions in cholesteryl esters and increased C20: 4 omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. J Affect Disord 1996;38:35-46.

3. Peet M, Murphy B, Shay J, Horrobin D. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry 1998;43:315-9.

4. Maes M, Christophe A, Delanghe J, et al. Lowered omega-3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Res 1999;85:275-91.

5. Adams PB, Lawson S, Sanigorski A, Sinclair AJ. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996;31:S157-S161.

6. Nemets H, Nemets B, Apter A, et al. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry 2006;163:1098-100.

7. Su KP, Huang SY, Chiu CC, Shen WW. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13:267-71.

8. Rondanelli M, Giacosa A, Opizzi A, et al. Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 2010;29:55-64.))

9. Grenyer BFS, Crowe T, Meyer B, et al. Fish oil supplementation in the treatment of major depression: a randomised double-blind placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:1393-6.

10. Rogers PJ, Appleton KM, Kessler D, et al. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr 2008;99:421-31.

11. Puri BK, Counsell SJ, Richardson AJ, Horrobin DF. Eicosapentaenoic acid in treatment-resistant depression. Arch Gen Psychiatry 2002;59:91-92 [Letter].

12. Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry 2002;59:913-9.

13. Panahi Y, Badeli R, Karami GR, Sahebkar A. Investigation of the efficacy of adjunctive therapy with bioavailability-boosted curcuminoids in major depressive disorder. Phytother Res 2015;29:17–21.

14. Lopresti AL, Maes M, Maker GL, et al. Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. J Affect Disord 2014;167:368–75.

15. Yu JJ, Pei LB, Zhang Y, et al. Chronic supplementation of curcumin enhances the efficacy of antidepressants in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study. J Clin Psychopharmacol 2015;35:406-410.

16. Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897-904.

17. Russ CS, Hendricks TA, Chrisley BM, et al. Vitamin B-6 status of depressed and obsessive-compulsive patients. Nutr Rep Int 1983;27:867-73.

18. Gunn ADG. Vitamin B6 and the premenstrual syndrome (PMS). Int J Vitam Nutr Res 1985;(Suppl 27):213-24 [review].

19. Kleijnen J, Riet GT, Knipschild P. Vitamin B6 in the treatment of the premenstrual syndrome—a review. Br J Obstet Gynaecol 1990;97:847-52.

20. Van Praag HM, Lemus C. Monoamine precursors in the treatment of psychiatric disorders. Nutrition and the Brain, vol. 7, RJ Wurtman, JJ Wurtman, eds. New York: Raven Press, 1986 [review].

21. Van Praag H, de Hann S. Depression vulnerability and 5-hydroxytryptophan prophylaxis. Psychiatry Res 1980;3:75-83.

22. Angst J, Woggon B, Schoepf J. The treatment of depression with L-5-hydroxytryptophan versus imipramine. Results of two open and one double-blind study. Arch Psychiatr Nervenkr 1977;224:175-86.

23. Nolen WA, van de Putte JJ, Dijken WA, et al. Treatment strategy in depression. II. MAO inhibitors in depression resistant to cyclic antidepressants: two controlled crossover studies with tranylcypromine versus L-5-hydroxytryptophan and nimifensine. Acta Psychiatr Scand 1988;78:676-83.

24. Nolen WA, van de Putte JJ, Dijken WA, Kamp JS. L-5-HTP in depression resistant to re-uptake inhibitors. An open comparative study with tranylcypromine. Br J Psychiatry 1985;147:16-22.

25. D'Elia G, Hanson L, Raotma H. L-tryptophan and 5-hydroxytryptophan in the treatment of depression. A review. Acta Psychiatr Scand 1978;57:239-52 [review].

26. Jangid P, Malik P, Singh P, et al. Comparative study of efficacy of L-5-hydroxytryptophan and fluoxetine in patients presenting with first depressive episode. Asian J Psychiatr 2013;6:29–34.))

27. Tempesta E, Casella L, Pirrongelli C, et al. L-acetylcarnitine in depressed elderly subjects. A cross-over study vs placebo. Drugs Exp Clin Res 1987;13:417-23.

28. Garzya G, Corallo D, Fiore A, et al. Evaluation of the effects of L-acetylcarnitine on senile patients suffering from depression. Drugs Exp Clin Res 1990;16:101-6.

29. Guarnaschelli C, Fugazza G, Pistarini C. Pathological brain ageing: evaluation of the efficacy of a pharmacological aid. Drugs Exp Clin Res 1988;14:715-8.

30. Bella R, Biondi R, Raffaele R, Pennisi G. Effect of acetyl-L-carnitine on geriatric patients suffering from dysthymic disorders. Int J Clin Pharmacol Res 1990;10:355-60.

31. Barrett-Connor E, von Mühlen D, Laughlin GA, Kripke A. Endogenous levels of dehydroepiandrosterone sulfate, but not other sex hormones, are associated with depressed mood in older women: The Rancho Bernardo Study. J Am Geriatr Soc 1999;47:685-91.

32. Heuser I, Deuschle M, Luppa P, et al. Increased diurnal plasma concentrations of dehydroepiandrosterone in depressed patients. J Clin Endocrinol Metab 1998;83:3130-3.

33. Morales AJ, Nolan JJ, Nelson JC, Yen SSC. Effects of replacement dose of DHEA in men and women of advancing age. J Clin Endorcrionol Metab 1994;78:1360.

34. Wolkowitz OM, Reus VI, Keebler A, et al. Double-blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry 1999;156:646-9.

35. Bloch M, Schmidt PJ, Danaceau MA, et al. Dehydroepiandrosterone treatment of midlife dysthymia. Biol Psychiatry 1999;45:1533-41.

36. Wolf OT, Neumann O, Hellhammer DH, et al. Effects of a two-week physiological dehydroepiandrosterone substitution on cognitive performance and well-being in healthy elderly women and men. J Clin Endocrinol Metab 1997;82:2263-7.

37. Gaby AR. Research review. Nutr Healing 1997;8.

38. Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord 1998;48:149-55.

39. Maes M, Smith R, Christophe A, et al. Fatty acid composition in major depression: decreased omega 3 fractions in cholesteryl esters and increased C20: 4 omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. J Affect Disord 1996;38:35-46.

40. Peet M, Murphy B, Shay J, Horrobin D. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry 1998;43:315-9.

41. Maes M, Christophe A, Delanghe J, et al. Lowered omega-3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Res 1999;85:275-91.

42. Adams PB, Lawson S, Sanigorski A, Sinclair AJ. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996;31:S157-S161.

43. Nemets H, Nemets B, Apter A, et al. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry 2006;163:1098-100.

44. Su KP, Huang SY, Chiu CC, Shen WW. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13:267-71.

45. Grenyer BFS, Crowe T, Meyer B, et al. Fish oil supplementation in the treatment of major depression: a randomised double-blind placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:1393-6.

46. Rogers PJ, Appleton KM, Kessler D, et al. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr 2008;99:421-31.

47. Puri BK, Counsell SJ, Richardson AJ, Horrobin DF. Eicosapentaenoic acid in treatment-resistant depression. Arch Gen Psychiatry 2002;59:91-92 [Letter].

48. Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry 2002;59:913-9.

49. Almeida OP, Ford AH, Hirani V, et al. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry 2014;205:450–57.

50. Schubert H, Halama P. Depressive episode primarily unresponsive to therapy in elderly patients; efficacy of Ginkgo biloba extract (EGb 761) in combination with antidepressants. Geriatr Forsch 1993;3:45-53.

51. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.

52. Barkai AI, Dunner DL, Gross HA, et al. Reduced myo-inositol levels in cerebrospinal fluid from patients with affective disorder. Biol Psychiatry 1978;13:65-72.

53. Levine J, Rapaport A, Lev L. Inositol treatment raises CSF inositol levels. Brain Res 1993;627:168-70.

54. Levine J, Barak Y, Gonzalves M, et al. Double-blind, controlled trial of inositol treatment of depression. Am J Psychiatry 1995;152:792-4.

55. Levine J, Barak Y, Kofman O, Belmaker RH. Follow-up and relapse analysis of an inositol study of depression. Isr J Psychiatry Relat Sci 1995;32:14-21.

56. Stockmeier CA: Neurobiology of serotonin in depression and suicide. Ann N Y Acad Sci 1997, 836:220-32.

57. Eccleston D. L-tryptophan and depressive illness: a valuable adjunct to therapy? Psychiatric Bulletin 1993;17:223-4 [review].

58. Young SN, Teff KL. Tryptophan availability, 5HT synthesis and 5HT function. Prog Neuropsychopharmacol Biol Psychiat 1989;13:373—9.

59. Werbach MR. Nutritional influences on mental illness, 2nd ed. Tarzana, CA: Third Line Press, 1999, 266-67 [review].

60. Buist R: The therapeutic predictability of tryptophan and tyrosine in the treatment of depression. Int J Clin Nutr Rev 1983;3:1-3 [review].

61. Lindberg D, Ahlfors UG, Dencker SJ, et al. Symptom reduction in depression after treatment with L-tryptophan or imipramine. Item analysis of Hamilton rating scale for depression. Acta Psychiatr Scand 1979;60:287-94.

62. Young SN. The clinical psychopharmacology of tryptophan. In Wurtman RJ, Wurtman JJ, eds. Nutrition and the Brain, Volume 7. New York: Raven Press, 1986, 49-88.

63. Thomson J, Rankin H, Ashcroft GW, et al.The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo. Psychol Med 1982;12:741-51.

64. Bennie E. Mianserin hydrochloride and Ltryptophan compared in depressive illness. Br J Clin Soc Psych 1982;1:90-1.

65. Jaffe G, Grimshaw J. A placebo-controlled comparison of L-tryptophan and amitriptyline in the treatment of depressive illness in general practice. Br J Clin Soc Psych 1985;3:51-5.

66. Cooper AJ, Datta SR. A placebo controlled evaluation of L-tryptophan in depression in the elderly. Can J Psychiatry 1980;25:386-90.

67. Young SN, Chouinard G, Annable L. Tryptophan in the treatment of depression. Adv Exp Med Biol 1981;133:727-37 [review].

68. Angst J, Woggon B, Schoepf J. The treatment of depression with L-5-hydroxytryptophan versus imipramine. Results of two open and one double-blind study. Arch Psychiatr Nervenkr 1977;224:175-86.

69. Nolen WA, van de Putte JJ, Dijken WA, et al. Treatment strategy in depression. II. MAO inhibitors in depression resistant to cyclic antidepressants: two controlled crossover studies with tranylcypromine versus L-5-hydroxytryptophan and nimifensine. Acta Psychiatr Scand 1988;78:676-83.

70. Nolen WA, van de Putte JJ, Dijken WA, Kamp JS. L-5-HTP in depression resistant to re-uptake inhibitors. An open comparative study with tranylcypromine. Br J Psychiatry 1985;147:16-22.

71. D'Elia G, Hanson L, Raotma H. L-tryptophan and 5-hydroxytryptophan in the treatment of depression. A review. Acta Psychiatr Scand 1978;57:239-52 [review].

72. Van Praag HM, Lemus C. Monoamine precursors in the treatment of psychiatric disorders. Nutrition and the Brain, vol. 7, RJ Wurtman, JJ Wurtman, eds. New York: Raven Press, 1986 [review].

73. Van Praag H, de Hann S. Depression vulnerability and 5-hydroxytryptophan prophylaxis. Psychiatry Res 1980;3:75-83.

74. Rose DP, Cramp DG. Reduction of plasma tyrosine by oral contraceptives and oestrogens: a possible consequence of tyrosine aminotransferase induction. Clin Chim Acta 1970;29:49-53.

75. Moller SE. Tryptophan and tyrosine availability and oral contraceptives. Lancet 1979;2:472 [letter].

76. Kishimoto H, Hama Y. The level and diurnal rhythm of plasma tryptophan and tyrosine in manic-depressive patients. Yokohama Med Bull 1976;27:89-97.

77. Gelenberg AJ, Wojcik JD, Growdon JH, et al. Tyrosine for the treatment of depression. Am J Psychiatry 1980;137:622-3.

78. Lewy AJ, Bauer VK, Cutler NL, Sack RL. Melatonin treatment of winter depression: a pilot study. Psychiatr Res 1998;77:57-61.

79. Dolberg OT, Hirschmann S, Grunhaus L. Melatonin for the treatment of sleep disturbances in major depressive disorder. Am J Psychiatry 1998;155:1119-21.

80. Sabelli HC, Fawcett J, Gustovsky F, et al. Clinical studies on the phenylethylamine hypothesis of affective disorder: urine and blood phenylacetic acid and phenylalanine dietary supplements. J Clin Psychiatry 1986;47:66-70.

81. Beckmann H, Strauss MA, Ludolph E. DL-Phenylalanine in depressed patients: an open study. J Neural Transm 1977;41:123-34.

82. Beckmann H, Athen D, Olteanu M, Zimmer R. DL-phenylalanine versus imipramine: a double-blind controlled study. Arch Psychiatr Nervenkr 1979;227:49-58.

83. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15-8.

84. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7-14.

85. Salmaggi P, Bressa GM, Nicchia G, et al. Double-blind, placebo-controlled study of s-adenosyl-methionine in depressed postmenopausal women. Psychother Psychosom 1993;59:34-40.

86. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosyl-methionine in depression: A randomized, double-blind, placebo-controlled trial. Am J Psychiatry 1990;147:591-5.

87. Papakostas GI, Mischoulon D, Shyu I, et al. S-Adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry 2010;167:942-948.

88. Fava M, Rosenbaum JF, Birnbaum R, et al. The thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients. Acta Psychiatr Scand 1992;86:42-5.

89. De Vanna M, Rigamonti R. Oral S-adenosyl-L-methionine in depression. Curr Ther Res 1992;52:478-85.

90. Finley JW, Penland JG. Adequacy or deprivation of dietary selenium in healthy men: Clinical and psychological findings. J Trace Elem Exp Med 1998;11:11-27.

91. Benton D, Cook R. The impact of selenium supplementation on mood. Biol Psychiatry 1991;29:1092-8.

92. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500-4.

93. Harrer G, Sommer H. Treatment of mild/moderate depressions with Hypericum. Phytomedicine 1994;1:3-8.

94. Ernst E. St. John's wort, an antidepressant? A systemic, criteria-based review. Phytomedicine 1995;2:67-71.

95. Kasper S, Anghelescu IG, Szegedi A, et al. Superior efficacy of St John's wort extract WS 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial [ISRCTN77277298]. BMC Med 2006 Jun 23;4:14.

96. Vorbach EU, Hübner WD, Arnoldt KH. Effectiveness and tolerance of the Hypericum extract LI 160 in comparison with imipramine: Randomized double-blind study with 135 outpatients. J Geriatr Psychiatry Neurol 1994;7(suppl):S19-23.

97. Philipp M, Kohnen R, Hiller KO. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomized multicenter study of treatment for eight weeks. BMJ 1999;319:1534-9.

98. Woelk H. Comparison of St. John's wort and imipramine for treating depression: Randomized controlled trial. BMJ 2000;321:536-9.

99. Wheatley D. LI 160, an extract of St. John's wort versus amitriptyline in mildly to moderately depressed outpatients—controlled six week clinical trial. Pharmacopsychiatry 1997;30(suppl):77-80.

100. Volz HP, Laux P. Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine. Compr Psychiatry 2000;41(2 Suppl 1):133-7 [review].

101. Harrer G, Hübner WD, Poduzweit H. Effectiveness and tolerance of the Hypericum extract LI 160 compared to maprotiline: A multicenter double-blind study. J Geriatr Psychiatry Neurol 1994;7(suppl 1);S24-8.

102. Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St. John's wort extract LoHyp-57 and fluoxetine. Arzneimittelforschung 1999;49:289-96.

103. Schrader D. Equivalence of St. John's wort extract (ZE 117) and fluoxetine: a randomized, controlled study in mild - moderate depression. International Clin Psychopharmacol 2000;15:61-8.

104. Vorbach EU, Arnoldt KH, Hübner WD. Efficacy and tolerability of St. John's wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry 1997;30(suppl):81-5.

105. Shelton RC, Keller MB, Gelenberg A, et al. Effectiveness of St John's wort in major depression: a randomized controlled trial. JAMA 2001;285:1978-86.

106. Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John's Wort) in major depressive disorder: a randomized controlled trial. JAMA 2002;287:1807-14.

107. Amr M, El-Mogy A, Shams T, et al. Efficacy of vitamin C as an adjunct to fluoxetine therapy in pediatric major depressive disorder: a randomized, double-blind, placebo-controlled pilot study. Nutr J 2013;12:31.

108. Hoogendijk WJ, Lips P, Dik MG, et al. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry 2008;65:508-12.

109. Lansdowne ATG, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology 1998;135:319-23.

110. Arasteh K. A beneficial effect of calcium intake on mood. J Orthomolec Med 1994;9:199-204.

111. Khoraminya N, Tehrani-Doost M, Jazayeri S, et al. Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust N Z J Psychiatry 2012;Oct 23:[Epub ahead of print].

112. Arasteh K. A beneficial effect of calcium intake on mood. J Orthomolec Med 1994;9:199-204.

113. McLeod MN, Gaynes BN, Golden RN. Chromium potentiation of antidepressant pharmacotherapy for dysthymic disorder in 5 patients. J Clin Psychiatry 1999;60:237-40.

114. Reynolds E, Preece JM, Bailey J, Coppen A. Folate deficiency in depressive illness. Br J Psychiatry 1970;117:287-92.

115. Coppen A, Chaudrhy S, Swade C. Folic acid enhances lithium prophylaxis. J Affect Disord 1986;10:9-13.

116. Di Palma C, Urani R, Agricola R, et al. Is methylfolate effective in relieving major depression in chronic alcoholics? A hypothesis of treatment. Curr Ther Res 1994;55:559-67.

117. Birkmayer JGD, Birkmayer W. The coenzyme nicotinamide adenine dinucleotide (NADH) as biological antidepressive agent: Experience with 205 patients. New Trends Clin Neuropharmacol 1991;5:19-25.

118. Maggioni M, Picotti GB, Bondiolotti GP, et al. Effects of phosphatidylserine therapy in geriatric patients with depressive disorders. Acta Psychiatr Scand 1990;81(3):265-70.

119. Jorissen BL, Brouns F, Van Boxtel MPJ, et al. The influence of soy-derived phosphatidylserine on cognition in age-associated memory impairment. Nutr Neurosci 2001;4:121-34.

120. Eagles JM. Treatment of depression with pumpkin seeds. Br J Psychiatry 1990;157:937-8.

121. Ranjbar E, Shams J, Sabetkasaei M, et al. Effects of zinc supplementation on efficacy of antidepressant therapy, inflammatory cytokines, and brain-derived neurotrophic factor in patients with major depression. Nutr Neurosci 2014;17:65-71.

122. Han JS. Electroacupuncture: an alternative to antidepressants for treating affective diseases? Int J Neurosci 1986;29:79-92.

123. Hechun L, Yunkui J, Li Z. Electro-acupuncture vs amitriptyline in the treatment of depressive states. J Tradit Chin Med 1985;5:3-8.

124. Xiang L, Hechun L, Yunkui J. Clinical observation on needling extrachannel points in treating mental depression. J Tradit Chin Med 1994;14:14-8.

125. Luo H, Meng F, Jia Y, Zhao X. Clinical research on the therapeutic effect of the electro acupuncture treatment in patients with depression. Psychiatry Clin Neurosci 1998;52:S338-S340.

126. Roschke J, Wolf C, Kogel P, et al. Adjuvant whole body acupuncture in depression. A placebo-controlled study with standardized mianserin therapy. Nervenarzt 1998;69:961-7 [in German].

127. Niklson IA, Reimitz PE, Sennef C. Factors that influence the outcome of placebo-controlled antidepressant clinical trials. Psychopharmacol Bull 1997;33:41-51.

128. DeRubeis RJ, Gelfand LA, Tang TZ, Simons AD. Medications versus cognitive behaviour therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am J Psychiatry 1999;156:1007-13.

129. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, et al. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord 2000;57:255-9.

130. Berman RM, Narasimhan M, Sanacora G, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry 2000;47:332-7.

131. Gettis A. Food sensitivities and psychological disturbance: a review. Nutr Health 1989;6:135-46.

132. King DS. Can allergic exposure provoke psychological symptoms? A double-blind test. Biol Psychiatry 1981;16:3-19.

133. Brown M, Gibney M, Husband PR, Radcliffe M. Food allergy in polysymptomatic patients. Practitioner 1981;225:1651-4.

134. Weber B, Schweiger U, Deuschle M, Heuser I. Major depression and impaired glucose tolerance. Exp Clin Endocrinol Diabetes 2000;108:187-90.

135. Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 1990;301:309-14.

136. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996;335:1001-9.

137. Wardle J, Armitage J, Collins R, et al. Randomised placebo controlled trial of effect on mood of lowering cholesterol concentration. Oxford Cholesterol Study Group. BMJ 1996;313:75-8.

138. Hibbeln JR, Salem N Jr. Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nutr 1995;62:1-9 [review].

139. Makiya H. Epidemiological investigation of psychiatric disorders of old age in Sashiki-village, Okinawa. Keio J Med 1978;55:503.

140. O'Hara MW, Kohout FJ, Wallace RB. Depression among the rural elderly. A study of prevalence and correlates. J Nerv Ment Dis 1985;173:582-9.

141. Krause N, Liang J. Cross-cultural variations in depressive symptoms in later life. Int Psychogeriatr 1992;4(Suppl 2):185-202.

142. Iribarren C, Reed DM, Wergowske G, et al. Serum cholesterol level and mortality due to suicide and trauma in the Honolulu Heart Program. Arch Intern Med 1995;155:695-700.

143. Christensen L. Psychological distress and diet-effects of sucrose and caffeine. J Applied Nutr 1988;40:44-50.

144. Greden JF, Fontaine P, Lubetsky M, Chamberlin K. Anxiety and depression associated with caffeinism among psychiatric inpatients. Am J Psychiatry 1978;135:963-6.

145. Kawachi I, Willett WC, Colditz GA, et al. A prospective study of coffee drinking and suicide in women. Arch Intern Med 1996;156:521-5.

146. Gilliland K, Bullock W. Caffeine: a potential drug of abuse. Adv Alcohol Subst Abuse 1983-84;3:53-73.

147. Martinsen EW. Benefits of exercise for the treatment of depression. Sports Med 1990;9:380-9.

148. Martinsen EW, Medhus A, Sandivik L. Effects of aerobic exercise on depression: a controlled study. BMJ 1985;291:109.

149. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999;159:2349-56.

Copyright © 2018 Healthnotes, Inc. All rights reserved. www.healthnotes.com

Learn more about Healthnotes, the company.

The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.