More than 17 million American men and women experience depression in one form or another every year, according to the National Mental Health Association (NMHA) in Alexandria, Virginia. This includes the deeply destructive major, or clinical, depression, the wide mood swings of bipolar disorder (manic-depressive illness), and dysthymia, a milder, long-lasting form of emotional suffering.

Twice as Many Women
In the depression scenario, women suffer twice as much: Two times as many women as men endure clinical depression, reports the NMHA. The mood-deteriorating effects of the hormonal disruptions women are heir to may be partly to blame.

According to the National Institute of Mental Health (NIMH), about one of 10 Americans wades through at least one depressive swamp sometime during his or her life.

The good news: Research shows that diet and lifestyle can lower your risk of depression.

Birth of the Blues
Nowadays, mounting evidence suggests that depression may result more from physiological factors than psychological woes.

Some of the hidden reasons why you may be depressed include: nutritional deficiencies, exacerbated by overdosing on too much caffeine, sugar, alcohol and high fat foods; allergies; anxiety and chronic stress; and a chemical imbalance in the brain's gray matter. According to the NMHA, people with depression often possess too little or too large a quantity of the neurotransmitters norepinephrine, serotonin and dopamine. Changes in levels of these brain chemicals may cause, or contribute to, clinical depression.

The NMHA also reports that an imbalance of melatonin, a chemical made by the body's pineal gland (located at the base of the brain), contributes to a form of wintertime depression called seasonal affective disorder (SAD). This hormone is made at increased levels in the dark. Therefore, the body may oversupply this hormone during winter's shortened daylight hours.

Plan B
Since the B vitamins are often involved in the production of energy, and a large component of depression may encompass the inability to get out of bed and deal with the world, experts believe that at least some of the signs of depression are linked to B deficiencies. For instance, studies cited in the Encyclopedia of Natural Medicine (Prima) by Michael Murray, ND and Joseph Pizzorno, ND, demonstrate that folate deficiency and lack of vitamin B12 can compromise mental health (Drugs 45, 1993: 623-36; Lancet 336, 1990: 392-5).

Inositol: This vitamin is also part of the B vitamin complex, and it, too, has shown its ability to lift spirits. Research work in Israel shows that daily inositol given to 28 depressed patients for four weeks produced an overall positive effect. (Eur Neuropsychopharmacol 7:2, May 1997: 147-55). Inositol is found in whole, unprocessed grains, citrus fruits (except lemons) and brewer's yeast.

NADH: Allan Magaziner, DO, in his book The Idiot's Complete Guide To Living Longer & Healthier (Alpha), reports that brain energizing NADH, a metabolite of vitamin B3, enhances the production of the key neurotransmitters dopamine, noradrenaline and serotonin. "In a recent clinical trial," he claims, "nearly all patients given NADH for depression reported improvement in their symptoms and the absence of side effects or adverse reactions."

Moody Spotlight
Another substance winning the spotlight for its effect on mood is SAM-e: S-adenosylmethionine. In New York on February 24, a symposium coordinated by the American Health Foundation met to hear researchers present information from studies of SAM-e's ability to possibly ease depression.

"SAM-e is a natural product. You and I have it but as people age it declines in production in the body. And that's why we believe supplementation in older people is a beneficial means of bringing that back up and helping people that have depression," said the lead symposium researcher, John H. Weisburger, PhD, MD, Director Emeritus, American Health Foundation in Valhalla, New York.

Another researcher, Teodoro Bottiglieri, PhD, Associate Professor of Biomedical Studies and Neurology, Director of Neuropharmacology at Baylor University reported: "SAM-e has been shown to enhance brain dopamine and serotonin neurotransmitter metabolism and receptor function. It may also aid in the repair of myelin that surrounds nerve cells. These mechanisms are likely to be responsible for the antidepressant effect of SAM-e."

(Bottiglieri is co-author with Richard Brown, MD, and Carol Colman of Stop Depression Now, a report on the powers of SAM-e just published by G.P. Putnam's Sons.)

SAM-e was first touted as an antidepressant in Italy in 1973. It's been reported that nearly 40 clinical trials demonstrate its beneficial effects as a natural antidepressant.

For instance, an analysis of more than 1000 people suffering depression showed that the effect of antidepressants in patients taking SAM-e was 17% to 38% better than dummy preparations. Conventional antidepressants show a 20% effectiveness rate (Bressa G. Acta Neurol Scand S154, 1994: 7-14).

5-HTP: Another popular supplement to boost mood and relieve depression is hydroxytryptophan. "This medication is actually a brain chemical that is metabolized from tryptophan into serotonin," says Magaziner. And since low serotonin levels have been linked with depression, and certain prescribed medications may up serotonin levels, 5-HTP is in demand.

"One of the more impressive studies supporting the efficacy of 5-HTP for depression evaluated 100 people who had previously found conventional antidepressant therapy to be inadequate. Forty-three of these folks reported a complete recovery, and eight showed significant improvement," reports Magaziner. Not only has 5-HTP been shown to work slightly better than drugs known as SSRIs (these include Prozac), he adds, it has fewer side effects than standard antidepressants, too. DHEA: Medical experts also believe that levels of the hormone DHEA (dehydroepiandrosterone) may influence mood. Ray Sahelian, MD, in his book All About DHEA (Avery) reports an interesting study conducted by Dr. Owen Wolkowitz of the Department of Psychiatry, University of California, San Francisco. A group of six depressed middle-aged and elderly individuals who took DHEA found that within a month they had better memory and mood. (Biological Psychiatry 41, 1997: 311-18.) "In addition," adds Sahelian, "other studies have also found that DHEA increases energy levels and a sense of well being." But follow package directions: Some people complain of greater irritability and overstimulation with DHEA, when they take large amounts.

Herbal Relief
St. John's wort: still the most touted natural therapy for defeating depression. In Europe, 23 clinical studies, reviewed in the August 3, 1996 British Medical Journal, found that this herb, also known as Hypericum perforatum, can be helpful in alleviating cases of mild to moderate depression. The work, which included 757 patients, has shown that hypericum produced fewer side effects than conventional anti-depressants.

Although experts have never satisfactorily explained exactly how St. John's wort benefits the brain, some theorize that it boosts serotonin levels. And it can help SAD sufferers.

"In a recent study of 20 people with SAD, four weeks' worth of St. John's wort significantly alleviated feelings of depression. Those people who added full-spectrum lights to the treatment program gained an even greater benefit," notes Dr. Magaziner.

Valerian: Anxiety and stress, which can cause depression and insomnia, may be helped by this herb, says the prolific Dr. Sahelian in his book Kava: The Miracle Antianxiety Herb (St. Martin's). In 101 Medicinal Herbs (Interweave), Steven Foster reports that "Ten controlled clinical studies have been published on valerian...one of which suggests that valerian should be used for two to four weeks before daily mood and sleep patterns improve."

Amino Acid Help
Amino acids, the building blocks of protein, may also help improve mood. (For more on protein, see page 65.) These chemicals are used by the body to construct neurotransmitters, brain chemicals that facilitate mental activity.

For instance, the amino acid L-tyrosine is necessary for the formation of transmitters adrenaline and dopamine. This substance, therefore, is given to alleviate depression and anxiety.

The substance L-dopa which is given to victims of Parkinson's disease is concocted from tyrosine. And several antidepressants alleviate bad moods by boosting the interaction of brain chemicals related to tyrosine.

In addition, since tyrosine is used to make adrenaline, this amino acid may be helpful for folks trying to cope with the mood problems related to stress.

Another amino acid that experts believe useful for better moods, L-methionine, is used by the body to make choline, a crucial substance for brain function. (Choline goes into the formation of acetylcholine, a neurotransmitter.)

Methionine has been given to people suffering from schizophrenia and depression as well as to those with Parkinson's. Methionine plays a number of crucial roles in the brain and body since it helps form other vital proteins.

Depressive Smoking
For those concerned about preserving a positive mood, researchers are positive that smoking worsens depression. A study at the Department of Behavioral Services at the Henry Ford Health System in Michigan found that daily smokers run twice the risk for major depression compared to those who only smoked occasionally.

Unfortunately, the investigators found that not only did smoking seem to lead to depression, depression, in turn, led to more smoking (Archives of General Psychiatry, 2/99).

"Smokers who have depression tend to see their smoking become a daily habit and it may be because they use nicotine to medicate their depressed mood," reported Naomi Breslau, PhD, who headed the research. Over a five year period, the researchers looked at about a thousand young people aged 21 to 30. They found that daily smokers generally start smoking in adolescence, and those who report early depression are three times as likely to eventually become daily smokers.

If you're feeling down, don't give up hope. Although depression can prove to be a depressingly complicated malady, daily, healthy habits can offset its effects. Getting consistent exercise, dousing your cigarettes and turning to herbal and nutritional help to treat mild depression may defeat those blues.