The diagnosis of depression includes the presence, for at least 2 weeks, of at least four of the following signs and symptoms:
Poor appetite or significant weight loss
Either lack of sleep or abnormally long periods of sleep
Mental agitation or slowing of mental functioning
Loss of interest in usual activities, including decreased sex drive
Loss of energy and fatigue
Low self-esteem and feelings of worthlessness or self-reproach
Complaints or evidence of decreased ability to concentrate or think clearly Recurrent thoughts of death or talk of suicide or actual suicide attempts
Depression is a broad definition and can range from mild, situational depression to more serious states requiring medication and possible hospitalization. The depressed individual should be under the supervision of a health care professional. Treatment of depression is usually complicated and requires the input of many different medical specialties.
Older people with impaired blood flow to the brain (known as cerebrovascular insufficiency) are particularly susceptible to depression. Depression often occurs with memory loss and, sometimes, irritability. It's ironic that this form of depression is often described as "resistant" because it does not respond well to many prescription antidepressants. As noted in the chapter on ginkgo in Part 5, reestablishing healthy blood flow often leads to a dramatic reversal of these symptoms.
Herbal Prescriptions
Mild to Moderate Depression
St. John's wort extract—A daily dose that delivers at least 1 milligram
of hypericin is recommended. For example, an extract standardized to
contain 0.2 percent hypericin would require a daily dose of 500 mil
ligrams (usually given in two or three divided doses).
Action: Mild monoamine oxidase-inhibiting action leads to increased
levels of norepinephrine in the brain. This has an antidepressive effect
Older Individuals with "Resistant" Depression Ginkgo biloba extract—240 milligrams daily in two to three divided doses Action:' Increases blood flow to the brain
Other Herbal Considerations
Eleuthero (Siberian ginseng)—Standardized, concentrated extract of the root and rhizomes, 300 to 400 milligrams daily; dry, powdered root and rhizomes, 2 to 3 grams daily in two or three divided-doses; alcohol-based extract, 8 to 10 ml in two to three divided doses. Use continuously for 4 to 6 weeks with a 1- to 2-week break before resuming.
Milk thistle extract (standardized to 70 or 80 percent silymarin)— 420 milligrams of silymarin in three divided doses
Note: Milk thistle extract protects the liver if you are taking prescription antidepressants.
Nutritional Supplement Recommendations
Vitamin B complex~--50 milligrams twice daily1 Folic acid 100 micrograms daily2
Vitamin B12—Intramuscular injection of 1,000 micrograms (1 milliliter) once monthly
Note: The vitamin B12 treatment should be performed only by a skilled health care practitioner3,4
Vitamin B6—100 milligrams daily
Note: A combination of vitamin B6, B12, and folic acid helps to counter the formation of homocysteine. This substance has been linked to atherosclerosis, as well as depression and dementia, in the elderly.5 These three nutrients should be paired with ginkgo in elderly depressed individuals
Dietary Recommendations
Identify and eliminate food allergens under the supervision of a trained health care practitioner. A trial elimination of wheat and cow's milk may prove beneficial. Small, frequent meals high in protein and complex carbohydrates help regulate blood sugar. Avoid excessive consumption of sugar and other simple carbohydrates.
Other Medical Considerations
Be sure your doctor checks for anemia and low thyroid function.