Excerpt from "Alcoholism - The Biochemical Connection" by Joan Larson, PhD.

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?

• Withdrawal from activity; isolating yourself
• Continual fatigue, lethargy
• Indecisiveness
• 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

• 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?

The Seven Kinds of Alcoholic Depression

 

1. Neurotransmitter depletion
2. Unavailability of prostaglandin E1
3. Vitamin/mineral deficiency
4. Hypothyroidism
5. Hypoglycemia
6. Food and chemical allergies
7. 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.

The two major neurotransmitters involved in preventing depression are serotonin (converted from the amino acid L- tryptophan) and norepinephrine (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.

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

*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

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.

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.

• 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

One of the most dramatic cases of vitamin and mineral deficiencies I have seen involved a man I'll name Paul. He had been arrested four times for drunken driving but continued to drink daily. His probation officer brought him to the Health Recovery Center. The three of us had to decide if an outpatient program would be proper for someone as depressed as Paul. The court had just ordered him back to treatment; judging by the miserable look on his face,it was the last place he wanted to be. Paul was thirty, divorced and living alone. He rarely ate more than one meal a day, usually fast food or junk food. He lived on coffee, cigarettes, and beer. Paul confided that he was probably going to lose his sales job because he could no longer motivate himself. He blamed all of his troubles on depression. There were so many aspects of his life-style that suggested a real depletion of the natural chemicals he needed to recover from alcoholism and depression that I urged Paul to let us work with him. Two days later, after receiving his B-complex shots, Paul remarked that we must have injected him with an amphetamine. The effect of restoring these life-giving substances was dramatic. He also made many life-style changes that contributed to his recovery, but one of the most important was the replacement of certain key natural substances that helped relieve his depression.

Here's a rundown of recent finding about the relationship of B-complex vitamins to depression:

• Vitamin B1 (thiamine): Deficiencies trigger depression and irritability and can cause neurological and cardiac disorders among alcoholics.
• Vitamin B2 (riboflavin): In 1982 an article published in the British Journal of Psychiatry reported that every one of 172 successive patients admitted to a British psychiatric hospital for treatment of depression was deficient in B2.
• Vitamin B3 (niacin): Depletion causes anxiety, depression, apprehension, and fatigue.
• Vitamin B5 (pantothenic acid): Symptoms of deficiency are fatigue, chronic stress, and depression. Vitamin B5 is needed for hormone formation and the uptake of amino acids and the brain chemical acetylcholine, which combine to prevent certain types of depression.
• Vitamin B6 (pyridoxine): Deficiency can disrupt formation of neurotransmitters. Vitamin B6 is a co-enzyme needed for conversion of tryptophan to serotonin and phenylalanine and tyrosine to norepinephrine. I have discussed the relationships of these neurotransmitters to depression.
• Vitamin B12: Deficiency will cause depression.
• Folic acid: Deficiency is a common cause of depression.

Vitamin C
Continued vitamin C deficiency causes chronic depression, fatigue, and vague ill health.

Minerals
Deficiencies in a number of minerals can also cause depression. I would like you to familiarize yourself with the minerals that can underlie depression so you can better understand the rationale for taking supplementary doses:

• Magnesium: Symptoms of deficiency include confusion, apathy, loss of appetite, weakness, and insomnia.
• Calcium: Depletion affects the central nervous system. Low levels of calcium cause nervousness, apprehension, irritability, and numbness.
• Zinc: Inadequacies result in apathy, lack of appetite, and lethargy. When zinc is low, copper in the body can increase to toxic levels, resulting in paranoia and fearfulness.
• Iron: Depression is often a symptom of chronic iron deficiency. Other symptoms include general weakness, listlessness, exhaustion, lack of appetite, and headaches.
• Manganese: This metal is needed for proper use of the B-complex vitamins and vitamin C. Since it also plays a role in amino-acid formation, a deficiency may contribute to depression stemming from low levels of the neurotransmitters serotonin and norepinephrine. Manganese also helps stabilize blood sugar and prevent hypoglycemic mood swings.
• Potassium: Depletion is frequently associated with depression, tearfulness, weakness, and fatigue. A 1981 study found that depressed patients were more likely than controls to have decreased intracellular potassium. Decreased brain levels of potassium have also been found on autopsy of suicides. You can boost your potassium intake by using one teaspoon of Morton's Lite-Salt every day.

The Safety of Supplements
Vitamin C and the B-complex vitamins discussed above are all water soluble. This means that they can't accumulate in your body or he stored for future use. Amounts above and beyond your current nutritional needs are dumped into your urine. As a result, there is no danger of overdose. Unlike water soluble vitamins, minerals can be stored in your tissues. [Refer to the Optimum Nutrition Formula for the RDAs and suggested optimum levels.] For therapeutic doses you will need the advice of a qualified nutrition consultant. Do not exceed the recommended therapeutic doses, since accumulation of minerals in the body can be dangerous.

• Depression
• Mental sluggishness
• Confusion
• Poor memory
• Fatigue
• Low sex drive
• Brittle hair
• Dry skin
• Puffiness around the eyes
• Cold hands and feet
• Sleeping more than eight hours a night
• Susceptibility to colds and infections

Researchers speculate that hypothyroidism causes depression because there is an insufficient supply of oxygen to the brain, since people with low thyroid function do not use oxygen efficiently. Linus Pauling contends that all depression could be eliminated if brain cells received sufficient oxygen.

In Mary's case, standard lab tests indicated low-normal thyroid function, but her morning temperature never rose above 96.9 degrees. We treated her with Armour Thyroid, a prescription drug. It relieved her depression and eliminated her mental sluggishness and fatigue. She also lost weight. If your home thyroid test shows that your temperature is consistently below 97.8 degrees, see your physician to discuss treatment. If the doctor wants more information on your testing method, refer him or her to Dr. Barnes's book "Hypothyroidism: The Unsuspected Illness". Another useful book is "Solving the Puzzle of Illness" by Steven Langer, M.D. Dr. Barnes has published more than a hundred papers and several books on the role of the thyroid gland in human health. He treats thyroid disorders with natural desiccated thyroid rather than synthetic thyroid preparations. The advantage of natural thyroid over synthetic is that all thyroid hormones are replaced with the natural product, whereas synthetics have not yet been able to duplicate nature completely and do not affect two troublesome symptoms of hypothyroidism, dry skin and water retention.

By the end of the week-long modified fast, Carol was feeling much better. Her depression was gone and her energy had returned. Then she tested wheat. Within two hours she crashed. Crying over the telephone, she told me she was too depressed to continue the program. The next day she apologized. We were both grateful to find a major trigger to her depression. After her severe reaction, I expected Carol to avoid wheat religiously. At the time, I didn't understand the addiction aspect of the allergic/addicted response. Carol had enormous cravings for breads and pasta, so her resolve lasted only a few days. Then she succumbed to temptation and ate pizza for lunch. An hour later, she arrived at her treatment group sobbing inconsolably while the others groped for emotional explanations for her behavior. After her wheat reaction wore off, her depression again lifted.

Wheat is not the only substance capable of triggering a maladaptive reaction within the brains and nervous systems of sensitive people. Alcohol, certain foods (particularly the grains from which alcohol is made), and many chemicals (particularly hydrocarbon-based products like gasoline and paints) can also cause reactions. Food addiction keeps us coming back for more of certain foods. We love the initial mild energy they provide as they bring us out of our withdrawal state. We don't understand that the downside of this addiction is depression, anxiety, and mental confusion, the result of the inevitable withdrawal in the nervous system and the brain. So be suspect of foods that you feel you cannot do without.

Suicide and Depression

Often, those touched by the tragedy are tormented by guilt. They can't stop wondering whether they could have done something to prevent the suicide, whether they missed warning signs that tragedy was approaching. Recent scientific findings provide some of the answers to these agonizing questions and offer comfort and insight.

Most people experience some major disappointment or stress in the course of life, but suicide is rarely the outcome. And, there is no good evidence suggesting that most depression predates alcoholism or that any personality traits underlie alcoholism. Indeed, researchers have so far failed to find genetically transmitted depression among most alcoholics. Instead, studies suggest that the prolonged use of alcohol causes biochemical changes in the brain associated with depression and suicide. The most striking of these findings (from the National Institute of Mental Health) shows that the neurotransmitter serotonin is almost depleted in all the brains of suicides examined during autopsies. Since alcoholism causes the destruction of tryptophan and other precursor amino acids needed for production of the antidepressant neurotransmitters, it's not surprising that many alcoholics are prone to depression and even suicide. As I have explained earlier in this chapter, alcohol can also precipitate depression by destoying a number of other natural chemicals, including

• The neurotransmitter norepinephrine, formed from the amino acids phenylalanine and tyrosine
• Endorphins
• Essential fatty acids needed to form brain metabolites, including prostaglandin E1 (PGE1)
• B vitamins, which supply the brain's energy and maintain mental and emotional balance
• Trace elements and enzymes that govern the body's hormonal balance

A cerebral allergic reaction to alcohol or other substances can cause suicidal depression. High levels of toxins from Candida albicans overgrowth can also affect the brain and central nervous system and induce suicidal depression. Alcoholism promotes both proliferation of candida and escalation of cerebral allergies. Since alcohol can inflict so much biochemical damage on the brain and nervous system, it should not be surprising that many alcoholics attempt suicide. One recent study found that up to 40 percent of all alcoholics try to take their own lives at east once; another study found that 26 percent of the deaths of treated alcoholics were suicides. If you feel that you or someone close to you is a suicide risk, please re-read this chapter carefully and encourage the changes recommended to restore normal balance and banish depression once and for all.

Where Do You Fit In?

1. Restoring the neurotransmitters serotonin and/or norepinephrine
2. Replacing essential fatty acids to create PGE1
3. Restoring key vitamins and minerals
4. Treating hypothyroidism
5. Correcting hypoglycemia
6. Avoiding foods/chemicals responsible for cerebral allergy/addition
7. Treating candida related complex

Don't be surprised if you fit several of these seven categories. Heavy alcohol use wreaks havoc on your biochemical balance. But with a repair program you can restore your health. In some cases you'll need a physician's help or the help of a nutrition consultant. I can't overemphasize the importance of expert medical advice when you are dealing with depression, especially if it is severe. It is equally important to choose a professional attuned to your special needs. Orthomolecular MDs are experts in both allopathic and nutritional science who treat disorders at the cellular level with biological weapons--nutrients that nature has provided in its own system of defense for millions of years. An orthomolecular psychiatrist or physician can help you address the following problems:

• Restoration of neurotransmitter levels via amino-acid therapy
• Vitamin, mineral, and essential fatty acid testing and restoration
• Thyroid testing and treatment
• Hypoglycemia testing and treatment
• Allergy testing and treatment
• Candida testing and treatment

For a list of such physicians in your area, contact the American Academy of Environmental Medicine, P.O.Box 16106, Denver, CO 80216, (303) 622-9755.

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