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Depression is more than just a bout of the blues. While we all feel sad and low from time to time, some people experience these feelings intensely and persistently for long periods of time (weeks, months or even years). Depression is not something that people can just "snap out of" – it is a mood disorder that causes a persistent feeling of sadness and loss of interest.
In Australia, it is estimated in any one year, around one million adults are suffering depression.
Alarmingly, the success of antidepressant drug therapy is not high, with studies suggesting that the majority of depressed patients do not experience remission when treated with a first-line antidepressant. Therefore, it is essential that we continue the search for more effective mood disorder management. Integrative approaches may complement pharmaceuticals, or, offer an alternative in cases where negative side effects or contraindications are noted.
...the majority of depressed patients do not experience remission when treated with a first-line antidepressant.
The process of methylation appears to be one very important piece of the mood puzzle. Methylation is the essential biochemical process involving the addition of methyl groups to a vast range of compounds in the body. These methylation processes are important for normal gene function, detoxification, cardiovascular health, regulation of inflammation and energy production. In the brain, methylation plays a critical role, and is responsible for the production and metabolism of hormones and neurotransmitters such as melatonin, serotonin, cortisol, adrenalin and noradrenaline. If methylation is impaired, the critical balance between hormone and neurotransmitter production and breakdown is affected, adversely impacting mood and cognition.
In this infographic, we explore the methylation cycle, the nutrients upon which it depends and how supporting this cycle can support patients with depression.
- The facts. Beyond Blue 2016. Viewed 14 December 2016. [Link]
- Fava M. Switching treatments for complicated depression. J Clin Psychiatry. 2010 Feb;71(2):e04. [Full text]
- Bottiglieri T, Laundy M, Crelli R, et al. Homocysteine, folate, methylation, monoamine synthesis in depression. J Neurol Neurosurg Psych 2000;69(2):228-232. [Full text]
- Fryar-Williams S, Strobel JE. Biomarker symptom profiles for schizophrenia and schizoaffective psychosis. Open J Psych 2015;5:78-112. [Full text]
- Carney MW, Edeh J, Bottiglieri T, et al. Affective illness and s-adenosyl methionine: a preliminary report. Clin Neuropharmacol 1986;9(4):379-385. [Abstract]
- Freeman MP, Fava M, Lake J, et al. Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association Task Force report. J Clin Psychiatry 2010;71:669-681. [Abstract]
- Almeida OP, McCaul K, Hankey GJ, et al. Homocysteine and depression in later life. Arch Gen Psych 2008;65(11):1286-1294. [Abstract]
- Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside--molecular basis of a pleiotrophic molecule. Am J Clin Nutr 2002;76(5):1151S-1157S. [Full text]
- Carpenter DJ. St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Rev 2011;16(1):17-39. [PDF]
- Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide, 3rd ed. Sydney: Churchill Livingstone Elsevier, 2010.
- 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(8):942-948. [Abstract]
- Williams AL, Girard C, Jui D, et al. S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med 2005;28(3):132-139. [Abstract]
- Delle Chiaie R, Pancheri P, Scapicchio P. Efficacy and tolerability of oral and intramuscular S-adenosyl-L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Am J Clin Nutr 2002;76(5):1172S-1176S. [Full text]
- Papakostas GI. Evidence for S-adenosyl-L-methionine (SAM-e) for the treatment of major depressive disorder. J Clin Psychiatry 2009;70 Suppl 5:18-22. [Abstract]
- Vitamin B12. Micronutrient Information Center. Linus Pauling Institute 2003. Viewed 3 Sep 2016. [Link]
- Folate. Micronutrient Information Center. Linus Pauling 2002. Viewed 3 Sep 2016. [Link]
- Fava M, Mischoulon D. Folate in depression: efficacy, safety, differences in formulations, and clinical issues. J Clin Psychiatry 2009;70(Suppl 5):12-17. [Abstract]
- Kelly GS. Folates: supplemental forms and therapeutic applications. Alt Med Rev 1998;3(3):208-220. [PDF]