Depression and dementia are often associated with one another because they share common origins, and so are connected at a much deeper level than most people realize. And for this reason, the same simple remedies may help both at the same time.
When I first began researching Alzheimer’s and related dementias I was already quite familiar with depression, having studied it as part of my master’s thesis project, and having worked with several hundred depressed, even suicidal individuals as a Chaplain and suicide prevention counselor. When I began working with the Alzheimer’s Association I could see the two were connected, and like most observers I wondered which came first, was it that depression put people in a mental fog that resulted in dementia, or that Alzheimer’s and other types of dementia were such frustrating and debilitating losses that this just naturally resulted in depression? What I later discovered was that not only were both hypothesis likely true, but that the physiological connection was much deeper than most people realize. In short research has now shown that some of the same biochemical problems, and nutritional deficits are at the heart of both problems. And the good news is that if you can address those biochemical deficits, as Dr. Shea’s team at U of Mass-Lowell have shown in research related to MemoryXL, you can alleviate both depression and dementia.
First, however, before ruminating on the remedies, I want to help you to understand the connections between these two, because this understanding, I believe, can be both enlightening as well as encouraging and motivational – i.e. it leads to the necessary actions to maintain our brain and resolve both problems.
Dr. Dharma Khalsa, M.D., a pioneer in brain research and recovery, has long espoused the belief that stress can contribute to dementia. I read about this in his 1997 book “Brain Longevity” a decade ago. Then finally in the late 90’s new research began to emerge which helped to confirm this. The most impressive evidence for me came through a PBS documentary in 2007 on research conducted by Robert Sapolsky, Ph.D., professor of neuroscience at Stanford University. Dr. Sapolsky traveled to Africa and for months observed the behaviors of Baboons (biologically similar to humans) living freely in the jungle. His research showed that social stress increased cortisol in the hippocampus (our memory center). Moreover, prolonged stress prolonged elevated levels of cortisol, which eventually resulted in damage to the delicate cells and membrane’s in this critical organ, and further result in memory problems or dementia.1
Stress -> elevates cortisol -> over time damages brain cells
About that same time I learned from Neil Nedley, M.D. that prolonged depression (longer than 2 years) can also cause brain damage, which makes sense because we know depression is akin to stress, it’s basically just a deeper form of stress or distress, and so is usually associated with elevated cortisol as well.2 Therefore, in the Maintain Your Brain program people are cautioned to address stress and depression, because both can, over time, cause brain damage that can result in memory problems or dementia.
Of course having memory problems can also be distressing, and thus perpetuates a vicious cycle leading to one’s cognitive demise.
One of the other things I learned from Nedley’s research was that a lack of certain B vitamins, particularly folate and B-12 can also lead to depression, and in fact he notes that if a person does not have sufficient folate (from plant sources) or folic acid (in the pills form) in their system, even anti-depressant medications won’t work.3
I have long known, like most health care workers, that a vitamin B-12 deficiency can lead to depression, mood and memory problems. Then as I went through the master trainer program for the Alzheimer’s Association I learned that folate or folic acid can as well. In fact 4 major international studies found that sufficient levels of these two simple vitamins may cut the risk for dementia in half.4 Together they, among other things, reduce homocystein levels in the body. Homocystein is an inflammatory that has long been associated, not only with cardio-vascular problems, but Alzheimer’s as well.
So there we find at least one underlying connection – a lack of these two simple B vitamins contributes BOTH to depression and eventually dementia. This was well illustrated recently by a man in our local, federally funded early stage intervention project. After attending my Maintain Your Brain class, a second time, wherein I talk about the research related to the importance of B-vitamins for the brain, he went out and bought himself a bottle of balanced B-50 complex. And within 2 weeks reported that he was feeling better, was less depressed and his memory abilities seemed to have improved – he was having an easier time finding the words he wanted. Interestingly enough, he also had followed my advice to see his doctor and have a good physical, including blood workup which included a test for homocystein. He didn’t get the results back until after he had been on the B-vitamins for a while and was feeling better. But when he did he was interested to hear from his doctor that in fact he had elevated homocystein and what did his doctor recommend? A simple B vitamin supplement. But of course he was glad to report that he was already doing that, and feeling the positive effects.
Now of course, not all depression is immediately alleviated by a few B-vitamins. And often in order for B-12 to be effective it needs to be taken in a shot or sublingual – dissolved under the tongue. My friend was lucky, he had only mild depression and cognitive impairment. The deeper and more prolonged the depression or dementia, the harder it seems to be and the longer it seems to take to overcome this deficit, which makes sense. And in these cases it appears that often other nutrients are needed, for a prolonged period, to make a significant difference. It takes years for our brain to deteriorate, and we have gotten so used to just taking some little pharmaceutical pill to feel better, that many people seem to think if they take a few vitamins for a couple weeks it ought to fix them up. But not everyone responds as quickly is the gentleman noted above. I might add that he was also getting in at least 30 minutes of good exercise per week and eating a lot more vegetables, and fewer sweets, and his problems were admittedly mild, and recent in origin.
When people are out of shape or can’t or won’t exercise or eat right, when the problems are more deeply entrenched it seems to take much longer for nutritional remedies to work. Dr. Nedley suggests at least 4 months. That’s why his depression recovery program, which focuses primarily on non-pharmacological remedies, is a 20 week program. It takes time to get used to a new diet, and exercise program and for the body to make the adjustments needed to feel better. And often people actually feel worse for a while, before they feel better. So it’s not a quick fix, but on the other hand, although it may take a while longer, it seems to get more to the roots of depression and dementia and result in better, and eventually more cost effective outcomes.
There are a lot of things we could talk about in terms of diet and lifestyle which contribute to brain health – that help prevent both depression and dementia. I just want to mention 5 more things that are very important if not essential to consider. You can read more about these in other sections of this website, but they are fish oil, exercise, sunlight, water and SAMe.
One of the most important nutrients for healthy brain function is DHA (docohexanoic acid). The is one of the Omega-3 fatty acids. But not all Omega-3 fatty acids contain high levels of DHA. The body can convert other Omega-3s from plant sources, like linolenic acid, into DHA, but not very efficiently, especially as we age, and if we have too many other bad fats in our diet. So nearly all of the studies done with Omega-3s and depression used fish oil or algae sources.5 Of course you can also obtain this from eating fatty cold water fish, like salmon, mackerel, halibut or tuna in water. But you want to make sure you are getting these from wild sources, like wild sockeye salmon, as many domestic fish contain high levels of mercury or other toxins. Smaller fish like sardines and anchovies are also considered safe sources. The added value of fish is that it contains L-carnitine, which is also important for energy production in the brain.
This is why two Chicago studies were able to demonstate a 60% reduction in the risk for dementia for those who ate just one or two pieces of fish a week, compared to those who did not eat any.(See The Omega-3 fatty acid DHA, under Diet and Nutrition)
Exercise has also been shown to be as effective as leading anti-depressants in helping people to avoid and over come depression. This is also documented much better in the articles under Physical Exercise on this site.
Sunlight is also essential for brain health. Many people who are depressed have seasonal affect disorder (SAD) which has been directly linked to a lack of sunlight. Sunlight is the natural, and best way to obtain vitamin D, which is made in our skin from 15 minutes or more of ultraviolet light. Note these are the same rays that are blocked by most sun screens. Is it any wonder that scientists are now finding an epidemic of biological problems related to a lack of vitamin D, such as osteoporosis, depression and dementia. Vitamin D is a very powerful hormone as well as vitamin which also has powerful antioxidant effects, which help to protect the brain.7 Moreover, bright light therapy has also been shown to very helpful in rebalancing circadian rhythms, promoting restful sleep and overcoming symptoms of depression.8
Another important element that many people forget and few seniors get enough of is water. Dr. Batmangelid, author of “Your Body’s Many Cries for Water” proposed that both depression and Alzheimer’s disease may be a result of dehydration. He noted that when the body becomes too dehydrated it becomes more acidic and thus more susceptible to poor neuro transmission and disease. And as most nurses who work on Alzheimer’s units know, few of these individuals drink enough water.
Finally, a good deal of research in recent years has focused on the value of a nutrient developed by the body from folate and B-12, called SAM or SAMe, in fighting both depression and dementia.8 Dr. Shea notes that if a person becomes too depleted in this nutrient, there body is not able to fully recharge itself with diet alone, and that’s when a SAMe supplement can be very helpful in restoring both the neurotransmitters of memory – acetylcholine, as well as improved mood – serotonin, which in turn help the body produce melatonin – essential for sleep. (It’s also been shown to help the liver and osteo-arthuritus). Dr. Nedley’s research has found that nearly 80% of individuals who are depressed, as well as many of those with dementia, have a history of not getting a good night’s sleep. So by supplementing with just this one extra, though moderately expensive, nutrient (found in MemoryXL) most people will feel an elevation in both mood and memory within days, and sleep better as well. See the following testimonial, from Joann Taylor of Ogden, Utah on the multiple and rapid impact of this synergistic formula.
“Several weeks ago while attending a health fair held in the Golden hour Center in Ogden, Utah we learned about a supplement called “Memory XL” and were told about the good results they are having in the trials. We bought two bottles and after the first day we could see excellent results with no after-effects. Dell took two pills in the morning and later in the afternoon his personality changed back to a happy, outgoing & friendly person once again. His memory is better in many ways, but he still shows signs of Alzheimer’s. We realize this is not a cure for Alzheimer’s, but it certainly helps to make him a happier and much easier person to live with. Thank you for suggesting we try Memory XL.” Note Dell also runs 4 miles a day, and they go dancing daily, so he’s getting his exercise and sunlight as well.
Note MemoryXL contain folic acid, B-12, Acetyl-L-carnitine, and SAMe as well as two other important nutrients to protect the body against oxidative stress. Now you know why I was so excited earlier this year to learn about this great new formula for the brain. All ya need to do is add water, sunlight, exercise and some fish oil, and it seems to me you would have a great winning formula to protect against stress, depression and dementia. If you give it a try let me know of your results!
References
1. Víctor S. Sierpina, MD; Michelle Sierpina, MS; Jose A. Loera, MD; Loretta Grumbles MD, Complementary and Integrative Approaches to Dementia. South Med J. 2005;98(6):636-645. ©2005 Lippincott Williams & Wilkins Posted 07/06/2005 [under] Relaxation Therapies
Agitation, stress, and increased cortisol production further restrict the functional capacities of patients with dementia. As Khalsa notes, cortisol is secreted in a situation of stress in which the teleological benefit is survival, not acquiring or seeking memories. Immediate action is required in the classic flight-or-fight reaction in which stress hormones such as cortisol, epinephrine, and norepinephrine are secreted. Indeed, high levels of cortisol are neurotoxic, accelerating aging and degeneration of the brain.[6] 6. Khalsa D. The Cortisol Connection, Healthy Aging, in: Brain Longevity . New York, Warner Books, 1997, pp 3-23.
From: The Memory Cure (2003) by Majid Fotuhi, MD, PhD. Neurology consultant, Alzheimer’s Disease Research Center Johns Hopkins Hospital, pp 122-124.
Fotuhi, citing the research of Dr. Sapolsky notes: “In other words, the cortisol hormone, which for brief periods can stimulate the brain to improve memory and attention in stressful situations, kills the brain cells in the hippocampus when present at high levels for extended periods of time.70 70. A. L. Lee, W. O. Ogle, and R. M. Sapolsky, “Stress And Depression: Possible Links To Neuron Death In The Hippocampus,” Bipolar Disorders 4 (2): 117-128 (2002).
See also: Newcomer JW; Selke G; Melson AK; et al; Decreased memory performance in healthy humans Induced by stress-level cortisol treatment. Department of Psychiatry, Washington University School of Medicine. St Louis. MO. Arch Gen Psychiatry 1999 Jun;56(6):527-33.
2. Neil Nedley, M.D., Depression The Way Out, Nedley Publishing, 2005, p. 17. Here Nedley notes in reference to the research “In fact, in some instances cortisol may be related to a gradual shrinking of areas of the brain responsible for verbal memory.” The Washington University study noted above is given as an example, where they found that “women with a history of depression had 9 to 13 percent smaller hippocampal sizes.”
Dr. Fotuhi, op cit. notes: “Depression may lead to memory loss in two ways. More than half the patients with depression have high cortisol levels in their blood. According to Dr. Sapolsky, it’s possible that they are experiencing injury to their hippocampus, which may explain at least part of their memory problems.”71 He later notes, “Additionally stress and cortisol are generally present in depression, at least in the early stages… And another [study] found those who stayed depressed more than 2 years experienced significant permanent brain damage.” P. 125 71 R. M. Sapolsky, “Depression, antidepressants, and the shrinking hippocampus,” Proceedings of the National Academy of Science of the United States of America 98 (22): 12320-12322 (2001)
3. Nedley, N. (2005) p. 36, notes. “Drugs in the figure that will fail to relieve depression caused by deficient folic acid are Prozac, ® Zoloft, ® Paxil, ® Elavil, ® and imipramine (or potentially any other currently available antidepressant).19
19 Fava, M, Borus, JS, et al. Folate, Vitamin B-12, and homocysteine in major depressive disoreders. Am J Psychiatry 1997, Mar; 154(3)426-428. Nedley goes on to note “It has been found that a low blood folate level not only increases the risk of depression but also increases the risk of Alzheimer’s disease.20 (The reference here is to Snowdon’s Nun study, Am J Clin Nutr 2000 Apr;71(4):993-998.
4. Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L, Ueland PM. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998;55(11):1449-1455. Wang HX, Wahlin A, Basun H, Fastbom J, Winblad B, Fratiglioni L. Vitamin B(12) and folate in relation to the development of Alzheimer’s disease. Neurology. 2001;56(9):1188-1194. Seshadri S, Beiser A, Selhub J, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer’s disease. N Engl J Med. 2002;346(7):476-483. cited in Oregon State Study Arch Neurol. 1998 Nov;55(11):1407-8. see http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/b12refs.html#ref16
See also Corradaa, M, Kawasab, C.H., et al. Reduced risk of Alzheimer’s disease with high folate intake: The Baltimore Longitudinal Study of Aging. Alzheimer’s & Dementia, The Journal of the Alzheimer’s Association, Volume 1, Issue 1, Pages 11-18 (July 2005). And more recently: Durga, J., vanBoxtel, M. PJ., et al Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial. The Lancet, Volume 369, Number 9557, 20 January 2007, 208-216
5. Blaylock, Russell M.D. DHA Supports Brain Development and Protects Neurological Function. LE Magazine January 2008 (see lef.org and enter dha in the search window)
Freeman MP. Omega-3 fatty acids and perinatal depression: a review of the literature and recommendations for future research. Prostaglandins Leukot Essent Fatty Acids. 2006 Oct;75(4-5):291-7. Sontrop J, Campbell MK. Omega-3 polyunsaturated fatty acids and depression: a review of the evidence and a methodological critique. Prev Med. 2006 Jan;42(1):4-13. 90. Hamazaki T, Sawazaki S, Nagasawa T, et al. Administration of docosahexaenoic acid influences behavior and plasma catecholamine levels at times of psychological stress. Lipids. 1999;34 SupplS33-7.
6. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Fish consumption and cognitive decline with age in a large community study. Arch Neurol.2005 Dec;62(12):1849-53.
7. Grant, William B. Does Vitamin D Reduce the Risk of Dementia? Journal of Alzheimer’s Disease, May, 2009 Pages 151-159.
8. A New Era For SAMe Report. LE Magazine June 2003 (see at www.lef.org place SAMe in the search window.) See also the article on Mild Cognitive Impairment under the Nutrition section.
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