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Dysthymia

	Description			Herbal Remedies
	Symptoms			Preparations
	Causes			Chemical Constituents
	Clinical Treatments			References

By: Monique Jackson, Miguel Garcia, Jenny Cook

Medicinal Plants Workshop Summer 2004

Description- Dysthymia is a mild but chronic form of depression, in which the affected individual will experience two or three depressive symptoms over a period of more than two years. This long term ailment is marked by bouts with severe depressive episodes. Because of the subdued nature of this disorder, herbal remedies can be very useful for treatment only after clinical diagnosis of Dysthymia. Treatment for manic or severe depression should be administered by a doctor because of the more severe nature of the symptoms.

Symptoms- Symptoms of Dysthymia vary in their combinations and possibilities. Dysthymia is classified as having two or more depressive symptoms so any combination of the following is possible. Dysthymic patients will often report that they do not recall the last time they felt happiness or enjoyment.

-anxiety	- loss of interest in activities
- general feeling of sadness	- loss of appetite
-lack of sleep	- dramatic weight loss
-restlessness/ distraction	- overeating
- feelings of worthlessness	- dramatic weight gain
-anger toward family or self	- irritability
- persistent headaches	-thoughts of death
- chronic pain	- feelings of hopelessness

Causes-The cause of Dysthymia is unknown. However, it is clear that those that have Dysthymia have chemical imbalances in brain and body neurotransmitters. Examples of neurotransmitters include serotonin, dopamine, norepinephedrine, and opiates. Neurotransmitters are important for moods, memory, etc. because they all interact with each other. To feel a sense of satisfaction in one's achievements, adequate levels of opiates are essential. Serotonin helps the brain with attention and memory, in making judgments, handling emotions, and supporting the immune system. Opiates and serotonin are influential for sleep and pain control and elevating moods. If one lacks norepinephedrine and dopamine, one is likely to feel lethargic. Therefore, one will lack the motivation to make changes in one's life because these two neurotransmitters are significant in determining energy and excitement. Stress, personality problems, exercise, and dietary choices may also play a role in Dysthymia, The possibilities of developing the disease increase for:

° those who have a family history of mood disorders

° drug or alcohol abusers

° women

°those who have had a major depression in the past

° those who have had a history of abuse or trauma.

Clinical Treatments-

Antidepressant medications

SSRI Selective Serotonin Reuptake inhibitors: Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and fluvoxamine (Luvox).

Monoamine oxidase inhibitors (MAOIs) are the earliest developed antidepressants. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting monoamine oxidase. Monoamine oxidase is the main enzyme that breaks down neurochemicals, such as norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down and, therefore, the amount of norepinephrine in the brain is increased.

Tricyclic antidepressants (TCAs) were developed in the 1950's and 60's to treat depression. They are called tricyclic antidepressants because their chemical structures consist of three chemical rings. TCAs work mainly by increasing the level of norepinephrine in the brain synapses

Electroconvulsive therapy (ECT)

In the ECT procedure, an electric current is passed through the brain to produce controlled convulsions (seizures). ECT is useful for certain patients, particularly for those who cannot take or are not responding to antidepressants, have severe depression, or are at a high risk for suicide. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. This procedure probably works, as previously mentioned, by a massive neurochemical release in the brain due to the controlled seizure. Highly effective, ECT relieves depression within 1 to 2 weeks after beginning treatments.

Psychotherapy

Talking therapies help patients gain insight into their problems and resolve them through verbal give-and-take with the therapist. Behavioral therapists help patients learn how to obtain more satisfaction and rewards through their own actions. These therapists also help patients to unlearn the behavioral patterns that contribute to their depression.

Herbal Remedies for Dysthymia:

St. John's Wort

Also called Hypericum, this is one of the most popular herbal remedies for depression. St. John's Wort is an extract from Hypericum perforatum, and has been used in treating "nervous disorders" for a couple thousand years. It is used much more in European countries; however, U.S. doctors are starting to use it more often. St. John's Wort works as an SSRI and a weak MAO-inhibitor. Because it is a physiological active chemical, it can cause side effects. Some of these include: dry mouth, fatigue, itching, upset stomach, dizziness, and rashes. Because it is an MAOI, food interactions may occur.

Passion Flower-Passiflora incarnata

Also known as Water Lemon, Maypop, Granadilla, Apricot Vine, Maracuja, Passion Vine, and Corona de Cristo

There are over 500 different species of Passion Flower known in the world. It is a hard, woody vine that thrives in tropical climates. They have tendrils similar to those on grape vine. The Passion Flower obtained its name from the Spanish missionaries. The missionaries believed the flowers represented the Crown of Thorns worn by Jesus Christ. Passion Flower contains serotonin and maltol. Maltol is a chemical which has sedative effects. Therefore, it is naturally calming. Passion flower contains three primary groups of chemicals: flavonoids, alkaloids, and glycosides. However, when the glycosides and flavonoids are isolated and individually tested, they exhibited opposite the effect for which the plant is actually used. The fruit juice is used to calm hyperactive children.

SAM-e

Also known as S-Adenosyl Methionine is an amino acid. It is a chemical naturally found in the human body and is effective as an antidepressant when taken in the proper doses. SAMe is necessary to preserve neurotransmitter processes in the brain. People who lack sufficient levels of serotonin, phosphatides, and dopamine usually suffer from depression. Their receptor site binding is also poor. SAMe quickly increases the levels of neurotransmitters and also improves receptor site binding with little to no side effects.

Ginkgo Biloba

Ginkgo is not as effective as St. John's Wort. However, it improves memory, increases blood flow to the brain and body, and promotes cardiac health. Ginkgo is also an antioxidant and can be taken with other herbs and nutrients to boost one's mood.

Siberian Ginseng-Eleutherococcus senticosus

Ginseng is an adaptogen. It is a substance that promotes the body to adjust to physical stress such as an illness or exposure to extreme temperatures. It improves the balance of significant neurotransmitters in the brain. The neurotransmitters include: epinephrine, serotonin, dopamine, and norepinephedrine. Ginseng has been shown to act as an MAOI. It is believes to improve abstract thinking, enhance aerobic capacity, and stimulate the immune system.

Preparations

St. John’s Wort

Tea – flowers in 1-2 cups of boiling water, can be consumed up to three times daily.
Tincture – ¼ to 1 teaspoon up to three times daily.
Decoction- leaves and seeds
Oil
Capsule form

Passion flower

Tea - Plant and flowers, dried, collected after some berries have matured
Capsule form – 200mg standardized to 3.5% isovitexin, 1 capsule daily 30-45min before bedtime.

Ginko Biloba

Capsule form - Dried leaves, often sold as concentrated extracts, Standardized GBE is one of the most popular prescriptions written in German and France, accounting for 1 to 1.5% of all prescriptions.

Siberian Ginseng