Pinning down the type and the cure?

from American Fitness:
 
A typical depression, a type of mild depression, is characterized by carbohydrate cravings, weight gain and lethargy. Growing at alarming rates in the past decade, it is thought to be associated with metabolic disturbances, acute exercise, physical trauma and a growing pattern of insulin resistance resulting from high sugar intake. People with atypical depression are confounded by a lethargy that isn’t eliminated by eating a bagel or bowl of rice–something many fitness instructors have noted when trying to re-energize after vigorous workouts or unrelenting fatigue.

Carb cravings occur about every two hours. Much of the problem stems from eating highly refined carbs which do not provide the satiety or other nutritional benefits of low glycemic index carbohydrates (i.e., whole grains). If you "load up" with poor-quality carbs (e.g., cookies and refined flours) instead of complex carbs (e.g., brown rice and oats), you can expect to experience fatigue, some mood swings and reduced physical activity. In turn, less activity affects metabolism and leads to chronic weight gain, which can refuel the cravings and fatigue cycle.

Chromium and Atypical Depression

As for the research on chromium picolinate and the atypical depression cycle, Davidson investigated Zeramax[TM], a chromium picolinate-based supplement from Nutrition 21, as a proprietary nutrition therapy for depression. The study was conducted on 15 patients with atypical depression. During the eight-week trial, patients received either a placebo or 400 micrograms of chromium picolinate per day. The dose was increased to 600 micrograms after two weeks. The results suggest chromium picolinate provides relief from symptoms in 70 percent of cases, in some cases rapid relief with minimal side effects. None of the patients on placebo responded.

The good news is depression possibly caused by a metabolic disturbance or mineral deficiency could be lifted with a nutritional approach. This beats the odds of treating depression with the usual monoamine oxidase inhibitors (MAOIs) or selective serotonin reputake inhibitors (SSRIs), both commonly prescribed and causing side effects often severe enough to convince about 44 percent of people to stop taking them within four to six weeks.

from http://www.bastyrcenter.org/content/view/912/:

Chromium supplementation may relieve symptoms in people with a mood disorder known as atypical depression, according to the Journal of Psychiatric Practice (2005;11:302–14). These findings are good news for the many people who suffer from this often difficult to treat condition.

Atypical depression, the most common form of depression in outpatients, is characterized by increased appetite, excessive sleepiness, sluggishness, and increased sensitivity to being rejected by another person and improved mood when something good happens (mood reactivity). Compared with other forms of depression, atypical depression tends to be more chronic and is associated with more suicidal thoughts and greater disability. Medical therapy usually consists of a specific type of antidepressant drug (monoamine oxidase inhibitors).

The symptoms of atypical depression resemble those of a blood sugar regulation disorder commonly called reactive hypoglycemia or dysinsulinism. This metabolism abnormality results in a wide range of physical and mental symptoms and may be relieved by changes to the diet, such as avoiding refined sugar, caffeine, and alcohol, and eating small meals six times a day.

Chromium is an essential trace mineral that plays a key role in blood sugar regulation by facilitating the action of insulin. Chromium deficiency in animals leads to insulin resistance and diabetes, and chromium supplementation has improved blood sugar control in people with either diabetes or reactive hypoglycemia. It is possible that, in some cases, atypical depression is a manifestation of reactive hypoglycemia or dysinsulinism. If so, chromium supplementation might relieve symptoms by improving blood sugar regulation.

In the new study, adults with atypical depression were randomly assigned to receive 600 mcg of chromium per day (in the form of chromium picolinate) or a placebo for eight weeks. In the chromium group, 54% experienced a clinically significant improvement in depression compared with 36% in the placebo group. While this difference was not statistically significant, the chromium group showed significant improvements in four depression-related symptoms: appetite increase, increased eating, carbohydrate craving, and daily fluctuations of feelings. Because chromium was effective for those specific symptoms, the participants who suffered from carbohydrate cravings at the start of the study were analyzed separately. In that subset, 65% of those receiving chromium but only 33% of those receiving placebo responded to treatment, a statistically significant difference. Chromium treatment did not cause any serious side effects.

The results of this study suggest that chromium supplementation relieves certain symptoms in people with atypical depression and also severe carbohydrate craving. If chromium works by improving blood sugar regulation, then its effects might be enhanced by appropriate dietary modifications and by supplementing with other blood sugar–stabilizing nutrients, including B vitamins, magnesium, zinc, and copper. It is also possible that chromium works by a separate mechanism: by altering the way in which the chemical messenger serotonin functions in the brain. Additional research is needed to further clarify which depressed patients are most likely to respond to chromium, what is the optimal dose, and what dietary modifications and other nutritional supplements would maximize its benefits.

from Psychology Today:

Take the form of depression known in the mental health world as atypical depression, actually something of a misnomer because it is hardly atypical. It afflicts more than a third of those with the mood disorder. What’s atypical is that sufferers crave carbohydrates, binge eat and sleep excessively and gain weight, in contrast to garden-variety depression, marked by obvious anxiety, loss of appetite, insomnia and weight loss. Persons with atypical depression also are exquisitely sensitive to rejection and experience overwhelming, sometimes paralyzing, fatigue.

In 2002, researchers at Duke University found that a daily dose of 600 mg of chromium picolinate led to a significant decrease in symptoms among those with atypical depression. The mineral was most effective in curbing their tendency to overeat. The dose was considerably higher than that which most people get through a normal diet

It’s not entirely clear how chromium works against depression. It’s known to affect important neurotransmitters in the brain, such as release of norepinephrine. It also influences the supply of serotonin.

But the action of chromium on mood may be directly and indirectly an effect of the mineral’s influence on insulin, the hormone that controls blood sugar. Lack of mental and physical energy seems to be a critical facet of the disorder.

Depression is known to make the body resistant to insulin, although it’s not clear which comes first—insulin resistance or depression. It may also be that the stress hormone cortisol, known to be elevated in depression, leads to insulin resistance.

Scientists also know that diabetics are especially susceptible to depression, twice as vulnerable than the rest of the population. Diabetic women are even more susceptible to depression. In the vast majority of diabetics, their condition results not from a lack of insulin but from the body’s increasing resistance to it.

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