The Treatment of Depression

9

AUGUST, 2018

Depression is so difficult to treat. The underlying factors that are at work with depression are many and elusive to many doctors and the patient themselves. Often, pharmaceuticals are the first intervention because of the unknown causes. These often come with undesirable side effects, though.

In fact, depression is often treated solely on a few reported symptoms by the patient. Rarely, does the psychiatrist listen to heart, run blood tests, monitor your pulse rate or look at outward symptoms that can give a picture of what’s happening on the inside. Have you been diagnosed with depression because of one or more of these symptoms?

  1. Fatigue – nearly every day
  2. Concentration – low focus and poor decision-making skills
  3. Diminished interests
  4. Low mood nearly every day

During an evaluation for potential depression, there’s not a lot of discussion about what you eat or what kind of toxins you may have been exposed to over the years. It’s beyond my understanding of why there seems to be no connection made (or attempted to be made) between what we put in our body and how that can affect our minds. Our bodies and how we treat it and our minds work together…they are not entirely separate and should be treated that way.

At some level, this is understood. Almost 60% of psychiatric evaluations resulted in patients walking away with two or more prescriptions. (Archives of General Psychiatry). This is an indication that there is an attempt made to target different possible causes for the depression. Most medications deal with neurotransmitters in the brain which is really important. But why aren’t nutritional deficiencies considered?

I deal with patients who have depression ALL the time. It does affect everyone differently but I have seen people make dramatic improvements once nutrient deficiencies are replenished. If one is taking medications to treat depression, nutrient depletions can become even worse. If these deficiencies are improved, medications often work better. I’ve even seen people avoid going on these medications and I’ve seen people get off them as well. (ALWAYS DO THIS UNDER THE SUPERVISION OF YOUR DOCTOR). Just refer back to the August 7th post on what these nutrients are. I can help you determine if you have any of these deficiencies. In my opinion and personal experience, food and nutrients are key to NOT feeling depressed.

Depression is notoriously difficult to treat. The underlying causes are often multifactorial and elusive to identify. Pharmaceutical drugs leave a lot to be desired. Not only are they often ineffectual, but many of them come with undesirable side-effects, which can be unpleasant for anyone to deal with, but may be even worse for someone already contending with depression. Moreover, many healthcare practitioners are quick to reach for the prescription pad without digging a little deeper to try and identify some of those elusive root causes.

Dietary changes—specifically, nutrition and supplement interventions—may be helpful for individuals who respond poorly to conventional treatments. Doctors can help patients complaining of depression by doing a thorough assessment of pertinent lab work. For starters, suboptimal thyroid function is a common cause of depression, but this will be missed if the first course of action is a prescription for an SSRI, rather than ordering the proper blood tests and beginning a treatment strategy to improve thyroid hormone levels.

Another underlying factor that may contribute to depression is vitamin B12 insufficiency. Among individuals with major depressive disorder, who had “low normal” B12 levels and had responded inadequately to SSRI treatment, adding B12 injections in combination with the drugs resulted in significant improvement of depression. At three months of follow-up, 100% of subjects in a study treatment arm that employed an SSRI plus B12 injection experienced at least a 20% improvement in symptoms, compared to 69% of subjects who were given the SSRI alone.

Some studies show that higher B12 levels are associated with better outcomes regarding recovery from depression, but findings are mixed. Single nucleotide polymorphisms that affect genes responsible for one-carbon metabolism (which includes methylation and the homocysteine cycle) may mean that some individuals benefit from high doses of supplemental B12 and folate, while others would experience no improvement. Findings are mixed, but considering the convenience and low cost of a trial of nutritional supplementation, it’s worth testing patients for these polymorphisms and seeing how they respond to B12 and/or folate. It would be a godsend to those individuals whose depression is primarily caused by something as easily correctable as a vitamin insufficiency. Some researchers recommending supplementing with both folate and B12. Compared to subjects with depression who responded to fluoxetine treatment, subjects who did not have a significant response were more likely to have low folate status. Increasing folate levels in these patients may help facilitate a more effective response to drugs that seem to result in better outcomes among those who are folate replete.

Other researchers propose that the nutritional state identified during recurrent depressive episodes may be the result, rather than the cause, of the depression. Compared to patients not experiencing depression when tested, patients in a depressive period had higher homocysteine and lower B6 levels. Other than that, however, no associations were found between depression and the one-carbon cycle. The study authors concluded that one-carbon-cycle “alterations in major depressive disorder are state-associated, possibly resulting from high levels of acute (psychological) stress.”

Another important angle to investigate when helping patients with depression is fatty acid status. Research indicates that some cases of depression may be linked to chronic inflammation. If so, then addressing a skewed omega-6/omega-3 ratio could correct an underlying physical problem that is ultimately manifesting as a psychological condition. A sufficient omega-3 intake may help facilitate the synthesis of healthy myelin and neuronal phospholipids, and therefore, improved neuronal communication.

Randomized controlled trials and meta-analyses alike support a therapeutic potential for omega-3 fats in depression. Specifically, EPA seems to have a more powerful effect than DHA, which is interesting, because DHA may be more effective than EPA for other, unrelated concerns, such as eye health. Just as with B12 and folate, considering the relative ease of correcting an n-3/n-6 imbalance, that’s a simple intervention that could potentially be a boon for depressed patients.

Some individuals may respond to nutritional interventions alone. Others may find that getting replete in particular nutrients, deficiencies of which are known to be associated with depression, may help improve the efficacy of antidepressant drugs that had otherwise been unhelpful. Either way, assessing a patient’s habitual diet and nutrient status should be a fundamental part of a multi-pronged strategy for working with depression.

Have you been diagnosed with depression because of one or more of the following symptoms?

  • Suffering a depressed mood most of the day nearly every day
  • Markedly diminished interest in activities
  • Significant weight loss (when not dieting) or weight gain
  • Sleeping more than usual or having difficulty sleeping
  • Feeling fatigued nearly every day
  • Feeling worthless or inappropriately guilty
  • Having difficulty concentrating or making decisions
  • Thinking about death or attempting suicide

Believe it or not, the head is attached to the body

It’s important to consider what was not included in your hypothetical initial psychiatric evaluation. Psychiatrists do not always ask you about various medical illnesses and physical symptoms that you, your siblings, your parents, and your grandparents currently have or have had in the past. Rarely would a psychiatrist listen to your heart, monitor your pulse rate, examine your eyes, look at your skin, or otherwise try to determine if any of your physical symptoms might be related to your depressed mood, lack of energy, or insomnia. Your hypothetical evaluation did not include a discussion of what you typically eat or which chemicals you have been exposed to, and there was no order for laboratory work to check your nutritional status and hormone levels or measure the environmental toxins that may have accumulated in your body. Additionally, there was no attempt to discover whether allergies you may or may not be aware of could be influencing your mood.

These omissions clearly demonstrate that psychiatry does not operate on the principle that what occurs in the body affects what occurs in the mind. To those in the psychiatric profession, the brain is the brain and the body is the body; they are two separate and very distinct entities. This separation of brain and body often prevents physicians and mental health professionals from discovering the real cause of depression. Thus, psychiatrists make treatment decisions in the dark, prescribing one medicine after another, hoping that one, or some combination of more than one, will work. Most psychiatrists rely on their personal favorites. Some favor older medicines for depression, such as Zoloft and Prozac, while others lean toward newer ones, such as Cymbalta and Remeron. Either way, patients usually undergo courses of multiple psychiatric medications and are typically prescribed two or more antidepressants to take simultaneously, in addition to medication for sleep and, perhaps, anxiety.

A recent study published in the Archives of General Psychiatry confirmed this trend, finding that a staggering 59.8 percent of visits to office-based psychiatrists resulted in two or more psychotropic medication prescriptions. About one third of the office visits resulted in three or more prescriptions. And if the initial prescriptions didn’t solve the problem, new ones were offered.

Why are psychiatrists the only doctors that don’t run tests before they diagnose and prescribe?

Something to think about…

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