Antidepressants:

Panacea or Just

Bad Medicine?

By: John King

They are on TV, in magazines, in your doctor’s office and even on billboards. What am I talking about? Advertisements for antidepressants, they are everywhere! The manufacturers of these drugs make some big claims as to their effectiveness. But do these drugs actually perform as advertised?

Currently, there is a TV commercial airing in the United States for a drug called Rexulti. A woman sits in her doctor’s office and tells her doctor that even though she is taking her antidepressant she is still depressed. Her physician then responds with the statistic that 2 of 3 people taking antidepressants still experience depressive symptoms. Think about that for a moment. This is a drug manufacturer stating that antidepressants are only 33% effective. Would you invest your retirement money in a fund that was 66% sure to lose your money? Would you agree to a potentially dangerous treatment for your child if it’s chance for success was only 1 in 3? Better yet, try to get your insurance to pay for a treatment with a 1 in 3 success rate. Yet for some reason pharmaceuticals seem to be exempt from this scrutiny.

Getting back the TV commercial, what do you think the doctor recommended to the woman who was still feeling depressed? Rexulti! That’s right, another drug. To add insult to injury Rexulti is not actually an antidepressant but an antipsychotic medication with some potentially life threatening side effects. In addition to the Black Box Warning regarding the risk of sudden death to the elderly and increased risk of suicide in young adults, she can look forward to such side effects such as: stroke, Neuroleptic Malignant Syndrome (NMS), tardive dyskinesia (uncontrolled body movements which may be permanent), diabetes, weight gain, elevated cholesterol and triglycerides, increased risk of infection due to low white blood cells, seizures, problems swallowing, orthostatic hypotension and uncontrolled compulsive behavior. To read more about the side effects of Rexulti click here.

Recently the FDA approved a ketamine nasal spray called Esketamine for treatment resistant depression. Ketamine is a powerful anesthetic often sold on the street illegally as Special K. Ketamine has a high potential for abuse which is why the the nasal spray will have to be administered in a doctors office. Part of the evidence used to persuade the FDA to approve such a potentially addictive drug was the statistic that up to 40% of patients with Major Depressive Disorder do not respond to antidepressant therapy. An even more bleak statistic than quoted by the makers of Rexulti.

In 2008 a study by Irving Kirsch, professor of psychology at the University of Hull in England, revealed that most people that benefit from antidepressants do so to a degree that is not clinically significant. The study also found that approximately 1 in 4 people were actually made worse by antidepressant therapy. So what if you are the 1 in 4 who are made worse by antidepressants? You could be plagued by terrible side effects or slip into a deeper depression, maybe to the point of taking your own life.

The following was taken directly from FDA.gov:

“WARNINGS-Clinical Worsening and Suicide Risk
Patients with major depressive disorder (MDD), both adult and pediatric, may experience
worsening of their depression and/or the emergence of suicidal ideation and behavior
(suicidality) or unusual changes in behavior, whether or not they are taking
antidepressant medications, and this risk may persist until significant remission occurs.
Suicide is a known risk of depression and certain other psychiatric disorders, and these
disorders themselves are the strongest predictors of suicide. There has been a longstanding concern, however, that antidepressants may have a role in inducing worsening of
depression and the emergence of suicidality in certain patients during the early phases of
treatment.”

From the pharmaceutical manufacturers’ own marketing it is clear that these drugs are missing the mark. They are not only ineffective for most people but potentially dangerous and possibly life threatening.

If you feel that your antidepressant is not working and tell your doctor one of several things might happen. He may increase the dosage of your current medication. After all, if a little is good more must be better! If you weren’t having side effects from your medication before, you are much more likely to get them at the higher dose. In which case your physician will probably prescribe you another medication to try and counteract the side effects of the first. This is a disturbing but an all too common practice. Less likely to occur is that he may switch your primary medication to another and you start the process all over again. This process can repeat itself many times while years of your life slip away. More likely he will add another medication like Rexulti, Seroquel, Latuda or Vraylar (all are Antipsychotic drugs used to treat Bipolar Disorder and Schizophrenia). The prescribing of antipsychotic medications along with antidepressants is dangerous and unfortunately an all too common occurrence. These are very powerful drugs with potentially permanent side effects. A quick Google search on Tardive Dyskinesia (a potentially permanent movement disorder) revealed no less than three websites advertising a tertiary drug to treat the side effects of the secondary drug you were given because the primary drug you were prescribed for your depression didn’t work. When does this cycle end?

All antipsychotic medications have a Black Box Warning associated with them, the most serious warning the FDA can issue about the dangerous side effects of a drug. So in addition to the side effects of your antidepressant you can look forward to a multitude of others, some of which could become permanent. All antipsychotics have similar side effect profiles. I took this directly from the Latuda website.

From Latuda.com:

INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of death in elderly people with dementia-related psychosis. Medicines like LATUDA can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LATUDA is not approved for the treatment of people with dementia-related psychosis.

Antidepressant medicines may increase suicidal thoughts or behaviors in some children, teenagers, and young adults within the first few months of treatment and when the dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed. Report any change in these symptoms immediately to the doctor.

LATUDA may cause serious side effects, including:

Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death
Neuroleptic malignant syndrome (NMS) is a serious condition that can lead to death. Call your health care provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS: high fever, increased sweating, stiff muscles, confusion, or changes in your breathing, heart rate, and blood pressure
Uncontrolled body movements (tardive dyskinesia). LATUDA may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LATUDA. Tardive dyskinesia may also start after you stop taking LATUDA
Problems with your metabolism such as:
- High blood sugar (hyperglycemia) and diabetes: Increases in blood sugar can happen in some people who take LATUDA. Extremely high blood sugar can lead to coma or death. If you have diabetes or risk factors for diabetes (such as being overweight or a family history of diabetes), your health care provider should check your blood sugar before you start and during treatment with LATUDA
  - – Call your health care provider if you have any of these symptoms of high blood sugar (hyperglycemia) while taking LATUDA: feel very thirsty, need to urinate more than usual, feel very hungry, feel weak or tired, feel sick to your stomach, feel confused, or your breath smells fruity
- Increased fat levels (cholesterol and triglycerides) in your blood
- Weight gain. You and your health care provider should check your weight regularly during treatment with LATUDA
Increased prolactin levels in your blood (hyperprolactinemia). Your health care provider may do blood tests to check your prolactin levels during treatment with LATUDA. Tell your health care provider if you have any of the following signs and symptoms of hyperprolactinemia:
- Females: absence of your menstrual cycle or secretion of breast milk when you are not breastfeeding
- Males: problems getting or maintaining an erection (erectile dysfunction) or enlargement of breasts (gynecomastia)
Low white blood cell count. Your health care provider may do blood tests during the first few months of treatment with LATUDA
Decreased blood pressure (orthostatic hypotension). You may feel lightheaded or faint when you rise too quickly from a sitting or lying position
Falls. LATUDA may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills, which may lead to falls that can cause fractures or other injuries
Seizures (convulsions)
Problems controlling your body temperature so that you feel too warm. Do not become too hot or dehydrated during treatment with LATUDA. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water
Mania or hypomania (manic episodes) in people with a history of bipolar disorder. Symptoms may include: greatly increased energy, severe problems sleeping, racing thoughts, reckless behavior, unusually grand ideas, excessive happiness or irritability, or talking more or faster than usual
Difficulty swallowing

Do not drive, operate heavy machinery, or do other dangerous activities until you know how LATUDA affects you. LATUDA may make you drowsy.

Avoid eating grapefruit or drinking grapefruit juice while you take LATUDA since these can affect the amount of LATUDA in the blood.

Do not take LATUDA if you are allergic to any of the ingredients in LATUDA or take certain medications called CYP3A4 inhibitors or inducers. Ask your health care provider if you are not sure if you are taking any of these medications.

Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. LATUDA and other medicines may affect each other, causing possible serious side effects. LATUDA may affect the way other medicines work, and other medicines may affect how LATUDA works. Your health care provider can tell you if it is safe to take LATUDA with your other medicines. Do not start or stop any other medicines during treatment with LATUDA without talking to your health care provider first.

Before taking LATUDA, tell your health care provider about all of your medical conditions, including if you:

have or have had heart problems or stroke
have or have had low or high blood pressure
have or have had diabetes or high blood sugar, or have a family history of diabetes or high blood sugar
have or have had high levels of total cholesterol or triglycerides
have or have had high prolactin levels
have or have had low white blood cell count
have or have had seizures
have or have had kidney or liver problems
are pregnant or plan to become pregnant. It is not known if LATUDA will harm your unborn baby. Talk to your health care provider about the risk to your unborn baby if you take LATUDA during pregnancy
- Tell your health care provider if you become pregnant or think you are pregnant during treatment with LATUDA
- If you become pregnant during treatment with LATUDA, talk to your health care provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or going to http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
are breastfeeding or plan to breastfeed. It is not known if LATUDA passes into your breast milk. Talk to your health care provider about the best way to feed your baby during treatment with LATUDA

The most common side effects of LATUDA include:

Adults with schizophrenia: sleepiness or drowsiness; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, or muscle stiffness; and nausea
Adolescents (13 to 17 years) with schizophrenia: sleepiness or drowsiness; nausea; restlessness or feeling like you need to move around (akathisia); difficulty moving, slow movements, muscle stiffness, or tremor; runny nose/nasal inflammation; and vomiting
Adults with bipolar depression: restlessness or feeling like you need to move around (akathisia); difficulty moving or slow movements; and sleepiness or drowsiness
Children (10 to 17 years) with bipolar depression: nausea; weight gain; and problems sleeping (insomnia)

These are not all the possible side effects of LATUDA. For more information, ask your health care provider or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

INDICATIONS

LATUDA is a prescription medicine used:

- To treat adults and adolescents (13 to 17 years) with schizophrenia
- Alone to treat adults, children and teens (10 to 17 years) with depressive episodes that happen with bipolar I disorder (bipolar depression)
- With the medicine lithium or valproate to treat adults with depressive episodes that happen with bipolar I disorder (bipolar depression)

Quite an impressive and scary list of side effects. Recently, I read a study that stated 80% of oncologists surveyed would not consent to treatment with the very same chemotherapy drugs that they administer to their patients. A very telling statistic. I am not aware of any such study among psychiatrists regarding antipsychotic drugs. If there were, I am sure it would yield similar results.

Given that some of these side effects can be quite debilitating and permanent, it makes me wonder what ever happened to the Hippocratic Oath? Consider this excerpt from a 1923 translation from the original Hippocratic Oath: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course….Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.”

The Process Is Part Of The Problem

For the moment, let us forget about the high degree of toxicity of these drugs, their endless lists of side effects or that they only work for 1 in 3 people. We will also need to completely forget about the fact that the scientists who invent these drugs don’t even know how they work. Look at the prescribing information for any antidepressant and it will say, “It is believed that Drug A alleviates depression by…”. We know that antibiotics kill germs. We don’t really know what antidepressants do.

Putting these factors aside, let’s take a look at some of the problems with the process of prescribing these medications.

The prescribing of these drugs is totally subjective. If you see your physician because of a suspected infection most likely he will do a blood test to actually see if you have one. If your test is positive he will then prescribe the appropriate antibiotic. In the world of psychiatric medicine, there is no test to tell your physician what medication to prescribe. You must rely on your psychiatrist’s experience to make his best guess as to what drug to prescribe. So depending on your physicians education and experience you may get Drug A or Drug B. Either way, it is your psychiatrists opinion as to which you need.

Marketing influences decisions. We have all been waiting in the doctor’s office and have seen the pharmaceutical salespeople come and go. Drug A’s representative is in your doctor’s office every other week leaving samples. Drug B’s representative only visits your doctor every three months. Which drug do you think your physician is most likely to give you?

Incentives cloud judgement. It is no secret that pharmaceutical companies incentivize physicians to prescribe their products. While it is illegal for a pharmaceutical company to pay physicians cash, a paid vacation in exchange for a 20 minute talk on some aspect of psychiatry is not uncommon. How do you think this influences what drug you will receive?

Doctors are only human. Your physician is only human and is prone to making judgements. We all do it. It is a part of human nature. Although not that common, biases can play a role in which prescription medication you receive. There are some physicians who are quick to snap to certain judgements when they certain key words are used during your intake session. It takes a lot more than just one visit to a psychiatrist for them to know you well enough to make the correct prescription recommendation. Yet many patients will walk out of their first visit with one or more prescriptions.

Newer is not always better. When a patent runs out and a drug becomes generic it becomes less profitable for the manufacturer. To maintain profits the manufacturer must come up with something new for which they can charge full price. Some physicians are quick to jump on the bandwagon of new drugs. This is not always the best practice as older medications have a track record of side effects and rate of success. This data is simply not there for newer medications. Keep in mind that it may take years for the full list of side effects of a drug to become known.

Depression has become a catchall diagnosis. It is well known that depression can cause a variety of seemingly unrelated symptoms. One may have unexplained aches and pains, feel tired all the time, have an inability to concentrate or loss of appetite to name a few. All of these symptoms can be attributed to serious health conditions. Disturbingly there is a now trend to blame it all on depression. This is a dangerous practice that leads to these medications being over-prescribed for conditions that are not true depression. Which brings me to my next point.

Underlying health conditions may not be considered. Many psychiatrists make the assumption that you have been fully evaluated medically when you walk into their office. This is rarely the case. So your psychiatrist may think he is dealing with a purely emotional or psychological problem when in reality the cause of your depression is some other underlying health condition. Further complicating this issue is that very few psychiatrists understand how things like autoimmune disease, digestive issues and reactivated viral infections cause the body to become depressed. I have worked with clients who have wasted years of their lives chasing a diagnosis of depression only to discover that their symptoms were caused by something else entirely. Sadly, these patients have no recourse and no way to reclaim those wasted years.

Iatrogenic depression is overlooked. In today’s world of quick fixes physicians are often all too quick to take out their prescription pad. As a result it is not uncommon for someone to be on multiple medications. Sadly this is becoming the norm. Hence, iatrogenic illness is becoming more common. Iatrogenic illness is quite simply an illness caused by a drug or medical treatment. Many drugs directly cause or interact with other drugs to cause depression. A prime example of this would be beta blockers used to control heart rhythm or blood pressure. This class of medications is notorious for causing depression and yet are rarely scrutinized. If you are concerned that a possible drug interaction may be causing your depression, please visit the RESOURCES page on this site and take advantage of the Drug Interaction Checker.

Side effects are not discussed. A problem that I see often is that the side effects (some of which can be quite troublesome) of these medications is either not discussed or glossed over (minimized). This leads to non-compliance and treatment failure. You have the right to informed consent. Never accept a prescription for any medication with fully discussing potential side effects (even if they are claimed to be minor) with your physician. Be educated and do your homework.

Ready To Play Roulette?

If you consider the shear number of antidepressants on the market, the long lists of possible side effects and the inconsistent manner in which they are prescribed, trying to find the right medication is like playing a game of roulette. It is truly amazing that anyone finds relief from their depression with a medication that they can tolerate.

Let us speculate for a moment that the stars aligned for you. You are the 1 in 3 that are helped by antidepressants and your psychiatrist got everything right. He has no biases and has asked all the right questions. He picked a drug for you at a dosage that you can tolerate and you’re feeling better. Will it be your plan to stay on this (these) medication(s) for the rest of your life? Give this question some serious thought. Patients on long term antidepressant therapy often report:

Sexual problems (72 percent)
Inability to reach orgasm (65 percent)
Weight gain (65 percent)
Feeling emotionally numb (65 percent)
Not feeling like themselves (54 percent)
Reduced positive feelings (46 percent)
Feeling as if they’re addicted (43 percent)
Caring less about other people (36 percent)
Feeling suicidal (36 percent)

If you do not wish to use antidepressants for the rest of your life and plan on withdrawing from them at some point you will be faced with yet another problem. Antidepressant withdrawal, sometimes referred to as Antidepressant Discontinuation Syndrome. You see, what your physician probably didn’t mention is that when antidepressants are taken for more than a few months it may be difficult if not impossible to discontinue taking them. You can look forward to such symptoms as:

Anxiety
Insomnia or vivid dreams
Headaches
Dizziness
Tiredness
Irritability
Flu-like symptoms, including achy muscles and chills
Nausea
Electric shock sensations
Return of depression symptoms

This is because the administration of antidepressants causes rapid changes in brain architecture, physically remodeling the structure of your brain. Given that this is a relatively new discovery and scientists do not fully understand the ramifications of the newly “rewired” brain, are you willing to take that risk?

New Hope?

The complexities in prescribing these medications are not new. In fact, the situation only becomes worse as more and more new antidepressant drugs are added to the market. The more frustrated patients become with treatment the less likely they are to be treatment compliant. Not good for the patient as they get no relief and continue to suffer. Also not good for the pharmaceutical companies as you are not buying their drugs.

Enter GeneSight™. GeneSight is a genetic test that is supposed to identify which psychotropic drugs will work best for you based on your DNA. If you view the sample patient report on their website you will see that the test identifies what drugs are most and least likely to give you side effects at various dosage levels. You will also notice that there are still many drugs listed in the report but does try to narrow it down for the prescriber. Keep in mind this test is no guarantee, it is just a tool. I felt I should mention it because if you absolutely must use an antidepressant, this test will at least give you a starting point based on science rather than opinion.

So Do Antidepressants Work?

Right out of the gate, by the pharmaceutical companies’ own admission, your odds of any one given medication helping you is 1 in 3. In my mind, those are pretty poor odds. Then factor in all the variables I discussed earlier such as experience, biases, incentives and unwanted side effects and the odds shrink even further. The fact is antidepressants do not work for many people. Studies have shown that for mild to moderate depression, antidepressants are not that much more effective than a placebo. These same studies also revealed that the patients who received the most benefit from these drugs were the most depressed at the onset of treatment. This suggests that antidepressants may have some value in treating the most severely depressed which is indicative of true congenital neurotransmitter dysfunction. This is quite different than mild to moderate depression caused by stress or life events. Conditions such as Post Traumatic Disorder (PTSD) can cause permanent structural changes in the brain depending on what stage of life the trauma occurs. In these cases antidepressants may be of some value. But until scientists fully understand the underlying neurobiological mechanisms that mediate symptoms of trauma-related disorders like PTSD it’s just another hit or miss proposition.

To answer the looming question, antidepressants do not work for most people to any degree of clinical significance and in some cases can make your depression worse. Unless you have actual physical changes in the neurons or other structures of the brain, you will probably not find much relief from taking antidepressant medications. Only the most severely depressed patients seem to receive any benefit from taking these medications. If you do not fall into this category you are in for a long arduous journey of trial and error.

What then is a person to do if they are feeling depressed? Below are things you need to investigate as well as some lifestyle recommendations that will help you.

What To Investigate

Get a full physical. This is the first step in ruling out an underlying health condition that may be causing your depression. Basic tests to include: CBC w/differential, Liver Function Tests, Cholesterol Profile, A1C, Vitamin D profile and urine analysis.
Evaluate Thyroid function. If you are depressed your thyroid function needs to be fully evaluated. Most physicians will only perform a Thyroid Stimulating Hormone (TSH) test. This test alone is woefully inadequate in evaluating overall thyroid function. You should request the following profile: TSH, Total T4 & T3, Free T4 & T3 and Reverse T3. You should also test for autoimmune thyroid disease if you have never been tested for it before. These tests include: Thyroid peroxidase antibody (TPO), Thyroglobulin antibody (Tg) and TSH Receptor antibody.
Evaluate Adrenal function. Both thyroid and adrenal function are intimately linked. They both depend on each other for proper function. A proper evaluation will include a fasting 8:00am Cortisol and a 4:00pm Cortisol measurement. If these two tests yield suspicious results then your physician should perform a ACTH Stimulation test to determine the cause of the abnormality. You may also want to consider a Cortisol Rhythm test which is done through testing timed saliva samples taken throughout the day. Not all doctors perform this test and you will most likely need to see out an Integrative Practitioner.
Look for hidden/reactivated infections. There are many types of infections that are not easy to detect and may play a role in your depression. Chronic low level bacterial infections, tick borne diseases (Lyme Disease and Lyme Co-Infections), reactivated viral infections (mumps, chickenpox, Epstein-Barr, et al), mycoplasmas and parasites need to be ferreted out.
Eliminate nutrient deficiencies. We may think we are getting all the nutrients we need from what we eat and while possible, it is unlikely. Over-farming, processing, pesticides, preservatives and a host of other toxic chemicals have invaded our food supply. What you eat today is not what your grandmother ate, probably not even what your mother ate. Nutritional testing is of great value here. Additionally, just because you consume a certain amount of a nutrient doesn’t mean you’re actually absorbing it.
Look for hidden inflammation. If you were to sprain your ankle it would become inflamed and painful. This is the obvious kind of inflammation. But there there is another kind of inflammation that occurs inside our bodies that we may not be aware of. Left unchecked, chronic low level inflammation is not only is detrimental to brain function but also damages the gut. The Gut-Brain connection has been underappreciated in the past but new research has shown strong connections to mental health. Your doctor should perform the following tests to look for hidden inflammation: High Sensitivity C-Reactive Protein, Sedimentation Rate, Homocysteine, Plasma Viscosity, Antinuclear Antibody and Hemoglobin A1C.
Heal digestive issues and optimize your gut. You’ll notice that I did not say “treat” digestive issues. This is because most of the time modern day “treatment” just masks symptoms, I prefer to heal the underlying issue as it is more likely to help your depression. For example, if you have heartburn your doctor may prescribe some type of stomach acid blocker. With less stomach acid your protein digestion will be less than optimal. When this occurs we are unable to breakdown protein into amino acids which are the building blocks for neurotransmitters. When these precursors are in short supply we cannot manufacture adequate neurotransmitters to support mood. Another example is in the case of patients who suffer with Irritable Bowel Syndrome (IBS), Ulcerative Colitis (UC) and Crohn’s Disease. Many of the drugs used to treat these diseases cause depression in many patients. Additionally, by just suppressing symptoms, the digestive tract is not healed and the Gut-Brain connection is not re-established.
Check for hidden environmental and food allergies. I say hidden allergies because most of us are aware of when we have an acute allergy as the symptoms are immediate. Hidden or delayed allergies are less obvious and sometimes hard to find as their symptoms do not occur for several days. This process may take some time but is well worth the effort as the allergy-depression connection is almost always overlooked. Feel free to contact me if you need assistance in this process as it can be difficult to know where to start.

Lifestyle Recommendations

Take a high quality multivitamin (not something like One-A-Day or Centrum). Without a solid foundation your body cannot manufacture all the enzymes and neurotransmitters needed to support a healthy mood. If you are under stress, consider adding additional B-Complex. Supplemental Vitamin C is also required as it is synergistic with B-Complex vitamins. If you prefer not to deal with multiple supplements try an all-in-one formula.
Optimize your Vitamin D levels. Vitamin D is not a vitamin but actually a neurohormone. It is one of the most important nutrients to support overall health. Most Americans are Vitamin D deficient leading to a myriad of diffuse seemingly unrelated symptoms. To get into all the health benefits of Vitamin D is beyond the scope of this article. Suffice it to say that maintaining an optimal Vitamin D level will go a long way in helping to manage your depression. Given Vitamin D deficiency is of epidemic proportion in this country, most people can supplement with 5,000iu of D3 daily with much concern of testing blood levels. Blood levels of Vitamin D should be checked twice per year (spring & fall) especially if you are using dosages in excess of 5,000iu daily.
Increase intake of Omega-3 fatty acids. Omega-3 fatty acids have many health benefits. By reducing inflammation and stabilizing cell membranes in the brain, Omega-3s help to alleviate depression. I recommend supplementation as most people are simply not going to eat a sufficient amount of the right kind of fish every single day. Additionally, eating all that fish will increase your burden of mercury which is a toxic heavy metal linked to brain dysfunction.
Take a quality probiotic supplement daily. One of the most important things you can do to maintain the health of your gut is to take a quality probiotic. Not only will this help to improve the condition of just about any digestive tract issue but also helps to prevent the enzyme Monoamine Oxidase (MAO) from running a muck. MAO is an enzyme that breaks down neurotransmitters, a process that a person suffering from depression can ill afford.
Eat quality food, shop the outer isles. Stay away from junk food. The old saying “You are what you eat.”, is more true than you know. Learn to shop the outer isles or perimeter of your grocery store. It is here where you will find the most wholesome foods. Avoid buying food that does not spoil. If something can sit on a shelf for two years without spoiling then it’s probably not good for you. As a side note, you should never leave your food lying around that long without consuming it as it loses some of it’s nutritional value everyday.
Stay away from refined sugar and artificial sweeteners. I classify sugar not as a food but as a drug because it’s negative effects are so vast and far reaching. Sugar will corrupt the integrity of your gut, which we have already learned contributes to depression. Sugar alters immune function and can contribute to a variety of immune issues. Undue stress is put on both the pancreas and adrenal glands possibly leading to sugar imbalances, which is a well known cause of anxiety and depression. If you feel the need for something sweet, stick with fresh whole fruits. Avoid fruit juices as they lack the fiber that slows sugar absorption, preventing blood sugar spikes. Artificial sweeteners like NutraSweet™ and Aspartame are neurotoxins that damage brain function. Do not consume them if you have depression.
Ensure you have adequate protein intake. This statement is a little misleading as the body does not actually use protein, it uses amino acids. Protein must be broken down into individual amino acids in order to be used by the body. So a “Quarter Pounder” does not actually contain a quarter pound of protein because some of that weight is water, fat and other substances. In fact, 1 ounce of beef (28 grams) only contains 7 grams of usable protein. Adults suffering from depression should strive to obtain a minimum of 50 grams of usable protein per day. If you have any digestive issue that prevents optimal digestion of dietary protein, consider using a powdered protein supplement such as whey or pea protein.
Exercise, exercise, exercise! In order to have a healthy mind we must have a healthy body. And in order to have a healthy body we must have a healthy mind. Exercise has many benefits such as enhancing immune function, improving sleep quality, improving digestion, reducing stress and anxiety…the list goes on. Our bodies were made to move and cannot function optimally if we don’t. If you have been sedentary, check with your physician before undertaking any exercise program. Optimally, you will want to incorporate aerobic exercise with strength training to maintain balanced cell function. Remember, this is not a race! The only one you have to compete with is yourself and long term consistency is your goal.
Get adequate sleep. The amount of sleep one needs varies on lifestyle. Athletes will require more restorative sleep than someone who works at a desk. Additionally, we also tend to sleep less as we get older contributing to premature brain aging. The optimal amount of sleep required for good health is somewhere between seven and ten hours daily. If you have trouble sleeping seek out holistic measures to help you get the rest you need.
Practice mindfulness. Be mindful about attitudes that may be contributing to your stress and depression. Pick your battles. If you’re going to get upset, take pause and ask yourself if this issue will matter a year from now, if not, let it go. Be present in the moment. The only thing we have any control over is what we are doing right now. It’s too late to do anything about yesterday and tomorrow isn’t here yet. Many times depression is caused by ruminating over what we should have done differently or worrying about what may not even happen tomorrow. If you find yourself in these thought patterns, stop and take a few deep breaths and bring yourself back to the present.
Practice stress reduction techniques. As important as it is to move your body and exercise it is equally important for your body to have quiet restorative time to heal. Maintain some sort of stress reduction practice. There are many to choose from such as Mindfulness Meditation, Focused Meditation, Guided Imagery, Yoga, Qi Gong and Tai Chi. It does not matter which one you chose just so long as you are consistent and like doing it. This is a slow and steady proposition, the longer you maintain your practice the more benefits you will realize.
Deal with unresolved trauma. Whether you realize it or not we all have had some sort of trauma in our lives. It could be an illness, a breakup, death of a loved one, child abuse, job loss and the list goes on. The only requirement for an event to be traumatic is for us to perceive it in that light. What is traumatic for you may not be traumatic for me. I guess you could say that “trauma is in the mind of the beholder”. I have not had one client with depression that has not had some degree of unresolved trauma. There are many methods for dealing with unresolved trauma such as talk therapy, EMDR, EFT and TRE. Lots of acronyms! You can find out more about proven these methods for dealing with trauma by visiting my RESOURCES page. Pick one that sounds good to you and give it a fair try, at least three months. If you don’t feel like it is helping try another as this is not a one size fits all proposition.

I wrote this article because I have become frustrated watching too many clients waste valuable years chasing the antidepressant rainbow simply because they were given no other alternative. My goal was to give the reader an appreciation of the complexities in prescribing these medications as well as the inconsistencies in patient evaluation. I have given you a place to start, things to look for and hopefully an understanding of why you should not look at treating your depression as a “one pill proposition”. The body is a complex machine, one that we will never come to fully understand in our lifetime. Treating the body with drugs that we do not fully understand only introduces another layer of complexity which leads us farther from the truth. The lifestyle changes I outlined above is a good place for most people to start. If your health situation is more complicated further investigation and supplementation will be required.

I hope I have provided you with information that will help you in treating your depression. Should you have any questions about the content of this article or the use of nutritional supplements for treating depression feel free to reach out and contact me.

Best in Health,

John

Antidepressants: Panacea or Just Bad Medicine?