Dr. Nancy A. Palermo
“The greatest medicine of all is teaching people how not to need it. “Hippocrates
It is estimated that over 44 million Americans suffer from mental disease and half of all adults will struggle with mental illness during their lifetime.
Depression and anxiety are the most common diagnoses. Women are twice as likely as men to be diagnosed. One in seven women are medicated for depression and anxiety and 1out of 4 are on a medication by the time they reach their forties.
Conventional approaches to mental disease focus on imbalances of neurotransmitters with treatment involving medications to increase or decrease the abnormalities.
For decades we have been led to believe this chemical imbalance was the cause of psychiatric disease and medicine, the only solution. While there are certainly those who need medication there is growing evidence that these conditions are more the effect of our modern lifestyle is incompatible with our genes. New York Times Bestseller Dr. Kelly Brogan states “Depression is not genetic, it is epigenetic”. Our lifestyle has been hijacked and our bodies and brains are rebelling. Our diet is filled with processed and inflammatory foods; our body lacks exercise and sunlight and is exposed to thousands of chemicals and stressors daily. Many of these triggers may be laying the groundwork for inflammation, nutritional deficiencies, gut inflammation, dysbiosis (microbiome disruption), hormonal changes and the activation of the HPA (hypothalamic-pituitary-adrenal) axis or stress factors in our bodies – all leading to mental illness.
A growing body of evidence has linked these very disruptions to the development of mental disorders, yet we have been “brain-washed” to believe medication is the answer. Despite heavy marketing, six decades of research have revealed these medications may not be any better than a placebo and worse yet, may leave individuals worse off after they stop taking them. There is certainly increasing evidence that we need to look deeper into addressing the root causes to avoid starting medications in the first place.
Medication Induced Mental Disease
There are over 200 commonly prescribed pharmaceutical drugs that list depression and anxiety as side effects yet few doctors counsel patients on these risks. Many include Beta-blockers, anti-anxiety medications, allergy medications, cholesterol lower drugs, over-the-counter acid reducers or PPIs, steroids, and yes, even anti-depressants which have been shown to increase the risk of suicide in users.
Nearly 2/5ths of the population suffer from a severe B12 deficiency and it is found in 27% of depressed patients. Gut dysbiosis (microbiome disruption), poor digestion, an inflammatory diet, and medications like PPIs have all been linked to the deficiency. B12 appears to be a powerful antidepressant. It is believed to be a powerful contributor to methylation in the body and the removal of an inflammatory protein, homocysteine. Methylation is a process that involves the activation of B12 and other substances like folate. Individuals who suffer from genetic methylation defects like MTHFR, are more likely to suffer deficiencies and thus depression and anxiety. This condition is easily remedied when individuals are supplemented with methylated or activated forms of B vitamins.
Researchers have also shown a link between declining consumption of omega 3 fatty acids from fish and other sources and an increasing trend in the incidence of major depression. The two omega 3 fatty acids, eicosatetraenoic acid (EPA) which is converted into docosahexaenoic acid (DHA) have antidepressant effects in humans. In depressed patients’ daily consumption of omega 3 fatty acids in doses of 1.5-2 grams have been associated with mood elevation.
Vitamin D deficiency has become more common due to the lack of sunshine exposure and gut dysbiosis. Vitamin D is important for several crucial functions in the body as well as in the brain. Vitamin D promotes healthy brain cells and reduces inflammation in the brain related to memory and cognitive abilities. Low Vitamin D has been linked to Seasonal Affective Disorder (SAD) which is depression associated with the darker months of the year. More severe deficiencies have been associated with depression and panic disorders.
Thyroid disorders including both hypothyroidism and hyperthyroidism may be associated with several neuropsychiatric disorders including depression and anxiety, yet often individuals go unscreened. Abnormalities associated include elevated TSH, Low free T4 and T3 levels, and elevations in thyroid autoantibodies. Often treatment of the thyroid disorder results in improvement or resolution of the associated depression and anxiety.
Gut Disruption and Inflammation
Hippocrates, the third-century Father of Medicine, said, “All disease begins in the gut”. It appears he was correct with respect to many disease states but possibly to mental disease as well. Several studies have linked the role of gut dysfunction in inflammatory conditions which directly affect the brain. The Vagus nerve is the longest-running nerve and connects the brain and the gut. The gut-brain axis appears to be bidirectional through the Vagus nerve but also through the immune system and the neuroendocrine system (HPA axis) Many of us know first-hand the gut-brain link when we experience distress felt as stomach upset or butterflies. It appears that inflammation in the gut can also trigger such reactions in the brain. Inflammation in the gut caused by infections, highly processed foods as well as allergenic foods like gluten, dairy, sugars, and additives appear to cause higher levels of inflammatory markers in the blood which can lead to depression. It appears these markers directly relate to the level of depression as well – higher levels of inflammatory markers are associated with more severe depression and anxiety. Some conditions, like Celiac disease, which are associated with such markers as well as significant inflammation in the gut, often present as psychiatric disorders first. Anxiety and depression are common presenting symptoms in Celiac disease.
Our microbiome, the trillions of bacteria that reside in our gut, is also essential for healthy brain function. Researchers have revealed certain types of bacteria types may be associated with anxiety and depression. Researchers in the Netherlands found that strains like Coprococcus and Dialister were severely deficient or absent in depressed patients. These bacteria are believed to be involved in the pathway to produce Dopamine, our feel-good neurotransmitter and are sources of butyrate production, a potent anti-inflammatory substance. Probiotics have demonstrated antidepressant effects in clinical research studies. Fecal Microbiota Transplant (FMT) is a procedure where a healthy donor’s fecal microbiota is transferred to an unhealthy recipient. FMT has been used to treat severe gastrointestinal infections like C. Difficile. Recently in a small study, FMT has been successfully used to treat individuals with severe depression and anxiety. The success of fecal transplants in the treatment of severe depression further support the microbiome’s role in mental health.
HPA (Hypothalamic-Pituitary-Adrenal) Axis Dysfunction
Stress has long been known as a contributing factor in the development of depression and anxiety. Long-standing elevations of cortisol, the stress hormone produced from the adrenal gland, have been linked to an increased incidence of several chronic conditions including severe depression and anxiety. Modalities that aim to reduce stress like mindful meditation, yoga, tai chi, and biofeedback therapies like Alpha-Stim and Heart Math have been successful in reducing associated neuropsychiatric disorders like anxiety and depression.
As ongoing research uncovers the non-psychiatric contributors to depression and anxiety it is prudent for patients to question starting medication before a more thorough workup is conducted. We now understand anti-anxiety and antidepressant medication may have more long-term effects for patients and consideration of all etiologies of psychiatric disease should be considered before committing patients to a lifetime of use.