No, Doc, I Don’t Need Antidepressants!

Clinical depression, or major depression, is a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.
Most people are unaware of how frequently depression occurs with Chronic Disease. A study in 2004 found an association between the presence of a mood disorder, and the presence of anti-TPO antibodies. It has also been observed that a slight reduction in thyroid hormone secretion (such as that found in subclinical hypothyroidism) may affect mood as well. Thus, it’s possible that the depression you are feeling is related to your thyroid.
About one in 10 U.S. adults are affected by depression, which can impact their mood, thoughts, physical health, and behavior. Depression affects more women than men, and the symptoms and severity of depression can vary from person to person.
The most common type of mood disorder reported in people with thyroid antibodies is obsessive compulsive disorder (OCD). OCD is also more common in pharmacists and Type A’s, so I am intimately familiar with it. 🙂
The amazing thing that I’ve learned with functional medicine is that many of the same root causes, triggers, and strategies that help Chronic Disease, can also help depression. In fact, 81 percent of the participants in my Chronic Disease Self-Management Program reported an improvement or resolution of depression!
While there are many different root causes, strategies, and solutions for depression, I want to focus on a few low hanging fruit that can help a person with depression, whether used in conjunction with antidepressants, or on their own.
These include common nutrient deficiencies, dietary changes, lifestyle changes, and supplements that have been shown to boost mood.
Dietary Changes
I have found that many people with Chronic Disease who are experiencing depression are reacting to a food that they are sensitive to. Some of the most common food sensitivities that can lead to symptoms of depression are gluten, dairy, grains, soy, nuts and seeds. Sometimes, eliminating these foods from the diet can bring enormous relief to a person’s mood and mental state. In fact, 60 percent of the people with Chronic Diseases who I surveyed, reported symptoms of improved mood by eliminating gluten, 59 percent by going grain free, and 45 percent by giving up dairy. I recommend starting with an elimination diet to begin to uncover the foods that are problematic for you.
Additionally, balancing blood sugar levels is one of the most important components in reducing anxiety for people with Chronic Disease, and can have an impact on symptoms of depression as well. When insulin levels swing from high to low, it’s like being on an emotional roller-coaster that can cause some of the extreme emotions that are characteristic of mood disorders. Of the people with Chronic Disease that I surveyed, 61 percent reported improved mood with a low glycemic index diet, while 65 percent experienced improvement on a sugar free diet.
Nutrients for Depression
Addressing nutrient depletions can be a game changer when it comes to relieving depression. Often times, a deficiency in a key nutrient results in many of the symptoms associated with depression, and supplementing with a quality supplement can make all the difference in improving mood.
Nutrient depletions that are often seen in people experiencing symptoms of depression include:

  • Vitamin B12: A deficiency in B vitamins, particularly B12, can have a huge impact on mental health. One study found that one quarter of women who were diagnosed with severe depression were deficient in this crucial nutrient. Of the readers with Hashimoto’s that I surveyed, 56 percent experienced improved mood when they began supplementing with B12.
  • Methylfolate: Studies have shown that people with low levels of folate have a 7 percent response rate to treatment with antidepressants, while those with high levels of folate have a 44 percent response rate; therefore, it is often used in the treatment of depression.
  • Iron (ferritin): Several symptoms of iron deficiency are similar to that of depression: fatigue, irritability, and brain fog. I personally became iron deficient while pregnant, and felt like I became tearful and emotional overnight… these symptoms are usually considered “normal” for pregnant women, yet iron deficiency is the most common deficiency in pregnancy. I was already taking an oral iron supplement, but ended up needing to supplement with two burgers a day and iron IV’s to stay happy. One day I told my husband that I didn’t feel loved because he hadn’t gotten burgers for me that day. 🙂 Testing iron and ferritin levels is incredibly important, and proper management may bring relief to symptoms of depression for many people. (As a side note, iron deficiency is more common in pregnant and menstruating women, while iron overload is more common in men and postmenopausal women. An overload of iron can also lead to mood alterations, so be sure to get tested and not just supplement).
  • Omega-3: A number of studies show that omega-3 fatty acids can be very effective against the treatment of major depression disorder and other psychiatric disorders, with no associated side effects. I generally advise 1-4 grams per day for most people.
  • Vitamin D: Most people, especially those of us living further away from the equator, are deficient in vitamin D, and a deficiency in this important nutrient has been linked to elevated thyroid antibodies and depression. Sixty-four percent of my readers have reported improvements to mood when they’ve taken a D3 supplement. 5000-10000 IU per day is what it usually takes to get your Vitamin D levels in range. I do recommend testing for vitamin D, and supplementing accordingly.
  • Magnesium: Multiple studies have linked magnesium and depression, as this vital nutrient plays a key role in hormone balance and brain chemistry. Magnesium is also an important component in thyroid hormone production, and helps balance blood sugar — key factors in mood stabilization.

Stress Response Support
Treating hypothyroidism without treating the adrenals is one of the biggest reasons people continue to feel exhausted despite receiving treatment with thyroid hormones, and it can lead to symptoms of depression.
The adrenal glands release hormones, such as cortisol and adrenaline, that impact many important functions throughout the body: among them, stress tolerance and mood.
In cases of chronic stress, the never-ending presence of stressful, yet non-life-threatening situations, can lead to the constant activation of the stress response. To help meet the demand for cortisol, your body will decrease the production of other hormones normally produced by the adrenals, such as progesterone, DHEA, and testosterone.
Eventually, with enough chronic stress, your body becomes overwhelmed and desensitized to the usual feedback loop, and stops sending messages to the adrenals to produce more hormones or less hormones, no matter what’s happening. We call this adrenal fatigue.
If you think stress could be at the root of your depression, you may want to look into supporting your adrenals. As a starting point, I recommend the ABC’s — Adaptogens, B Vitamins and Vitamin C.
Adaptogenic herbs support the body’s ability to deal with stressors and are thought to work by normalizing the hypothalamic-pituitary-adrenal (HPA) axis. Some herbs, such as Ashwagandha, can help normalize thyroid hormone levels, as well as support the body’s stress response. Of the readers I surveyed, 77 percent said they’re mood improved when they took adaptogenic herbs. Stay tuned for an upcoming article on using adaptogens for Hashimoto’s!
The B vitamins and vitamin C become depleted during high cortisol production. Pantothenic acid (B5) and biotin deficiency, in particular, have been linked to decreased adrenal function in animals and humans. Meanwhile, vitamin C helps to regulate cortisol and prevent blood pressure from spiking in response to stressful situations.
Thyroid Hormones
If your TSH is elevated or suppressed, you may need to initiate or adjust thyroid hormones. The ideal TSH for most people is between 0.5-2 μIU/mL. Levels that are too high or too low indicate an imbalance of thyroid hormone levels and have been associated with various symptoms, including depression and anxiety.
Taking a T3 containing medication, in particular, has been shown to reduce symptoms of depression. You may want to read my articles on understanding your thyroid labs and taking thyroid medications for more information on how adjusting thyroid medication dosages can help optimize your thyroid hormone levels and elevate your mood.
Lifestyle Interventions
There are many types of therapies, exercise, and activities aimed at reducing depression — the important thing is finding one that will work for you. This may take some experimentation, but a few of my favorite forms of mental health therapy include:

  • Bright light therapy: Bright light therapy (BLT) is considered among the first-line treatments for seasonal affective disorder (SAD), yet a growing body of literature supports its use in other mental health conditions, including non-seasonal depression. BLT uses a lamp to mimic sunlight to adjust the person’s circadian rhythm and elevate their mood. I’m a big proponent of being out in nature and enjoying the sunshine (especially on a beach vacation), however, those of us living in colder climates may not always have the ability to escape. In that case, you can purchase a therapy light online to sit under for 15 minutes a day, in the comfort of your home.
  • Meditation: Stress and anxiety are major triggers of depression, and meditation can alter your reaction to those feelings by training the brain to sustain focus, and return to that focus when negative thinking arises. Meditation has even been found to change certain regions of the brain that are linked with depression. There are many apps that can help you begin a meditation practice (Headspace is a popular one), but even just closing your eyes, sitting still, and focusing on your breath for five minutes is a wonderful place to start.
  • Exercise: Research has shown that exercise works as well as antidepressants for some people with depression. While high-intensity exercise releases the body’s feel-good chemicals called endorphins, low intensity energy over a sustained period of time causes the release of proteins called neurotrophic (or growth) factors. These proteins cause nerve cells to grow and make new connections, which improves brain function and makes you feel better. My favorite forms of exercise to give me a mental boost are hiking, yoga, and walking with my little family. 🙂
  • Art therapy: The healing power of art is emerging as an evidence-based therapeutic modality for depression. One meta-review published in 2015 examined the impact of art therapy on depression, anxiety, trauma, distress, inability to cope, and low self-esteem. It concluded that patients receiving art therapy (using the process of creating artwork as a form of mental therapy) had significant improvements in 14 out of 15 randomized control trials. By immersing themselves in the art of creation, people with depression are often able to push back against the darkness inside their minds and find ways to express themselves when words fail. You don’t have to consider yourself an “artist” to explore this form of therapy — it’s all about the process of creation, not the final product.
  • Yoga: Gentle forms of yoga, such as Yin Yoga and Hatha Yoga, have been shown to calm the nervous system and relax the mind. Many controlled studies have found benefits from yoga for depression and its symptoms, such as difficulty concentrating and lack of energy. The combination of meditation and physical movement involved in yoga provide two important elements for relieving depression: meditation helps allows a person to clear their mind, while controlled, focused movements help strengthen the body-mind connection.
  • Sauna therapy: Infrared saunas provide many benefits for Chronic Disease, including stress relief and mood elevation. The sympathetic nervous system and HPA-axis try to respond to compensate when the body is stressed by the body temperature rising. When a person is in the infrared sauna, the norepinephrine levels rise, but the body’s stress hormones epinephrine and cortisol do not. Growth hormone, beta-endorphins and prolactin also increase. Beta-endorphins account for the reason a sauna session feels so pleasurable. The muscles also relax, allowing the body to release any tension and be free of stress. During this time, the body’s parasympathetic nervous system takes over, putting the body in a state of complete relaxation.
  • Neurofeedback: This is a form of biofeedback therapy that uses real-time displays of brain activity to help self-regulate brain function. Research has shown its effectiveness for a variety of brain-related conditions, including depression. I like the Neuroptimal system and recommend finding a local neurofeedback practitioner in your area who has one.
  • Therapy: If your depression results from events that occurred in your past, utilizing therapy may be the path to healing. EMDR, or Eye Movement Desensitization and Reprocessing, is a method used by psychotherapists to help people eliminate the lasting effects of traumatic events. Francine Shapiro, PhD, who noticed that certain eye movements reduced the intensity of her disturbing thoughts and made her less anxious during a walk in nature, initially developed this method. She tested the method with trauma victims and published her findings in 1989, establishing it as an evidence-based level treatment for trauma and post-traumatic stress disorder. I highly recommend working with a therapist who specializes in EMDR if you have encountered traumatic events in your past. I assure you, you can get past them.

Though this is not a comprehensive list of all of the therapies available to treat depression, they are easy places to start if you are looking for alternatives to prescription antidepressants. Speaking with a counselor or therapist is another important step toward mental health for many people. Sometimes, talking through the problem can be the best way to find the root cause — especially if past trauma is a factor.
Please note that, if you are currently taking prescription anti-depressants, it is important not to stop taking your medications without the oversight of your physician or therapist.
The Takeaway
Going back to my lucid dream… I did things differently this time during that doctor’s appointment. I stopped him mid-sentence and said, “No, Doctor, I don’t need antidepressants. I came in because of my physical symptoms.” I may have thrown a swear word or two in there somewhere. And it was liberating!
Now that I’m a rebel with a cause — a Root Cause Rebel — my voice is getting stronger, and my pathological politeness is getting weaker with each and every day.
So if you’ve ever been told that it’s all in your head, or that you need antidepressants, or that you should just settle for the status quo, say it with me, my fellow Root Cause Rebel: “No, Doctor, I don’t need antidepressants!”
References

  1. Oldham M, Ciraulo D. Bright light therapy for depression: A review of its effects on chronobiology and the autonomic nervous system. Chronobiol Int. 2014 Apr; 31(3): 305–319.
  2. Uttley L, Scope A, Stevenson M, et al. Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders. Health Technology Assessment, No. 19.18.
  3. Major Depression. National Institute of Health. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Accessed August 29, 2019.
  4. Serefko A, Szopa A, Wlaź P, Nowak G, Radziwoń-Zaleska M, Skalski M, et al. Magnesium in depression. Pharmacol Rep. 2013;65(3):547-54.
  5. Beard J. Iron Deficiency Alters Brain Development and Functioning. The Journal of Nutrition. https://doi.org/10.1093/jn/133.5.1468S.
  6. Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005 Jan;19(1):59-65.

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No, Doc, I Don’t Need Antidepressants!

Clinical depression, or major depression, is a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in

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