Depression is a disabling illness that can result in chronic despair and a feeling of hopelessness. It is currently ranked by the World Health Organization as the leading cause of global disability and may affect up to 300,000,000 (probably double that now) people worldwide, an increase of more than 18% from 2005 to 2015. The global cost is approximately 210.5 billion annually. There is a life time prevalence rate of around 19% and on the rise. In the US, as elsewhere, depression episodes are increasing, especially in the adolescent population. Between the years 2017 and 2018, rates of adolescent depression increased by approximately 60% involving primarily teen and pre-teen girls. Those who have experienced depression can relate to the devastating impact on body, mind and spirit. So how is depression treated? The psychiatric field has failed miserably. As with most allopathic specialties, "symptom-drug", however most specialties, i.e. infectious disease have lab work to work with. Psychiatrists, after interviewing you (no testing) pick from the DSM (the diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric association. After matching your reported symptoms with the criteria in the manual they arrive at a "diagnosis" and formulate a plan. The plan inevitably includes drugs. They subjectively pick a drug that they think may benefit (and in fact, may benefit for short periods of time). Frequently, the first drug does not work and the patient is placed on a second drug then a third, etc. I had a patient on 5 psychotropics. Rarely, does the psychiatrist drop the drugs that are not working, maintaining the side effect profiles. What are the alternatives? Treating depression, even from a functional medicine perspective is still not easy, however, identifying the "why" is imperative. Allopathy, including psychiatry, is not interested in the why. When approaching the why for depression, a functional medicine/alternative clinician goes down the following list:

  1. Has there been a life altering event, i.e. death, etc. that can be addressed with mourning counseling?

  2. Is there a genetic component? Unfortunately genetics does play significant role in most every pathology including depression. Depression can be genetically linked to up to 50% of the time. A percentage I observed when I was doing genetics. (there are genetic tests that can identify genetic propensity (methylation etc.)

  3. Vitamin deficiencies (can impact emotions)

  4. Toxic metals (can cause a lot of neurological issues)

  5. Hormonal imbalances (sex hormones/men and women play a significant role in how one feels both physically and emotionally. A healthy thyroid is also essential for both physical and emotional well being.

  6. Amino acid and fatty acid imbalances (many amino acids are precursors to neurotransmitters, phenylalanine and tyrosine for example.

  7. Low or high levels of certain minerals

  8. The gut. SIBOdysbosis can have a dramatic impact on both physical and emotional well being. Some of our neurotransmitters are made in the gut (serotonin, dopamine, gaba, etc.)

  9. Imbalances in digestive enzymes

  10. Parasites

Once all of these tests have been completed an integrative clinician can accurately assess the "why" and come up with an individualized intervention including supplements like CBD/PEA, SAMe with magnesium, etc. This is a way of looking at an individual as a whole person with unique biochemistry and nutritional needs that when balanced allow health and vitality.

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