Finally Hopeful

Finally Hopeful

Chapter 1

Understanding Depression

The first essential step in healing your depression is knowing the real causes.

This book is about overcoming depression and feeling good again. You’ll learn how to create a personalized Functional Psychiatry Treatment Plan—an individualized plan of self-care and professional care. A plan that will address the unique, underlying, root causes of your depression. A plan that is much more than just trying to manage symptoms with a one-size-fits-all medication.

This chapter is about understanding depression as it is clinically diagnosed—the many types, and their many causes, including biochemical imbalances. Understanding your condition and what really causes it is one of the first steps in overcoming depression.

My patient Laura is a good example of what happens when you really understand the causes of your depression—and a good example of the effectiveness of the Functional Psychiatry Treatment Plan in addressing those causes.

Depressed, Bingeing, and Fatigued

Laura was a forty-one-year-old with a history of depression. She’d always struggled with binge eating, but after she was prescribed the antidepressant Paxil (paroxetine), she felt like she was in less control over resisting certain foods (particularly carbs). She had gained fifty-five pounds in the past three years. (Weight gain is a common side effect of the class of antidepressants called SSRIs, or selective serotonin reuptake inhibitors, affecting an estimated 25 percent of patients who take these drugs.) Her doctor added Wellbutrin (bupropion), an antidepressant that can help manage weight gain problems. But Laura still continued to struggle with episodes of bingeing—and continued to gain weight.

Because Paxil was making Laura’s problems worse, she had been trying to wean herself off the antidepressant medication with the help of her doctor. But the effects of tapering her medication were severe, as they often are. She and her doctor had reduced the dose of Paxil from 30 milligrams (mg) to 10 mg a day. But even at 10 mg Laura was experiencing side effects—insomnia, increased anxiety, and occasional brain sensations much like electric shocks. At that point, she decided to see me.

I listened as Laura described her concerns: her depression, her binge eating, and the side effects from deprescribing. (You can read more about deprescribing side effects—and how to stop them—in Chapters 16 and 17.) I explained to her my approach—first test, then treat—and we discussed a range of laboratory tests that I thought would be relevant to her situation. Laura requested them all.

Revealing Results

The laboratory testing revealed several biological imbalances that were probably contributing to both her depression and her binge eating.

Vitamin B12. Laura had a very low level of B12, which in turn boosted her levels of homocysteine, a metabolic byproduct of the breakdown of the amino acid cysteine. High levels of homocysteine are neurotoxic—and high levels are commonly found in people with (you guessed it) depression and binge eating.

Vitamin D. Laura also had a very low level of vitamin D, a precursor to serotonin, a neurotransmitter that plays a key role in mood, appetite, and sleep.

Food sensitivity. Laura had a food sensitivity to eggs, which she ate daily. Food sensitivities can disrupt the brain’s biochemical balance, impacting mood and potentially contributing to depression.

Kryptopyrroles. She had high levels of this chemical, a condition called pyroluria. Krptopyrroles can bind with vitamin B6 and zinc, forcing those key, brain-nourishing nutrients out of the body. In my clinical experience, patients with pyroluria struggle with more intense symptoms during antidepressant deprescribing.

The Functional Psychiatry Treatment Plan

At her second office visit, a few weeks later, I prescribed for Laura her individualized Functional Psychiatry Treatment Plan, based on her lab results. It included:

Curcumin. I prescribed 300 mg of curcumin, two times per day, using the supplement CurcumaSorb Mind, from Pure Encapsulations, which delivers both curcumin and other therapeutic plant compounds. Curcumin is the active ingredient in the spice turmeric, and it can help control kryptopyrroles. Research also shows it can improve mood and help balance appetite in patients with binge eating.

Zinc and B6. To counter the nutrient-stealing effects of kryptopyrroles, I also prescribed zinc (30 mg daily) and vitamin B6 (50 mg, twice daily).

B12. To counter her low levels of vitamin B12 and high levels of homocysteine, I prescribed a highly absorbable, sublingual form of vitamin B12: Pure Melt B12 Folate from Pure Encapsulations. It also contains L-methylfolate (a form of folate that isn’t affected by a common genetic mutation that stops the absorption of folic acid), which helps drive down homocysteine.

Vitamin D. To boost her low levels of vitamin D, I prescribed 5,000 IU daily of the nutrient.

Magnesium glycinate. This mineral supports vitamin D in producing serotonin, and is known to help with depression.

Eliminating eggs. This dietary change was intended to help stabilize her brain chemistry.

Laura readily agreed to implement this protocol.

Two months later: Remarkable improvement

I saw Laura two months later—and her improvement was remarkable. Her mood was more upbeat. Her anxiety had decreased. But most importantly to her, the episodes of bingeing were mostly under control, and she had started to lose weight. Plus, the side effects from Paxil deprescribing had stopped, and she was ready to lower the dose even further, which we did, getting her off Paxil over the next few months.

Without the Functional Psychiatry Treatment Plan—without first testing, and then treating—it’s likely Laura would still be struggling with depression, binge eating, and the side effects of deprescribing. With her personalized Functional Psychiatry Treatment Plan, she was well on the way to recovery.

The same type of success can happen for you—and for any of the seventy million Americans who will experience depression during their lifetime. But what happened for Laura is not typically what happens when a person visits a traditional psychiatrist.

The Limitations of Traditional Psychiatry

What happens when a patient with depression visits a traditional psychiatrist?

Imagine that patient is you, and you are stepping into the psychiatrist’s office. For whatever reason—because you feel depressed; because a family member has noticed how depressed you are and urged you to see a psychiatrist; because your primary care physician has referred you—you’ve made the decision to seek medical treatment.

One of the first things you notice when you enter the psychiatrist’s office is that it’s not like most medical offices. There is no stethoscope hanging from a hook, or a blood pressure cuff on a side table, or other instruments that doctors typically use to take measurements of patients. Instead, there is the psychiatrist behind their desk, you in a chair in front of the desk—and a box of tissues on the desk. Clearly, this is not going to be a standard medical exam, despite the fact that psychiatrists are medical doctors who go to four years of medical school, followed by at least four years of special training in psychiatry.

The doctor sits down, offers you a seat, and encourages you to describe your symptoms, and then interviews you to get the additional information needed to make a diagnosis.

Maybe you start to wonder, “What is a psychiatric diagnosis?” Maybe you wonder how a psychiatrist can even make a diagnosis based only on a conversation, rather than from a physical exam or test results. But that’s the way it’s always been done, so you go along with the program.

After your session, the psychiatrist may consult the DSM-5-TR, the big blue book that sits behind them on a bookshelf. The doctor is seeking to match the symptoms you described with one of the lists of symptoms in the book in order to arrive at an official diagnosis and to formulate an approach to your treatment.