James Greenblatt, MD
Integrative Psychiatry
Aired on: December 13, 2019
Episode Description
Dr. Greenblatt explains his integrative as well as a functional medicine approach to depression. This combines traditional medical science with nutritional and metabolic therapies. There are many contributing factors to depression including metabolic, physical illnesses, the immune system, hormones, genetics, and psychological factors such as stress. He looks at these factors as well as the uniqueness of each person’s metabolic and nutrition abnormalities that may contribute to depression. This approach can successfully treat many individuals suffering from depression. This book offers hope and treatment models that are simple, safe, and effective. He has been using these therapies for more than thirty years and has seen thousands of patients improve and recover from depression
- 120 million people worldwide; 15 M in US
- 7 % older than 18
- 2x as many females
- One in 8 teens equal sex
- 1/33 kids
- Runs in families 3 x as likely to have it
- Hx increases risk;
- 50 % if one episode
- 90 % if had several episodes
- Over next 20 years, projected to be #1 cause
disability in hi income countries and #2 world wide - Annual cost 30 – 44 billion.
- Every person is different- biochemically unique
Suicide
- 8th leading cause death in US 32K
deaths Q year - 15 % untxed suicide
- More than 2/3 suicides caused by depression
- Women 2-3 x more likely SA
- Men more than 4 x women to die of suicide
- Risk
- Family hx, impulsive drugs, separation, divorce,
family violence, impulsive
- Family hx, impulsive drugs, separation, divorce,
- Times
- Anxiety, anniversaries, drug /etoh abuse, untx
derpession
- Anxiety, anniversaries, drug /etoh abuse, untx
- He uses integrative psychiatry
- Factors contributing to depression are unique
- THE ZEBRA
- Nutrition important
- 1601 Capt James Lancaster discovered that lemon
juice prevented scurvy - British government waited 264 years after it was
proven - Just be cause MDs ignore does not mean not true
- Tomato Effect Dr. James Goodwin `984 JAMA
efficacious tx for certain ds is ignored or rejected because does not make
sense- Named tomato effect because 16 th – 19 th
century believed tomatoes were poisonous..
- Named tomato effect because 16 th – 19 th
- 1601 Capt James Lancaster discovered that lemon
- Longer one suffers, more difficult it is to
recover
Meds
- James Watson winner of Nobel Prize ifor
determining the structure of DNA urged
doctors to have better understanding of mental illness and develop tx based on
their results - Prescribe carefully
Stigma
- We are more than our experience and genes
Symptoms
- Also stomach ache, irritability, work too much
- Aches and pains,
- Etoh and drug abuse
- Chain smoking
- Constant exhaustion
- Crying a lot
- Decreased physical activity QD
- Reckless doing risky things
- Difficulty getting up in am
- Irritability, frustration
- Lack of energy or motivation
- Reduced sex drive
- Working long hours long term difficulty sleeping
Results
- Hard to work, loss relationships
- No energy to take care of self
- 4 x risk MI
- More likely to abuse etoh or drugs
Types
- Major depressive disorder MDD
- Depressin, anhedonia and five other
- Worthless common
- Not grief or sadness
- Persistent depressive disorder dysthmica
- Most of days more often or not for 2 years.
- If start before age 21, more likely co occurring
personality disorder or substance abuse
- Disruptive Mood Dysregulation Disorder kids
- Chronic, sever, persistent irritability
- Can be temper outburst, aggression out of
proptortion in intensity - Over at least one year in two settings (home,
work) - Developmentally in appropriate.
- Have low frustration tolerance
- Family lie disrupted
- Premenstrual dysphoric disorder
- Premenstrual dysphoric disorder is sever form of
pMS - Most cycles, sx must be present in final week
before period then better - At least one of following
- Emotional changes (mood swings)
- Irritability, anger, increased conflicts
- Depressed mood, hoplessnes, self deprecating
- Anxiety, tension, feeling on edge
- One or more of following total five
- Decreased interest in usual activities
- Difficulties concentrating
- Lack eergy
- Change appetite
- Difficulty sleeping
- Feeling overwhelmed or out of control
- Physical sx such as breast tenderness, swelling,
jt pain, muscle pain, bloating or wt gain
- Lead to distress or interference with work,
school, social, relationship
- Premenstrual dysphoric disorder is sever form of
- Substance/ medication induced depressive
disorder- Depressive sx associated with substance
- Typically starts within first fee weeks or one
month after start - Stop, get better
- Depressive disordered due to another medical
condition- CVa, HD, PD, TBI, Cushings, hypothyroid
- Depression with Anxious Distress
- Hi anxiety linked to higher suicide risk, longer
length of illness, greater likelihood of not responding to tx - At least tow during most days
- anxious, tense
- Unusually restless
- Difficulties concentrating because of worry
- Fear that something awful may happen
- Feeling one might lose control
- Hi anxiety linked to higher suicide risk, longer
- Depression with atypical Features
- Mood
reactivity can be cheered up- Can be euthymic if environment positive
- Weight gain or inc appetite
- Sleep at least ten hours per day
- Leaden paralysis
- Rejection sensitivity
- Mood
- Post partum Depression
- 70 % have baby blues
- Short term worry, unhappiness, fatigue 2 weeks
- Post partum depression `6 %
- For 4 weeks
- Sluggishness, fatigue
- Sad, hopeless, helpless or worthless
- Change sleep
- Change appetite
- Difficulty concentration, confusion
- Crying for no reason
- Lack of interest in baby or family
- Fear of harming baby or self
- Difficulties bonding with baby
- Often have anxiety or panic attacks
- Rapid changed in hormones or thyroid after
delivery may contribute - Lack of sleep, stress, family hx depression,
lack support may play rold
- For 4 weeks
- 70 % have baby blues
- Depression with a seasonal Pattern (seasonal
affective disorder- Relationship between the start of depressive
episodes and time of hear- Seasonal
- Loss energy, sleep too much, overeat, wt gain,
carb craving - Linked to biochemical imbalance caused by
shorter daylight hours - More common far from equator
- Less commonly occurs in summer
- Possibly in response to hi heat and humidity
- More likely insomnia, dec appetite, wt loss,
agitation, anxiety - Younger adults and women higher risk
- Average age onset is 18 – 30 years.
- Loss energy, sleep too much, overeat, wt gain,
- Seasonal
- Relationship between the start of depressive
CAUSES
- Biochemical
- Neurotransmitters
- Serotonin,
- Lack sleep problems, binge eating, irritability
- norepinephrine,
- too little low mood and fatigue
- dopamine
- due to too little or too much
- lack due to
- lack amino acids, vitamins, minerals
- breaking down neurotransmitters too quickly
- Serotonin,
- Neurotransmitters
- Physical
- Illnesses
- 25 % cancer, 94 % eating disorders
- 20- 40 % heart attack, 10 – 20 % HIV
- 50 % HD, 30 % chronic long term pain
- 50 % PD
- 25-50 % stroke
- 60 % disabling tinnitus
- 27 % drug or etoh
- 30 – 35 % AD
- Anxiety disorder, tobacco addiction
- Depressed people more likely to have DM2 and HD
- Illnesses
- Meds
- Antipsychotic,
- antihistamine,
- beta blockers,
- birth control pills,
- htn,
- anti inflammatory meds,
- adrenal hormone agents and
- corticosteroids
- Etoh, amphotericin B, bismuth nitrate,
carbamazepine, cis-retinoic acid, cyloserine - Cyclosporine, digitalis
- Estrogen therapy, flunarizine, h2 blockers
(cimetidine, ranitidine) - Interferon, levodopa, methyldopa mazindol,
mercury - Methylxantines (caffeine, theophylline),
metoclopramide (reglan) - Metronidazole, nifedipine, organic nitrates
- Phenytoin
- Psychostimulants (fenfluramine, methylphenidate,
permoline, phenylpropanolamine) - Reserpine
- Sedative hypnotics (barbiturates,
benzodiazepines, methaqualone) - Thallium
- Thiazide diuretics
- Vinblastine and vincristine
- Overactive
immune system- Sickness behavior normal reaction to infection
- Poor sleep, concentration, lack of desire
- Pro inflammatory chemicals inflammatory
cytokines cause changes in neurotransmitters - Depression has changed in cytokines
- High levels of inflammatory cytokines
- Low levels of anti inflammatory cytokines
- Anti inflammatory IL 4 and TGF b1 were lower
- Sertraline decrease pro inflammatory and
increase anti inflammatory - Depressed with inc inflammatory biomarkers less
likely to respond to antidepressants - Pt with hx no response to antidepressants have
inc inflammation
- Sickness behavior normal reaction to infection
- Inflammatory brain illnesses linked to
depression- Areas of brain dealing with mood regulation inflammation was 30 % higher in depressed
- 2017 Manchester MDD have inc microglial
activation- BiolPysch Krystal , J
- Hormones
- Estrogen
- Teen girls = teen boys in depression
- In women short depression 7 – 10 days before
period - Baby blues
- Testosterone
- Men low testosterone may be linked to depression
- Men may not respond with low testosterone
- Thyroid sub clinically low in mood disorders
- Women depressed hi TSH
- Low thyroid
poorer response - Give thyroid better response to antidepressants
- Estrogen
- Genetics
- Tendency to have is inherited not ds
- Family hx depression 3 x risk
- Twins
- Other one depressed 27 %
- Raised separately risk 67 %
- Tendency to have is inherited not ds
- Psychological
factors- Stress
- Aging
KEY POINTS
- GP. 62 % scripts for depression’ 65 % for
anxiety - Depression, 4 x likely to have MI than no hx
- s/p MI, chance another higher
- depressed more likely to abuse drugs, etoh
Treatment
- 2/3
effectively tx have sx that impair- 28 % mild impairment
- 23 % moderate impairment
- 12 % severe impairment; 4 % very severe impairment
- Research show 94 % meds work closer to 51 %
- 1/3 studies showing antidepressants don’t work
submitted to FDA don’t work not published - ½ studies failed to show any benefit other than
placebo
- 1/3 studies showing antidepressants don’t work
- Studies only short term 6 weeks
- based on symptoms and vulnerabilities. Severity
What is missing in psych eval
- diet, toxins nutrition, allergies
Drug tx don’t work
Research
- drug companies sponsoring research have conflict
of interest- 4.9 x likely to report med works
- Direct advertising to consumer spend billions
- People not depressed account for 94 % new
antidepressant use - JAMA 2010 antidepressants don’t work for less severe forms depression
- Paxil and imipramine do not reduce sx in mild,
moderate or severe depression - Antidepressants only work in severe depression
- by Vittengl at Truman U; Pt who took
antidepressants more sx at 9 years - Robert Whitaker Anatomy of an Epidemic 50 yrs
data; over time, people not on meds do
better than those who are.- Since 1987,
3x more on disability - Only 15 % 5x with meds remained healthy over
time- The other 85 % have chronic depression
- Since 1987,
- Yale found that universities hire to perform
drug research were part owners - Studies more likely to prove if funded by drug
industry or researchers have financial interest - British Psych Joanna Moncrieff paper, “There are
no signs that the rapidly escalating use antidepressants reduces burden of
depressive disorders - JAMA found standard antidepressants no more
effective than placebo for people with
less severe forms of depression
Bioindividuality
- Only speciality where no measurements
- Side
effects- Agitation,
- Blurred vision, constipation, dec sex drive, dry
mouth - Erectile dysfunction, fatigue, insomnia, nausea
- Osteoporosis, wt gain risk SI
- SRRI
- Sexual
- St gain
- Physical
- Headache, nausea, stomach problems
- mEd withdrawal
like flu- Irritability, agitation, restlessness, insomnia
- Migraines, headaches, not able to focus,
depression - Physical
- Sweat, palpitation, B &V, difficulties
breathing, sensory dist
- Sweat, palpitation, B &V, difficulties
- Reason: body/ brain no time to adjust to change
Brain and body. Influence each other
- Brain 3 pounds uses 20 % energy
- Scars in Brodmann
area 25 BA 25 hyperactive in depressed people- Activity normalized when depressive sx relieved
- Does not matter if relieved by tx or meds
- Is directly linked to amygdala which processes
anxiety, fear and the hypothalamus
(important in stress) - Generous supply of special transporter
molecules. Serotonin
- Serotonin gene coding for serotonin transporter
molecule comes in long and short- Long triggers production of more transporter
molecules - Short gene have smaller BA 25 and does not act
with amygdala and other brain areas - Is sped up activity in BA 25 the cause or result
of depression?
- Long triggers production of more transporter
Genes
- Some contribution 37 %
- Epigenetics
- Methylation
- Causes
- Stress
- Study mice remove from mothers 3 hrs QD x 10
days epigenetic changes last a week - Mice of good mothers exchanged with bad mothers,
stress handling abilities of foster
mothers.- Same for monkeys
- Study mice remove from mothers 3 hrs QD x 10
- Stress
- Good nutrition etc best hope
- Makes each person unique
- Genetic testing, twice as likely to be
prescribed the correct med
IDeal
- Diet meds, supplements, family hx
- Labs
- Vitamin deficiencies, toxic metals, hormone
imbalances - Vitamin levels, amino acid and fatty acid
imbalances - Hi or low minerals
- Celiac disease and other food sensibilities
- Imbalanced levels of digestive enzymes
- Disbiosis, parasites
- Focus on individual unique
- Care for how pt, not just ds
- Understand how body and mind are connected
- Restore health instead of reducing sx
- Increase boy nutrients to promote long term
health
T take care of yourself
H hormones and herbs
E exclude
Z zinc and other minerals
E essential fatty acids and cholesterol
E exercise and energy
B and other vitamins
R restore
A amino acids and proteins
T take care of yourself
- Link betn mental and psyical vauge
- Diet
- Studies
- 2010 AJP unhealthy diet more depressed
- 2010 teens unhealthy diet more likely depressed
- 2014 Iranian children
- Diets hi in saturated fats and refined carbs can
affect proteins important in brain development such as BDNF
- Studies
- Digestion
- HCl
- Dissolve food into parts
- To absorb vit B12, minerals
- Make enzyme pepsin necessary in digestion of
protein
- In SI sodium bicarbonate neutralizes HCL
- Fat and protein and carbs broken down
- Digestive enzymes
- Need zinc, protein, vitamin c
- Good nutrition leads to good digestion
- Good digestion ensures all necessary nutrients
are absorbed - Poor digestion=poor nurtition
- Gut bacteria
- Probiotics help digest
- HCl
- Sleep
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
TWINS - Brain dev needs sleep for brain dev.
- Sleep problems predict GAD, depression, and other behavioural d/0
- Poor sleep caused by
- Sleep apnea 5 x depression
- Tx sleep apnea can tx depression
- Sx tired in am and day
- Memory problems
- Toss, turn, choke, asp, snore
- Headaches in am
- Bathroom > once or twice
- Swelling legs
- c/p sweat during sleep
- stress, caffeine, etoh , drugs, OTC, allergies,
asthma, hyperthyroid, chronic pain nutritional deficiencies Mg, zn - restless legs
- Sleep apnea 5 x depression
- sleep hygience
- sleep same time
- avoid caffeine after lunch
- comfortable bed
- thermostat cool
- dark
- use bed for sleep and sex
- no work, TV in bed
- ritual
- no computers, games,
- don’t ty to hard
- sleep remedies
- melatonin,
- pineal body clock. 1 – 3 mg sleep in 30 min
- Mg, 200- 300 mg
- Works c Ca for muscle relax, contract
- Anti-stress.
Reduce cortisol, muscle cramps - First mineral to disappear with processed foods
- First mineral to leave when body stressed
- Depleted by etoh, caffeine, meds
- valerian,
300- 500 mg- Does not work right away
- Side effects h/a, restlessness, sleeplessness,
irregular heart beat - Sleep anti anxiety
- inositol,
- made by body and intestinal bactiera
- helps transmit nerve signals
- prevents buildup of fat in liver and other
organs - 1t 8 PM helps with obcessive thought
- 5 HTP, 50
– 200 mg- Reduce anxiety
- glycine, 3 g
- inh neurotransmitter
- helps relax blood vessels
- lower core body temperature
- GABA
- Low GABA anxiety, depression, irritability,
headache, htn
- Low GABA anxiety, depression, irritability,
- melatonin,
- Sugar
- Glucose,
- Fructose cant be absorbed by cellsà goes to liver
- Sucrose homes- fructose and glucose
- Dextrose from corn identical to glucose
- Galactose in milk
- Lactose glucose and galactose
- Maltose in barley – is two glucose
- Xylose in wood or straw
- Low sugar in brain weak, irritability, anxiety,
headaches, faint, depression - Hi insulin an d sugar inc negatively affects
kidney function, inc blood fats, TG, cholesterol - Sugar substitute. Xylitol, cinnamon, cardamom,
ginger, nutmeg
- Stress
- Inc inflammation ~ depressive sx
- Activate inactive genes that affect future
generations- Inc maternal stress in pregnancy ~ inc risk mod
to severe depression in offspring - Stressed ma -kids depressed 11 years later
- Inc maternal stress in pregnancy ~ inc risk mod
- Key Points
- AJP study unhealthy dietà more depressive and anxiety
- Diets 13,486 Iranian kids inc junk food ~
psychiatric stress - Survey, 40 % uS less than 8 hours sleep
- Met analysis 23 studies adolescents 12- 20 with
mdd more sleep disturbances - 2015 study consistently poor sleep inc
depression by 2.5 - More soft drinks higher levels depression,
hopelessness and aggression - 72 % of people with daily stress and anxiety
claim interferes with lives
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
HORMONES
- Low
thyroid- Anxiety , memory, hi cholesterol, constipation,
gum disease, fat, hypoglycemia, muscle aches and pains, acne, exzema, hair
loss, recurrent infections, pMS, irregular menstrual, ovarian cysts,
endometriosis, fluid retention, fatigue - Faulty testing à
faulty dx - TSH only show pituitary asks for correct amount
thyroid- But body might not be using it properly
- Taking imipramine plus T 3 faster recovery
- Replacing missing thyroid relieves depression
- Metanalysis T3 increased improvements seen with
antidepressants for tx resistant depression - 2014, T3 and T4 were both predictors of the
level of improvement in depression sx. - T3 works better for depression
- Better for women
- Thyroid needs iodine, tyrosine, zinc and iron
- Toxins get in the way
- Plastics, air fresheners
- Polychlorinated biphenyls, dioxin, phthalates,
and polybrominated diphenyl ether (PBDE)- Upset ratios in diff T hormone
- Interfere with thyroid hormone synthesis
- Suppress production thyroid hormone receptors
and binding thyroid hormone transport proteins.
- Anxiety , memory, hi cholesterol, constipation,
- DHEA
- Produced by adrenals
- When stressed , makes more
- Changes in liver to dHEA S which is measured
- When stressed , makes more
- Antiaging supplement controversial
- For depression
- 60 % depressed respond
- Maybe works better for men
- Makes testosterone and estrogen and all steroid
hormones- Need cholesterol
- Highest in mid 20s
- Produced by adrenals
- Testosterone
- Made in
testes, ovaries, adrenal glands, liver, skin and brain - Responsible for protein synthesis
- Maintenance of bone mineral density
- Lean body mass, muscle strength
- Sensitization or serotonin recptors
- Physiologic processes that contribute to sex
appeal - Decreases with age
- Diet, exercise
- Sleep quality
- Endocrine do
- Low testosterone
- Dec strength, fatigue,
- poor libido,
- htn, inc CV risk,
- loss lean body mass inc fat
- lowers depression with (and without?) meds
- lowest testosterone group (age 71-89)2 x
depression - 11/18
JAMA significant reductions in depressive sx d - Low
testosterone levels are linked to depression - In some
men depression cannot be relived until testosterone raised to a normal level - Antidepressants
cannot raise testosterone to a normal level - Other
ways to raise testosterone- Zinc
- Exercise
to strengthen muscles - Reduce
stress to reduce cortisol (which breaks down muscle - Cut or
avoid soy. Phytoestrogens which can counteract testosterone - Eat
plenty EPA and DHA in salmon and other cold water fish - Monitor
cholesterol and DHEA (needed to make testosterone - Supplement
with tribulus, herb than enhances testosterone synthesis
- Made in
- Estrogen
and Progesterone- 2014 study estrogen affects brain derived
neurotrophic factor (BDNF)- BDNF support survival of neurons and growth of
new neurons and their connections
- BDNF support survival of neurons and growth of
- Estrogen
can affect mood by degrading or reducing levels of MAO (which breaks down
serotonin.
- 2014 study estrogen affects brain derived
- Herbs
- St John’s
Wort 300 mg po TID- Anti depressant mild to moderate depression
- Germany licensed for anxiety,d epression, sleep
disorder - Pain disorder
- Cochrane
mild to moderate for 4 – 12 weeks did better than placebo - Fewer side effects than antidepressants.
- Safe long term prevents relapse
- Has hypericin
- Antiviral, against cancer and HIV in stored
blood
- Antiviral, against cancer and HIV in stored
- and hyperforin
- activates a specific receptor in liver that
triggers production of an enzyme used to metabolize meds
- activates a specific receptor in liver that
- Curcumin
- For Inflammation
- Regulates stress response system
- Degrades MAO which breaks down serotonin and by
protecting against oxidative stress and mitochondrial damage. - Regulates the level of neurotransmitters in body
- Promotes birth of new neurons in hippocampus
- Improve cognition
- Daily improved memory and mood in people with
mild, age-related memory loss
- Daily improved memory and mood in people with
- Safe and effective
- Rhodiola
- Recognized by Russian ministry of health as med
and herbal tonic - Reduce depressive sx, boost mood diminish
fatigue, tx opioid addiction - Assists in normalizing body stress response by
increasing body resilience - Reduce nicotine withdrawal sx by inc serotonin
and serotonin receptors - Degrades MAO A and MAO B
- Affects 1062 genes, fifty of which are linked to
behavior and 62 related to psych d/o - Ay improve emotional behavior thru effects of
transcriptions of certain genes - Depression. Rhodiola revolution
- Can enhance mood, concentration, energy
- Helps with anxiety and BAD although may be too
stimulating
- Recognized by Russian ministry of health as med
- St John’s
Summary
- Thyroid avoid toxins cleaning products,
pesticides, eat organic, use glass- T3, T 4 predict levels of improvement in
depression
- T3, T 4 predict levels of improvement in
- DHEA, testosterone, estrogen, progesterone
- Archive Gen Psych 2005 DHEA for midlife major and minor depression
- DHEA decrease with age
- Australians men with low test 2 x depressed >
highest test - Harvard topical test greater improvements in
depression > placebo
- Curcumin, SJW, rhodiola
E exclude harmful foods
- Celiac ds
- Body mistakenly mistakes gluten for a dangerous
toxin - Immunity system attacking gluten destroys the
intestine - Absorption vit A, B6, B 12, D, E K, iron, zn, Mg and ca, essential fats other aa
- Sx anemia, anorexia, arthritis, dermatitis
herpetiformis, edema, fatigue, infertility, jt pain, migraines, missed
menstrual periods, numbing hands - Osteoporosis, sz, stunted growth, tooth decay
and discoloration - 1/3 have depression
- Dx Ab: anti gliadin, anti endomysial, anti tissue
transglutaminase - Will develop nutritional problems
- Take multivit with iron, EFA, digestive enzymes
- Test for iron, folate, Mg, amino acids
- Need HCl
- Casomorphin,
gliadorphin- Similar to morphine
- Originally in pee of people with autism
- Incomplete digestion of proteinsà ADHD, child psychosis,
dyslexia, down, CD, post partum psychosis, Rett’s ds, severe depression - These excess peptides maybe these are unique carriers of info to
brain that may worsen many psych d/o - Elevated these caused by lack functioning of enzyme
dipeptidyl peptidase IV (DPP IV) which snips casomorphin and gliadorphin into
small pieces- These absorbed
- Cause deficiency DDPP IV
- Lack zn
- Antibiotics, interferon, gelatin
- Candida,
- Hi mercury and heavy metals and pesticides
- Depression suffered from incomplete digestion of
casein and gluten
- Food
Allergies and depression- IgG mediated delayed hypersensitivity rxn
- Have more depression
- Body mistakenly mistakes gluten for a dangerous
Summary
- 18 studies on depression and 11 on CD depression
is more common ore more severe in cD - Teens with CD have 31 % risk mde vs 7 % in
healthy children - Correlation CD and depressive disorders
- 2016 AJ Gastroenterology correlation between
feelings of depression and Crohns’ ds
Z Zinc and other minerals
- Zn
- 200 different reactions
- In brain
- Helps make DNA and proteins
- Helps immune fight off viruses and bacteria
- Helps wounds heal
- Regulates neurotransmission in brain
- Makes it possible to taste and smell
- Make sex and reproduction possible
- Helps make all enzymes needed to digest fats,
carbs and proteins
- In
- Oysters, poultry, red meat, beans, whole grains
and nuts
- Oysters, poultry, red meat, beans, whole grains
- Causes of lack
- Vegetarians
- Eating disorders
- UC, crohns
- Meds
- Asa, benazepril, cholestyramine
- Reduce cholesterol and ofloxacin
- Asa, benazepril, cholestyramine
- Results of lack
- Delayed growth in kids and infants
- Hair loss
- Diarrhea
- Loos appetite
- Weight loss
- Difficulty tasting food
- Acne
- Fatigue
- Elevated cholesterol
- More infections
- Memory impairment
- Impotence
- Anorexia, impaired cognitive, other behavioural
disturbances - Poorer appetite
- Depression
- Lower levels in major depression, postpartum
depression - Depression à
inflammation- Lowers albumin which transports zinc thru
bloodstream - Maybe liver snatches up zn to use for
inflammation
- Lowers albumin which transports zinc thru
- Zinc inh NMDA which controls glutamate
- Glutamate
- Sends signals between nerve cells
- Helps learning, memory
- Too much glutamateà
overstimulation- Progressive damage to nerve function (~
depression)
- Progressive damage to nerve function (~
- Glutamate
- Zinc can relieve depression’
- Animals given celexa inc zinc levels
- Given celexa or imrapmine, inc zinc in
hippocampus, dec other parts of brain - Given ECT inc zinc in hippocampus
- Zinc antidepressant in lab animals
- Low doses celexa and imipramine ineffective as
antidepressants stressed by - Chronic tx with antidepressants and ECT causes
zinc to inc in rat brains - Lab, zinc deficient diet à> depressive like sx
including anorexia and anxiety - Zinc improves depression
- Zinc taste
no eat 1 hour before
- Lower levels in major depression, postpartum
Copper
- In liver, heat, brain and kidneys
- Helps growth , maintenance of TBC, bones,
nerves, brains - Makes prostaglandins needed for heart beat and
blood pressure - Part in getting energy out of fats, protein an
carbs - Helps body fight free radicals
- Found in
- Liver, organ meats, shellfish, whole grain
cereals and bread, dark green leafy veggies, peas, poultry , nuts and beans
- Liver, organ meats, shellfish, whole grain
- Comes from
- Dental fixtures, copperpipes, cookware
- Copper at work
- Birth control pills and iUD
- Results of low copper
- Anemia, htn, diarrhea, difficulties breathing,
lowered immune function, EKG abnormalities
- Anemia, htn, diarrhea, difficulties breathing,
- Causes low copper
- Poor diet, digestive or intestinal disorders
that interfere with nutrient absorption - Chronic diarrhea and
- Excess zinc
- Meds which interfere with cu absorption
- Delavirdine (resciptor for HIV), ethambutol,
(TB), penicillamine (for RA) - Elderly persons, vegetarians, athletes, pregnant
women and premature infants likely to lack copper
- Delavirdine (resciptor for HIV), ethambutol,
- Poor diet, digestive or intestinal disorders
- Too much copper and depression
- Involved in monoamine oxidase, dopamine beta
hydroxylase and tyrosine hydroxylase all of which stimulate dopamine - Hi levels found in depressed
- Involved in monoamine oxidase, dopamine beta
Magnesium
- 54 % in bones 27 % in muscles
- 19 % in heart and liver
- 1 % in blood
- 300 biochemical reactions
- Maintain health immune system
- Keeps bones strong
- Regulates BP
- Making proteins
- Ensuring nerves work properly
- Keep heart beating steadily
- Lacks cause
- Irregular heartbeat, nausea, lack appetite, sz,
fatigue, muscle weakness, poor coordination, personality changes - May worsen depression and apathy, irritability,
nervousness, anxiety, excessive emotional reactions and frequent mood changes,
decreased memory and concentration, migraines, fatigue and ADHD - Link to depression especially in young adults
- Irregular heartbeat, nausea, lack appetite, sz,
- Risks for low Mg
- Crohn’s and ds interfere with absorption
- Etohics, dm senior citizens
- Meds that interfere with absorption or use
- Diuretics (Lasix) bumetanide (bumex) antibiotics
(gentamicin)
- Diuretics (Lasix) bumetanide (bumex) antibiotics
- Stress
- Symptoms low Mg
- Insomnia
- Constipation
- Anxiety
- Muscle spasms
- Mg found in
- Dark green leafy veggies, nuts, whole grain
breads, beans, peas - One of first minerals stripped with processed
foods.
- Dark green leafy veggies, nuts, whole grain
- Most Americans low in Mg
- Is low in processed foods
- Lack of Mg can trigger depression
- In mice inc anxiety and depression like
behaviours
- In mice inc anxiety and depression like
- High magnesium also in depressed patients.
- How Mg works
- Permits excess of calcium into nervous system
damaging nerves and causing sx similar to depression - Lack Mg may reduce brain levels of serotonin
- Permits excess of calcium into nervous system
Lithium 2.5 – 20 mg
- In every organ
- Helps stabilize mood
- Regulate neurotransmitter signaling
- Protects brain cells from early death
- Helps with antidepressants
- Aggression suicide attempts
- Finnish study with li in water
- Mechanism
- Fight inflammation
- Inc enzymes that produce glutathione
- Regulates pro inflammatory cytokines
- Reduce synthesis of proinflammatory cytokines
which can regulate expression responsible for their production
- Reduce synthesis of proinflammatory cytokines
Chromium
- In foods
- Cleared by
- Infection, exercise, physical trauma, diets with
large amounts of simple sugars, stress
- Infection, exercise, physical trauma, diets with
- Keeps insulin
and blood sugar balance and energy levels- Helps insulin sensitivity
- Lowers Cholesterol levels, body fat, Tg, Low
density lipoprotein - Raises HDL good cholesterol
- Helps with depression
Iodine
- Make thyroid hormones
- Thyroid snatches iodine and incorporates it into
these hormones- Thyroid enlarges as tries to get iodine
- In ocean water and soil
Iron
- For regulate cell growth
- Part of hemoglobin within RBC that carries
oxygen thru blood - Lack of iron
- Lack of oxygen brought to body
- Fatigue
- Weakened immune system
- Psycho problems
- Poor attention
- Sx of lack
- Weak ess, fatigue, disgestive problems fragile
bones, difficulties maintaining body temperature - Requeent infections
- Poor performance at school or work
- Weak ess, fatigue, disgestive problems fragile
- Found in red meat, fish, poultry, beans,
lentils, iron fortified cereals - Cause of deficiency
- Low consumption certain foods
- Pregnant
- Older infants, toddlers, teenage girls
- Women of childbearing age
- Celiac dx and dx interfere with iron absorption
- Supplement with ferrous bisglycinate
- Does not cause side effects of nausea,
constipation, stomach upset - 10 mg ferritin BID til normal
- Does not cause side effects of nausea,
- Lack of oxygen brought to body
SUMMARY
- Minerals and other nutrients influence brain
function and mood - Consider hi and low trace minerals
- Every depressed would asses for lack of trace
minerals - Everyone is unique
- Taking too much trace mineral can lead to
imbalance. - Zinc
numerous pathways- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
crohns, absorption disorders- Test zinc taste test
- Lower zinc in major depressed
- Zinc helps antidepressants
- Copper
- higher in depressed
- needed for dopamine
- Mg
helps in depressed who ar mg deficient- 2/3 Americans consume less than RDA Mg
- Depression inc when Mg low or hi
- Risk crohns, nutrient absorption, etoh, DM,
seniors
- Li
BJP adding lithium relieved sx depression in 48 hours- Finnish 2017 nutritional li highly effective
- Chromium
promising in antidepressants - Iron
- lower in depressed; supplement 25 % improvement
- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
- Iron
for oxygen- Iodine
- Thyroid with antidepressants do better
E essential fatty acids and cholesterol
- Saturated; mono unsaturated let go of one
hydrogen carbon- If on 6th is omega 6
- If on third carbon is omega 3 FA
- Recommended omega; 6 / omega 3 is 4:1
- Depression
correlated with low omega 3, and DHA - BAD lower
DPA, DHA, and alpha linolenic acid (body uses to make EPA) - Suicide
attempts low DHA, high o6/03 - Omega 6
- In corn, soy, sunflower oil, margarine, eggs,
meat
- In corn, soy, sunflower oil, margarine, eggs,
- Omega 3
- Higher o3 consumption linked with lower levels
of depressionIn fish, fish oil, flaxseed oil and walnuts - Kids less likely to sit still or pay
attention - Risk memory problems, dementia, strokes
- Higher levels lower risk depression but in
depression without anxiety - Don’t take too much
- Higher o3 consumption linked with lower levels
- EPA, DHA fuel the brain
- Help control chronic inflammation of
degenerative brains (AD)
- Help control chronic inflammation of
- EFA
- As RBC EFA dec, severity of depression inc and
vice versa - Low EFA in post partum
- As RBC EFA dec, severity of depression inc and
- EPA
- Can help with inflammation
- Maintains cell membranes
- EPA content of RBC decreases, severity epression
inc - Same for EPA and DHA in fat tissue
- Levels related in post partum depression for
developing fetus
- DHA
- Suicide attempts correlate with low plasma DHA
- Mildly depressed 34 % less DHA in fat tissue
- Main fatty acid in brain, grey matter and eye
retina - Improves sending brain signals and brain
communications - Bottle fed baby lacking DHA poor vision or
cognitive ability - LINKED TO DEPRESSION AND BAD
- Hi amount in brain where brain altering
neurotransmitters stored- Can regulate mood by inc serotonin
- 3rd trimester taking DHA linked to
less perceived stress and reduced stress hormones
- Low cholesterol and depression, suicide
E EXERCISE
- Less likely depression, anxiety
- Exercised less likely to have depression reoccur
- Weight lifting, crew, tai chi
- Reverse harmful effects of stress
- Lifts depression
- Improve learning
- Builds self esteem and improves body image
- Feel euphoric or joyful
- How exercise works
- Release endorphins
- Change level or effects norepinephrine,
serotonin - Lower cortisol
- Inc body temperature
- Gets mind off activities, improve self esteem,
self image interaction - BDNF
- Mitochondria
- Brain has lots of mitochondria
- Energy
- Vitamin
B12- With other vit B strengthening nervous and
immune systems - Helps muscle tone and healthy skin
- Role in energy metabolism
- Deficiency à
- Fatigue
- Inc homocsyteine which can worsen heart disease
- trouble absorbing vitamins
- antacids
- Vegans no animal, dairy no ingest B 12
- Amoxicillin,
antibiotics, colestipol to reduce cholesterol
- With other vit B strengthening nervous and
- Carnitine
- Made from aa found in meat
- In meat, milk, poultry, fish
- Some made in liver and kidneys from aa lysine
and methionine
- Produces energy in mitochondria by carrying
fatty acids into mIT - Inc energy and helps with depression
- Made from aa found in meat
- Co Q 10
- Enhances carnitine
- Antioxidant
- Boosts energy
- Ubiquinol
- In diet
- Whole grains, salmon, oily fish, organ meats
such as liver - Statins, some beta blockers, imipramine can
deplete coQ10
- Whole grains, salmon, oily fish, organ meats
- Rhodiola
- Boost energy endure exercise
- Supports exercise program
SUMMARY
- 60.3 % exercise regularly to have depression,
anxiety - NIH exercised less likely to have depressive
symptoms - Over time, exercise feasible tx for mdd
- 2008 found weakened mitochondrial activity
translated to less cellular energy was related to physical discomfort.
B B vitamins that affect mood
Niacin, B 6 make serotonin
- Vit D, B vitamins, SAMe
- B
vitamins- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
folate, inositol work as a team - Regulate carb metabolism
- Stabilize blood sugar
- Ease mood swings improve sleep
- Help liver deactivate and dispose of old
estrogen - Critical to energy making (Krebs)
- Vitamin B deficiency causes
- Harm brain leading to depression, anxiety,
irritability difficulty concentrating
- Harm brain leading to depression, anxiety,
- Vitamin B 6 and niacin
- Help make serotonin (help mood, sleep, appetite
- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
- Thiamine
(Vitamin B1)- Free thiamine crosses BBBHelps convert glucose
into fuel - Stimulates brain action
- Needed for nervous system health
- Aids in digestion
- Brain rapidly loses energy when thiamine in
short supply- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Depression, fatigue anxiety irritability,
- Lack
- Interfere with uptake of glucose in brain
- Leads to mental fatigue and poorer moods
- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Free thiamine crosses BBBHelps convert glucose
- Niacin
Vitamin B 3)- When niacin in short supply, tryptophan goes to
niacin instead of serotonin - Lack niacin can result in depression, agitation
and anxiety - Helps maintain health nervous and digestive
systems - Also stimulates circulation causing blood
vessels and RBC to become more flexible- Easier thru body and brain
- Lack. Pellagra
- When niacin in short supply, tryptophan goes to
- Pyridoxine
(Vitamin B 6)- Lack depression, confusion and irritability
- Needed to make neurotransmitters serotonin,
dopamine and norepinephine, GABA - Depressed pts have low B 6
- Necessary for normal brain function for
synthesis of RNA and DNA and formation of myelin sheath around nerve cells
- Inteffering with above B vitamins. Eating simple
sugar flour, cake, candy pies, etoh - Folate (vitamin
B 9)- SOURCES
- Asparagus,
citrus, fortified cereals, green leafy veggies, legumes (peas, beans,
lentils) - Required for Normal cell development and
manufacture of DNA and RNA
- Asparagus,
- Cause lack
- Birth control pills, anti-sz meds, antacids,
some antibiotic, etoh, smoking
- Birth control pills, anti-sz meds, antacids,
- Necessary to make SAMe needed for
neurotransmitter metabolism - May protect against colorectal, breast and
cervical cancers - Protects the heart by breaking down homocysteine
(linked to HD) - Homocysteine
- Heart disease
- Poor memory and compromised thinking
- To protect fetus from fetal brain and spinal
cord defects - Lack
- Can lead to depression
- Lower folate
- Higher likelihood of depression
- Poor response to antidepressants
- Higher relapse rate
- Folate supplementation makes antidepressants
work better.
- Depressed have lower folate than normal or other
psych d/o - Antidepressants do not work well I low folate
- People with low folate more likely to experience
depression relapse - Women (not men) who took folic acid with tx do
better than placebo
- Lower folate
- Can lead to depression
- FOLate natural form in foods
- Folic acid man made
- MTHFR MORE PRONE TO DEPRESSION
- 5 methyltetrahydrofolate= L methlfolate natural
active form- Used at cellular level for DNA , reproduction,
regulation of homocysteine. - Crosses BBB
- Used at cellular level for DNA , reproduction,
- SOURCES
- Vitamin
B6- Necessary to make serotonin and dopamine
- Lack trigger depression and mental confusion
- Vitamin B
12- Works with B6, and folic acid to make serotonin
and dopamine - Necessary to make RBC
- Lack
- Problems moving oxygen thru body
- Can cause fatigue, mood swings, irritability,
dementia or mania - neurological problems including tingling in
hands - difficulties coordination walking
- psychiatric: depression, anxiety, paranoia, AH,
memory loss, confusion, outbursts, and behavioural challenges
- Works with B6, and folic acid to make serotonin
Inositol (Vitamin B 8)
- for depression, panic, OCD
- is carb that can make from glucose
- too much sugar can disrupt the inositol shuttle
and other messenger pathways leading to deficiency
- too much sugar can disrupt the inositol shuttle
- forms health cell membranes
- maintains proper electrical energy and nutrient
transfer between cells - changed into substance that regulates action of
serotonin- lack serotonin depression, panic disorder, OCD
Vitamin D
- from food and sunlight
- cholesterol is precursor
- important for absorption and utilization of Ca
and phosphorus for bone and teeth growth - involved in brain function
- vitamin D receptors in both neurons and glial
cells in brain - forms
- D2 ergocalciferol made by plants
- Cholecalciferol made when skin exposed to UV-B
- Lack related to
- Psoriasis, muscle pain, weakness, htn, some
cancer, autoimmune disease - Depression, suicide
- Common in seniors
- Psoriasis, muscle pain, weakness, htn, some
- Depression and vitamin D
SAMe. 800 – 1600 mg for depression
- Made from methionine
- Helps make neurotransmitters, proteins and
hormones - Helps create mood enhancers
- Can help relieve depression
- Response rate 45 % (30 % for escitalopram and 26 % for placebo
- Add on for depression vs placebo
SUMMARY
- every
depressed person should take B complex vitamin with L methylfolate - Check vitamin B 12 and D
- Everyone unique
- Vitamins
- Make neurotransmitters, stabilize blood sugar,
ease mood swings, improve sleep, control inflammation
- Make neurotransmitters, stabilize blood sugar,
- Affect mood
- B vitamins, D, SAMe
- Deficiency of B
- Harm brain, leading to depression, anxiety,
irritability and difficulty concentrating - Folate natural
- Low folate higher likelihood of depression, poor
response to antidepressants, higher relapse rate
- Low folate higher likelihood of depression, poor
- Folic acid man made
- Harm brain, leading to depression, anxiety,
- Vitamin B
12 is family of compounds. Psych- Lack depression, anxiety, paranoia, AH, memory
loss, confucsion, outbursts, behavioural changes - From beef liver, cheese, eggs, milk, fish,
yogurt - If B 12 low and homocysteine hi recommends B 12
shot
- Lack depression, anxiety, paranoia, AH, memory
- Vitamin D
eat, sun- Linked to depression
- SAMe
depression - Inositol
changed to substance that regulates action of serotonin- Depression, panic disorder, OCD
- From inositol from foods including wheat germ,
brewer’s yeast, grapefruit, liver, raisins, unrefined molasses
- Thiamine
- Helps brain change glucose into fuel
- Brain rapidly loses energy when thiamin low
leading to depression, fatigue anxiety, irritability, insomnia, memory problems
- Niacin
- Lack lead to depression, agitation, anxiety all
linked to low serotonin - Lack pellagra sx depression, anxiety, apathy
- Lack lead to depression, agitation, anxiety all
- B vitamins depleted by eating too many simple
sugar, etoh - Folic acid, V12 and vitamin D and other
nutrients effective tx for depression - Folic acid with meds happier for women , not men
- L methylfolate decrease depression 3 months
later - Elderly with vitamin B 12 deficiency more likely
to be depressed - Duke Seniors lower vitamin D greater likelihood
of depression - Swedish depression improve with vitamin D
- SAMe large improvement in depression
R RESTORE HEALTHY DIGESTION
- GUT HOUSES > 70 % IMMUNE SYSTEM
- SUCROSE ALTERS BACTERIà CANDIDA YEAST
- Factors that decrease good bacteria
- Lack zinc, B vitamins, Fatty acid
- Lack of sun
- Lack of social support
- Poor nutrition
- Poor connection with nature
- Stress
- Lots sugar
- Antibiotics, alcohol , birth control pills
- Corticosteroids and anti inflammatory drugs
- Infections, laxatives
- Excessive use of antibacterial soap
- Meat from animals with growth hormones or
antibiotics - Gluten containing grains
- Gut Brain connection 2 way street
- Enteric thru Vagus nerve ascending
- Descending ANS
- Capillaries within epithelial tissues
- Brain can communicate with enteric nervous
system both directly (thru capillaries and nerve endings in gut wall) and
directly thru chemical signaling and hormone secretion - Gut communicates directly with the brain
Mood is affected by inflammatory markers in the gut
- Microbiota
- Microorganisms in a specific region or location
- Can be gut, skin, lungs oral mucosa
- Microorganisms in a specific region or location
- Microbiome
- Collection within a given microbiota
- Gut microbiota
- Associated with BAD, schizophrenia anxiety, OCD
- Pigs given lactobacillus probiotics healthier
and more resistant to swine flu - Bacterioides
- hi in depression
- linked to inflammation
- depressed
- hi bacteroides
- firmicutes, bacteroides, proteobacteria abnormalities
- inc Enterobacteriaceae and alisitpes
- reduced faecal bacterium negative correlation
with depression - depression can actually be transmitted thru gut
microbes
- To help gut
- For persons over 40, much depression is related
to gut - He recommends
- Digestive enzyme with hydrochloric acid
- Hydrochloric acid important for digesting
protein - Ant-acids especially 24 hour PPI lower stomach
acid- So don’t absorb B 12, digest protein
- Hydrochloric acid important for digesting
- Probiotics 50 billion CFUs
- Digestive enzyme with hydrochloric acid
- Can do these without testing without adverse
side effects.
- For persons over 40, much depression is related
- Disrupting
Gut function- ant acids
– especially 24 hour PPI lower stomach acid- so don’t absorb vitamin b 12 and digest/
breakdown protein
- so don’t absorb vitamin b 12 and digest/
- antibiotics
- can get an overgrowth of yeast, dsybiotic gut
- stress
- inflammation
- bad diet
- food sensitivities
- celiac disease abnormal reaction to gluten
- higher incidence of depression
- the action of gluten interferes with absorption
- zinc, folate, amino acids not absorbed
increasing risk of depression
- zinc, folate, amino acids not absorbed
- food allergies
- celiac disease abnormal reaction to gluten
- ant acids
Toxins can affect mood
- Toxins are synergistic
- BPA and phthalates are in many things
- Affect metabolism and absorption of zinc
- Have direct effects on neurons on brain
- Indirect effects to make trace minerals
unavailable
- BPA and phthalates are in many things
Toxins can interfere with the conversion of thyroid hormones T4 to T3
Role of Inflammation in depression
- Inflammation is Implicated for Heart Disease,
arthritis, cancer, Alzheimer’s disease - Heavily involved in a subset of depressed
- Overstimulated immune system produces chemicals
that go into the brain that affects how we synthesize chemicals to make our
brain regular- Chronic inflammation regardless of cause
(trauma, stress, infection) affects mood
- Chronic inflammation regardless of cause
- If we have the illness feel depressed.
Medications causing depression
- Propranolol, beta blockers
- Steroids
- Contribute to depression and suicide
- Hormones
- Blood pressure medications
- Chantix increases risk of suicide
- Antidepressants can contribute to more
depression of suicidality- FDA has put out warnings
To help stress
- Mindfulness
- Magnesium
- Interfere with overactive stress response system
Supplements to help with depression
- Magnesium
- Most common nutritional deficiency
- Inverse relationship with stress
- Magnesium is repleted in soil, so foods are low
in magnesium - Can lower blood pressure
- Helps with sleep, anxiety
- Helps with concentration
- Helps convert fats into energy
- In hundreds of reactions for brain function
- Zinc
- Commonly deficient because of toxins (BPS,
phthalates) - Is not plentiful in a vegan of vegetarian diet
- Is most bioavailable in animal products
- Adolescents commonly have low zinc levels
- Needed as biopathway to make neurotransmitters
- Linked to depression
- Symptoms of low zinc levels
- Hair loss, diarrhea, white marks on nails, skin
lesions, acne, less zinc
- Hair loss, diarrhea, white marks on nails, skin
- Taking zinc makes antidepressants work better
- Test for zinc with zinc taste test
- Have strong bitter taste if have adequate zinc
- Taste buds are zinc dependent
- Restore zinc, taste return
- Commonly deficient because of toxins (BPS,
- Vitamin B
12 - Vitamin D
- Recommends testing
- Take at least 2000 iu per day
- Omega 3.
Fish oil- Helps with mood
- 5HTP.
Precursor to serotonin - Don’t take tryptophan by it self
- SAMe
can be helpful. Do not take if have bipolar- Studies show good results
- 800 – 1600 mg per day
- St John’s
Wort- 600 mg 900 mg per day
- Make sure it comes from a reputable company
- Rhodiola
- He has had a lot of success
- Fewer side effects, fewer interactions with
drugs - Russians used for many years for concentration,
stamina, energy - 100 – 400 mg per day
- Role of Hormones important
- Bioidentical hormones
- Neurotransmitter testing not accurate
- Can look in urine for break down products of
serotonin and dopamine - He tests levels of amino acids and supplements
to give the building blocks to make neurotransmitters - He gives amino acid precursor molecules
- Can look in urine for break down products of
Role of trauma
- Depression from trauma is not as easily treated
with nutritional supplements - Look at therapy and nutritional deficiencies
Summary Points
- 120 million people worldwide; 15 M in US
- 7 % older than 18
- 2x as many females
- One in 8 teens equal sex
- 1/33 kids
- Runs in families 3 x as likely to have it
- Hx increases risk;
- 50 % if one episode
- 90 % if had several episodes
- Over next 20 years, projected to be #1 cause
disability in hi income countries and #2 world wide - Annual cost 30 – 44 billion.
- Every person is different- biochemically unique
Suicide
- 8th leading cause death in US 32K
deaths Q year - 15 % untxed suicide
- More than 2/3 suicides caused by depression
- Women 2-3 x more likely SA
- Men more than 4 x women to die of suicide
- Risk
- Family hx, impulsive drugs, separation, divorce,
family violence, impulsive
- Family hx, impulsive drugs, separation, divorce,
- Times
- Anxiety, anniversaries, drug /etoh abuse, untx
derpession
- Anxiety, anniversaries, drug /etoh abuse, untx
- He uses integrative psychiatry
- Factors contributing to depression are unique
- THE ZEBRA
- Nutrition important
- 1601 Capt James Lancaster discovered that lemon
juice prevented scurvy - British government waited 264 years after it was
proven - Just be cause MDs ignore does not mean not true
- Tomato Effect Dr. James Goodwin `984 JAMA
efficacious tx for certain ds is ignored or rejected because does not make
sense- Named tomato effect because 16 th – 19 th
century believed tomatoes were poisonous..
- Named tomato effect because 16 th – 19 th
- 1601 Capt James Lancaster discovered that lemon
- Longer one suffers, more difficult it is to
recover
Meds
- James Watson winner of Nobel Prize ifor
determining the structure of DNA urged
doctors to have better understanding of mental illness and develop tx based on
their results - Prescribe carefully
Stigma
- We are more than our experience and genes
Symptoms
- Also stomach ache, irritability, work too much
- Aches and pains,
- Etoh and drug abuse
- Chain smoking
- Constant exhaustion
- Crying a lot
- Decreased physical activity QD
- Reckless doing risky things
- Difficulty getting up in am
- Irritability, frustration
- Lack of energy or motivation
- Reduced sex drive
- Working long hours long term difficulty sleeping
Results
- Hard to work, loss relationships
- No energy to take care of self
- 4 x risk MI
- More likely to abuse etoh or drugs
Types
- Major depressive disorder MDD
- Depressin, anhedonia and five other
- Worthless common
- Not grief or sadness
- Persistent depressive disorder dysthmica
- Most of days more often or not for 2 years.
- If start before age 21, more likely co occurring
personality disorder or substance abuse
- Disruptive Mood Dysregulation Disorder kids
- Chronic, sever, persistent irritability
- Can be temper outburst, aggression out of
proptortion in intensity - Over at least one year in two settings (home,
work) - Developmentally in appropriate.
- Have low frustration tolerance
- Family lie disrupted
- Premenstrual dysphoric disorder
- Premenstrual dysphoric disorder is sever form of
pMS - Most cycles, sx must be present in final week
before period then better - At least one of following
- Emotional changes (mood swings)
- Irritability, anger, increased conflicts
- Depressed mood, hoplessnes, self deprecating
- Anxiety, tension, feeling on edge
- One or more of following total five
- Decreased interest in usual activities
- Difficulties concentrating
- Lack eergy
- Change appetite
- Difficulty sleeping
- Feeling overwhelmed or out of control
- Physical sx such as breast tenderness, swelling,
jt pain, muscle pain, bloating or wt gain
- Lead to distress or interference with work,
school, social, relationship
- Premenstrual dysphoric disorder is sever form of
- Substance/ medication induced depressive
disorder- Depressive sx associated with substance
- Typically starts within first fee weeks or one
month after start - Stop, get better
- Depressive disordered due to another medical
condition- CVa, HD, PD, TBI, Cushings, hypothyroid
- Depression with Anxious Distress
- Hi anxiety linked to higher suicide risk, longer
length of illness, greater likelihood of not responding to tx - At least tow during most days
- anxious, tense
- Unusually restless
- Difficulties concentrating because of worry
- Fear that something awful may happen
- Feeling one might lose control
- Hi anxiety linked to higher suicide risk, longer
- Depression with atypical Features
- Mood
reactivity can be cheered up- Can be euthymic if environment positive
- Weight gain or inc appetite
- Sleep at least ten hours per day
- Leaden paralysis
- Rejection sensitivity
- Mood
- Post partum Depression
- 70 % have baby blues
- Short term worry, unhappiness, fatigue 2 weeks
- Post partum depression `6 %
- For 4 weeks
- Sluggishness, fatigue
- Sad, hopeless, helpless or worthless
- Change sleep
- Change appetite
- Difficulty concentration, confusion
- Crying for no reason
- Lack of interest in baby or family
- Fear of harming baby or self
- Difficulties bonding with baby
- Often have anxiety or panic attacks
- Rapid changed in hormones or thyroid after
delivery may contribute - Lack of sleep, stress, family hx depression,
lack support may play rold
- For 4 weeks
- 70 % have baby blues
- Depression with a seasonal Pattern (seasonal
affective disorder- Relationship between the start of depressive
episodes and time of hear- Seasonal
- Loss energy, sleep too much, overeat, wt gain,
carb craving - Linked to biochemical imbalance caused by
shorter daylight hours - More common far from equator
- Less commonly occurs in summer
- Possibly in response to hi heat and humidity
- More likely insomnia, dec appetite, wt loss,
agitation, anxiety - Younger adults and women higher risk
- Average age onset is 18 – 30 years.
- Loss energy, sleep too much, overeat, wt gain,
- Seasonal
- Relationship between the start of depressive
CAUSES
- Biochemical
- Neurotransmitters
- Serotonin,
- Lack sleep problems, binge eating, irritability
- norepinephrine,
- too little low mood and fatigue
- dopamine
- due to too little or too much
- lack due to
- lack amino acids, vitamins, minerals
- breaking down neurotransmitters too quickly
- Serotonin,
- Neurotransmitters
- Physical
- Illnesses
- 25 % cancer, 94 % eating disorders
- 20- 40 % heart attack, 10 – 20 % HIV
- 50 % HD, 30 % chronic long term pain
- 50 % PD
- 25-50 % stroke
- 60 % disabling tinnitus
- 27 % drug or etoh
- 30 – 35 % AD
- Anxiety disorder, tobacco addiction
- Depressed people more likely to have DM2 and HD
- Illnesses
- Meds
- Antipsychotic,
- antihistamine,
- beta blockers,
- birth control pills,
- htn,
- anti inflammatory meds,
- adrenal hormone agents and
- corticosteroids
- Etoh, amphotericin B, bismuth nitrate,
carbamazepine, cis-retinoic acid, cyloserine - Cyclosporine, digitalis
- Estrogen therapy, flunarizine, h2 blockers
(cimetidine, ranitidine) - Interferon, levodopa, methyldopa mazindol,
mercury - Methylxantines (caffeine, theophylline),
metoclopramide (reglan) - Metronidazole, nifedipine, organic nitrates
- Phenytoin
- Psychostimulants (fenfluramine, methylphenidate,
permoline, phenylpropanolamine) - Reserpine
- Sedative hypnotics (barbiturates,
benzodiazepines, methaqualone) - Thallium
- Thiazide diuretics
- Vinblastine and vincristine
- Overactive
immune system- Sickness behavior normal reaction to infection
- Poor sleep, concentration, lack of desire
- Pro inflammatory chemicals inflammatory
cytokines cause changes in neurotransmitters - Depression has changed in cytokines
- High levels of inflammatory cytokines
- Low levels of anti inflammatory cytokines
- Anti inflammatory IL 4 and TGF b1 were lower
- Sertraline decrease pro inflammatory and
increase anti inflammatory - Depressed with inc inflammatory biomarkers less
likely to respond to antidepressants - Pt with hx no response to antidepressants have
inc inflammation
- Sickness behavior normal reaction to infection
- Inflammatory brain illnesses linked to
depression- Areas of brain dealing with mood regulation inflammation was 30 % higher in depressed
- 2017 Manchester MDD have inc microglial
activation- BiolPysch Krystal , J
- Hormones
- Estrogen
- Teen girls = teen boys in depression
- In women short depression 7 – 10 days before
period - Baby blues
- Testosterone
- Men low testosterone may be linked to depression
- Men may not respond with low testosterone
- Thyroid sub clinically low in mood disorders
- Women depressed hi TSH
- Low thyroid
poorer response - Give thyroid better response to antidepressants
- Estrogen
- Genetics
- Tendency to have is inherited not ds
- Family hx depression 3 x risk
- Twins
- Other one depressed 27 %
- Raised separately risk 67 %
- Tendency to have is inherited not ds
- Psychological
factors- Stress
- Aging
KEY POINTS
- GP. 62 % scripts for depression’ 65 % for
anxiety - Depression, 4 x likely to have MI than no hx
- s/p MI, chance another higher
- depressed more likely to abuse drugs, etoh
Treatment
- 2/3
effectively tx have sx that impair- 28 % mild impairment
- 23 % moderate impairment
- 12 % severe impairment; 4 % very severe impairment
- Research show 94 % meds work closer to 51 %
- 1/3 studies showing antidepressants don’t work
submitted to FDA don’t work not published - ½ studies failed to show any benefit other than
placebo
- 1/3 studies showing antidepressants don’t work
- Studies only short term 6 weeks
- based on symptoms and vulnerabilities. Severity
What is missing in psych eval
- diet, toxins nutrition, allergies
Drug tx don’t work
Research
- drug companies sponsoring research have conflict
of interest- 4.9 x likely to report med works
- Direct advertising to consumer spend billions
- People not depressed account for 94 % new
antidepressant use - JAMA 2010 antidepressants don’t work for less severe forms depression
- Paxil and imipramine do not reduce sx in mild,
moderate or severe depression - Antidepressants only work in severe depression
- by Vittengl at Truman U; Pt who took
antidepressants more sx at 9 years - Robert Whitaker Anatomy of an Epidemic 50 yrs
data; over time, people not on meds do
better than those who are.- Since 1987,
3x more on disability - Only 15 % 5x with meds remained healthy over
time- The other 85 % have chronic depression
- Since 1987,
- Yale found that universities hire to perform
drug research were part owners - Studies more likely to prove if funded by drug
industry or researchers have financial interest - British Psych Joanna Moncrieff paper, “There are
no signs that the rapidly escalating use antidepressants reduces burden of
depressive disorders - JAMA found standard antidepressants no more
effective than placebo for people with
less severe forms of depression
Bioindividuality
- Only speciality where no measurements
- Side
effects- Agitation,
- Blurred vision, constipation, dec sex drive, dry
mouth - Erectile dysfunction, fatigue, insomnia, nausea
- Osteoporosis, wt gain risk SI
- SRRI
- Sexual
- St gain
- Physical
- Headache, nausea, stomach problems
- mEd withdrawal
like flu- Irritability, agitation, restlessness, insomnia
- Migraines, headaches, not able to focus,
depression - Physical
- Sweat, palpitation, B &V, difficulties
breathing, sensory dist
- Sweat, palpitation, B &V, difficulties
- Reason: body/ brain no time to adjust to change
Brain and body. Influence each other
- Brain 3 pounds uses 20 % energy
- Scars in Brodmann
area 25 BA 25 hyperactive in depressed people- Activity normalized when depressive sx relieved
- Does not matter if relieved by tx or meds
- Is directly linked to amygdala which processes
anxiety, fear and the hypothalamus
(important in stress) - Generous supply of special transporter
molecules. Serotonin
- Serotonin gene coding for serotonin transporter
molecule comes in long and short- Long triggers production of more transporter
molecules - Short gene have smaller BA 25 and does not act
with amygdala and other brain areas - Is sped up activity in BA 25 the cause or result
of depression?
- Long triggers production of more transporter
Genes
- Some contribution 37 %
- Epigenetics
- Methylation
- Causes
- Stress
- Study mice remove from mothers 3 hrs QD x 10
days epigenetic changes last a week - Mice of good mothers exchanged with bad mothers,
stress handling abilities of foster
mothers.- Same for monkeys
- Study mice remove from mothers 3 hrs QD x 10
- Stress
- Good nutrition etc best hope
- Makes each person unique
- Genetic testing, twice as likely to be
prescribed the correct med
IDeal
- Diet meds, supplements, family hx
- Labs
- Vitamin deficiencies, toxic metals, hormone
imbalances - Vitamin levels, amino acid and fatty acid
imbalances - Hi or low minerals
- Celiac disease and other food sensibilities
- Imbalanced levels of digestive enzymes
- Disbiosis, parasites
- Focus on individual unique
- Care for how pt, not just ds
- Understand how body and mind are connected
- Restore health instead of reducing sx
- Increase boy nutrients to promote long term
health
T take care of yourself
H hormones and herbs
E exclude
Z zinc and other minerals
E essential fatty acids and cholesterol
E exercise and energy
B and other vitamins
R restore
A amino acids and proteins
T take care of yourself
- Link betn mental and psyical vauge
- Diet
- Studies
- 2010 AJP unhealthy diet more depressed
- 2010 teens unhealthy diet more likely depressed
- 2014 Iranian children
- Diets hi in saturated fats and refined carbs can
affect proteins important in brain development such as BDNF
- Studies
- Digestion
- HCl
- Dissolve food into parts
- To absorb vit B12, minerals
- Make enzyme pepsin necessary in digestion of
protein
- In SI sodium bicarbonate neutralizes HCL
- Fat and protein and carbs broken down
- Digestive enzymes
- Need zinc, protein, vitamin c
- Good nutrition leads to good digestion
- Good digestion ensures all necessary nutrients
are absorbed - Poor digestion=poor nurtition
- Gut bacteria
- Probiotics help digest
- HCl
- Sleep
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
TWINS - Brain dev needs sleep for brain dev.
- Sleep problems predict GAD, depression, and other behavioural d/0
- Poor sleep caused by
- Sleep apnea 5 x depression
- Tx sleep apnea can tx depression
- Sx tired in am and day
- Memory problems
- Toss, turn, choke, asp, snore
- Headaches in am
- Bathroom > once or twice
- Swelling legs
- c/p sweat during sleep
- stress, caffeine, etoh , drugs, OTC, allergies,
asthma, hyperthyroid, chronic pain nutritional deficiencies Mg, zn - restless legs
- Sleep apnea 5 x depression
- sleep hygience
- sleep same time
- avoid caffeine after lunch
- comfortable bed
- thermostat cool
- dark
- use bed for sleep and sex
- no work, TV in bed
- ritual
- no computers, games,
- don’t ty to hard
- sleep remedies
- melatonin,
- pineal body clock. 1 – 3 mg sleep in 30 min
- Mg, 200- 300 mg
- Works c Ca for muscle relax, contract
- Anti-stress.
Reduce cortisol, muscle cramps - First mineral to disappear with processed foods
- First mineral to leave when body stressed
- Depleted by etoh, caffeine, meds
- valerian,
300- 500 mg- Does not work right away
- Side effects h/a, restlessness, sleeplessness,
irregular heart beat - Sleep anti anxiety
- inositol,
- made by body and intestinal bactiera
- helps transmit nerve signals
- prevents buildup of fat in liver and other
organs - 1t 8 PM helps with obcessive thought
- 5 HTP, 50
– 200 mg- Reduce anxiety
- glycine, 3 g
- inh neurotransmitter
- helps relax blood vessels
- lower core body temperature
- GABA
- Low GABA anxiety, depression, irritability,
headache, htn
- Low GABA anxiety, depression, irritability,
- melatonin,
- Sugar
- Glucose,
- Fructose cant be absorbed by cellsà goes to liver
- Sucrose homes- fructose and glucose
- Dextrose from corn identical to glucose
- Galactose in milk
- Lactose glucose and galactose
- Maltose in barley – is two glucose
- Xylose in wood or straw
- Low sugar in brain weak, irritability, anxiety,
headaches, faint, depression - Hi insulin an d sugar inc negatively affects
kidney function, inc blood fats, TG, cholesterol - Sugar substitute. Xylitol, cinnamon, cardamom,
ginger, nutmeg
- Stress
- Inc inflammation ~ depressive sx
- Activate inactive genes that affect future
generations- Inc maternal stress in pregnancy ~ inc risk mod
to severe depression in offspring - Stressed ma -kids depressed 11 years later
- Inc maternal stress in pregnancy ~ inc risk mod
- Key Points
- AJP study unhealthy dietà more depressive and anxiety
- Diets 13,486 Iranian kids inc junk food ~
psychiatric stress - Survey, 40 % uS less than 8 hours sleep
- Met analysis 23 studies adolescents 12- 20 with
mdd more sleep disturbances - 2015 study consistently poor sleep inc
depression by 2.5 - More soft drinks higher levels depression,
hopelessness and aggression - 72 % of people with daily stress and anxiety
claim interferes with lives
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
HORMONES
- Low
thyroid- Anxiety , memory, hi cholesterol, constipation,
gum disease, fat, hypoglycemia, muscle aches and pains, acne, exzema, hair
loss, recurrent infections, pMS, irregular menstrual, ovarian cysts,
endometriosis, fluid retention, fatigue - Faulty testing à
faulty dx - TSH only show pituitary asks for correct amount
thyroid- But body might not be using it properly
- Taking imipramine plus T 3 faster recovery
- Replacing missing thyroid relieves depression
- Metanalysis T3 increased improvements seen with
antidepressants for tx resistant depression - 2014, T3 and T4 were both predictors of the
level of improvement in depression sx. - T3 works better for depression
- Better for women
- Thyroid needs iodine, tyrosine, zinc and iron
- Toxins get in the way
- Plastics, air fresheners
- Polychlorinated biphenyls, dioxin, phthalates,
and polybrominated diphenyl ether (PBDE)- Upset ratios in diff T hormone
- Interfere with thyroid hormone synthesis
- Suppress production thyroid hormone receptors
and binding thyroid hormone transport proteins.
- Anxiety , memory, hi cholesterol, constipation,
- DHEA
- Produced by adrenals
- When stressed , makes more
- Changes in liver to dHEA S which is measured
- When stressed , makes more
- Antiaging supplement controversial
- For depression
- 60 % depressed respond
- Maybe works better for men
- Makes testosterone and estrogen and all steroid
hormones- Need cholesterol
- Highest in mid 20s
- Produced by adrenals
- Testosterone
- Made in
testes, ovaries, adrenal glands, liver, skin and brain - Responsible for protein synthesis
- Maintenance of bone mineral density
- Lean body mass, muscle strength
- Sensitization or serotonin recptors
- Physiologic processes that contribute to sex
appeal - Decreases with age
- Diet, exercise
- Sleep quality
- Endocrine do
- Low testosterone
- Dec strength, fatigue,
- poor libido,
- htn, inc CV risk,
- loss lean body mass inc fat
- lowers depression with (and without?) meds
- lowest testosterone group (age 71-89)2 x
depression - 11/18
JAMA significant reductions in depressive sx d - Low
testosterone levels are linked to depression - In some
men depression cannot be relived until testosterone raised to a normal level - Antidepressants
cannot raise testosterone to a normal level - Other
ways to raise testosterone- Zinc
- Exercise
to strengthen muscles - Reduce
stress to reduce cortisol (which breaks down muscle - Cut or
avoid soy. Phytoestrogens which can counteract testosterone - Eat
plenty EPA and DHA in salmon and other cold water fish - Monitor
cholesterol and DHEA (needed to make testosterone - Supplement
with tribulus, herb than enhances testosterone synthesis
- Made in
- Estrogen
and Progesterone- 2014 study estrogen affects brain derived
neurotrophic factor (BDNF)- BDNF support survival of neurons and growth of
new neurons and their connections
- BDNF support survival of neurons and growth of
- Estrogen
can affect mood by degrading or reducing levels of MAO (which breaks down
serotonin.
- 2014 study estrogen affects brain derived
- Herbs
- St John’s
Wort 300 mg po TID- Anti depressant mild to moderate depression
- Germany licensed for anxiety,d epression, sleep
disorder - Pain disorder
- Cochrane
mild to moderate for 4 – 12 weeks did better than placebo - Fewer side effects than antidepressants.
- Safe long term prevents relapse
- Has hypericin
- Antiviral, against cancer and HIV in stored
blood
- Antiviral, against cancer and HIV in stored
- and hyperforin
- activates a specific receptor in liver that
triggers production of an enzyme used to metabolize meds
- activates a specific receptor in liver that
- Curcumin
- For Inflammation
- Regulates stress response system
- Degrades MAO which breaks down serotonin and by
protecting against oxidative stress and mitochondrial damage. - Regulates the level of neurotransmitters in body
- Promotes birth of new neurons in hippocampus
- Improve cognition
- Daily improved memory and mood in people with
mild, age-related memory loss
- Daily improved memory and mood in people with
- Safe and effective
- Rhodiola
- Recognized by Russian ministry of health as med
and herbal tonic - Reduce depressive sx, boost mood diminish
fatigue, tx opioid addiction - Assists in normalizing body stress response by
increasing body resilience - Reduce nicotine withdrawal sx by inc serotonin
and serotonin receptors - Degrades MAO A and MAO B
- Affects 1062 genes, fifty of which are linked to
behavior and 62 related to psych d/o - Ay improve emotional behavior thru effects of
transcriptions of certain genes - Depression. Rhodiola revolution
- Can enhance mood, concentration, energy
- Helps with anxiety and BAD although may be too
stimulating
- Recognized by Russian ministry of health as med
- St John’s
Summary
- Thyroid avoid toxins cleaning products,
pesticides, eat organic, use glass- T3, T 4 predict levels of improvement in
depression
- T3, T 4 predict levels of improvement in
- DHEA, testosterone, estrogen, progesterone
- Archive Gen Psych 2005 DHEA for midlife major and minor depression
- DHEA decrease with age
- Australians men with low test 2 x depressed >
highest test - Harvard topical test greater improvements in
depression > placebo
- Curcumin, SJW, rhodiola
E exclude harmful foods
- Celiac ds
- Body mistakenly mistakes gluten for a dangerous
toxin - Immunity system attacking gluten destroys the
intestine - Absorption vit A, B6, B 12, D, E K, iron, zn, Mg and ca, essential fats other aa
- Sx anemia, anorexia, arthritis, dermatitis
herpetiformis, edema, fatigue, infertility, jt pain, migraines, missed
menstrual periods, numbing hands - Osteoporosis, sz, stunted growth, tooth decay
and discoloration - 1/3 have depression
- Dx Ab: anti gliadin, anti endomysial, anti tissue
transglutaminase - Will develop nutritional problems
- Take multivit with iron, EFA, digestive enzymes
- Test for iron, folate, Mg, amino acids
- Need HCl
- Casomorphin,
gliadorphin- Similar to morphine
- Originally in pee of people with autism
- Incomplete digestion of proteinsà ADHD, child psychosis,
dyslexia, down, CD, post partum psychosis, Rett’s ds, severe depression - These excess peptides maybe these are unique carriers of info to
brain that may worsen many psych d/o - Elevated these caused by lack functioning of enzyme
dipeptidyl peptidase IV (DPP IV) which snips casomorphin and gliadorphin into
small pieces- These absorbed
- Cause deficiency DDPP IV
- Lack zn
- Antibiotics, interferon, gelatin
- Candida,
- Hi mercury and heavy metals and pesticides
- Depression suffered from incomplete digestion of
casein and gluten
- Food
Allergies and depression- IgG mediated delayed hypersensitivity rxn
- Have more depression
- Body mistakenly mistakes gluten for a dangerous
Summary
- 18 studies on depression and 11 on CD depression
is more common ore more severe in cD - Teens with CD have 31 % risk mde vs 7 % in
healthy children - Correlation CD and depressive disorders
- 2016 AJ Gastroenterology correlation between
feelings of depression and Crohns’ ds
Z Zinc and other minerals
- Zn
- 200 different reactions
- In brain
- Helps make DNA and proteins
- Helps immune fight off viruses and bacteria
- Helps wounds heal
- Regulates neurotransmission in brain
- Makes it possible to taste and smell
- Make sex and reproduction possible
- Helps make all enzymes needed to digest fats,
carbs and proteins
- In
- Oysters, poultry, red meat, beans, whole grains
and nuts
- Oysters, poultry, red meat, beans, whole grains
- Causes of lack
- Vegetarians
- Eating disorders
- UC, crohns
- Meds
- Asa, benazepril, cholestyramine
- Reduce cholesterol and ofloxacin
- Asa, benazepril, cholestyramine
- Results of lack
- Delayed growth in kids and infants
- Hair loss
- Diarrhea
- Loos appetite
- Weight loss
- Difficulty tasting food
- Acne
- Fatigue
- Elevated cholesterol
- More infections
- Memory impairment
- Impotence
- Anorexia, impaired cognitive, other behavioural
disturbances - Poorer appetite
- Depression
- Lower levels in major depression, postpartum
depression - Depression à
inflammation- Lowers albumin which transports zinc thru
bloodstream - Maybe liver snatches up zn to use for
inflammation
- Lowers albumin which transports zinc thru
- Zinc inh NMDA which controls glutamate
- Glutamate
- Sends signals between nerve cells
- Helps learning, memory
- Too much glutamateà
overstimulation- Progressive damage to nerve function (~
depression)
- Progressive damage to nerve function (~
- Glutamate
- Zinc can relieve depression’
- Animals given celexa inc zinc levels
- Given celexa or imrapmine, inc zinc in
hippocampus, dec other parts of brain - Given ECT inc zinc in hippocampus
- Zinc antidepressant in lab animals
- Low doses celexa and imipramine ineffective as
antidepressants stressed by - Chronic tx with antidepressants and ECT causes
zinc to inc in rat brains - Lab, zinc deficient diet à> depressive like sx
including anorexia and anxiety - Zinc improves depression
- Zinc taste
no eat 1 hour before
- Lower levels in major depression, postpartum
Copper
- In liver, heat, brain and kidneys
- Helps growth , maintenance of TBC, bones,
nerves, brains - Makes prostaglandins needed for heart beat and
blood pressure - Part in getting energy out of fats, protein an
carbs - Helps body fight free radicals
- Found in
- Liver, organ meats, shellfish, whole grain
cereals and bread, dark green leafy veggies, peas, poultry , nuts and beans
- Liver, organ meats, shellfish, whole grain
- Comes from
- Dental fixtures, copperpipes, cookware
- Copper at work
- Birth control pills and iUD
- Results of low copper
- Anemia, htn, diarrhea, difficulties breathing,
lowered immune function, EKG abnormalities
- Anemia, htn, diarrhea, difficulties breathing,
- Causes low copper
- Poor diet, digestive or intestinal disorders
that interfere with nutrient absorption - Chronic diarrhea and
- Excess zinc
- Meds which interfere with cu absorption
- Delavirdine (resciptor for HIV), ethambutol,
(TB), penicillamine (for RA) - Elderly persons, vegetarians, athletes, pregnant
women and premature infants likely to lack copper
- Delavirdine (resciptor for HIV), ethambutol,
- Poor diet, digestive or intestinal disorders
- Too much copper and depression
- Involved in monoamine oxidase, dopamine beta
hydroxylase and tyrosine hydroxylase all of which stimulate dopamine - Hi levels found in depressed
- Involved in monoamine oxidase, dopamine beta
Magnesium
- 54 % in bones 27 % in muscles
- 19 % in heart and liver
- 1 % in blood
- 300 biochemical reactions
- Maintain health immune system
- Keeps bones strong
- Regulates BP
- Making proteins
- Ensuring nerves work properly
- Keep heart beating steadily
- Lacks cause
- Irregular heartbeat, nausea, lack appetite, sz,
fatigue, muscle weakness, poor coordination, personality changes - May worsen depression and apathy, irritability,
nervousness, anxiety, excessive emotional reactions and frequent mood changes,
decreased memory and concentration, migraines, fatigue and ADHD - Link to depression especially in young adults
- Irregular heartbeat, nausea, lack appetite, sz,
- Risks for low Mg
- Crohn’s and ds interfere with absorption
- Etohics, dm senior citizens
- Meds that interfere with absorption or use
- Diuretics (Lasix) bumetanide (bumex) antibiotics
(gentamicin)
- Diuretics (Lasix) bumetanide (bumex) antibiotics
- Stress
- Symptoms low Mg
- Insomnia
- Constipation
- Anxiety
- Muscle spasms
- Mg found in
- Dark green leafy veggies, nuts, whole grain
breads, beans, peas - One of first minerals stripped with processed
foods.
- Dark green leafy veggies, nuts, whole grain
- Most Americans low in Mg
- Is low in processed foods
- Lack of Mg can trigger depression
- In mice inc anxiety and depression like
behaviours
- In mice inc anxiety and depression like
- High magnesium also in depressed patients.
- How Mg works
- Permits excess of calcium into nervous system
damaging nerves and causing sx similar to depression - Lack Mg may reduce brain levels of serotonin
- Permits excess of calcium into nervous system
Lithium 2.5 – 20 mg
- In every organ
- Helps stabilize mood
- Regulate neurotransmitter signaling
- Protects brain cells from early death
- Helps with antidepressants
- Aggression suicide attempts
- Finnish study with li in water
- Mechanism
- Fight inflammation
- Inc enzymes that produce glutathione
- Regulates pro inflammatory cytokines
- Reduce synthesis of proinflammatory cytokines
which can regulate expression responsible for their production
- Reduce synthesis of proinflammatory cytokines
Chromium
- In foods
- Cleared by
- Infection, exercise, physical trauma, diets with
large amounts of simple sugars, stress
- Infection, exercise, physical trauma, diets with
- Keeps insulin
and blood sugar balance and energy levels- Helps insulin sensitivity
- Lowers Cholesterol levels, body fat, Tg, Low
density lipoprotein - Raises HDL good cholesterol
- Helps with depression
Iodine
- Make thyroid hormones
- Thyroid snatches iodine and incorporates it into
these hormones- Thyroid enlarges as tries to get iodine
- In ocean water and soil
Iron
- For regulate cell growth
- Part of hemoglobin within RBC that carries
oxygen thru blood - Lack of iron
- Lack of oxygen brought to body
- Fatigue
- Weakened immune system
- Psycho problems
- Poor attention
- Sx of lack
- Weak ess, fatigue, disgestive problems fragile
bones, difficulties maintaining body temperature - Requeent infections
- Poor performance at school or work
- Weak ess, fatigue, disgestive problems fragile
- Found in red meat, fish, poultry, beans,
lentils, iron fortified cereals - Cause of deficiency
- Low consumption certain foods
- Pregnant
- Older infants, toddlers, teenage girls
- Women of childbearing age
- Celiac dx and dx interfere with iron absorption
- Supplement with ferrous bisglycinate
- Does not cause side effects of nausea,
constipation, stomach upset - 10 mg ferritin BID til normal
- Does not cause side effects of nausea,
- Lack of oxygen brought to body
SUMMARY
- Minerals and other nutrients influence brain
function and mood - Consider hi and low trace minerals
- Every depressed would asses for lack of trace
minerals - Everyone is unique
- Taking too much trace mineral can lead to
imbalance. - Zinc
numerous pathways- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
crohns, absorption disorders- Test zinc taste test
- Lower zinc in major depressed
- Zinc helps antidepressants
- Copper
- higher in depressed
- needed for dopamine
- Mg
helps in depressed who ar mg deficient- 2/3 Americans consume less than RDA Mg
- Depression inc when Mg low or hi
- Risk crohns, nutrient absorption, etoh, DM,
seniors
- Li
BJP adding lithium relieved sx depression in 48 hours- Finnish 2017 nutritional li highly effective
- Chromium
promising in antidepressants - Iron
- lower in depressed; supplement 25 % improvement
- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
- Iron
for oxygen- Iodine
- Thyroid with antidepressants do better
E essential fatty acids and cholesterol
- Saturated; mono unsaturated let go of one
hydrogen carbon- If on 6th is omega 6
- If on third carbon is omega 3 FA
- Recommended omega; 6 / omega 3 is 4:1
- Depression
correlated with low omega 3, and DHA - BAD lower
DPA, DHA, and alpha linolenic acid (body uses to make EPA) - Suicide
attempts low DHA, high o6/03 - Omega 6
- In corn, soy, sunflower oil, margarine, eggs,
meat
- In corn, soy, sunflower oil, margarine, eggs,
- Omega 3
- Higher o3 consumption linked with lower levels
of depressionIn fish, fish oil, flaxseed oil and walnuts - Kids less likely to sit still or pay
attention - Risk memory problems, dementia, strokes
- Higher levels lower risk depression but in
depression without anxiety - Don’t take too much
- Higher o3 consumption linked with lower levels
- EPA, DHA fuel the brain
- Help control chronic inflammation of
degenerative brains (AD)
- Help control chronic inflammation of
- EFA
- As RBC EFA dec, severity of depression inc and
vice versa - Low EFA in post partum
- As RBC EFA dec, severity of depression inc and
- EPA
- Can help with inflammation
- Maintains cell membranes
- EPA content of RBC decreases, severity epression
inc - Same for EPA and DHA in fat tissue
- Levels related in post partum depression for
developing fetus
- DHA
- Suicide attempts correlate with low plasma DHA
- Mildly depressed 34 % less DHA in fat tissue
- Main fatty acid in brain, grey matter and eye
retina - Improves sending brain signals and brain
communications - Bottle fed baby lacking DHA poor vision or
cognitive ability - LINKED TO DEPRESSION AND BAD
- Hi amount in brain where brain altering
neurotransmitters stored- Can regulate mood by inc serotonin
- 3rd trimester taking DHA linked to
less perceived stress and reduced stress hormones
- Low cholesterol and depression, suicide
E EXERCISE
- Less likely depression, anxiety
- Exercised less likely to have depression reoccur
- Weight lifting, crew, tai chi
- Reverse harmful effects of stress
- Lifts depression
- Improve learning
- Builds self esteem and improves body image
- Feel euphoric or joyful
- How exercise works
- Release endorphins
- Change level or effects norepinephrine,
serotonin - Lower cortisol
- Inc body temperature
- Gets mind off activities, improve self esteem,
self image interaction - BDNF
- Mitochondria
- Brain has lots of mitochondria
- Energy
- Vitamin
B12- With other vit B strengthening nervous and
immune systems - Helps muscle tone and healthy skin
- Role in energy metabolism
- Deficiency à
- Fatigue
- Inc homocsyteine which can worsen heart disease
- trouble absorbing vitamins
- antacids
- Vegans no animal, dairy no ingest B 12
- Amoxicillin,
antibiotics, colestipol to reduce cholesterol
- With other vit B strengthening nervous and
- Carnitine
- Made from aa found in meat
- In meat, milk, poultry, fish
- Some made in liver and kidneys from aa lysine
and methionine
- Produces energy in mitochondria by carrying
fatty acids into mIT - Inc energy and helps with depression
- Made from aa found in meat
- Co Q 10
- Enhances carnitine
- Antioxidant
- Boosts energy
- Ubiquinol
- In diet
- Whole grains, salmon, oily fish, organ meats
such as liver - Statins, some beta blockers, imipramine can
deplete coQ10
- Whole grains, salmon, oily fish, organ meats
- Rhodiola
- Boost energy endure exercise
- Supports exercise program
SUMMARY
- 60.3 % exercise regularly to have depression,
anxiety - NIH exercised less likely to have depressive
symptoms - Over time, exercise feasible tx for mdd
- 2008 found weakened mitochondrial activity
translated to less cellular energy was related to physical discomfort.
B B vitamins that affect mood
Niacin, B 6 make serotonin
- Vit D, B vitamins, SAMe
- B
vitamins- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
folate, inositol work as a team - Regulate carb metabolism
- Stabilize blood sugar
- Ease mood swings improve sleep
- Help liver deactivate and dispose of old
estrogen - Critical to energy making (Krebs)
- Vitamin B deficiency causes
- Harm brain leading to depression, anxiety,
irritability difficulty concentrating
- Harm brain leading to depression, anxiety,
- Vitamin B 6 and niacin
- Help make serotonin (help mood, sleep, appetite
- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
- Thiamine
(Vitamin B1)- Free thiamine crosses BBBHelps convert glucose
into fuel - Stimulates brain action
- Needed for nervous system health
- Aids in digestion
- Brain rapidly loses energy when thiamine in
short supply- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Depression, fatigue anxiety irritability,
- Lack
- Interfere with uptake of glucose in brain
- Leads to mental fatigue and poorer moods
- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Free thiamine crosses BBBHelps convert glucose
- Niacin
Vitamin B 3)- When niacin in short supply, tryptophan goes to
niacin instead of serotonin - Lack niacin can result in depression, agitation
and anxiety - Helps maintain health nervous and digestive
systems - Also stimulates circulation causing blood
vessels and RBC to become more flexible- Easier thru body and brain
- Lack. Pellagra
- When niacin in short supply, tryptophan goes to
- Pyridoxine
(Vitamin B 6)- Lack depression, confusion and irritability
- Needed to make neurotransmitters serotonin,
dopamine and norepinephine, GABA - Depressed pts have low B 6
- Necessary for normal brain function for
synthesis of RNA and DNA and formation of myelin sheath around nerve cells
- Inteffering with above B vitamins. Eating simple
sugar flour, cake, candy pies, etoh - Folate (vitamin
B 9)- SOURCES
- Asparagus,
citrus, fortified cereals, green leafy veggies, legumes (peas, beans,
lentils) - Required for Normal cell development and
manufacture of DNA and RNA
- Asparagus,
- Cause lack
- Birth control pills, anti-sz meds, antacids,
some antibiotic, etoh, smoking
- Birth control pills, anti-sz meds, antacids,
- Necessary to make SAMe needed for
neurotransmitter metabolism - May protect against colorectal, breast and
cervical cancers - Protects the heart by breaking down homocysteine
(linked to HD) - Homocysteine
- Heart disease
- Poor memory and compromised thinking
- To protect fetus from fetal brain and spinal
cord defects - Lack
- Can lead to depression
- Lower folate
- Higher likelihood of depression
- Poor response to antidepressants
- Higher relapse rate
- Folate supplementation makes antidepressants
work better.
- Depressed have lower folate than normal or other
psych d/o - Antidepressants do not work well I low folate
- People with low folate more likely to experience
depression relapse - Women (not men) who took folic acid with tx do
better than placebo
- Lower folate
- Can lead to depression
- FOLate natural form in foods
- Folic acid man made
- MTHFR MORE PRONE TO DEPRESSION
- 5 methyltetrahydrofolate= L methlfolate natural
active form- Used at cellular level for DNA , reproduction,
regulation of homocysteine. - Crosses BBB
- Used at cellular level for DNA , reproduction,
- SOURCES
- Vitamin
B6- Necessary to make serotonin and dopamine
- Lack trigger depression and mental confusion
- Vitamin B
12- Works with B6, and folic acid to make serotonin
and dopamine - Necessary to make RBC
- Lack
- Problems moving oxygen thru body
- Can cause fatigue, mood swings, irritability,
dementia or mania - neurological problems including tingling in
hands - difficulties coordination walking
- psychiatric: depression, anxiety, paranoia, AH,
memory loss, confusion, outbursts, and behavioural challenges
- Works with B6, and folic acid to make serotonin
Inositol (Vitamin B 8)
- for depression, panic, OCD
- is carb that can make from glucose
- too much sugar can disrupt the inositol shuttle
and other messenger pathways leading to deficiency
- too much sugar can disrupt the inositol shuttle
- forms health cell membranes
- maintains proper electrical energy and nutrient
transfer between cells - changed into substance that regulates action of
serotonin- lack serotonin depression, panic disorder, OCD
Vitamin D
- from food and sunlight
- cholesterol is precursor
- important for absorption and utilization of Ca
and phosphorus for bone and teeth growth - involved in brain function
- vitamin D receptors in both neurons and glial
cells in brain - forms
- D2 ergocalciferol made by plants
- Cholecalciferol made when skin exposed to UV-B
- Lack related to
- Psoriasis, muscle pain, weakness, htn, some
cancer, autoimmune disease - Depression, suicide
- Common in seniors
- Psoriasis, muscle pain, weakness, htn, some
- Depression and vitamin D
SAMe. 800 – 1600 mg for depression
- Made from methionine
- Helps make neurotransmitters, proteins and
hormones - Helps create mood enhancers
- Can help relieve depression
- Response rate 45 % (30 % for escitalopram and 26 % for placebo
- Add on for depression vs placebo
SUMMARY
- every
depressed person should take B complex vitamin with L methylfolate - Check vitamin B 12 and D
- Everyone unique
- Vitamins
- Make neurotransmitters, stabilize blood sugar,
ease mood swings, improve sleep, control inflammation
- Make neurotransmitters, stabilize blood sugar,
- Affect mood
- B vitamins, D, SAMe
- Deficiency of B
- Harm brain, leading to depression, anxiety,
irritability and difficulty concentrating - Folate natural
- Low folate higher likelihood of depression, poor
response to antidepressants, higher relapse rate
- Low folate higher likelihood of depression, poor
- Folic acid man made
- Harm brain, leading to depression, anxiety,
- Vitamin B
12 is family of compounds. Psych- Lack depression, anxiety, paranoia, AH, memory
loss, confucsion, outbursts, behavioural changes - From beef liver, cheese, eggs, milk, fish,
yogurt - If B 12 low and homocysteine hi recommends B 12
shot
- Lack depression, anxiety, paranoia, AH, memory
- Vitamin D
eat, sun- Linked to depression
- SAMe
depression - Inositol
changed to substance that regulates action of serotonin- Depression, panic disorder, OCD
- From inositol from foods including wheat germ,
brewer’s yeast, grapefruit, liver, raisins, unrefined molasses
- Thiamine
- Helps brain change glucose into fuel
- Brain rapidly loses energy when thiamin low
leading to depression, fatigue anxiety, irritability, insomnia, memory problems
- Niacin
- Lack lead to depression, agitation, anxiety all
linked to low serotonin - Lack pellagra sx depression, anxiety, apathy
- Lack lead to depression, agitation, anxiety all
- B vitamins depleted by eating too many simple
sugar, etoh - Folic acid, V12 and vitamin D and other
nutrients effective tx for depression - Folic acid with meds happier for women , not men
- L methylfolate decrease depression 3 months
later - Elderly with vitamin B 12 deficiency more likely
to be depressed - Duke Seniors lower vitamin D greater likelihood
of depression - Swedish depression improve with vitamin D
- SAMe large improvement in depression
R RESTORE HEALTHY DIGESTION
- GUT HOUSES > 70 % IMMUNE SYSTEM
- SUCROSE ALTERS BACTERIà CANDIDA YEAST
- Factors that decrease good bacteria
- Lack zinc, B vitamins, Fatty acid
- Lack of sun
- Lack of social support
- Poor nutrition
- Poor connection with nature
- Stress
- Lots sugar
- Antibiotics, alcohol , birth control pills
- Corticosteroids and anti inflammatory drugs
- Infections, laxatives
- Excessive use of antibacterial soap
- Meat from animals with growth hormones or
antibiotics - Gluten containing grains
- Gut Brain connection 2 way street
- Enteric thru Vagus nerve ascending
- Descending ANS
- Capillaries within epithelial tissues
- Brain can communicate with enteric nervous
system both directly (thru capillaries and nerve endings in gut wall) and
directly thru chemical signaling and hormone secretion - Gut communicates directly with the brain
Mood is affected by inflammatory markers in the gut
- Microbiota
- Microorganisms in a specific region or location
- Can be gut, skin, lungs oral mucosa
- Microorganisms in a specific region or location
- Microbiome
- Collection within a given microbiota
- Gut microbiota
- Associated with BAD, schizophrenia anxiety, OCD
- Pigs given lactobacillus probiotics healthier
and more resistant to swine flu - Bacterioides
- hi in depression
- linked to inflammation
- depressed
- hi bacteroides
- firmicutes, bacteroides, proteobacteria abnormalities
- inc Enterobacteriaceae and alisitpes
- reduced faecal bacterium negative correlation
with depression - depression can actually be transmitted thru gut
microbes
- To help gut
- For persons over 40, much depression is related
to gut - He recommends
- Digestive enzyme with hydrochloric acid
- Hydrochloric acid important for digesting
protein - Ant-acids especially 24 hour PPI lower stomach
acid- So don’t absorb B 12, digest protein
- Hydrochloric acid important for digesting
- Probiotics 50 billion CFUs
- Digestive enzyme with hydrochloric acid
- Can do these without testing without adverse
side effects.
- For persons over 40, much depression is related
- Disrupting
Gut function- ant acids
– especially 24 hour PPI lower stomach acid- so don’t absorb vitamin b 12 and digest/
breakdown protein
- so don’t absorb vitamin b 12 and digest/
- antibiotics
- can get an overgrowth of yeast, dsybiotic gut
- stress
- inflammation
- bad diet
- food sensitivities
- celiac disease abnormal reaction to gluten
- higher incidence of depression
- the action of gluten interferes with absorption
- zinc, folate, amino acids not absorbed
increasing risk of depression
- zinc, folate, amino acids not absorbed
- food allergies
- celiac disease abnormal reaction to gluten
- ant acids
Toxins can affect mood
- Toxins are synergistic
- BPA and phthalates are in many things
- Affect metabolism and absorption of zinc
- Have direct effects on neurons on brain
- Indirect effects to make trace minerals
unavailable
- BPA and phthalates are in many things
Toxins can interfere with the conversion of thyroid hormones T4 to T3
Role of Inflammation in depression
- Inflammation is Implicated for Heart Disease,
arthritis, cancer, Alzheimer’s disease - Heavily involved in a subset of depressed
- Overstimulated immune system produces chemicals
that go into the brain that affects how we synthesize chemicals to make our
brain regular- Chronic inflammation regardless of cause
(trauma, stress, infection) affects mood
- Chronic inflammation regardless of cause
- If we have the illness feel depressed.
Medications causing depression
- Propranolol, beta blockers
- Steroids
- Contribute to depression and suicide
- Hormones
- Blood pressure medications
- Chantix increases risk of suicide
- Antidepressants can contribute to more
depression of suicidality- FDA has put out warnings
To help stress
- Mindfulness
- Magnesium
- Interfere with overactive stress response system
Supplements to help with depression
- Magnesium
- Most common nutritional deficiency
- Inverse relationship with stress
- Magnesium is repleted in soil, so foods are low
in magnesium - Can lower blood pressure
- Helps with sleep, anxiety
- Helps with concentration
- Helps convert fats into energy
- In hundreds of reactions for brain function
- Zinc
- Commonly deficient because of toxins (BPS,
phthalates) - Is not plentiful in a vegan of vegetarian diet
- Is most bioavailable in animal products
- Adolescents commonly have low zinc levels
- Needed as biopathway to make neurotransmitters
- Linked to depression
- Symptoms of low zinc levels
- Hair loss, diarrhea, white marks on nails, skin
lesions, acne, less zinc
- Hair loss, diarrhea, white marks on nails, skin
- Taking zinc makes antidepressants work better
- Test for zinc with zinc taste test
- Have strong bitter taste if have adequate zinc
- Taste buds are zinc dependent
- Restore zinc, taste return
- Commonly deficient because of toxins (BPS,
- Vitamin B
12 - Vitamin D
- Recommends testing
- Take at least 2000 iu per day
- Omega 3.
Fish oil- Helps with mood
- 5HTP.
Precursor to serotonin - Don’t take tryptophan by it self
- SAMe
can be helpful. Do not take if have bipolar- Studies show good results
- 800 – 1600 mg per day
- St John’s
Wort- 600 mg 900 mg per day
- Make sure it comes from a reputable company
- Rhodiola
- He has had a lot of success
- Fewer side effects, fewer interactions with
drugs - Russians used for many years for concentration,
stamina, energy - 100 – 400 mg per day
- Role of Hormones important
- Bioidentical hormones
- Neurotransmitter testing not accurate
- Can look in urine for break down products of
serotonin and dopamine - He tests levels of amino acids and supplements
to give the building blocks to make neurotransmitters - He gives amino acid precursor molecules
- Can look in urine for break down products of
Role of trauma
- Depression from trauma is not as easily treated
with nutritional supplements - Look at therapy and nutritional deficiencies
Summary Points
- Look at whole body
- Look at contributing factors
- Use integrative approach
- Nurture brain and mind
- Mind body approaches,
- Nature
- Spirituality helps with resilience and recovery
- Mindfulness, meditation
- These can change anatomy and neurochemistry of
the brain
- These can change anatomy and neurochemistry of
- Mindfulness, meditation
- Meaning, gratitude and hope are important parts
of mental health
- Look at whole body
- Look at contributing factors
- Use integrative approach
- Nurture brain and mind
- Mind body approaches,
- Nature
- Spirituality helps with resilience and recovery
- Mindfulness, meditation
- These can change anatomy and neurochemistry of the brain
- Mindfulness, meditation
- Meaning, gratitude and hope are important parts of mental health
- 120 million people worldwide; 15 M in US
- 7 % older than 18
- 2x as many females
- One in 8 teens equal sex
- 1/33 kids
- Runs in families 3 x as likely to have it
- Hx increases risk;
- 50 % if one episode
- 90 % if had several episodes
- Over next 20 years, projected to be #1 cause
disability in hi income countries and #2 world wide - Annual cost 30 – 44 billion.
- Every person is different- biochemically unique
Suicide
- 8th leading cause death in US 32K
deaths Q year - 15 % untxed suicide
- More than 2/3 suicides caused by depression
- Women 2-3 x more likely SA
- Men more than 4 x women to die of suicide
- Risk
- Family hx, impulsive drugs, separation, divorce,
family violence, impulsive
- Family hx, impulsive drugs, separation, divorce,
- Times
- Anxiety, anniversaries, drug /etoh abuse, untx
derpession
- Anxiety, anniversaries, drug /etoh abuse, untx
- He uses integrative psychiatry
- Factors contributing to depression are unique
- THE ZEBRA
- Nutrition important
- 1601 Capt James Lancaster discovered that lemon
juice prevented scurvy - British government waited 264 years after it was
proven - Just be cause MDs ignore does not mean not true
- Tomato Effect Dr. James Goodwin `984 JAMA
efficacious tx for certain ds is ignored or rejected because does not make
sense- Named tomato effect because 16 th – 19 th
century believed tomatoes were poisonous..
- Named tomato effect because 16 th – 19 th
- 1601 Capt James Lancaster discovered that lemon
- Longer one suffers, more difficult it is to
recover
Meds
- James Watson winner of Nobel Prize ifor
determining the structure of DNA urged
doctors to have better understanding of mental illness and develop tx based on
their results - Prescribe carefully
Stigma
- We are more than our experience and genes
Symptoms
- Also stomach ache, irritability, work too much
- Aches and pains,
- Etoh and drug abuse
- Chain smoking
- Constant exhaustion
- Crying a lot
- Decreased physical activity QD
- Reckless doing risky things
- Difficulty getting up in am
- Irritability, frustration
- Lack of energy or motivation
- Reduced sex drive
- Working long hours long term difficulty sleeping
Results
- Hard to work, loss relationships
- No energy to take care of self
- 4 x risk MI
- More likely to abuse etoh or drugs
Types
- Major depressive disorder MDD
- Depressin, anhedonia and five other
- Worthless common
- Not grief or sadness
- Persistent depressive disorder dysthmica
- Most of days more often or not for 2 years.
- If start before age 21, more likely co occurring
personality disorder or substance abuse
- Disruptive Mood Dysregulation Disorder kids
- Chronic, sever, persistent irritability
- Can be temper outburst, aggression out of
proptortion in intensity - Over at least one year in two settings (home,
work) - Developmentally in appropriate.
- Have low frustration tolerance
- Family lie disrupted
- Premenstrual dysphoric disorder
- Premenstrual dysphoric disorder is sever form of
pMS - Most cycles, sx must be present in final week
before period then better - At least one of following
- Emotional changes (mood swings)
- Irritability, anger, increased conflicts
- Depressed mood, hoplessnes, self deprecating
- Anxiety, tension, feeling on edge
- One or more of following total five
- Decreased interest in usual activities
- Difficulties concentrating
- Lack eergy
- Change appetite
- Difficulty sleeping
- Feeling overwhelmed or out of control
- Physical sx such as breast tenderness, swelling,
jt pain, muscle pain, bloating or wt gain
- Lead to distress or interference with work,
school, social, relationship
- Premenstrual dysphoric disorder is sever form of
- Substance/ medication induced depressive
disorder- Depressive sx associated with substance
- Typically starts within first fee weeks or one
month after start - Stop, get better
- Depressive disordered due to another medical
condition- CVa, HD, PD, TBI, Cushings, hypothyroid
- Depression with Anxious Distress
- Hi anxiety linked to higher suicide risk, longer
length of illness, greater likelihood of not responding to tx - At least tow during most days
- anxious, tense
- Unusually restless
- Difficulties concentrating because of worry
- Fear that something awful may happen
- Feeling one might lose control
- Hi anxiety linked to higher suicide risk, longer
- Depression with atypical Features
- Mood
reactivity can be cheered up- Can be euthymic if environment positive
- Weight gain or inc appetite
- Sleep at least ten hours per day
- Leaden paralysis
- Rejection sensitivity
- Mood
- Post partum Depression
- 70 % have baby blues
- Short term worry, unhappiness, fatigue 2 weeks
- Post partum depression `6 %
- For 4 weeks
- Sluggishness, fatigue
- Sad, hopeless, helpless or worthless
- Change sleep
- Change appetite
- Difficulty concentration, confusion
- Crying for no reason
- Lack of interest in baby or family
- Fear of harming baby or self
- Difficulties bonding with baby
- Often have anxiety or panic attacks
- Rapid changed in hormones or thyroid after
delivery may contribute - Lack of sleep, stress, family hx depression,
lack support may play rold
- For 4 weeks
- 70 % have baby blues
- Depression with a seasonal Pattern (seasonal
affective disorder- Relationship between the start of depressive
episodes and time of hear- Seasonal
- Loss energy, sleep too much, overeat, wt gain,
carb craving - Linked to biochemical imbalance caused by
shorter daylight hours - More common far from equator
- Less commonly occurs in summer
- Possibly in response to hi heat and humidity
- More likely insomnia, dec appetite, wt loss,
agitation, anxiety - Younger adults and women higher risk
- Average age onset is 18 – 30 years.
- Loss energy, sleep too much, overeat, wt gain,
- Seasonal
- Relationship between the start of depressive
CAUSES
- Biochemical
- Neurotransmitters
- Serotonin,
- Lack sleep problems, binge eating, irritability
- norepinephrine,
- too little low mood and fatigue
- dopamine
- due to too little or too much
- lack due to
- lack amino acids, vitamins, minerals
- breaking down neurotransmitters too quickly
- Serotonin,
- Neurotransmitters
- Physical
- Illnesses
- 25 % cancer, 94 % eating disorders
- 20- 40 % heart attack, 10 – 20 % HIV
- 50 % HD, 30 % chronic long term pain
- 50 % PD
- 25-50 % stroke
- 60 % disabling tinnitus
- 27 % drug or etoh
- 30 – 35 % AD
- Anxiety disorder, tobacco addiction
- Depressed people more likely to have DM2 and HD
- Illnesses
- Meds
- Antipsychotic,
- antihistamine,
- beta blockers,
- birth control pills,
- htn,
- anti inflammatory meds,
- adrenal hormone agents and
- corticosteroids
- Etoh, amphotericin B, bismuth nitrate,
carbamazepine, cis-retinoic acid, cyloserine - Cyclosporine, digitalis
- Estrogen therapy, flunarizine, h2 blockers
(cimetidine, ranitidine) - Interferon, levodopa, methyldopa mazindol,
mercury - Methylxantines (caffeine, theophylline),
metoclopramide (reglan) - Metronidazole, nifedipine, organic nitrates
- Phenytoin
- Psychostimulants (fenfluramine, methylphenidate,
permoline, phenylpropanolamine) - Reserpine
- Sedative hypnotics (barbiturates,
benzodiazepines, methaqualone) - Thallium
- Thiazide diuretics
- Vinblastine and vincristine
- Overactive
immune system- Sickness behavior normal reaction to infection
- Poor sleep, concentration, lack of desire
- Pro inflammatory chemicals inflammatory
cytokines cause changes in neurotransmitters - Depression has changed in cytokines
- High levels of inflammatory cytokines
- Low levels of anti inflammatory cytokines
- Anti inflammatory IL 4 and TGF b1 were lower
- Sertraline decrease pro inflammatory and
increase anti inflammatory - Depressed with inc inflammatory biomarkers less
likely to respond to antidepressants - Pt with hx no response to antidepressants have
inc inflammation
- Sickness behavior normal reaction to infection
- Inflammatory brain illnesses linked to
depression- Areas of brain dealing with mood regulation inflammation was 30 % higher in depressed
- 2017 Manchester MDD have inc microglial
activation- BiolPysch Krystal , J
- Hormones
- Estrogen
- Teen girls = teen boys in depression
- In women short depression 7 – 10 days before
period - Baby blues
- Testosterone
- Men low testosterone may be linked to depression
- Men may not respond with low testosterone
- Thyroid sub clinically low in mood disorders
- Women depressed hi TSH
- Low thyroid
poorer response - Give thyroid better response to antidepressants
- Estrogen
- Genetics
- Tendency to have is inherited not ds
- Family hx depression 3 x risk
- Twins
- Other one depressed 27 %
- Raised separately risk 67 %
- Tendency to have is inherited not ds
- Psychological
factors- Stress
- Aging
KEY POINTS
- GP. 62 % scripts for depression’ 65 % for
anxiety - Depression, 4 x likely to have MI than no hx
- s/p MI, chance another higher
- depressed more likely to abuse drugs, etoh
Treatment
- 2/3
effectively tx have sx that impair- 28 % mild impairment
- 23 % moderate impairment
- 12 % severe impairment; 4 % very severe impairment
- Research show 94 % meds work closer to 51 %
- 1/3 studies showing antidepressants don’t work
submitted to FDA don’t work not published - ½ studies failed to show any benefit other than
placebo
- 1/3 studies showing antidepressants don’t work
- Studies only short term 6 weeks
- based on symptoms and vulnerabilities. Severity
What is missing in psych eval
- diet, toxins nutrition, allergies
Drug tx don’t work
Research
- drug companies sponsoring research have conflict
of interest- 4.9 x likely to report med works
- Direct advertising to consumer spend billions
- People not depressed account for 94 % new
antidepressant use - JAMA 2010 antidepressants don’t work for less severe forms depression
- Paxil and imipramine do not reduce sx in mild,
moderate or severe depression - Antidepressants only work in severe depression
- by Vittengl at Truman U; Pt who took
antidepressants more sx at 9 years - Robert Whitaker Anatomy of an Epidemic 50 yrs
data; over time, people not on meds do
better than those who are.- Since 1987,
3x more on disability - Only 15 % 5x with meds remained healthy over
time- The other 85 % have chronic depression
- Since 1987,
- Yale found that universities hire to perform
drug research were part owners - Studies more likely to prove if funded by drug
industry or researchers have financial interest - British Psych Joanna Moncrieff paper, “There are
no signs that the rapidly escalating use antidepressants reduces burden of
depressive disorders - JAMA found standard antidepressants no more
effective than placebo for people with
less severe forms of depression
Bioindividuality
- Only speciality where no measurements
- Side
effects- Agitation,
- Blurred vision, constipation, dec sex drive, dry
mouth - Erectile dysfunction, fatigue, insomnia, nausea
- Osteoporosis, wt gain risk SI
- SRRI
- Sexual
- St gain
- Physical
- Headache, nausea, stomach problems
- mEd withdrawal
like flu- Irritability, agitation, restlessness, insomnia
- Migraines, headaches, not able to focus,
depression - Physical
- Sweat, palpitation, B &V, difficulties
breathing, sensory dist
- Sweat, palpitation, B &V, difficulties
- Reason: body/ brain no time to adjust to change
Brain and body. Influence each other
- Brain 3 pounds uses 20 % energy
- Scars in Brodmann
area 25 BA 25 hyperactive in depressed people- Activity normalized when depressive sx relieved
- Does not matter if relieved by tx or meds
- Is directly linked to amygdala which processes
anxiety, fear and the hypothalamus
(important in stress) - Generous supply of special transporter
molecules. Serotonin
- Serotonin gene coding for serotonin transporter
molecule comes in long and short- Long triggers production of more transporter
molecules - Short gene have smaller BA 25 and does not act
with amygdala and other brain areas - Is sped up activity in BA 25 the cause or result
of depression?
- Long triggers production of more transporter
Genes
- Some contribution 37 %
- Epigenetics
- Methylation
- Causes
- Stress
- Study mice remove from mothers 3 hrs QD x 10
days epigenetic changes last a week - Mice of good mothers exchanged with bad mothers,
stress handling abilities of foster
mothers.- Same for monkeys
- Study mice remove from mothers 3 hrs QD x 10
- Stress
- Good nutrition etc best hope
- Makes each person unique
- Genetic testing, twice as likely to be
prescribed the correct med
IDeal
- Diet meds, supplements, family hx
- Labs
- Vitamin deficiencies, toxic metals, hormone
imbalances - Vitamin levels, amino acid and fatty acid
imbalances - Hi or low minerals
- Celiac disease and other food sensibilities
- Imbalanced levels of digestive enzymes
- Disbiosis, parasites
- Focus on individual unique
- Care for how pt, not just ds
- Understand how body and mind are connected
- Restore health instead of reducing sx
- Increase boy nutrients to promote long term
health
T take care of yourself
H hormones and herbs
E exclude
Z zinc and other minerals
E essential fatty acids and cholesterol
E exercise and energy
B and other vitamins
R restore
A amino acids and proteins
T take care of yourself
- Link betn mental and psyical vauge
- Diet
- Studies
- 2010 AJP unhealthy diet more depressed
- 2010 teens unhealthy diet more likely depressed
- 2014 Iranian children
- Diets hi in saturated fats and refined carbs can
affect proteins important in brain development such as BDNF
- Studies
- Digestion
- HCl
- Dissolve food into parts
- To absorb vit B12, minerals
- Make enzyme pepsin necessary in digestion of
protein
- In SI sodium bicarbonate neutralizes HCL
- Fat and protein and carbs broken down
- Digestive enzymes
- Need zinc, protein, vitamin c
- Good nutrition leads to good digestion
- Good digestion ensures all necessary nutrients
are absorbed - Poor digestion=poor nurtition
- Gut bacteria
- Probiotics help digest
- HCl
- Sleep
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
TWINS - Brain dev needs sleep for brain dev.
- Sleep problems predict GAD, depression, and other behavioural d/0
- Poor sleep caused by
- Sleep apnea 5 x depression
- Tx sleep apnea can tx depression
- Sx tired in am and day
- Memory problems
- Toss, turn, choke, asp, snore
- Headaches in am
- Bathroom > once or twice
- Swelling legs
- c/p sweat during sleep
- stress, caffeine, etoh , drugs, OTC, allergies,
asthma, hyperthyroid, chronic pain nutritional deficiencies Mg, zn - restless legs
- Sleep apnea 5 x depression
- sleep hygience
- sleep same time
- avoid caffeine after lunch
- comfortable bed
- thermostat cool
- dark
- use bed for sleep and sex
- no work, TV in bed
- ritual
- no computers, games,
- don’t ty to hard
- sleep remedies
- melatonin,
- pineal body clock. 1 – 3 mg sleep in 30 min
- Mg, 200- 300 mg
- Works c Ca for muscle relax, contract
- Anti-stress.
Reduce cortisol, muscle cramps - First mineral to disappear with processed foods
- First mineral to leave when body stressed
- Depleted by etoh, caffeine, meds
- valerian,
300- 500 mg- Does not work right away
- Side effects h/a, restlessness, sleeplessness,
irregular heart beat - Sleep anti anxiety
- inositol,
- made by body and intestinal bactiera
- helps transmit nerve signals
- prevents buildup of fat in liver and other
organs - 1t 8 PM helps with obcessive thought
- 5 HTP, 50
– 200 mg- Reduce anxiety
- glycine, 3 g
- inh neurotransmitter
- helps relax blood vessels
- lower core body temperature
- GABA
- Low GABA anxiety, depression, irritability,
headache, htn
- Low GABA anxiety, depression, irritability,
- melatonin,
- Sugar
- Glucose,
- Fructose cant be absorbed by cellsà goes to liver
- Sucrose homes- fructose and glucose
- Dextrose from corn identical to glucose
- Galactose in milk
- Lactose glucose and galactose
- Maltose in barley – is two glucose
- Xylose in wood or straw
- Low sugar in brain weak, irritability, anxiety,
headaches, faint, depression - Hi insulin an d sugar inc negatively affects
kidney function, inc blood fats, TG, cholesterol - Sugar substitute. Xylitol, cinnamon, cardamom,
ginger, nutmeg
- Stress
- Inc inflammation ~ depressive sx
- Activate inactive genes that affect future
generations- Inc maternal stress in pregnancy ~ inc risk mod
to severe depression in offspring - Stressed ma -kids depressed 11 years later
- Inc maternal stress in pregnancy ~ inc risk mod
- Key Points
- AJP study unhealthy dietà more depressive and anxiety
- Diets 13,486 Iranian kids inc junk food ~
psychiatric stress - Survey, 40 % uS less than 8 hours sleep
- Met analysis 23 studies adolescents 12- 20 with
mdd more sleep disturbances - 2015 study consistently poor sleep inc
depression by 2.5 - More soft drinks higher levels depression,
hopelessness and aggression - 72 % of people with daily stress and anxiety
claim interferes with lives
- POOR SLEEP RISK FOR DEPRESSION 2.5 TIMES FOR
HORMONES
- Low
thyroid- Anxiety , memory, hi cholesterol, constipation,
gum disease, fat, hypoglycemia, muscle aches and pains, acne, exzema, hair
loss, recurrent infections, pMS, irregular menstrual, ovarian cysts,
endometriosis, fluid retention, fatigue - Faulty testing à
faulty dx - TSH only show pituitary asks for correct amount
thyroid- But body might not be using it properly
- Taking imipramine plus T 3 faster recovery
- Replacing missing thyroid relieves depression
- Metanalysis T3 increased improvements seen with
antidepressants for tx resistant depression - 2014, T3 and T4 were both predictors of the
level of improvement in depression sx. - T3 works better for depression
- Better for women
- Thyroid needs iodine, tyrosine, zinc and iron
- Toxins get in the way
- Plastics, air fresheners
- Polychlorinated biphenyls, dioxin, phthalates,
and polybrominated diphenyl ether (PBDE)- Upset ratios in diff T hormone
- Interfere with thyroid hormone synthesis
- Suppress production thyroid hormone receptors
and binding thyroid hormone transport proteins.
- Anxiety , memory, hi cholesterol, constipation,
- DHEA
- Produced by adrenals
- When stressed , makes more
- Changes in liver to dHEA S which is measured
- When stressed , makes more
- Antiaging supplement controversial
- For depression
- 60 % depressed respond
- Maybe works better for men
- Makes testosterone and estrogen and all steroid
hormones- Need cholesterol
- Highest in mid 20s
- Produced by adrenals
- Testosterone
- Made in
testes, ovaries, adrenal glands, liver, skin and brain - Responsible for protein synthesis
- Maintenance of bone mineral density
- Lean body mass, muscle strength
- Sensitization or serotonin recptors
- Physiologic processes that contribute to sex
appeal - Decreases with age
- Diet, exercise
- Sleep quality
- Endocrine do
- Low testosterone
- Dec strength, fatigue,
- poor libido,
- htn, inc CV risk,
- loss lean body mass inc fat
- lowers depression with (and without?) meds
- lowest testosterone group (age 71-89)2 x
depression - 11/18
JAMA significant reductions in depressive sx d - Low
testosterone levels are linked to depression - In some
men depression cannot be relived until testosterone raised to a normal level - Antidepressants
cannot raise testosterone to a normal level - Other
ways to raise testosterone- Zinc
- Exercise
to strengthen muscles - Reduce
stress to reduce cortisol (which breaks down muscle - Cut or
avoid soy. Phytoestrogens which can counteract testosterone - Eat
plenty EPA and DHA in salmon and other cold water fish - Monitor
cholesterol and DHEA (needed to make testosterone - Supplement
with tribulus, herb than enhances testosterone synthesis
- Made in
- Estrogen
and Progesterone- 2014 study estrogen affects brain derived
neurotrophic factor (BDNF)- BDNF support survival of neurons and growth of
new neurons and their connections
- BDNF support survival of neurons and growth of
- Estrogen
can affect mood by degrading or reducing levels of MAO (which breaks down
serotonin.
- 2014 study estrogen affects brain derived
- Herbs
- St John’s
Wort 300 mg po TID- Anti depressant mild to moderate depression
- Germany licensed for anxiety,d epression, sleep
disorder - Pain disorder
- Cochrane
mild to moderate for 4 – 12 weeks did better than placebo - Fewer side effects than antidepressants.
- Safe long term prevents relapse
- Has hypericin
- Antiviral, against cancer and HIV in stored
blood
- Antiviral, against cancer and HIV in stored
- and hyperforin
- activates a specific receptor in liver that
triggers production of an enzyme used to metabolize meds
- activates a specific receptor in liver that
- Curcumin
- For Inflammation
- Regulates stress response system
- Degrades MAO which breaks down serotonin and by
protecting against oxidative stress and mitochondrial damage. - Regulates the level of neurotransmitters in body
- Promotes birth of new neurons in hippocampus
- Improve cognition
- Daily improved memory and mood in people with
mild, age-related memory loss
- Daily improved memory and mood in people with
- Safe and effective
- Rhodiola
- Recognized by Russian ministry of health as med
and herbal tonic - Reduce depressive sx, boost mood diminish
fatigue, tx opioid addiction - Assists in normalizing body stress response by
increasing body resilience - Reduce nicotine withdrawal sx by inc serotonin
and serotonin receptors - Degrades MAO A and MAO B
- Affects 1062 genes, fifty of which are linked to
behavior and 62 related to psych d/o - Ay improve emotional behavior thru effects of
transcriptions of certain genes - Depression. Rhodiola revolution
- Can enhance mood, concentration, energy
- Helps with anxiety and BAD although may be too
stimulating
- Recognized by Russian ministry of health as med
- St John’s
Summary
- Thyroid avoid toxins cleaning products,
pesticides, eat organic, use glass- T3, T 4 predict levels of improvement in
depression
- T3, T 4 predict levels of improvement in
- DHEA, testosterone, estrogen, progesterone
- Archive Gen Psych 2005 DHEA for midlife major and minor depression
- DHEA decrease with age
- Australians men with low test 2 x depressed >
highest test - Harvard topical test greater improvements in
depression > placebo
- Curcumin, SJW, rhodiola
E exclude harmful foods
- Celiac ds
- Body mistakenly mistakes gluten for a dangerous
toxin - Immunity system attacking gluten destroys the
intestine - Absorption vit A, B6, B 12, D, E K, iron, zn, Mg and ca, essential fats other aa
- Sx anemia, anorexia, arthritis, dermatitis
herpetiformis, edema, fatigue, infertility, jt pain, migraines, missed
menstrual periods, numbing hands - Osteoporosis, sz, stunted growth, tooth decay
and discoloration - 1/3 have depression
- Dx Ab: anti gliadin, anti endomysial, anti tissue
transglutaminase - Will develop nutritional problems
- Take multivit with iron, EFA, digestive enzymes
- Test for iron, folate, Mg, amino acids
- Need HCl
- Casomorphin,
gliadorphin- Similar to morphine
- Originally in pee of people with autism
- Incomplete digestion of proteinsà ADHD, child psychosis,
dyslexia, down, CD, post partum psychosis, Rett’s ds, severe depression - These excess peptides maybe these are unique carriers of info to
brain that may worsen many psych d/o - Elevated these caused by lack functioning of enzyme
dipeptidyl peptidase IV (DPP IV) which snips casomorphin and gliadorphin into
small pieces- These absorbed
- Cause deficiency DDPP IV
- Lack zn
- Antibiotics, interferon, gelatin
- Candida,
- Hi mercury and heavy metals and pesticides
- Depression suffered from incomplete digestion of
casein and gluten
- Food
Allergies and depression- IgG mediated delayed hypersensitivity rxn
- Have more depression
- Body mistakenly mistakes gluten for a dangerous
Summary
- 18 studies on depression and 11 on CD depression
is more common ore more severe in cD - Teens with CD have 31 % risk mde vs 7 % in
healthy children - Correlation CD and depressive disorders
- 2016 AJ Gastroenterology correlation between
feelings of depression and Crohns’ ds
Z Zinc and other minerals
- Zn
- 200 different reactions
- In brain
- Helps make DNA and proteins
- Helps immune fight off viruses and bacteria
- Helps wounds heal
- Regulates neurotransmission in brain
- Makes it possible to taste and smell
- Make sex and reproduction possible
- Helps make all enzymes needed to digest fats,
carbs and proteins
- In
- Oysters, poultry, red meat, beans, whole grains
and nuts
- Oysters, poultry, red meat, beans, whole grains
- Causes of lack
- Vegetarians
- Eating disorders
- UC, crohns
- Meds
- Asa, benazepril, cholestyramine
- Reduce cholesterol and ofloxacin
- Asa, benazepril, cholestyramine
- Results of lack
- Delayed growth in kids and infants
- Hair loss
- Diarrhea
- Loos appetite
- Weight loss
- Difficulty tasting food
- Acne
- Fatigue
- Elevated cholesterol
- More infections
- Memory impairment
- Impotence
- Anorexia, impaired cognitive, other behavioural
disturbances - Poorer appetite
- Depression
- Lower levels in major depression, postpartum
depression - Depression à
inflammation- Lowers albumin which transports zinc thru
bloodstream - Maybe liver snatches up zn to use for
inflammation
- Lowers albumin which transports zinc thru
- Zinc inh NMDA which controls glutamate
- Glutamate
- Sends signals between nerve cells
- Helps learning, memory
- Too much glutamateà
overstimulation- Progressive damage to nerve function (~
depression)
- Progressive damage to nerve function (~
- Glutamate
- Zinc can relieve depression’
- Animals given celexa inc zinc levels
- Given celexa or imrapmine, inc zinc in
hippocampus, dec other parts of brain - Given ECT inc zinc in hippocampus
- Zinc antidepressant in lab animals
- Low doses celexa and imipramine ineffective as
antidepressants stressed by - Chronic tx with antidepressants and ECT causes
zinc to inc in rat brains - Lab, zinc deficient diet à> depressive like sx
including anorexia and anxiety - Zinc improves depression
- Zinc taste
no eat 1 hour before
- Lower levels in major depression, postpartum
Copper
- In liver, heat, brain and kidneys
- Helps growth , maintenance of TBC, bones,
nerves, brains - Makes prostaglandins needed for heart beat and
blood pressure - Part in getting energy out of fats, protein an
carbs - Helps body fight free radicals
- Found in
- Liver, organ meats, shellfish, whole grain
cereals and bread, dark green leafy veggies, peas, poultry , nuts and beans
- Liver, organ meats, shellfish, whole grain
- Comes from
- Dental fixtures, copperpipes, cookware
- Copper at work
- Birth control pills and iUD
- Results of low copper
- Anemia, htn, diarrhea, difficulties breathing,
lowered immune function, EKG abnormalities
- Anemia, htn, diarrhea, difficulties breathing,
- Causes low copper
- Poor diet, digestive or intestinal disorders
that interfere with nutrient absorption - Chronic diarrhea and
- Excess zinc
- Meds which interfere with cu absorption
- Delavirdine (resciptor for HIV), ethambutol,
(TB), penicillamine (for RA) - Elderly persons, vegetarians, athletes, pregnant
women and premature infants likely to lack copper
- Delavirdine (resciptor for HIV), ethambutol,
- Poor diet, digestive or intestinal disorders
- Too much copper and depression
- Involved in monoamine oxidase, dopamine beta
hydroxylase and tyrosine hydroxylase all of which stimulate dopamine - Hi levels found in depressed
- Involved in monoamine oxidase, dopamine beta
Magnesium
- 54 % in bones 27 % in muscles
- 19 % in heart and liver
- 1 % in blood
- 300 biochemical reactions
- Maintain health immune system
- Keeps bones strong
- Regulates BP
- Making proteins
- Ensuring nerves work properly
- Keep heart beating steadily
- Lacks cause
- Irregular heartbeat, nausea, lack appetite, sz,
fatigue, muscle weakness, poor coordination, personality changes - May worsen depression and apathy, irritability,
nervousness, anxiety, excessive emotional reactions and frequent mood changes,
decreased memory and concentration, migraines, fatigue and ADHD - Link to depression especially in young adults
- Irregular heartbeat, nausea, lack appetite, sz,
- Risks for low Mg
- Crohn’s and ds interfere with absorption
- Etohics, dm senior citizens
- Meds that interfere with absorption or use
- Diuretics (Lasix) bumetanide (bumex) antibiotics
(gentamicin)
- Diuretics (Lasix) bumetanide (bumex) antibiotics
- Stress
- Symptoms low Mg
- Insomnia
- Constipation
- Anxiety
- Muscle spasms
- Mg found in
- Dark green leafy veggies, nuts, whole grain
breads, beans, peas - One of first minerals stripped with processed
foods.
- Dark green leafy veggies, nuts, whole grain
- Most Americans low in Mg
- Is low in processed foods
- Lack of Mg can trigger depression
- In mice inc anxiety and depression like
behaviours
- In mice inc anxiety and depression like
- High magnesium also in depressed patients.
- How Mg works
- Permits excess of calcium into nervous system
damaging nerves and causing sx similar to depression - Lack Mg may reduce brain levels of serotonin
- Permits excess of calcium into nervous system
Lithium 2.5 – 20 mg
- In every organ
- Helps stabilize mood
- Regulate neurotransmitter signaling
- Protects brain cells from early death
- Helps with antidepressants
- Aggression suicide attempts
- Finnish study with li in water
- Mechanism
- Fight inflammation
- Inc enzymes that produce glutathione
- Regulates pro inflammatory cytokines
- Reduce synthesis of proinflammatory cytokines
which can regulate expression responsible for their production
- Reduce synthesis of proinflammatory cytokines
Chromium
- In foods
- Cleared by
- Infection, exercise, physical trauma, diets with
large amounts of simple sugars, stress
- Infection, exercise, physical trauma, diets with
- Keeps insulin
and blood sugar balance and energy levels- Helps insulin sensitivity
- Lowers Cholesterol levels, body fat, Tg, Low
density lipoprotein - Raises HDL good cholesterol
- Helps with depression
Iodine
- Make thyroid hormones
- Thyroid snatches iodine and incorporates it into
these hormones- Thyroid enlarges as tries to get iodine
- In ocean water and soil
Iron
- For regulate cell growth
- Part of hemoglobin within RBC that carries
oxygen thru blood - Lack of iron
- Lack of oxygen brought to body
- Fatigue
- Weakened immune system
- Psycho problems
- Poor attention
- Sx of lack
- Weak ess, fatigue, disgestive problems fragile
bones, difficulties maintaining body temperature - Requeent infections
- Poor performance at school or work
- Weak ess, fatigue, disgestive problems fragile
- Found in red meat, fish, poultry, beans,
lentils, iron fortified cereals - Cause of deficiency
- Low consumption certain foods
- Pregnant
- Older infants, toddlers, teenage girls
- Women of childbearing age
- Celiac dx and dx interfere with iron absorption
- Supplement with ferrous bisglycinate
- Does not cause side effects of nausea,
constipation, stomach upset - 10 mg ferritin BID til normal
- Does not cause side effects of nausea,
- Lack of oxygen brought to body
SUMMARY
- Minerals and other nutrients influence brain
function and mood - Consider hi and low trace minerals
- Every depressed would asses for lack of trace
minerals - Everyone is unique
- Taking too much trace mineral can lead to
imbalance. - Zinc
numerous pathways- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
crohns, absorption disorders- Test zinc taste test
- Lower zinc in major depressed
- Zinc helps antidepressants
- Copper
- higher in depressed
- needed for dopamine
- Mg
helps in depressed who ar mg deficient- 2/3 Americans consume less than RDA Mg
- Depression inc when Mg low or hi
- Risk crohns, nutrient absorption, etoh, DM,
seniors
- Li
BJP adding lithium relieved sx depression in 48 hours- Finnish 2017 nutritional li highly effective
- Chromium
promising in antidepressants - Iron
- lower in depressed; supplement 25 % improvement
- Risk deficiency zinc vegetarians, etohic, eating disorder, ulcerative colitis,
- Iron
for oxygen- Iodine
- Thyroid with antidepressants do better
E essential fatty acids and cholesterol
- Saturated; mono unsaturated let go of one
hydrogen carbon- If on 6th is omega 6
- If on third carbon is omega 3 FA
- Recommended omega; 6 / omega 3 is 4:1
- Depression
correlated with low omega 3, and DHA - BAD lower
DPA, DHA, and alpha linolenic acid (body uses to make EPA) - Suicide
attempts low DHA, high o6/03 - Omega 6
- In corn, soy, sunflower oil, margarine, eggs,
meat
- In corn, soy, sunflower oil, margarine, eggs,
- Omega 3
- Higher o3 consumption linked with lower levels
of depressionIn fish, fish oil, flaxseed oil and walnuts - Kids less likely to sit still or pay
attention - Risk memory problems, dementia, strokes
- Higher levels lower risk depression but in
depression without anxiety - Don’t take too much
- Higher o3 consumption linked with lower levels
- EPA, DHA fuel the brain
- Help control chronic inflammation of
degenerative brains (AD)
- Help control chronic inflammation of
- EFA
- As RBC EFA dec, severity of depression inc and
vice versa - Low EFA in post partum
- As RBC EFA dec, severity of depression inc and
- EPA
- Can help with inflammation
- Maintains cell membranes
- EPA content of RBC decreases, severity epression
inc - Same for EPA and DHA in fat tissue
- Levels related in post partum depression for
developing fetus
- DHA
- Suicide attempts correlate with low plasma DHA
- Mildly depressed 34 % less DHA in fat tissue
- Main fatty acid in brain, grey matter and eye
retina - Improves sending brain signals and brain
communications - Bottle fed baby lacking DHA poor vision or
cognitive ability - LINKED TO DEPRESSION AND BAD
- Hi amount in brain where brain altering
neurotransmitters stored- Can regulate mood by inc serotonin
- 3rd trimester taking DHA linked to
less perceived stress and reduced stress hormones
- Low cholesterol and depression, suicide
E EXERCISE
- Less likely depression, anxiety
- Exercised less likely to have depression reoccur
- Weight lifting, crew, tai chi
- Reverse harmful effects of stress
- Lifts depression
- Improve learning
- Builds self esteem and improves body image
- Feel euphoric or joyful
- How exercise works
- Release endorphins
- Change level or effects norepinephrine,
serotonin - Lower cortisol
- Inc body temperature
- Gets mind off activities, improve self esteem,
self image interaction - BDNF
- Mitochondria
- Brain has lots of mitochondria
- Energy
- Vitamin
B12- With other vit B strengthening nervous and
immune systems - Helps muscle tone and healthy skin
- Role in energy metabolism
- Deficiency à
- Fatigue
- Inc homocsyteine which can worsen heart disease
- trouble absorbing vitamins
- antacids
- Vegans no animal, dairy no ingest B 12
- Amoxicillin,
antibiotics, colestipol to reduce cholesterol
- With other vit B strengthening nervous and
- Carnitine
- Made from aa found in meat
- In meat, milk, poultry, fish
- Some made in liver and kidneys from aa lysine
and methionine
- Produces energy in mitochondria by carrying
fatty acids into mIT - Inc energy and helps with depression
- Made from aa found in meat
- Co Q 10
- Enhances carnitine
- Antioxidant
- Boosts energy
- Ubiquinol
- In diet
- Whole grains, salmon, oily fish, organ meats
such as liver - Statins, some beta blockers, imipramine can
deplete coQ10
- Whole grains, salmon, oily fish, organ meats
- Rhodiola
- Boost energy endure exercise
- Supports exercise program
SUMMARY
- 60.3 % exercise regularly to have depression,
anxiety - NIH exercised less likely to have depressive
symptoms - Over time, exercise feasible tx for mdd
- 2008 found weakened mitochondrial activity
translated to less cellular energy was related to physical discomfort.
B B vitamins that affect mood
Niacin, B 6 make serotonin
- Vit D, B vitamins, SAMe
- B
vitamins- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
folate, inositol work as a team - Regulate carb metabolism
- Stabilize blood sugar
- Ease mood swings improve sleep
- Help liver deactivate and dispose of old
estrogen - Critical to energy making (Krebs)
- Vitamin B deficiency causes
- Harm brain leading to depression, anxiety,
irritability difficulty concentrating
- Harm brain leading to depression, anxiety,
- Vitamin B 6 and niacin
- Help make serotonin (help mood, sleep, appetite
- Thiamine, riboflavin, niacin, vitamin B 6, B 12,
- Thiamine
(Vitamin B1)- Free thiamine crosses BBBHelps convert glucose
into fuel - Stimulates brain action
- Needed for nervous system health
- Aids in digestion
- Brain rapidly loses energy when thiamine in
short supply- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Depression, fatigue anxiety irritability,
- Lack
- Interfere with uptake of glucose in brain
- Leads to mental fatigue and poorer moods
- Depression, fatigue anxiety irritability,
insomnia, memory problems
- Free thiamine crosses BBBHelps convert glucose
- Niacin
Vitamin B 3)- When niacin in short supply, tryptophan goes to
niacin instead of serotonin - Lack niacin can result in depression, agitation
and anxiety - Helps maintain health nervous and digestive
systems - Also stimulates circulation causing blood
vessels and RBC to become more flexible- Easier thru body and brain
- Lack. Pellagra
- When niacin in short supply, tryptophan goes to
- Pyridoxine
(Vitamin B 6)- Lack depression, confusion and irritability
- Needed to make neurotransmitters serotonin,
dopamine and norepinephine, GABA - Depressed pts have low B 6
- Necessary for normal brain function for
synthesis of RNA and DNA and formation of myelin sheath around nerve cells
- Inteffering with above B vitamins. Eating simple
sugar flour, cake, candy pies, etoh - Folate (vitamin
B 9)- SOURCES
- Asparagus,
citrus, fortified cereals, green leafy veggies, legumes (peas, beans,
lentils) - Required for Normal cell development and
manufacture of DNA and RNA
- Asparagus,
- Cause lack
- Birth control pills, anti-sz meds, antacids,
some antibiotic, etoh, smoking
- Birth control pills, anti-sz meds, antacids,
- Necessary to make SAMe needed for
neurotransmitter metabolism - May protect against colorectal, breast and
cervical cancers - Protects the heart by breaking down homocysteine
(linked to HD) - Homocysteine
- Heart disease
- Poor memory and compromised thinking
- To protect fetus from fetal brain and spinal
cord defects - Lack
- Can lead to depression
- Lower folate
- Higher likelihood of depression
- Poor response to antidepressants
- Higher relapse rate
- Folate supplementation makes antidepressants
work better.
- Depressed have lower folate than normal or other
psych d/o - Antidepressants do not work well I low folate
- People with low folate more likely to experience
depression relapse - Women (not men) who took folic acid with tx do
better than placebo
- Lower folate
- Can lead to depression
- FOLate natural form in foods
- Folic acid man made
- MTHFR MORE PRONE TO DEPRESSION
- 5 methyltetrahydrofolate= L methlfolate natural
active form- Used at cellular level for DNA , reproduction,
regulation of homocysteine. - Crosses BBB
- Used at cellular level for DNA , reproduction,
- SOURCES
- Vitamin
B6- Necessary to make serotonin and dopamine
- Lack trigger depression and mental confusion
- Vitamin B
12- Works with B6, and folic acid to make serotonin
and dopamine - Necessary to make RBC
- Lack
- Problems moving oxygen thru body
- Can cause fatigue, mood swings, irritability,
dementia or mania - neurological problems including tingling in
hands - difficulties coordination walking
- psychiatric: depression, anxiety, paranoia, AH,
memory loss, confusion, outbursts, and behavioural challenges
- Works with B6, and folic acid to make serotonin
Inositol (Vitamin B 8)
- for depression, panic, OCD
- is carb that can make from glucose
- too much sugar can disrupt the inositol shuttle
and other messenger pathways leading to deficiency
- too much sugar can disrupt the inositol shuttle
- forms health cell membranes
- maintains proper electrical energy and nutrient
transfer between cells - changed into substance that regulates action of
serotonin- lack serotonin depression, panic disorder, OCD
Vitamin D
- from food and sunlight
- cholesterol is precursor
- important for absorption and utilization of Ca
and phosphorus for bone and teeth growth - involved in brain function
- vitamin D receptors in both neurons and glial
cells in brain - forms
- D2 ergocalciferol made by plants
- Cholecalciferol made when skin exposed to UV-B
- Lack related to
- Psoriasis, muscle pain, weakness, htn, some
cancer, autoimmune disease - Depression, suicide
- Common in seniors
- Psoriasis, muscle pain, weakness, htn, some
- Depression and vitamin D
SAMe. 800 – 1600 mg for depression
- Made from methionine
- Helps make neurotransmitters, proteins and
hormones - Helps create mood enhancers
- Can help relieve depression
- Response rate 45 % (30 % for escitalopram and 26 % for placebo
- Add on for depression vs placebo
SUMMARY
- every
depressed person should take B complex vitamin with L methylfolate - Check vitamin B 12 and D
- Everyone unique
- Vitamins
- Make neurotransmitters, stabilize blood sugar,
ease mood swings, improve sleep, control inflammation
- Make neurotransmitters, stabilize blood sugar,
- Affect mood
- B vitamins, D, SAMe
- Deficiency of B
- Harm brain, leading to depression, anxiety,
irritability and difficulty concentrating - Folate natural
- Low folate higher likelihood of depression, poor
response to antidepressants, higher relapse rate
- Low folate higher likelihood of depression, poor
- Folic acid man made
- Harm brain, leading to depression, anxiety,
- Vitamin B
12 is family of compounds. Psych- Lack depression, anxiety, paranoia, AH, memory
loss, confucsion, outbursts, behavioural changes - From beef liver, cheese, eggs, milk, fish,
yogurt - If B 12 low and homocysteine hi recommends B 12
shot
- Lack depression, anxiety, paranoia, AH, memory
- Vitamin D
eat, sun- Linked to depression
- SAMe
depression - Inositol
changed to substance that regulates action of serotonin- Depression, panic disorder, OCD
- From inositol from foods including wheat germ,
brewer’s yeast, grapefruit, liver, raisins, unrefined molasses
- Thiamine
- Helps brain change glucose into fuel
- Brain rapidly loses energy when thiamin low
leading to depression, fatigue anxiety, irritability, insomnia, memory problems
- Niacin
- Lack lead to depression, agitation, anxiety all
linked to low serotonin - Lack pellagra sx depression, anxiety, apathy
- Lack lead to depression, agitation, anxiety all
- B vitamins depleted by eating too many simple
sugar, etoh - Folic acid, V12 and vitamin D and other
nutrients effective tx for depression - Folic acid with meds happier for women , not men
- L methylfolate decrease depression 3 months
later - Elderly with vitamin B 12 deficiency more likely
to be depressed - Duke Seniors lower vitamin D greater likelihood
of depression - Swedish depression improve with vitamin D
- SAMe large improvement in depression
R RESTORE HEALTHY DIGESTION
- GUT HOUSES > 70 % IMMUNE SYSTEM
- SUCROSE ALTERS BACTERIà CANDIDA YEAST
- Factors that decrease good bacteria
- Lack zinc, B vitamins, Fatty acid
- Lack of sun
- Lack of social support
- Poor nutrition
- Poor connection with nature
- Stress
- Lots sugar
- Antibiotics, alcohol , birth control pills
- Corticosteroids and anti inflammatory drugs
- Infections, laxatives
- Excessive use of antibacterial soap
- Meat from animals with growth hormones or
antibiotics - Gluten containing grains
- Gut Brain connection 2 way street
- Enteric thru Vagus nerve ascending
- Descending ANS
- Capillaries within epithelial tissues
- Brain can communicate with enteric nervous
system both directly (thru capillaries and nerve endings in gut wall) and
directly thru chemical signaling and hormone secretion - Gut communicates directly with the brain
Mood is affected by inflammatory markers in the gut
- Microbiota
- Microorganisms in a specific region or location
- Can be gut, skin, lungs oral mucosa
- Microorganisms in a specific region or location
- Microbiome
- Collection within a given microbiota
- Gut microbiota
- Associated with BAD, schizophrenia anxiety, OCD
- Pigs given lactobacillus probiotics healthier
and more resistant to swine flu - Bacterioides
- hi in depression
- linked to inflammation
- depressed
- hi bacteroides
- firmicutes, bacteroides, proteobacteria abnormalities
- inc Enterobacteriaceae and alisitpes
- reduced faecal bacterium negative correlation
with depression - depression can actually be transmitted thru gut
microbes
- To help gut
- For persons over 40, much depression is related
to gut - He recommends
- Digestive enzyme with hydrochloric acid
- Hydrochloric acid important for digesting
protein - Ant-acids especially 24 hour PPI lower stomach
acid- So don’t absorb B 12, digest protein
- Hydrochloric acid important for digesting
- Probiotics 50 billion CFUs
- Digestive enzyme with hydrochloric acid
- Can do these without testing without adverse
side effects.
- For persons over 40, much depression is related
- Disrupting
Gut function- ant acids
– especially 24 hour PPI lower stomach acid- so don’t absorb vitamin b 12 and digest/
breakdown protein
- so don’t absorb vitamin b 12 and digest/
- antibiotics
- can get an overgrowth of yeast, dsybiotic gut
- stress
- inflammation
- bad diet
- food sensitivities
- celiac disease abnormal reaction to gluten
- higher incidence of depression
- the action of gluten interferes with absorption
- zinc, folate, amino acids not absorbed
increasing risk of depression
- zinc, folate, amino acids not absorbed
- food allergies
- celiac disease abnormal reaction to gluten
- ant acids
Toxins can affect mood
- Toxins are synergistic
- BPA and phthalates are in many things
- Affect metabolism and absorption of zinc
- Have direct effects on neurons on brain
- Indirect effects to make trace minerals
unavailable
- BPA and phthalates are in many things
Toxins can interfere with the conversion of thyroid hormones T4 to T3
Role of Inflammation in depression
- Inflammation is Implicated for Heart Disease,
arthritis, cancer, Alzheimer’s disease - Heavily involved in a subset of depressed
- Overstimulated immune system produces chemicals
that go into the brain that affects how we synthesize chemicals to make our
brain regular- Chronic inflammation regardless of cause
(trauma, stress, infection) affects mood
- Chronic inflammation regardless of cause
- If we have the illness feel depressed.
Medications causing depression
- Propranolol, beta blockers
- Steroids
- Contribute to depression and suicide
- Hormones
- Blood pressure medications
- Chantix increases risk of suicide
- Antidepressants can contribute to more
depression of suicidality- FDA has put out warnings
To help stress
- Mindfulness
- Magnesium
- Interfere with overactive stress response system
Supplements to help with depression
- Magnesium
- Most common nutritional deficiency
- Inverse relationship with stress
- Magnesium is repleted in soil, so foods are low
in magnesium - Can lower blood pressure
- Helps with sleep, anxiety
- Helps with concentration
- Helps convert fats into energy
- In hundreds of reactions for brain function
- Zinc
- Commonly deficient because of toxins (BPS,
phthalates) - Is not plentiful in a vegan of vegetarian diet
- Is most bioavailable in animal products
- Adolescents commonly have low zinc levels
- Needed as biopathway to make neurotransmitters
- Linked to depression
- Symptoms of low zinc levels
- Hair loss, diarrhea, white marks on nails, skin
lesions, acne, less zinc
- Hair loss, diarrhea, white marks on nails, skin
- Taking zinc makes antidepressants work better
- Test for zinc with zinc taste test
- Have strong bitter taste if have adequate zinc
- Taste buds are zinc dependent
- Restore zinc, taste return
- Commonly deficient because of toxins (BPS,
- Vitamin B
12 - Vitamin D
- Recommends testing
- Take at least 2000 iu per day
- Omega 3.
Fish oil- Helps with mood
- 5HTP.
Precursor to serotonin - Don’t take tryptophan by it self
- SAMe
can be helpful. Do not take if have bipolar- Studies show good results
- 800 – 1600 mg per day
- St John’s
Wort- 600 mg 900 mg per day
- Make sure it comes from a reputable company
- Rhodiola
- He has had a lot of success
- Fewer side effects, fewer interactions with
drugs - Russians used for many years for concentration,
stamina, energy - 100 – 400 mg per day
- Role of Hormones important
- Bioidentical hormones
- Neurotransmitter testing not accurate
- Can look in urine for break down products of
serotonin and dopamine - He tests levels of amino acids and supplements
to give the building blocks to make neurotransmitters - He gives amino acid precursor molecules
- Can look in urine for break down products of
Role of trauma
- Depression from trauma is not as easily treated
with nutritional supplements - Look at therapy and nutritional deficiencies
Summary Points
- Look at whole body
- Look at contributing factors
- Use integrative approach
- Nurture brain and mind
- Mind body approaches,
- Nature
- Spirituality helps with resilience and recovery
- Mindfulness, meditation
- These can change anatomy and neurochemistry of
the brain
- These can change anatomy and neurochemistry of
- Mindfulness, meditation
- Meaning, gratitude and hope are important parts
of mental health
- Look at whole body
- Look at contributing factors
- Use integrative approach
- Nurture brain and mind
- Mind body approaches,
- Nature
- Spirituality helps with resilience and recovery
- Mindfulness, meditation
- These can change anatomy and neurochemistry of the brain
- Mindfulness, meditation
- Meaning, gratitude and hope are important parts of mental health