Last year, I was seeing four different doctors: a psychiatrist for my mood disorder; an endocrinologist for my pituitary tumor and thyroid issues; a cardiologist for my aortic valve regurgitation; and a primary care physician for some digestive problems and fungus growth.
I suspected that all of my health problems were connected but most of the doctors were uncomfortable looking beyond their specialties to achieve a systemic, balanced perspective of how the conditions were related. For example, when I asked my endocrinologist about the mood effects of too much prolactin (a hormone produced by the tumor), she told me to ask my psychiatrist. When I asked my primary care physician if my digestive problems could be related to my depression, she looked very confused. I searched for an integrative doctor who could piece together all of my broken parts and help me determine some underlying causes for all of the ailments. After spending a few months with a functional doctor who was very anti-medication and anti-psychiatry, I finally—much like Goldilocks—found the right physician: an internist who was willing to look through my files from past doctors and x-rays that exist somewhere on the internet in order to gain a holistic view at my health.
I have been helped by psychiatry and medications. No doubt about that. But my biggest frustration with psychiatry is that most physicians won’t consider any contributing factors below the neck. So when people like me don’t get better after 20, 30, 40, or 50 medication combinations, they aren’t sure what to do. They tell us we can try some brain stimulation possibilities, like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). Or we will have to learn to live around our death thoughts and suicidal ideations. My psychiatrist is very open-minded and is always learning from her patients and research studies, but in general, it seems like most of them do not want to venture too far from the limbic system (emotional center of the brain).
I believe the vast majority of persons who have been told their depression is treatment resistant can benefit from working with an integrative doctor—someone who considers all of your biological systems and organs when trying to determine the reason why you don’t want to get out of bed in the morning–in addition to a psychiatrist. However, many integrative doctors are expensive and don’t take insurance, so I thought I would interview my doctor, Alan Weiss, to provide you with some ideas about next steps to take if you are stuck and not getting better.
Dr. Alan Weiss serves as the Medical Director of Annapolis Integrative Medicine. He earned his bachelors degree from the University of Virginia and his medical degree from McGill University. He is board certified in internal medicine and is a fellow of the American Academy for Advancement in Medicine and the American College of Physicians. Dr. Weiss has practiced medicine for over 15 years. His clinical interests have led him to conduct studies and publish various articles relating to diabetes, chronic pain, fibromyalgia and chronic fatigue syndrome. Dr. Weiss’ goal is to educate and treat his patient by incorporating the latest research in the areas of conventional and alternative medicine. He continues to pursue and educate himself in leading-edge methods of achieving wellness.
I’m pleased to share some of what I have learned from him with you.
Q: What are the primary underlying or accompanying causes of depression that you’ve encountered in your years practicing internal medicine?
The top five underlying causes of depression that I see in my patients are a bad diet, leaky gut, sleep disorders, hypothyroidism, and low Vitamin D and B-12.
Bad diet: I don’t think people truly understand the impact of what they eat on their mood. Processed foods, hydrogenated oils, sugar, and lots of bread and cracker-like snacks can certainly contribute to symptoms of depression and anxiety. For optimal mental health, I advise my patients to eat a clean, Paleo (also called primal or ancestral) diet: eating whole or nutrient-dense foods, and avoiding refined sugar, gluten, pasteurized dairy products, and processed factory foods like Fritos and Oreos. I also recommend taking fish oil supplements, vitamins B-12 and D, a multi-vitamin and a multi-mineral.
Leaky gut: Leaky gut is clinically known as increased intestinal permeability or hyperpermeability, a condition in which food is allowed to pass through the small intestinal lining. Substances leak into the bloodstream that shouldn’t be there, causing bloating, gas, and sometimes mood disturbances.
Sleep disorders: We’ve always known that depression causes interruptions in sleep, and that a lack of sleep makes persons more susceptible to mood disorders. But studies now show that sleep problems can cause mood disorders and that sleep deprivation can rewire the brain’s emotional circuits.
Hypothyroidism: Since most psychiatrists and primary-care physicians don’t run a full thyroid panel, I see a number of patients who have undiagnosed hypothyroidism, an underactive thyroid, which causes symptoms of fatigue, apathy, and depression.
Low Vitamin D and B12: These are the two most common nutrient deficiencies for my patients who have depression symptoms. Both Vitamin D and B-12 are essential for positive mood.
Q: Why don’t some people get better after working tirelessly with a psychiatrist?
They may not be addressing root medical issues like the ones I mention above: hypothyroidism, leaky gut, sleep disorders, and vitamin deficiencies. Some people being treated with medications need cognitive behavioral therapy, as well, or vice versa. Patients can have food allergies and food intolerances that affect mood, or they have toxicities—such as mercury poisoning —that an antidepressant can’t treat. Addictions can prevent recovery from depression, or less-than-full disclosure about something like an addiction with a psychiatrist. And there are always some people who are just simply being treated for the wrong things.
Q: What should a person do who can’t afford to see a functional or integrative doctor? What are the best blood tests to have their primary care physician run?
I would have your doctor run a full thyroid panel that should include TSH, Free T4, Free T3, Reverse T3, and Thyroid Antibodies. Test for deficiencies in Vitamin D, B12, Ferritin and Iron. Rule out food allergies by doing an elimination diet. Simply remove specific foods from your diet for a few weeks that you suspect could be causing allergy symptoms (milk, eggs, nuts, wheat, and soy are typical triggers). Keep a food diary to record the foods you are eating and omitting, and if the symptoms disappear when you stop eating them. Slowly add back in the suspicious foods, one at a time (give yourself a week between each reintroduction). Record any allergic symptom you feel as you add each food in. That should help you confirm that the food is triggering the symptom.
Q: Do you have any other recommendations or advice you’d give a person who fights chronic depression or anxiety?
My advice is to clean up your diet, exercise on a regular basis, optimize your hormones (for example, get a full thyroid panel done to be sure your thyroid isn’t underactive), clean up any integrity issues you may have in your life. If the depression continues, you may need to change something else in your life.
Continue the discussion in the “Holistic Health” Group of Project Beyond Blue, the new depression community.
Originally published on Sanity Break at Everyday Health.
Therese, I think you touched upon one of the weakest links in our health care system. There are so many specialists that no doctor knows the whole person anymore……just his or her parts. Not a good situation.
You are a genuine wealth of objective information and subjective insight, supported by outstanding reputable sources. Thank you for sharing your special knowledge and passion.
Dr. Weiss’s advice in the final paragraph sounds great, but feels like a lot for a moderate to low-functioning depressive to pursue. I suppose it takes teamwork, constant coaching, and accountability. I’m too easily discouraged, distracted, and undisciplined to follow through, especially left to my own devices.