WRITTEN BY Nancy Palermo Lietz, MD, Thrive Personalized Healthcare and Wellness
Over 44 million Americans currently suffer from mental disease, and half of all adults will struggle with mental illness during their lifetimes. Depression and anxiety are the most common diagnoses. Women are twice as likely as men to be diagnosed. One in seven women are medicated for depression and anxiety, and one in four are on medication by the time they reach their forties.
Conventional approaches to mental disease focus on imbalances of neurotransmitters with treatment involving medications to regulate the abnormalities. For decades, this chemical imbalance was believed to be the cause of psychiatric disease, and medicine was the only solution. While there are certainly those who need medication, there is growing evidence that these conditions are more the effect of our modern lifestyle being incompatible with our genes. Our lifestyle has been hijacked, and our bodies and brains are rebelling. Our diets are filled with processed and inflammatory foods; our bodies lack exercise and sunlight and are exposed to thousands of chemicals and stressors daily. These triggers lay the groundwork for inflammation, nutritional deficiencies, gut inflammation, microbiome disruption, hormonal changes, and the activation of other stress factors in our bodies—all potentially leading to mental illness.
While evidence has linked these disruptions to the development of mental disorders, we have been “brainwashed” to believe medication is the answer. Despite heavy marketing, six decades of research have revealed these medications may not be any better than a placebo and may leave individuals worse off after they stop taking them. We need to look deeper into addressing the root causes to avoid starting medications in the first place.
Medication-Induced Mental Disease
There are over 200 commonly prescribed pharmaceutical drugs which list depression and anxiety as side effects, yet few doctors counsel patients on these risks. Beta-blockers, anti-anxiety medications, allergy medications, cholesterol-lowering drugs, over-the-counter acid reducers, steroids, and even anti-depressants have been shown to increase the risk of depression and suicide in users.
Nearly two-fifths of our population suffers from a severe B12 deficiency, which is also found in 27% of depressed patients. Microbiome disruption, poor digestion, an inflammatory diet, and medications have all been linked to the deficiency. B12 appears to be a powerful antidepressant.
There is also a link between declining consumption of omega-3 fatty acids from fish and other sources and an increasing trend in the incidence of major depression. Omega-3 fatty acids have antidepressant effects in humans. Daily consumption has been associated with mood elevation in depressed patients.
Vitamin D deficiency has become more common due to lack of sun exposure and microbiome disruption. Vitamin D, which is important for several crucial functions in the body and brain, promotes healthy brain cells and reduces inflammation related to memory and cognitive abilities. Low vitamin D also has been linked to Seasonal Affective Disorder (SAD), depression associated with the darker months of the year. More severe deficiencies have been associated with depression and panic disorders.
Thyroid disorders, including hypothyroidism and hyperthyroidism, may be associated with neuropsychiatric disorders including depression and anxiety, yet often individuals go unscreened. Treatment of a thyroid disorder can result in improvement or resolution of associated depression and anxiety.
Gut Disruption and Inflammation
Hippocrates, the third century father of medicine, said, “All disease begins in the gut.” Several studies have linked gut dysfunction and inflammatory conditions with the brain. The vagus nerve, which connects the brain and the gut, is the longest-running nerve. The gut/brain link is evident when we experience distress felt as stomach upset or butterflies. Inflammation in the gut can also trigger such reactions in the brain. Gut inflammation is caused by infections, highly processed foods, allergenic foods, sugars, and additives. Higher levels of inflammatory markers are associated with more severe depression and anxiety. Some conditions, like celiac disease, often present as psychiatric disorders first.
Our microbiome—the trillions of bacteria that reside in our gut—is essential for healthy brain function. Certain bacteria types may be associated with anxiety and depression. Researchers in the Netherlands found that certain strains were deficient or absent in depressed patients. These bacteria are believed to be involved in the pathway to produce dopamine, our “feel-good” neurotransmitter. Probiotics have demonstrated antidepressant effects in clinical research studies. Fecal Microbiota Transplant (FMT) is a procedure where a healthy donor’s fecal microbiota is transferred to an unhealthy recipient. FMT has been used to treat severe gastrointestinal infections, and was also show recently in a small study to successfully treat severe depression and anxiety. The success of FMT in the treatment of depression further supports the microbiome’s role in mental health.
Hypothalamic-Pituitary-Adrenal Axis Dysfunction
The HPA axis is the body’s central stress response system. Stress has long been a contributing factor to depression and anxiety. Longstanding elevations of cortisol, the stress hormone produced from the adrenal gland, have been linked to an increased incidence of chronic depression and anxiety. Mindful meditation, yoga, tai chi, and biofeedback therapies have been successful in reducing anxiety and depression.
As ongoing research uncovers the non-psychiatric contributors to depression and anxiety, it is prudent for patients to question starting medication before a more thorough workup is conducted. We now understand anti-anxiety and antidepressant medication may have more long-term effects for patients, and various causes of psychiatric disease should be considered before committing patients to a lifetime of use.