“Every human being is the author of his own health or disease.” – Buddha
More than ever, we are seeing more and more cases of depression and anxiety, and more and more medication being prescribed for these issues. But there is a fine balance between knowing when to prescribe medication for depression and anxiety – and when to look deeper.
We tend to forget that many other things throughout the body can contribute to symptoms of depression and anxiety. Everything from mycotoxins, pesticides, hormonal imbalances, adrenal fatigue, thyroid disorders, abnormal gut health, substance abuse, vitamin deficiencies, neurotransmitter deficiencies, and brain injuries can cause or exacerbate depression and anxiety.
We also need to remember that the brain is an organ that has function. In my family medicine practice at Evoke 5 Medical Center, I tend to treat mental health as a function that needs to be fixed, versus just prescribing medication to put a Band-Aid on the symptoms. Again, there is a very fine line and balance between knowing when to prescribe medication and when there is an underlying condition that needs to be treated.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines major depression as experiencing five or more of the following symptoms for two weeks or more:
- Depressed mood
- Anhedonia (loss of interest or pleasure)
- Weight gain/loss
- Insomnia/hypersomnia
- Loss of energy
- Feeling of worthlessness/guilt
- Loss of concentration/decisiveness
- Thoughts of death/suicide
- Psychomotor agitation
Statistically, the year 2020 was shown to be the worst year for depression and anxiety diagnosis. Previously, 18% of the U.S. population recognized symptoms of depression, with the highest age group being 18 to 29 years old. In 2020, this figure more than doubled, rising another 20% within that population. Not surprisingly, the COVID-19 pandemic was the major risk factor that worsened fears and depression, leading to this significant increase.
Other causes of depression and anxiety include genetics, neurologic dysfunction, gut dysfunction, hormone deficiencies, toxins, medications, life stressors, neurotransmitter deficiency, and chronic disease. All of these need to be considered with diagnosing and treating depression and anxiety.
When treating mental illness as a function, rather than only prescribing medication, I follow a specific process to arrive at a diagnosis. This begins by listening to the patient and getting a thorough history. This is a critical first step in deciding whether the depression and anxiety should be treated with medication, or whether alternative methods are appropriate.
I do extensive lab work in my office to determine any deficiencies or hormonal imbalances. For example, specific testing can determine genetic abnormalities that may be causing deficiencies from enzymes being turned on or turned off. This can lead to vitamin deficiencies and also neurotransmitter deficiencies. Questionnaires, such as the Patient Health Questionnaire-9 (PHQ-9) and the Braverman Personality Type Assessment, are helpful in determining depression related to neurotransmitter excess or deficiency.
Gut health is another important area to consider when diagnosing and treating depression and anxiety. Many studies have shown that gut health is closely interwoven with our mood and how our brain functions. We know that 60% to 70% of our serotonin, the neurotransmitter responsible for mood stabilization, is produced in the gut. A fraction of that is used in the brain to help with mood and sleep. Therefore, an abnormality in the gut can lead to a sad brain.
Studies with mice have also shown that certain bacterial transplants or yeast transplants in the gut can worsen and even cause symptoms of depression and anxiety. By removing these bacteria or yeast from the system, the symptoms have been resolved. With my patients, I utilize stool studies and food intolerance testing to better determine what bacteria and yeast needs to be removed, so we can decrease inflammation and increase the ability to break down food and absorb nutrients properly.
Mycotoxins, which are toxic compounds that are naturally produced by certain types of molds, are an area of rising concern, as they are becoming more and more common to find. 75% of people can detox for mold appropriately, but can still have symptoms of mold. Meanwhile, 25% of the population has a very difficult time with the detox process. When combined with other stressors on the body, such as medication, chronic disease, gut inflammation, lack of sleep and poor diet, the toxins will start compromising mitochondrial function, along with neurologic and other cellular function. The major symptom of toxicity is worsening fatigue and depression, along with weight gain and insomnia.
With any history of concussion or traumatic brain injury, it’s important to assess the patient for neurologic dysfunction in the brain that could be causing symptoms of depression and anxiety. A very common treatment for members of the military and professional sports athletes is MeRT (Magnetic e-Resonance Therapy). This EEG- and EKG-patented technology assesses areas of the brain that are running slower than optimal. Treatment involves magnetic stimulation at a certain Hz that is specific to each patient, administered to the proper area. After a full treatment, which typically takes four to six weeks, changes can objectively be seen on the EEG and 90% of the time symptoms have mostly resolved.
Once we’ve uncovered the underlying causes of depression and anxiety, we can identify the best treatment plan for the individual patient. It may involve medication, complementary therapies or a combination of both.
A healthy lifestyle is also a major benefit when addressing any form of depression. For most patients at Evoke 5, I recommend exercising, yoga, improving sleep, a clean, low-carbohydrate diet, and supplementation to improve overall health and brain function, including reduced symptoms of depression and anxiety.