It’s time to consider alternatives to antidepressants.
Despite spending more than $200 billion dollars a year on mental health conditions, depression and anxiety disorders continue to be the most commonly diagnosed mental illnesses in the United States.
According to the Anxiety and Depression Association of America (ADAA), 40 million Americans over the age of 18 are affected by anxiety — roughly 18 percent of the nation’s population.
Depression affects approximately 14.8 million American adults in a given year. While there are many other illnesses that can be classified under mood, behavior, and mental health, the greatest prevalence is anxiety and depression. Combined data for these two disorders constitute 24.7 percent of diagnosed patients or nearly 55 million Americans.
What is worse is that published studies indicate that 50 percent of depressed Americans never seek treatment!
While talk therapy can certainly help you cope with the stresses and challenges of life, improve your mood, and provide coping skills, psychiatric drugs don’t seem to be a safe and effective way of dealing with many of these problems. Yes, there is a place for all medications, and there are times when they are applicable despite various concerns. The problem that arises with this approach is the frequency and ease of prescribing when patients present with mental health challenges. It has become a first line approach rather than the beginning of an in-depth investigation looking for causation. In addition, common side effect reactions range from dependency/discontinuation syndrome, weight gain, sleep disruptions, and sexual dysfunction, all which might just make things worse. For those who have tried to discontinue psychotropic drugs and have experienced severe withdrawal symptoms despite their doctors best efforts, here is a resource to assist you: The Withdrawal Project.
Baseline approaches from a functional medicine perspective would have the clinician evaluate the patient for vitamin B12 levels and its functionality, a full thyroid panel, serum and RBC magnesium levels, zinc, copper and ceruloplasmin, urinary amino acids, and/or organic acid testing to ascertain adequate amino acid levels, which are some of the building blocks for neurotransmitter formation and the latter for functionality of certain nutrients that are pivotal in neurotransmission. Essential fatty acid profiles tell us how the cell membrane is functioning and its role in brain and body inflammation.
A whole blood histamine level, or a SAMe:SAH ratio, determines global methylation status. This is a key determinant defining undermethylation versus overmethylation rather than the common use of looking at the MTHFR (methylenetetrahydrofolate reductase) genotype and suggesting methylfolate if you have a SNP (single nucleotide polymorphisms).
Urinary pyrroles can be another underlying variable in mood disorders used to ascertain pyroluria. Typically, a genetically expressed trait where the individual makes excessive amounts of a by product of hemoglobin known as pyrroles or kryptopyrroles. Pyrroles have a strong binding capacity for vitamin B6 and zinc, causing them to become excessively excreted depleting the person of these vital nutrients. B6 is a pivotal nutrient in the activation of GABA, serotonin, and dopamine. Zinc deficiency/insufficiency is associated with a host of psychological and physical illnesses.
Not all of these tests are necessary to start with. Some may argue that sounds like a lot of work for the doctor to do and my answer is: it’s not when you have been properly trained in functional medicine and the difference it will make in the patient’s life!
Alternatives To Antidepressants: How Genes Affect Prescription Medication
It is no longer an oddity to state that the role of diet and how your brain functions go hand and hand. Dr. Daniel Amen, Dr. Kelly Brogan, and Dr. William J. Walsh have published considerable data on these alternative approaches.
Specific vitamins, minerals, amino acids, and essential fatty acids are the building blocks of neurotransmitters — the chemicals that allow your brain to communicate with itself and govern how you think, behave, act, and feel.
Gluten, a protein in wheat, rye, and barley has been implicated in some cases of neuropsychiatric conditions including anxiety and depression. A small randomized controlled trial has found statistical correlation that warrants our attention. There are a considerable amount of people suffering from non-celiac gluten sensitivity (NCGS). You would assume that the symptoms might only be related to the gastrointestinal system, but we now know that a wide range of non-intestinal manifestations ranging from neurologic disorders to skin conditions are attributable to gluten consumption.
Genetics is another fundamental in the frontier to understanding how we tick. Pharmacogenetics is the science of how you metabolize pharmaceuticals, hormones, and detoxify. Nutrigenomics shows us how various foods and nutritional substrates like vitamins and minerals interact with our genes.
A more recent association is to look at polymorphisms, also known as SNP (single nucleotide polymorphisms), which are mutations on our genes. Genes are proteins that decipher the code for an enzyme to do its job. If we have a mutation(s) on a gene, it will alter its expression. A good example of this is the MTHFR gene. This gene is responsible for the metabolism of folates (folic acid), aka vitamin B9. SNP on this gene, along with approximately 20 others, control a process in all of your cells known as methylation. Many critical functions in our body are under the control of the methylation process, including neurotransmission.
Serotonin, dopamine, and norepinephrine, known collectively as the catecholamines, can be affected by these mutations. Serotonin is a calming or inhibitory neurotransmitter, with numerous other biological functions. Dopamine is associated with pleasure, reward and goal orientation. And norepinephrine controls rest cycles, alertness, and memory in the central nervous system. The takeaway here is to understand that investigating gene mutations can make the difference between success and failure in the treatment of mood disorders, including drug therapy. Vitamin B12, folates, B6, vitamins C and E, and minerals such as magnesium, copper, and zinc play pivotal roles is how these genes express.
Epigenetics is the science of how we can turn on or off genes through our environment. We inherit genes from our parents. Some come with mutations, but this does not mean they are expressed. They are largely predispositions. The lifestyle we live — e.g.,. diet, exercise, toxin exposure, drug and alcohol intake — all set the stage to either support the expression of these predispositions or silence them. This understanding goes a long way in helping us understand why some cancers form and how cardiovascular and other health issues are impacted by genetics.
5 Distinct Biotypes Of Depression
Nutrient imbalances can alter the gene expression of proteins that govern neurotransmitter activity at the synaptic level. Dr. William J. Walsh Ph.D., the author of Nutrient Power, created the Walsh Institute, a non-profit organization dedicated to the treatment of mood, behavior, and mental health through the identification of nutrient imbalances that have specific function on brain neurotransmission.
Walsh has found that deficiencies in antioxidant nutrients can cripple the brain’s protection against toxic metals. Our brains function electrochemically, and specific key nutrients play a vital role in how our brains function, as well as have an impact on mental health.
Walsh’s approach is aligned with functional medicine, a holistic medical paradigm where we address the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.
While psychiatry does incorporate a therapeutic approach, the field has primarily relied upon clinical observation and psychotropic medications to help their patients. Some continue to use talk therapy as well.
Dr. Walsh has defined five distinct biotypes of depression. Biotypes here are defined as a group of people expressing a specific genotype — or genetic characteristics. Only two biotypes exhibit low serotonin levels! This alone is groundbreaking, as the other three biotypes, when given the commonly prescribed standard SSRI medications such as Celexa, Prozac, etc., are typically unresponsive or poor responders to these medications. This might well explain why approximately 50 percent of patients that start on antidepressant therapy fail to achieve a clinical response utilizing monotherapy (one treatment: drugs).
This is a perfect example where the concept of linear relationships does not apply. Depression does not always equal low serotonin, as many people or drug companies might have you believe.
Dr. Walsh, with the largest database of blood chemistries on mental health in the world, expands our understanding of the links between biology and mental health.
The Five Biotypes
- Undermethylation: Reduced serotonin, dopamine — 38 percent
- Overmethylation/Folate Deficiency: Elevated serotonin, dopamine — 20 percent
- Copper Overload: Elevated Norepinephrine — 17 percent
- Elevated Pyrroles: Reduced serotonin, GABA –15 percent
- Toxic Metal Overload: 5 percent
Distinctive symptoms and traits are identified for each depressive group; you can belong to more than one group. To identify what group or groups you are in, you would need to seek out a practitioner trained in this approach. Working with a functional medicine practitioner that has a focus here as myself or contact the Walsh institute.
This data clearly depicts how a composite of factors can contribute to mood, behavior, and mental health. They include our genetics and how we express them biochemically, in addition to environmental exposures, diet, exercise, and adaptive capacity. We are now able to define, with specific blood and urine biomarkers, many aspects of brain chemistries that relate to our mental health. Since our blood chemistry directly reflects what nutrients we consume, many of these issues can be successfully managed through targeted nutritional therapy.
Meditation, exercise, and spirituality provide additional avenues to support a healthy mind and body. You would be surprised how effective these venues can be if properly instituted in a healthy model of mental health.
We need to move the model of health care forward, into a new paradigm that sees the value of functional medicine and approaches such as Dr. Walsh’s as a template for change and an opportunity to genuinely help people with anxiety and depression more than by simply prescribing a pill.
Dr. Loren Marks is a chiropractor, board-certified clinical nutritionist and functional medicine practitioner. Dr. Marks is the founder of Integrative Assessment Technique (IAT), an assessment methodology embracing, nutritional biochemistry, emotions, and structural neurology. In 2018 he was the first chiropractor to ever present to the New York County Psychiatric Society on Methylation defects, mineral imbalances, and their role in mood, behavior and mental health. You can learn more about Dr. Marks at DocMarks.
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