Depression, Biology, and Holistic Approaches

By: Garry Cooper, LCSW

Parts of this article appeared in the March/April 2008 Psychotherapy Networker

 

The antidepressant marketing blitz that’s sold millions of people on an overly simplistic connection between depression and low serotonin levels has obscured the fact that many psychiatrists have a much more complex view of depression’s biological causes and cures. A dramatic first-person article by Marlene Belfort in the October 30 New York Times helps alert therapists and the public that a malfunctioning thyroid, which regulates several hormones and neurotransmitters, can sometimes make therapy and antidepressants as useless as an umbrella in a hurricane.

Belfort, a research scientist in developmental genetics and bioinformatics with the Wadsworth Center of the New York State Health Department, writes that she had four years of psychotherapy for her mild depression, dealing with her father’s suicide and other issues. Three years after therapy successfully ended, she lapsed into a worse depression. She saw a psychiatrist, but despite different combinations and doses of antidepressants, her depression deepened into psychosis. She later had shock therapy, was better for a while, and then suffered three more relapses. Finally, her psychiatrist ordered a blood work-up, and discovered she suffered from hyperparathyroidism, a condition that affects about 100,000 Americans annually. Hyperparathyroidism is only one of several thyroid or adrenal disorders linked to depression. After two surgeries to control her hyperparathyroidism, Belfort has gone three years without another significant depressive episode and is cautiously optimistic.

How can therapists who treat moderate to severely depressed clients know when to think beyond psychosocial events and serotonin? In his 2000 book, The Antidepressant Survival Guide, psychiatrist Robert Hedaya, professor of psychiatry at Georgetown University, presents separate checklists to help determine whether a depression might be caused by malfunctioning thyroid or adrenal glands. Among the dozens of possible indicators: weak muscles (especially in the upper arms and thighs), unexplained weight fluctuation, dry skin, hair loss, swelling in the hands or feet, puffiness below the eyes, irregular menstrual periods, a craving for salty foods, excessive tiredness, dizziness or light-headedness when standing, an increased tendency to bruise, or darkening of the skin around elbows, knuckles, palms, knees, or nipples.

Although Belfort underwent several operations to control her thyroid, some thyroid and adrenal problems can be corrected with supplements and medications. For some adrenal problems, Hedaya recommends pantothenic acid (500mg, twice a day), folic acid (800 mcg, twice a day), B-complex (1,000 mg, twice a day), and zinc (25 mg, once a day on an empty stomach). It’s important to note a few points, however, when trying to treat depression with supplements and vitamins. First, physicians and/or certified nutritionists should always be consulted when embarking on any such program, especially when clients are already on medications. Even natural supplements can have serious interactions with medications. Second, many supplements are not under FDA control. Thus, no matter what the labels say, dosages can vary from bottle to bottle or even from pill to pill. When taking supplements, it’s always a good idea to consult a nutritionist for the most reliable brands. Third, anyone taking antidepressants should withdraw slowly, carefully, and under a physician’s supervision. If one is to consider substituting supplements and vitamins for antidepressants, it’s essential to do the transition gradually and under a physician’s supervision. Because not all physicians are adequately informed about nutritional supplements and antidepressant withdrawal, it’s important to choose a physician who’s well-versed and respectful about both.

Hedaya has developed a five-day jumpstart program for depressed patients which he claims will increase the effectiveness of antidepressants, eliminate or significantly reduce their side effects, and can in many cases eventually become a substitute. As with any treatment regimen, much of its success depends upon the client’s readiness to change, so it’s not enough to merely tell a client about the program and present it. Therapists should spend as much time as necessary assessing and buttressing the client’s readiness to change. Unless this is done, the client is much more likely to fail to follow the program, which will reinforce the sense of helplessness and hopelessness associated with depression. Clients must agree to give up for five days all caffeine (which includes chocolate), refined sugar and alcohol. They should be warned about the temporary effects of caffeine and sugar withdrawal—headaches, weakness, and sleepiness—so that they don’t become discouraged. The dietary part of the program avoids red meat and processed foods and substitutes whole grains, vegetables and fruit. (A meal by meal diet is included in Hedaya’s book). The exercise program, also outlines in detail, involves both aerobics and strength training. Again, before recommending an exercise program, therapists should ensure their clients, especially sedentary or out of shape ones, seek a doctor’s advice and/or a certified exercise physiologist or physical trainer.

Hedaya’s five-day program may help in several ways. First, a healthy diet and exercise are likely to improve quality of life. With conditions like depression, a chicken-and-egg situation often exists: poor quality of life and depression feed each other, just as good quality of life and sense of well-being also feed each other, and it’s not always possible to say which follows which. Second, embarking on a healthy program not only creates physical and psychological changes, but just doing it engenders a sense of hope and empowerment, which are powerful antidotes for depression. In clinical trials of antidepressants, placebo and treatment expectations reliably work a third of the time; when people believe they’re doing something that will help them, they’re often helped.

Perhaps the primary lesson of Belfort’s article and Hedaya’s book is that not all therapists pay sufficient attention to possible biological causes of depression. They are reminders that therapists should always consider underlying physical conditions. Equally important, therapists should make sure that they refer to psychiatrists who consider thyroid and adrenal problems and a holistic approach, instead of those whose first impulse is to hand out an antidepressant prescription. With adrenal and thyroid problems in particular, simple blood tests may head off months of anguish and deterioration.

RESOURCES

Belfort, M (2007). “Emotional Abyss; Physical Cause?” New York Times, October 30, 2007

Hedaya, RJ (2000). The Antidepressant Survival Guide. New York: Three Rivers Press