By Dr. Mercola
Depression is a very serious health problem and can be terminal, as up to 30,000 people who are depressed commit suicide every year. But are antidepressants the best approach?
Contrary to popular belief, there are safer—and oftentimes far more effective—alternatives to the drug route, as explained here by Dr. Hyla Cass, a practicing psychiatrist who uses integrative medicine.
Dr. Cass appears regularly on TV and radio shows, and is an associate editor of Total Health Magazine. She also serves on the boards of California Citizens for Health and the American College for Advancement in Medicine (ACAM), of which I was a member for some time.
Her father was a doctor, practicing out of their home in Toronto, so Dr. Cass was exposed to medicine first hand from a very early age. Her father’s old-fashioned medical values of personal care and attention was the model of healing after which she eventually modeled her own career.
“Doctors really relied on their own judgment then. It wasn’t just a pill for every ill,” she notes. “In my own practice, I began to notice that what people ate and how they lived actually influenced their health.
People who were eating junk were not doing very well. People who were eating healthier, more natural foods, actually were feeling better, doing better, were healthier (have less colds, flus and all the rest), and even, were nicer people to be around!”
Why Focus on Natural Interventions for Depression?
Early on, Dr. Cass began searching for other doctors of like mind, and discovered a mentor in Dr. Abram Hoffer, the co-founder of “orthomolecular medicine.” This refers to the concept of nutritional deficiencies being a source of mental illness, and the right nutrients or molecules can correct the problem.
“While I was in my residency at Cedars-Sinai Medical Center, I began to notice that medications had side effects... It would be okay if the side effects were worth it, but most of the time they weren’t...”
Side effects of antidepressants run the gamut from sexual side effects to lack of emotions or “emotional flatness,” restlessness, sleep disturbances, brain damage, and thoughts (and actions, tragically) of suicide, and even homicide. Virtually all of the school and mass shooters, for example, have been on antidepressants.
“You could say, “Well, of course, they were on antidepressants. They were disturbed and that’s why they did the shooting.” But a comparable number of people who were not on antidepressants and having similar problems did not become school shooters,” Dr. Cass notes.
“The difference was, first of all, they were genetically predisposed to have that reaction to the medications -- but nobody’s looking at genetics when they prescribe medication.
These shooters were either just newly on medication, or had just had some sort of change in their medications or dosage; ie regardless of details, there was something going on with their medications before the event. And that’s a terrible tragedy. A lot of this information has been suppressed, too.”
Nutrition Is Essential for Proper Brain Function
Long before holistic health became a catch phrase, Dr. Cass began pursuing the use of nutritional supplements rather than medication, and lo and behold, her patients improved.
A huge drawback of the conventional mental health care system is that few doctors have the time, or take the time, to sort out the root of the problem with each patient. It’s a lot easier to simply write a drug prescription. Dr. Cass, on the other hand, takes the time to focus on finding, and then treating, the root cause.
“It’s so scary when you think of what these medications do. They’re not to be handed out the way they are. That really is disturbing to me. People think, “My doctor knows what he or she is doing.” Well, that’s not always true. I think it’s up to people to educate themselves,” she says.
“At Cedars-Sinai I was trained in a more psychoanalytic way. That’s actually good. It’s a Freudian model. I don’t practice that way now, but it was a good basis; understanding that there’s an unconscious and that we have scripts in us that are outside of our regular awareness.
And when we make them conscious, we actually are liberated . We can go on and live more fulfilling lives. I began looking first of all, at their psyche, but also at their lifestyle – what they were eating and drinking,and their attitudes. So many things go into being healthy.”
The Placebo Effect in Action
People can get quite defensive when you mention that antidepressants may be doing more harm than good, and that there are better alternatives. Many insist their whole life changed for the better once they started taking an antidepressant, and they cannot conceive living without it.
According to Dr. Cass, this can often be the placebo effect in action. You are in essence healed by your belief. If you think the drug will work, it likely will. But the same power of belief could be applied to virtually any other treatment modality, including a sugar pill.
One 2010 study1 concluded that there is very little evidence to suggest antidepressants benefit people with mild to moderate depression, as these drugs work no better than a placebo in at least 80 percent of cases.
An earlier meta-analysis2 published in PLoS Medicine also concluded that the difference between antidepressants and placebo pills is very small. Other research3 into the placebo effect noted that “the placebo effect is an unacknowledged partner for powerful medications.”
"Here we are with these miracle bodies. What we have to do is feed them right and treat them right, and we'll get the most wonderful results," Dr. Cass says.
“On the other hand, if we overuse or misuse medication, which is often the case, you’re just going to cause these side effects, some of them very dangerous, and won’t ever deal with the root cause.
We need to look at psychodynamics. But we also must take a look at nutritional status. Is there an infection? Is there toxicity? Is there a Vitamin B12 deficiency? Is there an iron deficiency anemia? There are so many medical issues that actually appear as depression.
When a doctor just hands you a prescription for an SSRI, they are not doing you a favor unless they’ve first given you a thorough medical workup, looking hormonal imbalance including thyroid or adrenal, or gluten sensitivity, to name a few of the possible causes.”
Gluten Sensitivity—A Common But Hidden Cause of Depression
You may not have realized this, but the gluten level in our grains is much higher today than it ever was before, thanks to various breeding techniques, and gluten can produce depression if you're sensitive to it. In such a case, the key is to remove gluten from your diet entirely. You cannot simply cut down. It must be removed completely. In Dr. Cass' practice, she's seen many people recover from severe depression when going gluten-free.
“They start to feel better, their mood improves. The depression, it turned out was really due to gluten sensitivity. And you may ask, “How can gluten affect your brain like that? What is going on?” It has to do with inflammation,” she explains. “When gluten is inflaming your gut, it’s also inflaming your brain. Whatever’s going on in your gut is also going on in your brain. They’re very connected.
The gut is the second brain. In fact, there are more serotonin receptors in the gut than anywhere else in the whole body. What I’m saying is, to summarize, it can be gluten sensitivity, thyroid imbalance, anemia, some kind of infection, Lyme disease, or chronic fatigue syndrome. Many medical issues will show up as depression. Depression is a symptom. Depression is not a condition. It’s not an illness; it’s simply a symptom...
We have this three-pound sophisticated organ, the brain,, the control center of our whole body, and it does not get evaluated. No one looks at it. You have a symptom of depression, anxiety, or insomnia, and you get a prescription. That’s crazy. That is not good medicine. I’m saying I’m not even practicing alternative medicine; I’m practicing good medicine.”
An important issue to address is junk food, which also promotes gut inflammation. So one of the first steps in addressing problems like anxiety and depression is to clean up your diet and address your gut health. Otherwise, you’ll have virtually no chance of getting healthy emotionally and mentally. As noted by Dr. Cass, there are times when temporary use of an antidepressant may be warranted, but such occasions are really quite rare.
"I think that if we use the right doses of specific herbs and supplements, and get exactly the right diagnosis, the right biological, biochemical diagnosis, we probably won't need to use the meds," she says.
High Dose Niacin for Psychosis
Before he attended medical school, the mentor I mentioned, Dr. Abram Hoffer, received a PhD in biochemistry specializing in vitamin B research. So when he became director of the largest psychiatric hospital in Saskatchewan, he used his knowledge to research the administration of high doses of niacin (vitamin B3) to schizophrenic patients.
Amazingly, he was able to get many of these very ill mental patients well enough to be released, get married and go on to lead normal lives. It turns out that pellagra, a disorder caused by niacin deficiency, produces the same psychiatric symptoms such as irrational anger, feelings of persecution, mania, and dementia that were found in many of these “ hopelessly incurable” patients. The cure was giving them the deficient B vitamin. Sadly, despite “performing miracles” on these hard-to-treat patients, Dr. Hoffer’s ground-breaking research was discredited by the American Psychiatric Association (APA), which was sadly more interested in promoting drugs.
“As long as the patients continued to take their niacin, as well as vitamin C, they were OK. On the other hand, nowadays if psychotic patients stop their medication, they may or may not relapse. This brings up another issue; we’re seeing more relapses than we used to in psychosis and depression. It may be due to the meds. Before people were on meds to the extent that they are, they would have a depressive episode, [then] recover and not necessarily have another one...But we’re now having far more chronically relapsing depression and psychosis than before the introduction of medication.
Moreover, we’re having more bipolar illness than we ever had. Something is going on. The medications are actually changing the brain. This is what is so scary. We have people who start off being depressed, being put on antidepressants for their depression, end up becoming bipolar, and then they’re placed on a whole cocktail of medications. And they’re kept on that cocktail indefinitely, which frequently ends their ability to function normally.”
How to Revert from Antidepressants to More Natural Treatments
If you’re currently on an antidepressant and want to get off it, ideally you’ll want to have the cooperation of your prescribing physician. Some doctors are happy to help you to withdraw if they know that you’re going to be responsible about it. Others may not want to bother, or they don’t believe that you can get off the medication. As noted by Dr. Cass, you may need to do some reading in order to be better prepared. Dr. Joseph Glennmullen from Harvard wrote a very helpful book on how to withdraw called The Antidepressant Solution.
You can also turn to an organization with a referral list of doctors who practice more biologically or naturally, such as the American College for Advancement in Medicine www.ACAM.org. Also, it doesn’t make much sense to withdraw unless you’re implementing some other strategy to address the cause of your depression. In summary, Dr. Cass suggests keeping the following guidelines in mind:
Under your prescribing physician's supervision, start lowering the dosage of the antidepressant you're taking. There are protocols for gradually reducing the dose of the medication that your doctor should be well aware of. At the same time, start taking a multivitamin. Start taking low doses. If you're quitting an SSRI under doctor supervision, you can go on a low dose of 5-Hydroxytryptophan (5-HTP). For bipolar patients, Dr. Cass and other holistic psychiatrists may prescribe nutritional supplements such as fish oil (omega-3 fats), inositol, tryptophan, and others, depending on the individual's need. Bipolar symptoms can also be related to Lyme disease, so if Lyme infection is present, that needs to be addressed, also by a more functionally oriented doctor. Chronic inflammation in general appears to be a significant underlying factor causing symptoms of depression, so keeping inflammation in check is an important part of any effective treatment plan. If you're gluten sensitive, you will need to remove all gluten from your diet. A food sensitivity test can help ascertain this. Vitamin D deficiency is another important biological factor that can play a significant role in mental health. A double-blind randomized trial4 published in 2008 concluded that ideally, it's best to maintain your vitamin D level between 50-70 ng/ml year-round. Unbalanced gut flora have also been identified as a significant contributing factor to depression, so be sure to optimize your gut health, either by regularly eating traditionally fermented foods, or taking a high quality probiotic. Make sure you’re getting enough high quality sleep, as sleep is essential for optimal mood and mental health. A fitness tracker that tracks your sleep can be a useful tool. The inability to fall asleep and stay asleep can be due to elevated cortisol levels, so if you have trouble sleeping, you may want to get your saliva cortisol level tested with an Adrenal Stress Index test. If you’re already taking hormones, you can try applying a small dab of progesterone cream on your neck or face when you awaken during the night and can’t call back to sleep. Another alternative is to take adaptogens, herbal products that help lower cortisol and adjust your body to stress. There are also other excellent herbs and amino acids that help you to fall asleep and stay asleep. Meditation can also help. A new piece of technology that can be quite useful is a headband sensor called Muse.6 It gives you real-time feedback on your brain wave frequencies, which can help train you to enter into deeper states of relaxation and meditation. I've been using it for 15 minutes twice a day for about six months, and I've noticed some really impressive improvements. Slowing your breathing through meditation and/or using the Buteyko breathing technique also increases your partial pressure of carbon dioxide (CO2), which has enormous psychological benefits. Other helpful tools to ease symptoms of depression and anxiety include Eye Movement Desensitization and Reprocessing (EMDR), and Emotional Freedom Techniques (EFT). EFT is well-studied, and recent research found it significantly increased positive emotions, such as hope and enjoyment, and decreased negative emotional states like anger and shame. Another recent review found statistically significant benefits in using EFT for anxiety, depression, PTSD, and phobias.
Many 'Depressed' Women Are Actually in Perimenopause
Amazingly, 23 percent of women over the age of 40 are on antidepressants. According to Dr. Cass, this is likely due to misdiagnosis of perimenopause or other hormonal imbalances. Women are entering perimenopause at younger ages these days; some even before the age of 40, and this phase can last for years.
“Women who have never had PMS or mild PMS are suddenly having bad PMS. They are feeling depressed and irritable. They’re yelling at their kids and their partners. They’re having a very hard time. They may be fatigued and feeling like they’re falling apart. What do they do? They go to their doctor, and guess what they get? They get a prescription for an antidepressant. Guess what they shouldn’t get? An antidepressant.
They need to get their hormones balanced. Start with all the usual things: good diet, make sure your liver is able to detoxify properly so you may need some liver supportive herbs like milk thistle or bupleurum. There are also well-researched herbs for menopausal and PMS symptoms like dong quai, black cohosh and vitex.
You can also move into bioidentical hormones. [They are] very safe, particularly progesterone. Very safe. When these women get the hormones that they need, they stop feeling anxious and irritable, and start to feel good again. Their PMS goes away. And it doesn’t take long: one or two cycles and they are likely feeling great. They have a whole new lease on life.”
For more information, please see Dr. Cass’ website, CassMD.com. She has also authored four books on these subjects: Natural Highs, 8 Weeks to Vibrant Health, and The Addicted Brain: How to Break Free, which details how to get off addictive substances including medications. Another book, Supplement Your Prescription, deals with detecting and treating the nutrient deficiencies caused by medications. All four books are available on her website. She also has a special report called Reclaim Your Brain, available for free on her site, in which she discusses the different nutritional substances you can use to address conditions like anxiety, depression, and lagging memory.