Take a mind-body approach to treating depression, anxiety
By Dr. Martin Gleixner, MSc, ND
Depression and anxiety are common mood disorders affecting many Canadians.
It can be debilitating, but it is treatable.
"Stop feeling sorry for yourself," "Calm down," "Try to relax," "Get out more," or "Get over it," are common pieces of advice that only contribute to making the person feel even more helpless.
A January 2010 report published in the Journal of the American Medical Association, involving nearly 800 patients, examined the effectiveness of two commonly prescribed antidepressants, paroxetine (Paxil) and imipramine. This study found the drugs produced benefits only slightly greater than a placebo in patients with mild to moderate depression. Treatment alternatives without drug side-effects are therefore warranted.
Naturopathic care includes a medical assessment and diagnosis evaluation, including the interpretation of laboratory results. Treatments includes nutritional and exercise suggestions, the use of specific vitamins or minerals in medicinal doses as well individualized herbal or homeopathic combinations to address underlying functional or pathological imbalances.
Equally important is a mind-body approach that includes the integration of counselling practices and relaxation and stress management techniques.
Is it as simple as using natural remedies such as St. John's Wort or vitamin B12 commonly used to treat mood disorders? Although these remedies can be helpful, for a more deep acting and long-lasting effect it is important to consider a whole-body approach.
Whether it's serotonin (or other neurotransmitter) imbalances in the brain, hormone deficiencies, or inflammation in the body, the key is to first understand and address your own unique medical predispositions that are contributing to depression and anxiety.
This same concept is also very useful to help us understand the underlying causes of mood changes.
Let me review this analogy again. Let's think of our body as a bucket. Generally we are born in a state of health; our bucket is empty. As we go through life, a number of factors can interfere with our health. Perhaps it's a lack of sleep or exercise, a stressful job, pushing oneself too hard, feeling exhausted, excessive worrying or poor dietary choices that can contribute to increasing the level in our bucket. The level in our bucket represents our health status. Declining health comes with rising levels, an indication that the body is out of balance.
We are also exposed to a great number of toxins during the course of our lifetime. Our lung, kidneys, digestive tract, and liver can normally remove most toxins on a daily basis, but sometimes these detox mechanisms become inefficient or overwhelmed.
In addition, key systems in the body (such as the nervous or hormonal systems) can become imbalanced which can put the 'squeeze' on the bucket thereby significantly contributing to raising the level in the bucket. Deficient or inappropriate secretions of neurotransmitters or hormones are very important factors involved in both anxiety and depression.
Eventually, our bucket can overfill, leading to changes in our mood as well as other symptoms such as insomnia, fatigue, skin reactions, muscle aches and pains, and unexplained weight gain (or loss).
So what can one do to address an overfilled bucket? We don't want to put a lid on the bucket by suppressing symptoms. Such quick fixes or band-aid solutions rarely work for the long-term and do not enhance overall health status. Rather, a more long-lasting way to improve our mood is to address all aspects that are causing our bucket to overfill.
* Step 1: Rule out physical causes
Too commonly patients are treated for depression without sufficient detective work. Discuss with your medical doctor or naturopathic doctor to investigate any physical (i.e. pathological) causes for depression and anxiety. Thyroid disease, fibromyalgia, drug side-effects, and many serious chronic diseases are common causes of depression and other mood disorders.
Once a physical cause is ruled out, functional imbalances in the body should also be assessed and treated accordingly (as discussed below).
* Step 2: Address lifestyle factors
Numerous research studies have shown that exercise benefits both anxiety and depression. Not only does it provide a jolt of endorphins that can be enjoyed short-term, it provides a substantial boost in confidence that is required for long-term lifestyle changes. Increased blood flow to the brain provides pulses of nutrients and oxygen to the brain that are required for healing. The increased circulation also allows improved venous return, that is, old blood that carries waste and toxins away from the brain so that the body can excrete it.
A full night of restful sleep heals the body by reducing inflammation and balancing the nervous and hormonal system. It also improves daytime energy levels, which goes a long way to improve mood.
Nutritional deficiencies can occur with dietary restrictions, and insufficient whole foods. Addictions such as cigarette smoking, alcohol or other recreational drugs are common in mood disorders and can cause further depletion of many nutrients that are important for the nervous system.
* Step 3: Balancing body systems
As shown on the left-hand side of the 'bucket' diagram, imbalances in key systems (especially the hormonal and nervous system) are important causes of mood changes.
Most commonly, mood disorders are associated with neurotransmitter imbalances, such as serotonin (and dopamine). In order to successfully treat the underlying cause of mood disorders, addressing what created the imbalance in the first place is paramount.
Deficiencies in vitamin B12, folate and vitamin C for example, which activate enzymes that manufacture serotonin are important considerations. Our thoughts and behaviours are also believed to affect serotonin levels. Stress in any area of life (such as finances, work, or relationships) appears to decrease the availability of serotonin in the brain.
Herbal medicines are helpful to balance serotonin levels and to decrease the negative effects of stress on the body by reinforcing the nervous system.
Counselling and self-exploration can identify and improve our emotional and mental states. Byron Kate, author of 'Loving What Is' offers an excellent framework that one can use to move forward in the emotional realm. Many more exist.
Whether you prefer a one-one approach through psychological counselling or the use of self-help books, the key is to start somewhere.
Hormonal imbalances also have a strong influence on mood. Mood changes in premenstrual syndrome (PMS) often occur due to progesterone deficiency (or estrogen dominance). Many women also experience depression after childbirth. An article published in the British Medical Journal (1994), found that among 120 women, those who scored highest on postpartum depression scores were those with the lowest progesterone levels.
Since the placenta no longer provides progesterone, the adrenals become an important source of progesterone. It is possible, therefore, that adrenal exhaustion is an important contributing factor in post-partum depression.
Individualized prescriptions of herbal tonics and specific vitamins or minerals in medicinal doses that support and balance hormones in body are invaluable in these situations.
* Step 4: Optimize organ function
Many of our organs have the main role of taking in what the body needs (water, nutrients, oxygen) and removing what it doesn't need (excess water, metabolic waste products, toxins and carbon dioxide). Since a healthy nervous system is best obtained through a healthy body, improving the function of the lungs, kidneys, digestive tract and liver is also important. Through breathing, urination and bowel movements, these organ systems are consistently repairing and renovating our body.
Digestive health is particularly important because it has it's own nervous system (called the enteric nervous system). Our gut's nervous system contains 100 million sensory neurons, which, like the brain, also produce large quantities of serotonin. The gut-brain axis involves a constant exchange of chemical and electrical messages.
For many, poor digestive function can influence neurotransmitter levels and therefore affect our moods. Whether it's a motility issue (as in irritable bowel syndrome, or constipation and diarrhea due to other causes) or it's inflammation and abnormal flora in the gut (as in peptic ulcers, Crohn's disease and ulcerative colitis), improving digestive health can address one of the underlying causes of depression and anxiety. After all, most people would agree that a good poo lifts the spirit!
As always, a combination of naturopathic approaches tailored to each individual provide the best clinical results. The underlying causes for depression and anxiety are often unique to each individual and as such, deserve specific attention.
Published by Dr. Gleixner on Wednesday March 3rd, 2010 in Times & Transcript.
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