Are Mood Disorders an Epidemic?

Depression has a profound impact on society. According to the World Health Organization, depression is the leading cause of disability in the U.S. for people ages 15-44. Mental Health America reports $31 billion worth of productive time is lost each year to depression among U.S. workers. Mood-altering drugs are being dispensed at record levels.

Unfortunately, antidepressants do not work for everyone and many have frequent, unwanted side effects. Testing for the physical issues that cause or exacerbate depression is the first step in defeating this debilitating disorder. Treating metabolic or nutritional conditions can mitigate symptoms.

Depression is a complex disorder with many different symptoms, causes and treatments. Just as individuals are unique in their genetics, appearance, and personality, each case of depression is equally diverse.

The factors that contribute to depression are different in each patient and must be identified to effectively treat the disorder. Potential contributors include sleep disorders, poor digestion, food allergies, vitamin deficiencies, immune reactions, hormone levels, oxidative stress, detoxification capacity, inflammation, as well as the psychological and spiritual state of the patient.

Treatment for depression is often based on a list of subjective symptoms, not based on the individual’s pathology. Any improvements achieved from this one-size-fits-all approach are often temporary. Once the treatment stops working another pharmaceutical is prescribed. Some patients will remained trapped in this endless cycle of ineffective drugs for years.

Integrative Psychiatry is a method that treats both the mind and body. It is necessary to care for the whole patient, not just the disease. An evaluation of each patient’s biochemistry and nutritional needs is essential for effective treatment. The goal is to restore health for the long-term, not just reduce symptoms.

Integrative psychiatry offers new hope for those suffering from treatment-resistant depression and can augment traditional approaches for better treatment outcomes.

Experts and researchers from many fields have offered many theories as to the dramatic increase in depression in our society. One theory cites nutritional deficiencies as evident in the current popularity of overly-refined, processed foods that are deficient in trace minerals. About Mood DisordersDepressionDepression is a collection of unpleasant emotional and physical symptoms that can be disabling. Patients are often labeled psychosomatic and prescribed antidepressants. Depression can affect anyone but is most common in women. But because antidepressants are most commonly studied on middle-aged adults, adolescents and the elderly are the most vulnerable to adverse reactions to pharmaceutical treatments.

Bipolar DisorderIndividuals suffering from bipolar disorder, or manic-depressive illness, cycle between extreme happiness and sadness. Imbalances in neurotransmitters and hormones are thought to affect both the onset and severity of the disorder. Other triggers include genetic susceptibility and environmental factors. As with depression, physiological disturbances may worsen symptoms.

Mental Health Panels

Comprehensive laboratory testing can identify the physiological imbalances that contribute to a disorder and point to an individual treatment approach. The Mental Health Panels consist of tests that have been useful for patients with mental health disorders.

Comprehensive Mental Health PanelAdvanced Cholesterol Profile

Amino Acids Plasma/Urine Test Comprehensive Fatty Acids TestComprehensive Stool Analysis

Copper/Zinc Profile Gluten/Casein Peptides Test

IgG Food Allergy Test Metals Red Blood Cell Test

Organic Acids TestVitamin D Test

Basic Mental Health PanelAmino Acids Plasma/Urine Test Comprehensive Fatty Acids Test

Gluten/Casein Peptides Test IgG Food Allergy Test

Metals Red Blood Cell Test Organic Acids Test

An Integrative Approach to Depression & Bipolar DisorderApproximately 21 million American adults have a mood disorder

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Evaluating The Patient

Clinical assessment of a patient’s symptoms, a thorough medical history, and appropriate laboratory testing are the foundation for an effective treatment plan.

Folate & HomocysteineHomocysteine is a functional marker of folate, and vitamins B6, and B12 deficiencies. Research has found that up to one third of severely depressed patients also have folate deficiencies. The Advanced Cholesterol Profile includes homocysteine and thus can identify these deficiencies related to depression.

Gastrointestinal HealthAssessment of gastrointestinal function is a crucial first step in identifying a chronic candidiasis or yeast/bacterial overgrowth of the GI tract. The Organic Acids Test (OAT) includes measurements of urine metabolites produced by yeast or by dysbiotic bacteria. This test indicates if candidiasis or Clostridia bacteria are playing a part in depression or other psychiatric disorders. The HPHPA metabolite of the Organic Acids Test has been associated with schizophrenia, autism, obsessive compulsive disorder, hyperactivity, depression, and chronic fatigue.Severe digestive symptoms suggest that a Comprehensive Stool Analysis (CSA) is needed. Clinical observation suggests that by-products of intestinal microflora may contribute directly to mood disorders and depression, and that an inflamed immune system affects the nervous system. The CSA includes cultures of yeast and potentially pathogenic bacteria, as well as assesses overall digestive health, inflammation, and immune competency.

Nutritional DeficienciesLack of adequate nutrients affects mood as it does overall health. Antioxidants and B-vitamins as measured in the Organic Acids Test will show underlying nutritional deficiencies or functional disturbances. Several trace minerals are typically low in the Western diet, but magnesium and zinc are the most important missing minerals. The Metals Hair and Metals Red Blood Cell Tests evaluate several essential metals, including calcium, copper, iron, magnesium, zinc, and more.

Neurotransmitters & B-VitaminsNutrient deficiencies can result from poor diet or absorption in the gut. Prealbumin is an excellent marker for inadequate dietary protein. The Organic Acids Test measures the metabolites of neurotransmitters like norepinephrine, dopamine, and serotonin and also measures vitamin C and vitamin B6, important cofactors in the production of neurotransmitters. For example, B6 is directly required for synthesis of dopamine, norepinephrine, and serotonin. Immune system activation also stimulates production of quinolinic acids, a neurotoxic compound. In addition, the Organic Acids Test includes a major bacterial metabolite HPHPA that alters the metabolism of neurotransmitters. The Amino Acids Test measures neurotransmitter precursors like tryptophan and tyrosine; deficiencies of these amino acids may lead to depression or eating disorders.

Essential Fatty AcidsThe unsaturated fatty acids found in fish, grass-fed animals, eggs, and some plant oils, are essential to the proper functioning of the brain and nervous system. Fish oils are being used extensively for alleviating symptoms of mood and behavior disorders. The Comprehensive Fatty Acids Test evaluates the deficiencies of all essential fatty acids.

Copper/Zinc BalanceImmune dysfunction can have negative effects on mood and contribute to depression. Low zinc is associated with depression and anorexia. Copper is required for synthesis of the norepinephrine and dopamine neurotransmitters, which are essential for mental health. Low blood copper can lead to symptoms of depression. A deficiency of the copper-binding protein ceruloplasmin can cause anemia. Abnormally high copper has been associated with aggression, paranoia, and anxiety. The Copper/Zinc Profile (includes copper-binding ceruloplasmin) will identify any critical deficiencies or excesses.

Food Allergy & OpiatesStudies support the theory that food/chemical allergies can contribute to symptoms of depression, schizophrenia, and other mental disorders. The IgG Food Allergy Test serves as a guide to food elimination/challenge diets. In addition, when foods such as casein (milk)

and gluten (wheat) are digested, they may act as opiates in some patients, which can influence mood and cognitive ability. The Gluten/Casein Peptides Test can assess inadequate digestion of wheat and dairy products.

CholesterolInadequate hormone levels can affect mood and cognitive ability. Cholesterol is critical for the production of brain myelin and the brain development protein Sonic Hedgehog. Low cholesterol may prevent sufficient production of adrenal and sex hormones and is prevalent in depression, bipolar disorder, and autism. Individuals who have substance abuse problems are much more likely to relapse if they have low cholesterol. The Advanced Cholesterol Profile can determine if a cholesterol deficiency is present or if cholesterol is elevated. This profile also measures homocysteine which may be elevated in vitamin deficiencies as well as lipoproteins commonly deficient in mental illness.

HormonesThyroid hormone function requires iodine, measured in the Metals Hair Test. The Vitamin D Test is important to ensure that the patient has adequate levels of this multi-purpose vitamin that is now recognized as a hormone. Studies strongly indicate that both low thyroid activity and low levels of vitamin D contribute to the onset of depression and other mood disorders.

Toxic Environmental ExposureEven small amounts of lead and mercury are associated with increased hyperactivity, depression, criminal activity, and panic attacks. The Metals Hair and Metals Red Blood Cell Tests screens for all common toxic metals such as lead as well as for essential elements that can be toxic at high levels. The Organic Acids Test, checks for a variety of toxic chemicals that may impair brain function andpsychiatric disorders including organophos -phates, benzene, toluene, and many others.

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RESEARCH STUDIESNutritional Effects on Depression & Bipolar Disorder

Omega-3 Fatty Acids in Major Depressive DisorderPatients with major depressive disorder have high rates of cardiovascular disease and other medical comorbidity. Omega-3 fatty acids, particularly those found in fish and seafood, have cardiovascular health benefits and may play an adjunctive role in the treatment of mood disorders. …Epidemiologic and treatment evidence suggests that omega-3 fatty acids may play a role in the prevention and amelioration of mood disorders, particularly depressive disorders… higher per capita fish and seafood consumption is associated with lower prevalence rates of MDD, postpartum depression, and bipolar disorder.

Freeman, MP, J Clin Psychiatry, 2009;70(suppl 5):7-11.

Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues

Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin, is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine… Three commercially available folate formulations, folic acid, 5-methyltetrahydrofolate (5-MTHF; also known as 5-methylfolate and L-methylfolate), and folinic acid, can be used adjunctively with antidepressants and may have a role in improving MDD remission rates… augmentation with folate may enhance antidepressant efficacy from the start of treatment or convert partial and nonresponders into responders or even into remitters.

Maurizio, F and Mischoulon, D. J Clin Psychiatry, 2009;70(suppl 5):12-17.

L-methylfolate-Antidepressant Combination Therapy at Treatment Initiation for a Major Depressive Episode Produces Major Clinical Improvement and Decreases Time to Symptom Reduction

Compared to antidepressant monotherapy, the combination of L-methylfolate plus antidepressant therapy produced significantly greater improvement in CGI-S scores within 60 days. 18.1% of the L-methylfolate combination group versus 7.04% of the control group achieved major improvement in depressive symptoms, functionality and behavior… The significantly higher percentage of patients in the L-methylfolate plus antidepressant group with improved CGI-S scores suggests that this treatment is efficacious in reducing symptoms of MDD. A shorter time to improvement indicates a more rapid response to antidepressant treatment, which is likely to reinforce compliance with drug therapy.

Ginsberg, L et al., Poster presented at the annual Conference of the Virginia Council of Nurse Practitioners, March 2010..

The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled TrialMost epidemiologic studies evaluating the association between depression and fish and seafood consumption have reported statistically significant inverse association. In addition, the majority of studies examining omega-3 and omega-6 levels in serum phospholipids or red blood cell membranes have found lower levels of omega-3 and higher omega-6 to omega-3 ratios in individuals with depression than in controls.Lesperance, F et al., J Clin Psychiatry, 2010.

Effect of Omega-3 Fatty Acids Supplementation on Depressive Symptoms and on Health-Related Quality of Life in the Treatment of Elderly Women with Depression: A Double-Blind, Placebo-Controlled, Randomized Clinical TrialThis double-blind intervention study shows that the supplementation with 2.5 g/d of n-3 LCPUFA for 2 months is associated with a significant reduction in depressive symptoms among elderly patients with major depression or dysthymia… Another relevant advantage observed in this study is that the supplementation with n-3 LCPUFA is associated with a significant amelioration of quality of life. After 2 months of treatment, the group of patients who received the supplement showed a significant amelioration of physical and mental function, as demonstrated by the SF-36 score.Rondanelli, M et al., J Am Coll Nutr, 2010; 29(1):55-64.

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Comprehensive Mental Health Evaluation

Depression & Bipolar Disorder

Conclusion

Medically, depression and other mood disorders are treated as brain disorders separate from the rest of the body. The role of genetics in patients predisposed to depression is emphasized; studies indicate that mood disorders sometimes run in families. Physical human variation such as the size of the hippocampus in the brain and the number of serotonin receptors are being studied as possible risk factors for depression.

Treatment of mood disorders begins with an understanding of the patient’s biochemical profile, focusing on any abnormalities that may be contributing to symptoms. Comprehensive laboratory testing can identify the physiological imbalances that contribute to a disorder and focus treatment options. Test results can help medical practitioners create a treatment plan designed to restore balance and optimize function through nutritional support and diet. This integrative approach can enhance and reinforce traditional treatment methods, increasing the chance of recovery.

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