by Heidi Toy
Theresa was 34 years old when she came to see me. She was in therapy to deal with past issues of an abusive childhood. She was leading a productive life up until she started to experience increasing fatigue, depression, anxiety and difficulty sleeping. She had increased stress at work and lessened productivity. She went to her primary care provider (PCP) who did a routine workup of thyroid, CBC labs etc., and was told, “there is nothing wrong.” Yet she still felt terrible and the fatigue and depression continued and increased. She went back to the same PCP and was prescribed Lexapro and reported no change in symptoms. Two weeks later, Abilify and Ativan were added. At this point in time Theresa was on three psychotropic medications and still no resolve. The PCP then referred her to a psychiatrist who four weeks later added on Wellbutrin with still no change in her depression and fatigue, so eight weeks later Lamictal as a mood stabilizer was added. At the four-month mark, Theresa was taking several medications and she still felt miserable, and her words to me were, “I feel worse.”
Depression is costly to society. It is ranked as the second leading cause of disability in the world and is estimated that by 2030 it will be the number one reason for disability. Medical literature suggests that 94% of antidepressant clinical trials have positive beneficial results. Since approximately one-third of the negative trials submitted to the FDA were never published, that number is closer to 51% [1]. Conclusion: About half the antidepressant trials failed to show a benefit that exceeded that of a placebo.
Our current model for the treatment of depression is limited. The STAR*D study, an independent non-pharmaceutical sponsored study consisting of 4,000 patients being treated for depression, found that more than two-thirds of the patients still had unresolved symptoms of depression after twelve weeks of taking prescribed antidepressant medication. [2]
In brief, we need to do a better job!
Symptom based diagnosis and symptom treatment has no concept of individuality, as in Theresa’s case. If one meets the clinical criteria listed in the DSM 5 for depression, then they are prescribed psychotropic drugs and “why” they have depression is not ferreted out. This is where functional medicine differs from the conventional medical model. We ask why and look to balance digestion, detox, and neuroendocrine body systems, allowing the body to heal itself. Nutrition is the foundation of this work.
Neurotransmitter dysfunction, the base of depression, can be caused by genetics, stress, inflammation, toxins, and/or diet. I asked to see Theresa’s routine labs that the PCP had run to determine if there were any nutritional deficiencies in Iron or B12. There weren’t any. I took it a step further and ran an amino acid test and found that her essential amino acids were dramatically low. Most people with low level amino acids will not be able to make the neurotransmitters needed by the brain.
Amino acids are derived from eating protein. They are what we get when our body breaks down, digests, and absorbs protein. To adequately do this, we need stomach acid. If one is deficient in stomach acid or has heartburn, GERD, or is living on an acid blocker/ proton pump inhibitor, then stomach acid will be deficient and therefore digestion of food and the breakdown of protein for amino acids will be absent. Without amino acids we cannot make neurotransmitters, and without neurotransmitters the brain cannot run adequately.
Theresa was eating a healthy diet. So, what was the problem? The problem was that Theresa was not digesting her food, and if you cannot digest your food, you cannot absorb the nutrients from your food.
We added low-level, free form amino acids and the adjunct of digestive aids and within two weeks Theresa was feeling better. In four weeks she reported she was “back to herself,” simply because we treated her as an individual, not a symptom. We asked, “Why?” and we addressed the why.
Heidi Toy is a Nutritional Therapy Practitioner, and the owner of Heidi Toy Functional Medicine/Educated Nutrition, located in Eau Claire, WI. Her focus is helping people heal holistically, with an emphasis on autoimmune, digestive, weight, female hormone, and depression issues.
Citations
Turner et al., (2008). The New England Journal of Medicine, 358: 252-260
STAR*D = Sequenced Treatment Alternatives to Relieve Depression. Trivedi MH et al., Am J Psychiatry 206: 163; 28-40