Tag Archives: antidepressant

How Your Diet Affects Your Mood

Depression and Bipolar

Food is fuel.  The fuel we put into our body determines how efficiently it runs.  It’s a pretty simple concept yet when it comes to brain function there is a disconnect for many physicians.

When people come to me for help with various conditions, dietary changes are almost always part of the program.  They are especially important if someone if suffering from a mood disorder.

If a poor diet can lead to poor function of the heart, gall bladder, immune system, pancreas, intestines, etc., then why couldn’t it lead to poor brain function? It can, but it’s always overlooked by traditional medicine.  Let me explain.

The Basics

Remember, food is fuel.  The neurons in your brain consume up to 40% of your circulating blood sugar at a resting state.  That figure can jump up to 80% when your brain is working hard like studying for a test or doing your taxes. Your blood sugar is the fuel your brain needs to keep going.

Low blood sugar occurs when people do not eat frequently enough or in an amount that satisfies the demands for energy of the entire body, including the brain.  Low blood sugar, or hypoglycemia, causes mood to change.  Most notably, people experience irritability. This irritability is relieved by simply eating food and allowing your blood sugar to rise back to a normal level.  Next time you’re feeling irritable and you haven’t eaten in a few hours, try eating a healthy snack.  It might just be the fix you’re looking for.

If something as simple as low blood sugar can alter your mood, what else can?

Alcohol

Alcohol is consumed the world over mainly for one reason and one reason only – it has mind altering properties. Let’s face it; alcohol does not taste good in the way that ice cream does.  People are not consuming it solely for the taste. The per capita consumption of ethanol in the United States is 2.31 gallons per year.  That means, on average, every American over the age of 15 consumes 2.31 gallons of pure alcohol per year.  This is equivalent to 702 beers, 410 glasses of wine or 197 shots per year, per person.

Alcohol works on the brain by affecting the neurotransmitter GABA.  GABA is an inhibitory neurotransmitter in the brain.  Initially, consuming alcohol elevates mood and reduces anxiety and stress.  As a matter of fact, most current pharmaceuticals aimed at reducing anxiety work by acting on GABA.

However, continuing to consume alcohol has a downside.  When consumed to excess, moods begin to go down and depression is often the consequence.  It also causes sleepiness which illustrates alcohol’s powerful depressive effects.  Always remember, alcohol is a depressant and it’s this way because it acts on the inhibitory neurotransmitter in the brain called GABA.

How Foods Affect Our Neurotransmitter Levels

A few weeks ago I wrote a post about neurotransmission and how getting your neurotransmitters measured is a good way to assess your mood status and possibly change it for the better.  I went into the details of some neurotransmitters and it would be good to read before continuing to read this post.  Click here to view it.

The neurotransmitters in our brain allow one nerve to talk to the next.  It is the level of these neurotransmitters, to a large extent, that govern how we feel.  Low levels of some neurotransmitters lead to anxiety while others may lead to depression.  The interplay between all of them is complex and a problem with mood is often due to more than low levels of a single neurotransmitter but there are primary players to blame in each mood disorder.

Carbohydrate Heaven

Many people have noticed that when they eat a meal that is high in refined carbohydrates they notice an elevation in mood.  So much so that people can often become addicted to this type of food just to feel good.  This is for one very real physiological fact – eating refined carbohydrates increases serotonin production in the brain.

Serotonin is the neurotransmitter that most of the anti-depressant drugs like Prozac and Paxil work on.  They work by tricking the brain into thinking it has more serotonin than it actually does.  Consuming refined carbohydrates works by actually increasing serotonin levels.  Here’s how.

There is a barrier between our brain and our blood.  It prevents things from getting into the brain that should not.  It is very effective.  However, it also prevents necessary nutrients from getting in as well.  They need a special pass to  get in.  This includes the amino acid tryptophan. Tryptophan is what the body uses to make serotonin.  If one consumes a diet very low in tryptophan, serotonin levels are likely to be low.  Tryptophan is found in foods that contain protein.

In order for tryptophan (an other amino acids) to get into the brain a transporter system exists.  It is called the large neutral amino acid transporter or the LNAA.  Competition for the LNAA is fierce.  Tryptophan is a weak competitor.  It is often left out of brain except when refined carbohydrates are consumed. When refined carbohydrates are consumed high amounts of insulin are secreted.  Insulin sends free amino acids out of our blood into our muscles when it is circulating.  Because tryptophan is a bound to albumin it is left unaffected by this process.  It is now free to circulate up to the brain where competition for the LNAA is now low and it gets into the brain more easily.  It also allows more serotonin to be produced.

Now, I hear what you’re saying.  I am not suggesting you go eat tons of refined carbohydrates to feel good!  As a matter of fact you should avoid them because they just lead to a blood sugar crash later in the day resulting in irritability.  Now you’re irritable and depressed – not a good combination!

What you should do is make sure you eat foods that are high quality proteins.  This includes mostly animal products like meat and eggs.  Also, supplementing your diet with 5-HTP is helpful.  This is the direct precursor of serotonin and is in fact a type of tryptophan. It passes into the brain freely and does not compete for the LNAA.

Not Enough B6

Vitamin B6 is an essential vitamin in many ways.  In terms of brain health, it is essential to allow the conversion of the neurotransmitter glutamate into GABA.

Glutamate is the primary excitatory neurotransmitter in the brain.  When levels are too high seizures are known to occur.  At lower levels anxiety occurs.

GABA is the primary inhibitory neurotransmitter.  At very low levels seizures occur and when levels are slightly decreased anxiety is the result.

Glutamate ——–> GABA – GABA is converted from glutamate and B6 is required to do this.

A diet that is low in B6 will cause glutamate to build up in the brain and GABA levels will be low.  This may result in anxiety.  Foods that are highest in B6 are:

  • Spinach
  • Bell peppers
  • Turnip greens

Consuming these on a regular basis may help if your problem is the conversion of glutamate to GABA.  You may also have to supplement with B6.  This is easy to find over the counter.

No Fish? No Happy

Omega-3 fatty acids have been touted to help everything from heart disease to pain and inflammation.  Research also points to another aspect.  Brain health.  People who have the lowest level of a particular omega-3 called DHA report depression as a problem significantly more than people with the highest levels of DHA.

DHA is important for growing babies, but research is starting to show that it is important for overall brain health for adults as well.

Just how it wards off depression is not clear.  One theory suggests that because DHA is important for the insulation surrounding the nerves, low levels may prevent neurons from communicating effectively.  Whatever the reason, the research is pretty clear that low levels are not good for optimal brain function.

Consuming fish regularly is a good step.  However, more people will not be able to consume enough fish to get enough DHA.  Consider supplementing with a fish oil that is high in DHA.  Most nutrition companies now make fish oil that is high in DHA.  This may help ease your depression and prevent further episodes.

This list could go on and on.  The moral of the story is that what you eat can have a significant impact on how you feel.  If you want to feel good, inside and out, you must eat a healthy diet.  Hopefully some of these tips have helped.

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Pregnancy, Depression and Drugless Relief

Up to a quarter of all women suffer from depression during pregnancy, and many are reluctant to take antidepressants. Now a new study suggests that acupuncture may provide some relief during pregnancy, even though it has not been found to be an effective treatment against depression in general.

The Stanford University study recruited 150 depressed women who were 12 to 30 weeks pregnant, and randomly assigned 52 to receive acupuncture specifically designed for depressive symptoms, 49 to regular acupuncture and 49 to Swedish massage.

Each woman received 12 sessions of 25 minutes each; those given acupuncture did not know which type they were getting. (In the depression-specific treatment, needles are inserted at body points that are said to correspond to symptoms like anxiety, withdrawal and apathy.)

After eight weeks, almost two-thirds of the women who had depression-specific acupuncture experienced a reduction in at least 50 percent of their symptoms, compared with just under half of the women treated with either massage or regular acupuncture.

There was no significant difference in the rates of complete remission — about a third in each group. The findings appear in the March issue of Obstetrics & Gynecology.

The lead author, Rachel Manber, a professor of psychiatry and behavioral sciences at Stanford, said the results suggested that some symptoms of depression during pregnancy might be related to physical discomfort that is alleviated by acupuncture.

Still, the results were striking, she said, adding, “It’s quite remarkable, especially since the prevalence of depression is highest in the third trimester of pregnancy, so it goes against the course of how you would expect depression to go.”

via Vital Signs – Pregnancy – Some Depression Relief, Without Drugs – NYTimes.com.

Dr. Court’s Comments

Taking any drug is dangerous during pregnancy.  The fact that acupuncture can provide some relief is wonderful news.  Tissues that are most likely to be affected by pharmaceuticals are tissues with high metabolic activity.  Every single tissue in a baby’s body is highly metabolically active because it is growing so fast.  What is particularly scary is that most doctors will say you must weigh the benefits of taking them against the risks, yet antidepressants have shown to be no better than placebo at helping depression! To expose a growing fetus to a drug that has little to no actual value should be criminal.

Below is a list of drugs that are approved for use to treat depression and their potential side effects on growing babies.

Citalopram (Celexa)

Risks: Has been associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with a birth defect that affects the brain and skull (anencephaly), a birth defect that affect sutures on the head (craniosynostosis) and a birth defect that affects the abdominal organs (omphalocele)

Pregnancy Category C (see below for key)

Fluoxetine (Prozac, Sarafem)

Risks: Has been associated with PPHN when taken during the last half of pregnancy

Pregnancy Category C (see below for key)

Paroxetine (Paxil)

Risks: Has been associated with fetal heart defects when taken during the first three months of pregnancy; has been associated with PPHN when taken during the last half of pregnancy; has been associated with anencephaly, craniosynostosis and omphalocele

Pregnancy Category D (see below for key)

Sertraline (Zoloft)

Risks: Has been associated with PPHN when taken during the last half of pregnancy; has been associated with septal heart defects; has been associated with omphalocele

Pregnancy Category C (see below for key)

Amitriptyline

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Pregnancy Category C (see below for key)

Nortriptyline (Pamelor)

Risks: Suggested risk of limb malformation in early studies, but not confirmed by newer studies

Pregnancy Category D (see below for key)

Phenelzine (Nardil)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Pregnancy Category C (see below for key)

Tranylcypromine (Parnate)

Risks: May cause a severe increase in blood pressure that triggers a stroke

Pregnancy Category C (see below for key)

Bupropion (Wellbutrin)

Risks: No established risks during pregnancy

Pregnancy Category C (see below for key)

Key:

Category C:

Use with caution if benefits outweigh risks.  Animal studies show risk and human studies not available or neither animal studies nor human studies done.

Category D:

Use in LIFE-THREATENING emergencies when no safer drug available.  Positive evidence of human fetal risk.

The risks associated with these drugs is outrageous considering studies have shown they are ineffective for most people.  You should read category C very carefully.  It says to use with caution is the benefits outweigh the risks.  But the next line says that the studies that were conducted on animals showed that there was risk OR that animal or human studies have not been conducted.  In plain English that means one of the following:

1. The drug was studied in animals and was shown to have some serious risk or…

2. It was never studied in animals or humans.

Do you really want to risk your baby’s health on something that may or may not have been tested and if it was tested (on animals) it was shown to be dangerous?  You must understand that no matter how you look at it, these drugs have never actually been tested on humans while they were pregnant (thankfully!).  This makes them extremely unsafe, particularly when there is a safe alternative out there like acupuncture.

The pharmaceutical industry would love to tell you that their drugs are safe and can be taken by just about anyone.  What they fail to tell you is, in the case of antidepressants, is that they are ineffective wastes of money and the only affect they have is harmful.

If you happen to be pregnant and depressed, which is quite common, I would suggest a trial of acupuncture before you try any sort of medication.  They are no better than placebo therefor making the risks always outweigh the benefits.

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Depressed? Don’t take Antidepressants

Recently, a study was published in the Journal of the American Medical Association that showed that anti-depressants are no more effective for depression than a sugar pill (a placebo).  In fact, if you take into account the side effects that a person might experience while taking an antidepressant you could say that taking the medication was actually worse than taking nothing at all.  At $4 per pill, that is an expensive way to not treat depression.

There is no doubt that depression is a serious and sometimes debilitating condition.  I have many patients who complain from time to time they feel a little (or a lot) down.  About 9.5% of the American public is affected by some form of depression.  That’s almost 19 million people!  If you’re a pharmaceutical company that is also quite the market for a product.  From a business standpoint, I can understand their desire to push through products that could potentially tap into this.

There are many patients, however, that swear they have gotten help by taking one of several prescription antidepressants available.  They swear up and down that they had no preconceived notions or expectations as to whether the drug was going to work for them.  While this may be true, the participants in the studies also felt the same way because they knew there was a chance they might receive a dummy pill.  Patients who speak to their doctors about depression are looking for treatment.  They are hoping that something can be done to help improve their mood.  Whether they expect the medication to work for them is irrelevant.  The very fact that they seek treatment makes the placebo effect a very real possibility, despite their rationalizations.  Hope is not rational.

The next argument for antidepressants (an all drugs for that matter) is that the FDA would not approve a drug that doesn’t work or isn’t safe.  Consider what it takes for a drug to get approved.  It is not as difficult as it may seem.

The FDA requires two well-designed clinical trials showing a drug is more effective than a placebo. That’s two, period—even if many more studies show no such effectiveness. And the size of the “more effective” doesn’t much matter, as long as it is statistically significant. (From Newsweek)

Yes, you read that correctly.  A drug may have 10 studies that shows it is ineffective and just 2 that shows it works and it will get approved.  I wonder if the pharmaceutical industry had anything to do with “helping” write those requirements?

People want to believe that these drugs are helpful.  They scoff, “If these antidepressants are not better than placebo, then how come I have heard this before?” Consider the power and reach of the pharmaceutical industry.  Antidepressants are a $9.6 billion dollar industry.  They’ve got money and power to suppress people a research that may be unfavorable.  The story of psychology researcher Irving Kirsch is a good example.

The boy who said the emperor had no clothes didn’t endear himself to his fellow subjects, and Kirsch has fared little better. A nascent collaboration with a scientist at a medical school ended in 2002 when the scientist was warned not to submit a grant proposal with Kirsch if he ever wanted to be funded again. Four years later, another scientist wrote a paper questioning the effectiveness of antidepressants, citing Kirsch’s work. It was published in a prestigious journal. That ordinarily brings accolades. Instead, his department chair dressed him down and warned him not to become too involved with Kirsch. (From Newsweek)

These stories abound in research when it is unfavorable to corporate conglomerates like pharmaceutical companies.  They fund research, but not so they can remove products from the market.  They want more product.  Anything that is unfavorable is frowned upon and researchers who insist on truth are not funded.

So the next question I get is, “Then what am I supposed to do about my depression.” Do anything.  That’s right, anything other than antidepressants.  The placebo effect improves mood because the person thinks they are doing something to improve it.  And who cares?  If you decide you want to stand on your head and sing happy birthday and it improves your mood, the end result is achieved.  Placebo effect or not, you feel better.  There are things, however, that I recommend to my depressed patients to help them out of their depression.

  • I always recommend a healthy diet.  You must eat well to feel well.  Garbage in equals garbage out.
  • Exercise, exercise, exercise.  There is sound research that exercise is the number 1 cure for depression lasting less than 7 years.
  • Change your thought pattern.  In neurology there is a term called “top-down plasticity.”  Essentially what it means is that your thoughts change the wiring in your brain.  Learning about cognitive behavioral therapy or a similar discipline is often helpful.
  • Take supplements.  A balanced neurotransmitter system is important.  I routinely measure these in a urine and saliva test.  Many times serotonin is low, but not always.  We recommend our amino acid therapy based on these neurotransmitter tests.
  • Manage your stress levels.  Stress can produce a hormonal imbalance that is unfavorable for healthy mood.
  • Sleep well.  Getting enough restful sleep is also important.  There are many factors that play into sleeping well, but keeping a regular sleep schedule is a good start.

There are many effective ways to manage depression without resorting to pharmaceutical agents which can often result in side effects that are just as bad or worse than the symptoms of depression.  The research is pretty convincing that they are not very effective.  Don’t buy into the hype.  Just because it’s on TV doesn’t mean it’s true.

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