Tag Archives: depressed

Anxiety or Depression? Test the levels of your neurotransmitters to guide therapy.

Depression

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Happy New Year!  A new era began at the Vreeland Clinic on January 1st this year.  Dr. Carrie and I would like to thank all of our friends and family for their well wishes.  We looked forward to continuing to serve the community for years to come!

Today I’d like to touch on something that has revolutionized the way I practice.

People come to me for many reasons.  Some people come to my clinic for weight loss or to get more energy.  Others for help with a chronic condition that hasn’t responded to traditional care.  Still others come to see me for a wide range of neurologic conditions.  These include things like Parkinson’s disease, multiple sclerosis, depression or anxiety.  It is the last two that I’d like to focus on today.

Anxiety and depression are extremely common in America.  Millions of Americans suffer from anxiety, depression or both.  These conditions may have many etiologies but one theory is a chemical imbalance in the brain.

Just what is this chemical imbalance?  When someone states that they have a chemical imbalance they are referring to an imbalance in the neurotransmitter system of the brain.  These neurotransmitters are really just proteins that each nerve in the brain uses to communicate with its neighbors.  Sometimes people can have too little of a certain neurotransmitter or too much of another.  This is problematic because it alters the way the brain functions.  It may cause anxiety and/or depression.

The pharmaceutical industry has figured that out and makes a large class of drugs that alters neurotransmitter function in the brain.  These are drugs like Prozac, Zoloft, Wellbutrin and Lorazepam to name a few.

Neurotransmitters are broken down into two categories – they are either excitatory or inhibitory.  That means they either tell the brain to go or tell the brain to stop.  The complexities of the neurotransmitter system are extensive and there is much more to it than “go” and “stop” but that basic principle holds true in most cases.

Examples of neurotransmitters include serotonin, GABA, epinephrine, norepinephrine, glutamate and dopamine.  Serotonin and GABA are inhibitory while epinephrine, norepinephrine, glutamate and dopamine are excitatory.

If you have anxiety and depression often times an imbalance exists in the levels of these neurotransmitters.

For example, high levels of glutamate may cause anxiety or seizures.  Low levels of GABA may cause anxiety.  Low levels of serotonin may cause depression.  Same goes for norepinephrine.

So how do you tell which neurotransmitters are low or which are too high?

Measuring Neurotransmitters

Measuring your neurotransmitters with a urine test is the best way to estimate your levels of neurotransmitters.  We do this routinely in our office for many patients.  It is incredibly insightful and directs our care for patients with anxiety, depression and many other conditions.

The measurement of neurotransmitters in the urine has been around for many years.  I’ve read studies dating to the 1960’s of scientists using similar methods to evaluate neurotransmitter levels.

Until relatively recently, perhaps the last 10-15 years, it has not been used frequently in clinical practice.  Now, through specialized laboratories, it is available to the general public and it is very affordable.

The knock on urinary neurotransmitter testing is that it does not correlate with brain levels of these hormones because the urine test is in fact testing whole body levels of neurotransmitters.

The very neurotransmitters that exist in our brain to make us happy exist outside the brain to serve the body in other ways.  So, yes, it is true that checking urinary neurotransmitter levels is technically a check of the entire body’s store of neurotransmitters.  But, through hundreds of thousands of tests these specialized labs have shown with high correlation that when neurotransmitter levels are abnormal certain psychiatric and neurological conditions are much more common.

Clinically, I have seen an almost one to one correlation in my patients with certain conditions an alteration in their neurotransmitter system.

The lab that I use will test all of the basic neurotransmitters plus a slew of metabolites of these neurotransmitters.  It provides a wonderful window into the neurological system.

If I find that serotonin is low, I supplement with something called 5-HTP.  If dopamine is low, I like to use L-tyrosine or an herb called mucuna pruriens.  The list can go on and on.

Once someone has been on a program for 6-8 weeks we recheck their neurotransmitter profile to gauge our therapy and adjust it if necessary.  We find that once a person’s profile returns to normal, their symptoms resolve.

If you have anxiety or depression, consider seeking out someone who does this kind of testing to improve your outcomes.  The brain is incredibly complex.  It never hurts to have a little extra information to guide your therapy.

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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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