Читать книгу A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives - Dr Brogan Kelly - Страница 8

CHAPTER 1

Decoding Depression

It’s Not a Disease: What You Don’t Know About This Syndrome and How It Manifests

Depression can result from bodily imbalance rather than brain chemical imbalance.

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The medicalization of distress obliterates meaning and creates profit.

When I talk about medicine and mental health to large audiences, I often start with the following imagery and facts: think of a woman you know who is radiantly healthy. I bet your intuition tells you she sleeps and eats well, finds purpose in her life, is active and fit, and finds time to relax and enjoy the company of others. I doubt you envision her waking up to prescription bottles, buoying her way through the day with caffeine and sugar, feeling anxious and isolated, and drinking herself to sleep at night. All of us have an intuitive sense of what health is, but many of us have lost the roadmap to optimal health, especially the kind of health that springs forth when we simply clear a path for it. The fact that one in four American women in the prime of their life is dispensed medication for a mental health condition represents a national crisis.¹

Humans have used mind-altering substances to try to dull and deaden pain, misery, sorrow, and suffering since time immemorial, but only in the last few decades have ­people been persuaded that depression is a disease and that chemical antidepressants are the remedy. This is far from the truth. Many of my patients have been to multiple doctors, bumping up against the hard ceiling of what conventional medicine has to offer. Some have even tried integrative medicine, which aims to combine both traditional medicine (i.e., prescriptions) with alternative treatments (e.g., acupuncture). After all, they are told that there are great natural complements to all the wonders pharmaceutical products have to offer. But the reason they can’t find a solution is because nobody has asked why. Why are they unwell? Why are their bodies creating symptoms that manifest as depression? Why didn’t they stop to ask this important and obvious question the first time they experienced a flat mood, anxiety, insomnia, and chronic exhaustion?

Before I even get to the answers, let me be the first to tell you that the only path to a real solution is to leave the medical world you know behind. This, the journey I will take you on, is not just about symptom suppression, it’s about health freedom. First let me tell you that I was once a typical doctor, not to mention a typical American who loved pizza, soda, birth control, and ibuprofen. My message is from a personal journey and thousands of hours of research that has compelled me to share the truth about prescription-based care: we’ve been duped.

Yes, my entire training was based on a model of disease care that offers patients only one tool—­a drug—­and never a shot at true wellness. We’ve handed over our health to those who seek to profit from it, and we’ve been buying into a paradigm based on the following notions:

▶ We are broken.

▶ Fear is an appropriate response to symptoms.

▶ We need chemicals to feel better.

▶ Doctors know what they are doing.

▶ The body is a machine requiring calibration (via drugs). A little too much of this, too little of that.

I call this collective set of notions the Western Medical Illusion. It sets up a vicious system that ushers you into life­long customer status, dependent and disempowered.

As you can likely guess by now, I love to rant. But I do so with the best evidence science can offer, and there’s a lot we know today about the real root causes of depression—­and how to treat the ­condition safely and successfully—­without a prescription pad. If there’s one lesson I will drive home, it’s this: shed the fear, take back your inner compass, and embrace a commitment to your best self, medication free. Even if you don’t already take a prescription drug, I bet you still doubt living the rest of your life prescription free and reliant on your own inner intuition to know what’s best for you. The idea of supporting your body’s innate wisdom may sound quaint at best, or like dangerous hippie woo-woo at worst. From now on, I want you to embrace these new ideas:

▶ Prevention is possible.

▶ Medication treatment comes at a steep cost.

▶ Optimal health is not possible through medication.

▶ Your health is under your control.

▶ Working with lifestyle medicine—­simple everyday habits that don’t entail drugs—­is a safe and effective way to send the body a signal of safety.

How can I make these statements, and what do I mean by lifestyle medicine? You’re going to find out in this book, and I’ll be presenting the scientific proof to answer questions you may have and to satisfy the doubtful. When I meet a woman and her family, I speak about how to reverse her anxiety, depression, mania, and even psychosis. We map out the timeline that brought her where she is and identify triggers that often fall under one or more of the following categories: food intolerances or sensitivities, blood sugar imbalances, chemical exposures, thyroid dysfunction, and nutrient deficiency. I forge a partnership with my patient and witness dramatic symptom relief within thirty days. I do this by teaching my patients how they can make simple shifts in their daily habits, starting with the diet. They increase nutrient density, eliminate inflammatory foods, balance blood sugar, and bring themselves closer to food in its ancestral state. It’s the most powerful way to move the needle, because food is not just fuel. It is information (literally: “it puts the form into your body”), and its potential for healing is a wonder to me, every single day.

Achieving radical wellness takes sending the body the right information and protecting it from aggressive assault. This isn’t just about mental health; it’s about how mental health is a manifestation of all that your body is experiencing and your mind’s interpretation of its own safety and power. It’s also about how symptoms are just the visible rough edges of a gigantic submerged iceberg.

Note that none of these concepts connects with substances in the brain that might be “low.” If you had to define depression right now, before reading further, chances are you’d say something about it being a “mood disorder” or “mental illness” triggered by a chemical imbalance in the brain that probably needs to be fixed through a medication like Prozac or Zoloft that will lift levels of brain chemicals associated with a good mood. But you would be mistaken.

So many patients today who are being shepherded into the psychiatric medication mill are overdiagnosed, misdiagnosed, or mistreated. Indeed, they have “brain fog,” changes in metabolism, insomnia, agitation, and anxiety, but for reasons only loosely related to their brain chemicals. They have all the symptoms that are mentioned in a Cymbalta advertisement that tells them to talk to their doctor to see if Cymbalta is right for them. But it’s like putting a bandage over a splinter in the skin that continues to stir inflammation and pain. It’s absolutely missing an opportunity to remove the splinter and resolve the problem from the source. And it’s an iconic example of how conventional medicine can make grave mistakes, something the pharmaceutical industry is more than happy to encourage.

In holistic medicine, there are no specialties. It’s all connected. Here’s a classic case in point: Eva had been taking an antidepressant for two years but wanted to get off it because she was planning to get pregnant. Her doctor advised her not to stop taking the drug, which motivated her to see me. Eva explained that her saga had begun with PMS, featuring a week each month when she was irritable and prone to crying fits. Her doctor prescribed a birth control pill (a common treatment) and soon Eva was feeling even worse, with insomnia, fatigue, low libido, and a generally flat mood dogging her all month long. That’s when the doctor added the Wellbutrin to “pick her up,” as he said, and handle her presumed depression. From Eva’s perspective, she felt that the antidepressant helped her energy level, but it had limited benefits in terms of her mood and libido. And if she took it after midnight, her insomnia was exacerbated. She soon became accustomed to feeling stable but suboptimal, and she was convinced that the medication was keeping her afloat.

The good news for Eva was that with careful preparation, she could leave medication behind—­and restore her energy, her equilibrium, and her sense of control over her emotions. Step one consisted of some basic diet and exercise changes along with better stress response strategies. Step two involved stopping birth control pills and then testing her hormone levels. Just before her period, she had low cortisol and progesterone, which were likely the cause of the PMS that started her whole problem. Further testing revealed borderline low thyroid function, which may well have been the result of the contraceptives—­and the cause of her increased depressive symptoms.

When Eva was ready to begin tapering off her medication, she did so following my protocol. Even as her brain and body adjusted to not having the antidepressant surging through her system anymore, her energy levels improved, her sleep problems resolved, and her anxiety lifted. Within a year she was healthy, no longer taking any prescriptions, feeling good—­and pregnant.

I require my patients and I implore you to think differently about health-care decisions and consumerism. Part of my motivation in writing this book was to help you develop a new watching, questioning eye that you can bring to every experience. For my patients to be well, I know they will need to approach their health with an extreme commitment to the integrity of their mind and body. Personally, I have no intention of ever returning to a lifestyle that involves pharmaceutical products of any kind, under any circumstances.

Why?

Because we are looking at the body as an intricately woven spiderweb—­when you yank one area of it, the whole thing moves. And because there is a more powerful way to heal.

It’s so simple that it could be considered an act of rebellion.

You might think of yourself as averse to conflict—­someone who wants to keep the peace, keep your head low, and do what’s recommended. To be healthy in today’s world, however, you need to access and cultivate a reliance on yourself. And you’re going to do that by first shifting your perspective forever. Look behind the curtain and understand that medicine is not what you think it is. Drug-based medicine makes you sick. I will go so far as to say that hospital care makes you sick; though estimates vary, it’s reasonable to say that hospital care claims tens if not hundreds of thousands of lives annually due to preventable medical mistakes such as wrong diagnoses and medications or surgical errors, infections, and simply screwing up an IV.² The Cochrane Collaboration, a London-based network of more than 31,000 researchers from more than 130 countries, conducts the world’s most thorough independent analysis of health-care research. Based on data from the British Medical Journal, the Journal of the American Medical Association, and the Centers for Disease Control, it has found that prescription drugs are the third leading cause of death after heart disease and cancer.³ And when it comes to psychotropic drugs, the Cochrane Collaboration’s conclusions are compellingly uncomfortable. In the words of the Collaboration’s founder, Dr. Peter Gotzsche, “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.”⁴

By and large, doctors are not bad ­people. They are smart ­individuals who work hard, investing money, blood, sweat, and tears into their training. But where do doctors get their information? Whom are they told to trust? Have you ever wondered who’s pulling the strings? Some of us in the medical community are beginning to speak up and to expose the fact that our training and education is, for the most part, bought.

“Unfortunately in the balance between benefits and risks, it is an uncomfortable truth that most drugs do not work in most patients.”⁵ Before I read this quote in the prestigious British Medical Journal in 2013, I had already begun to explore the evidence that there really isn’t much to support the efficacy of most medications and medical interventions, particularly in psychiatry, where suppressed data and industry-funded and ghostwritten papers hide the truth. Another 2013 study published in the equally respected Mayo Clinic Proceedings confirmed that a whopping 40 percent of current medical practice should be thrown out.⁶ Unfortunately, it takes an average of seventeen years for the data that exposes inefficacy and/or a signal of harm to trickle down into your doctor’s daily routine, a time lag problem that makes medicine’s standard of care evidence-based only in theory and not practice.⁷ Dr. Richard Horton, the editor ­in ­chief of the much-revered Lancet at this writing, has broken rank and come forward about what he really thinks about published research—­that it’s unreliable at best, if not completely false. In a 2015 published statement, he wrote: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”⁸

In 2011 the British Medical Journal performed a general analysis of some 2,500 common medical treatments. The goal was to determine which ones are supported by sufficient reliable evidence.⁹ The results:

▶ 13 percent were found to be beneficial

▶ 23 percent were likely to be beneficial

▶ 8 percent were as likely to be harmful as beneficial

▶ 6 percent were unlikely to be beneficial

▶ 4 percent were likely to be harmful or ineffective

The treatments in the remaining 46 percent, the largest category, were found to be unknown in their effectiveness. Put simply, when you visit a doctor or hospital, you have only a 36 percent chance that you’ll receive a treatment that has been scientifically proven to be either beneficial or likely to be beneficial. Such results are strikingly similar to those of Dr. Brian Berman, who analyzed completed Cochrane reviews of conventional medical practices, finding that 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”¹⁰

Are there exceptions? I would like to argue that there aren’t. This is because the whole pharmaceutical approach is predicated on wrong-headed information. Pharmaceutical products as we know them have not been developed or studied with modern science’s most relevant principles in mind, such as the complexity and power of the human microbiome, the impact of low-dose toxic exposures, autoimmune disorders as a sign of environmental overstimulation, and the fundamental importance of individual biochemistry. Because medicine operates under the now antiquated one gene, one illness, one pill rubric, efficacy will be measured through a skewed lens, and safety cannot be accurately assessed or discussed with ­individual patients.

Many of us move through life with a sneaking fear that the other health shoe could drop at any moment. We can easily fall prey to the belief that our breasts are ticking time bombs, that infections are just a cough or handshake away, and that life is a process of adding more medications and drugs to put out small fires as we age. Before I stopped prescribing, I had never once cured a patient. Now ­people are cured every week in my practice. As I mentioned, my patients are my partners. We collaborate, and they work hard. They work hard at a time when they feel they can’t even lift a finger—­when the prospect of walking to the drugstore with a slip of paper twinkles like the North Star in their dark sky. They follow my lead because they feel inspired by my conviction and hope in this new model—­one that asks the question “Why?” and has the goal of not only symptom relief but an incredible boost in their vitality.

I realize that many of you reading this book may fear the change that will happen if you take my advice seriously. But no situation has ever been more easily resolved, better handled, or supported by freaking out. Responding with fear leads us to make decisions that are myopic. Some of these decisions may ease our sense of disorder, but they simultaneously engender new and more complex problems. Instead, when you have a symptom—­when you feel cloudy, sad, sore, gassy, weepy, tired, or unnecessarily anxious—­bring some wonder to it. Ask why and try to make the connections. Your body’s symptoms are telling you something about equilibrium. Your body is trying to tell you that it has lost balance. Stand back and appreciate the infinite complexity of your organism. Know that fear will only drive you to treat your body like a robotic machine that needs oil and gear changes. We are so much more than buttons and levers.

So it’s time to put on some new glasses and start to study your body. Start to think critically about what you buy, the medical advice you take, and what the media tells you to worry about. Let light shine on every dark corner of your beliefs about health. This critical thinking will liberate you to realize your full potential as a parent, spouse, or friend, and within your own sphere of existence. As one of my favorite quotes goes: “Everything you’ve ever wanted is on the other side of fear.”

In the rest of this chapter, we’re going to take a tour of what depression is—­from its true definition and biology to its myriad causes and the colossal failure of the pharmaceutical industry to treat this health challenge that has swiftly become the leading cause of disability in America and the rest of the world.¹¹ This will help ease your fears about the change that you’re about to make and set the stage for the balance of the book. And I’ll start with one of the most pervasive and harmful myths about depression.

DEPRESSION IS NOT A DISEASE¹²

Psychiatry, unlike other fields of medicine, is based on a highly subjective diagnostic system. Essentially you sit in the office with a physician and you are labeled based on the doctor’s opinion of the symptoms you describe. There are no tests. You can’t pee in a cup or give a drop of blood to be analyzed for a substance that definitely indicates “you have depression” much in the way a blood test can tell you that you have diabetes or are anemic.

Psychiatry is infamous for saying “oops!” It has a long history of abusing patients with pseudoscience-driven treatments and has been sullied by its shameful lack of diagnostic rigor. Consider, for example, the 1949 Nobel Prize winner Egas Moniz, a Portuguese neurologist who introduced invasive surgical techniques to treat ­people with schizophrenia by cutting connections between their prefrontal region and other parts of the brain (i.e., the prefrontal lobotomy). And then we had the Rosenhan experiment in the 1970s, which exposed how difficult it is for a doctor to distinguish between an “insane patient” and a sane patient acting insane. Today’s prescription pads for psychotropic drugs are, in my belief, just as harmful and absurd as physically destroying critical brain tissue or labeling ­people as “psychiatric” when really they are anything but.

My fellowship training was in consultation-liaison psychiatry, or “psychosomatic medicine.” I was drawn to this specialization because it seemed to be the only one that acknowledged physical processes and pathologies that could manifest behaviorally. I noticed that psychiatrists in this field appreciated the role of biological actions such as inflammation and the stress response. When I watched fellow psychiatrists consult on surgical patients in the hospital, they talked about these processes much ­differently from when they saw patients in their Park Avenue offices. They talked about delirium brought on by electrolyte imbalance, symptoms of dementia caused by B₁₂ deficiency, and the onset of psychosis in someone who was recently prescribed antinausea medication. These root causes of mental challenges are far from the “it’s all in your head” banter that typically swirls around conversations about mental illness.

The word psychosomatic is a loaded and stigmatized term that implies “it’s all in your head.” Psychiatry remains the wastebasket for the shortcomings of conventional medicine in terms of diagnosing and treating. If doctors can’t explain your symptoms, or if the treatment doesn’t fix the problem and further testing doesn’t identify a concrete diagnosis, you’ll probably be referred to a psychiatrist or, more likely, be handed a prescription for an antidepressant by your family doctor. If you are very persistent that you still need real help, your doctor might throw an antipsychotic at you as well. Most prescriptions for antidepressants are doled out by family doctors—­not psychiatrists, with 7 percent of all visits to a primary-care doctor ending with an antidepressant prescription.¹³ And almost three-quarters of the prescriptions are written without a specific diagnosis.¹⁴ What’s more, when the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health did its own examination into the prevalence of mental disorders, it found that “Many individuals who are prescribed and use antidepressant medications may not have met criteria for mental disorders. Our data indicate that antidepressants are commonly used in the absence of clear evidence-based indications.”¹⁵

I’ll never forget a case I consulted on several years ago that involved “psychosomatic” facial burning in a woman. Her story is insightful. She complained of an intense burning sensation in her face, though there was no explanation for it other than it being “all in her head.” Her symptoms were so disabling that she was barely able to function. I was still prescribing psychotropics at the time, but a voice inside of me knew there was something real going on, and it wasn’t at all in her head. But unfortunately the Western medical model had already labeled her as being a psychosomatic case, which called for psychiatric medication and couldn’t appreciate or even begin to understand the complexity of her condition. Antidepressants and benzodiazepines (tranquilizers including Valium or Xanax) didn’t help her. What ultimately did was dietary change, supplementation, and rebalancing of her bodily flora. Was this all a placebo effect? Clearly she wanted to feel better with such intensity that she would have done anything. But traditional medication didn’t cure her. At the heart of her pain and distress was an immune and inflammatory process that could not be remedied via antidepressants and antianxiety drugs. It was fixed through strategies that got to the core of her problem—­that yanked the nail out of her foot and let the injury heal.

The idea that depression and all of its relatives are manifestations of glitches in the immune system and inflammatory pathways—­not a neurochemical deficiency disorder—­is a topic we will explore at length throughout this book. This fact is not as new as you might think, but it’s probably not something your general doctor or even psychiatrist will talk about when you complain of symptoms and are hurried out of the office with a prescription for an antidepressant. Nearly a century ago, scientific researchers were already exploring a connection between toxic conditions in the gut and mood and brain function. This phenomenon was given the name auto intoxication. But studying such a wild idea fell out of fashion. By mid-century no one was looking into how intestinal health could affect mental health. Instead, the thinking was quickly becoming the reverse—­that depression and anxiety influenced the gut. And as the pharmaceutical industry took off in the second half of the twentieth century, gut theories were ignored and the brilliant researchers behind them were forgotten. The gut was regarded as the seat of health in ancient medical practices for centuries; now we can finally appreciate the validity of such old wisdom. Hippocrates, the father of medicine, who lived in the third century BCE, was among the first to say that “all disease begins in the gut.”

A multitude of studies now shows an undeniable link between gut dysfunction and the brain, chiefly by revealing the relationship between the volume of inflammatory markers in the blood (i.e., signs of inflammation) and risk for depression.¹⁶ Higher levels of inflammatory markers, which often indicate that the body’s immune system is on high alert, significantly increase the risk of developing depression. And these levels parallel the depth of the depression: higher levels equates with more severe depression. Which ultimately means that depression should be categorized with other inflammatory disorders including heart disease, arthritis, multiple sclerosis, diabetes, cancer, and dementia. And it’s no surprise, at least to me, that depression is far more common in ­people with other inflammatory and autoimmune issues like irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insulin resistance, and obesity. All of these conditions are characterized by higher levels of inflammation, a topic we’ll get into in Chapter 3.

To really grasp the fact that depression is not a disorder primarily rooted in the brain, look no further than some of the most demonstrative studies. When scientists purposefully trigger inflammation in the bodies of healthy ­people who exhibit no signs of depression by injecting them with a substance (more on this shortly), they quickly develop classic symptoms of depression.¹⁷ And when ­people with hepatitis C are treated with the pro-inflammatory drug interferon, as many as 45 percent of those individuals develop major depression.¹⁸

So when ­people ask me about why we’re suffering from what appears to be an epidemic of depression despite the number of ­people taking antidepressants, I don’t think about brain chemistry. I turn to the impact of our sedentary lifestyles, processed food diets, and unrelenting stress. I turn to the medical literature that says a typical Western diet—­high in refined carbs, unnatural fats, and foods that create chaos in our blood sugar balance—­contribute to higher levels of inflammation.¹⁹ Contrary to what you might assume, one of the most influential risk factors for depression is high blood sugar. Most ­people view diabetes and depression as two distinct conditions, but new scientific findings are rewriting the textbooks. One game-changing study published in 2010 that followed more than 65,000 women over a decade showed that women with diabetes were nearly 30 percent more likely to develop depression.²⁰ This heightened risk remained even after the researchers excluded other risk factors such as lack of physical exercise and weight. Moreover, diabetic women who took insulin were 53 percent more likely to develop depression.

Certainly you can draw the same conclusions that I’ve made: the rates of diabetes have skyrocketed alongside those of depression in the past two decades. And so have the rates of obesity, which is also correlated with increased inflammatory markers. Studies show that obesity is associated with a 55 percent increased risk of depression, and it cuts the other way too: depression is associated with a 58 percent increased risk of developing obesity.²¹ In the cogent words of a group of Australian researchers in a 2013 paper: “A range of factors appear to increase the risk for the development of depression and seem to be associated with systemic inflammation; these include psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut [function], [allergies], dental [cavities], sleep and vitamin D deficiency.”²²

In 2014 Scottish researchers addressed the gap between what the science says about the causes of depression and what patients experience when they find themselves caught in the default web of psychiatric care. In their paper they highlight the value of what I practice: psychoneuroimmunology.²³ Indeed, it’s a mouthful of a word, but it simply refers to examining (and respecting) the complex interplay between various systems and organs of the body, especially those that syncopate the nervous, gastrointestinal, and immune systems in a brilliant dance that in turn affects mental well-being. These researchers point out that many patients who are told they have psychiatric conditions originating in their head or related to some (fictitious) brain chemical deficiency actually share real biological imbalances related to their immune-inflammatory pathways. These patients show elevated levels of inflammatory markers in their blood, signs that their body is on the defensive, activating processes that can result in unexplainable physical symptoms and that are diagnosed as psychiatric rather than biologic. And rather than treating the underlying biology, they are instead relegated to a lifetime of therapy and medication, to no avail.

The conditions examined by these researchers were depression, chronic fatigue, and “somatization,” the latter of which is what we call the production of symptoms with no plausible organic cause. These diagnoses have a lot in common in terms of symptoms: fatigue, sensitivity to pain, inability to concentrate, flu-like malaise, and cognitive issues. Isn’t it interesting that each of these conditions is often diagnosed as a separate illness and yet they share so much in common from a biological standpoint? As the authors state: “If psychiatry is to rise to the challenge of being a science, then it must respond to the [existing] data in reconceptualizing boundaries. As such, the data reviewed here challenge the organizational power structures in psychiatry.”²⁴

Personalized lifestyle medicine that accounts for the role of the environment in triggering inflammation and the manipulation of the immune and endocrine systems is the most sensible way to approach those individuals who would otherwise be candidates for multiple medications. It turns out that it may not all be in your head—­but rather in the interconnectedness among the gut, immune, and endocrine systems.

In upcoming chapters, we’re going to be exploring all of these connections—­the indelible links between your gut and its microbial inhabitants, your immune system, and the orchestra of hormones that course through your body in sync with a day-night cycle. These connections influence the state of your entire physiology and, as important, your mental health and overall sense of well-being. While it may seem odd to talk about the gut-based immune system in terms of mental health, the latest science reveals that it may be the body’s—­and mind’s—­center of gravity. Just as I write this, yet another new study has emerged that overturns decades of textbook teaching about the brain and immune system. Researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by lymphatic vessels we didn’t know existed.²⁵ That we had no idea about these vessels given the fact that the lymphatic system has been so thoroughly studied and charted throughout the body is astonishing on its own. And such a discovery will have significant effects on the study and treatment of neurological diseases, from autism and multiple sclerosis to Alzheimer’s disease and, yes, depression. It’s time we rewrite the textbooks. And it’s time we treat depression for what it really is.

So if depression isn’t a disease, then what is it? As I briefly mentioned in the introduction, depression is a symptom, a vague surface sign at best that doesn’t tell you anything about its root cause. Consider, for a moment, that your toe hurts. Any number of things can cause a toe to hurt, from physically injuring it to a bunion, blister, or tumor growing inside. The hurting is a sign that something is wrong with the toe, simple as that. Likewise, depression is the hurting; it’s an adaptive response, intelligently communicated by the body, to something not being right within, often because things are also off in our environment.

Depression doesn’t always manifest with feelings of serious melancholy and sadness or the urge to sit on the couch all day brooding. I can’t even remember the last patient I saw who was like the person you see on a TV commercial for an antidepressant. All of my patients experience anxiety—­an inner kinetic discomfort, restlessness, unease, and a lot of insomnia. In fact, most cases of depression involve women who are very much on the go and productive, but they are also anxious, scatterbrained, overly stressed out, irritable, forgetful, worrywarts, unable to concentrate, and feeling “wired and tired” at the same time. And many of them have been dismissed by the medical system; their psychiatric problems were created by mistreatment as they fell into the vortex of endless prescription medications.

Take, for another example, a forty-two-year-old patient of mine we’ll call Jane, who fell into this black hole after being treated for irritable bowel and acne with drugs, including the now discontinued Accutane (isotretinoin). Jane experienced a depressed mood, a common side effect of Accutane, and was then put on an antidepressant as she stopped the medication (isotretinoin is a retinoid, a strong medication used to treat severe acne; it causes birth defects in babies born from mothers who take it during pregnancy, so it’s carefully regulated and only available in its generic form under a special program). After the death of her parents, which triggered more symptoms of depression, Jane was diagnosed with a thyroid problem, and her doctor at the time prescribed radioablation therapy, which destroys thyroid tissue with radioactive iodine 131. This led to her having acute panic attacks, and she soon began taking Xanax. Symptoms of more thyroid problems, including brain fog, extreme fatigue, and physical pain, culminated in a diagnosis of fibromyalgia. Jane was then treated with birth control pills and an antibiotic and soon developed chronic yeast infections, bloating, and abdominal pain. By the time she came to me, Jane had a twenty-four-hour home health aide.

Jane’s experience reflects that of so many ­people labeled as depressed and sent away with yet another prescription. The system creates patients who are otherwise healthy and just need to recalibrate their bodies using simple lifestyle interventions, mostly around diet—­not drugs. After all, it is through diet that we communicate with our environment. It’s a dialect that we’ve forgotten how to speak.

AN EVOLUTIONARY MISMATCH

Take a look around you and appreciate the world we live in today with its technologies and conveniences: computers, cars, cell phones, and supermarkets. But also consider the mismatch between this scenario and the days when we had to forage for our food and sleep under the stars. Our caveman days are still very much a part of our DNA because evolution is slow; what seems like ages in cultural time (20,000 years ago) is but a blink of an eye in biological time. Which brings me to ask the question: Is all this depression simply a sign of an evolutionary mismatch?

This is the term that encompasses the source of most modern ills. We are engaged in lifestyles that are not compatible with what our genome has evolved over millions of years to expect. We eat a poor diet, harbor too much stress, lack sufficient physical movement, deprive ourselves of natural sunlight, expose ourselves to environmental toxicants, and take too many pharmaceuticals. Our wayward departure is marked by two specific revolutions in the history of mankind: the Neolithic, or agricultural, Revolution and the Industrial Revolution. For 99 percent of our existence, we followed the so-called Paleolithic diet, which is devoid of inflammatory and “insulinotropic” foods like sugar, grains, and dairy. Our body’s microbial ecology has been one of the primary victims of this shift—­the 90 percent of our cells that are non-human in nature and that account for the majority of our body’s activities, which in turn impact the expression of our genes. I’ll be going into greater depth about the human microbiome in Chapter 3, but I’ll give you a short primer here because this discussion is important and will be carried throughout the book.

Although we’ve learned to think of bacteria as agents of death for the most part because certain strains can cause lethal infections in compromised hosts, new science is compelling us to consider how some of these microscopic bugs are fundamental to life—­and mental health. As you read this, some 100 trillion microbes are colonized in your intestines alone.²⁶ They outnumber your own cells by a factor of about ten, covering your insides and outsides. And they contain estimates of more than 8 million genes of their own, which means that fully 99 percent of the genetic material in your body is not your own. It belongs to your microbial comrades. These microbes not only influence the expression of our DNA, but research reveals that throughout our evolution microbial DNA has become part of our own DNA. In other words, genes from microbes have inserted themselves into our genetic code (mitochondrial DNA being the prime example) to help us evolve and flourish.

A great many of these invisible creatures live within your digestive tract, and while they include fungi, parasites, and viruses, it’s the bacteria that appear to hold the proverbial keys to the kingdom of your biology, as they support every conceivable feature of your health. In the future we’ll likely see how the other microbes contribute at least as much to our health as bacteria do. The microbiome is so crucial to human health that it could be considered an organ in and of itself. In fact, it has been suggested that since without it we could not live, we should consider ourselves a “meta-organism,” inseparable from it. This inner ecology helps you digest food and absorb nutrients, supports the immune system and the body’s detoxification pathways, produces and releases important enzymes and substances that collaborate with your biology (including chemicals for the brain, such as vitamins and neurotransmitters), helps you handle stress through its effects on your endocrine—­hormonal—­system, and even ensures you get a good night’s sleep. Put simply, your microbiome influences practically everything about your health, including how you feel both emotionally, physically, and mentally.

What compromises a healthy microbiome? Not surprisingly, your microbiome is vulnerable to three antagonizing forces: exposure to substances that kill or otherwise negatively change the composition of the bacterial colonies (these substances include everything from environmental chemicals and drugs like antibiotics to ingredients such as artificial sugars and processed gluten-containing foods); a lack of nutrients that support healthy, diverse tribes of good microbes; and unrelenting stress.

I’ve devoted an entire section to the amazing features of the microbiome, so you’ll gain plenty of knowledge about how it plays a role in your physical and mental well-being and how you can maintain an optimal colony of tribes. We have coevolved with these microorganisms throughout our journey on this planet, and we must respect them for what they are: the body’s—­and brain’s—­best friend. And they are as much a part of our survival and mental well-being as our own cells are.

DESIGNED FOR DEPRESSION

Have you ever stopped to wonder if depression has benefits? I know, it sounds a little outlandish to even suggest such an idea. But it’s an excellent question to ask and an even better one to answer. This conversation, however, is best couched within the topic of stress in general. So let’s go there next.

Most of us can recognize the symptoms of stress. We feel it inside and out. We become irritable, our heart races, our face may feel hot, we get a familiar headache or upset stomach, our mind is incessantly chattering, there’s a sense of impending doom, and we’re annoyed by the smallest things. For some ­people, stress has little outward effect. For these individuals, what they feel at the surface is internalized and sometimes expressed as disease. In fact, many of these ­people don’t believe they experience stress—­but they do; they just don’t consciously recognize it until it builds up to a certain point and seeps out in other ways.

The term stress as it is used today was coined by one of the founding fathers of stress research, Hans Selye, who in 1936 defined it as “the non-specific response of the body to any demand for change.”²⁷ Selye proposed that when subjected to persistent stress, both humans and animals could develop certain life-threatening afflictions such as heart attack or stroke that previously were thought to be caused by specific pathogens only. This is a crucial point, because it demonstrates the impact that everyday life and experiences have not only on our emotional well-being but also on our physical health.

The word stress as it relates to emotions became part of our vocabulary in the 1950s. Its use became common with the onset of the Cold War, which was an era when fear ruled. We were frightened of atomic war, so we built bomb shelters. As a society, we could not say we were afraid; instead, we used the word stress. Today we continue to use the word to describe anything that disrupts us emotionally—­we’re stressed, stressed out, under stress, and so on. Stress can also be described as the thoughts, feelings, behaviors, and physiological changes that happen when we respond to demands and perceptions. And if those demands placed on us overwhelm our perceived ability to cope, we experience “stress.” In our frenzied minds, we begin to pant silently like an animal and look for an escape.

Since Selye, researchers have broken stress down into several subcategories. Stress physiology has come a long way in the last fifty years in particular, and so have the stressors. A key concept to enter the medical vernacular more recently is what is known as allostatic load. Your allostatic load refers to environmental challenges—­the “wear and tear” on the body—­that cause it to begin efforts to maintain stability (allostasis, also known as homeostasis). It also represents the physiological consequences of adapting to chronic stress that entails repeated activation of the body’s stress response machinery involving many systems—­immune, endocrine, and neuronal. Researchers Bruce McEwen and Eliot Stellar coined this term in 1993 as a more precise alternative to the term stress.²⁸ The key players of the stress response, cortisol and epinephrine (adrenaline), have both protective and adverse effects on the body depending on when and how much they are used. On one hand, these hormones are essential for the body’s ability to adapt and maintain balance (homeostasis), but if they are flowing for a prolonged period or needed relatively frequently, they can accelerate disease processes. The allostatic load, as it’s called, becomes more harmful than helpful. This load can be measured in physiological systems as chemical imbalances in the activities of the nervous, hormonal, and immune systems. It can also be measured by disturbances in the body’s day-night cycle (what’s called the circadian rhythm, another concept we’ll explore later), and in some cases, changes to the brain’s physical structure.

Stress is actually a good thing, at least from an evolutionary and survivalist perspective. It serves an important function: to protect us from real danger by equipping us with a better means to escape a life-threatening situation or face it head on. But our physical reaction doesn’t change according to the type or magnitude of a perceived threat. Whether it’s a truly perilous stressor, or just the to-do list and an argument with a colleague, the body’s stress response is the same. Let me give you a quick lesson on what goes on when your body senses stress so we can come full circle back to, dare I say, the secret value of depression.

First, the brain sends a message to the adrenal glands that results in the release of adrenaline, also called epinephrine. This triggers your heart rate to increase as blood is directed to your muscles in the event you need to flee. When the threat is gone, your body normalizes again. But if the threat doesn’t go away and your stress response intensifies, then a series of events take place along what’s called the HPA axis, short for hypothalamic-pituitary-adrenal axis, and which involves multiple stress hormones. The hypothalamus is a small but key governing region of the brain that has a vital role in controlling many bodily functions, including the release of hormones from the pituitary gland housed inside. It’s often referred to as the seat of our emotions because it commands much of our emotional processing. The moment you feel nervous, anxious, extremely overwhelmed, or simply worried that you can’t deal with life, the hypothalamus releases a corticotropin-releasing hormone (CRH), a substance that starts a cascade of reactions, ending with cortisol flowing into your bloodstream. While this process has been well defined for a long time, newer research reveals that perceptions of stress trigger inflammatory signaling from the body to travel to the brain, priming it for hyper-response.²⁹

You’re probably already familiar with cortisol, the body’s main stress hormone that aids in that famous fight-or-flight response. It also controls how your body processes carbohydrates, fats, and proteins. Because it’s the hormone responsible for protecting you during times of stress, its actions increase your appetite, promote more fat storage, and break down complex molecules and tissues that can be used for quick forms of energy, including muscle. For this reason, continual exposure to excess cortisol over time can lead to increased abdominal fat, bone loss, a suppressed immune system, fatigue, and a heightened risk for insulin resistance, diabetes, heart disease, and full-blown depression. Cortisol does, however, serve a positive role. It directs and buffers the immune system and primes the body for attack. This would all be great if the attack were short-lived and easily resolved. The attack of our modern-day lifestyles is unrelenting.

The scientific study of the impact of stress on the body from the inside out, and even the outside in, has made tremendous advances in the fifteen years starting in 1998 when Harvard University researchers conducted a joint study with several Boston-area hospitals designed to examine the interactions between the mind and the body, specifically the skin. They called their discovery the NICE (neuro-immuno-cutaneous-endocrine) network.³⁰ In plain speak, it’s a giant interactive network consisting of your nervous system, immune system, the skin, and your endocrine (hormonal) system. All of these are intimately connected through a dialogue of a complex array of biochemicals.

The Boston researchers studied how various external forces influence our state of mind, from massage and aromatherapy to depression and isolation. What they discovered confirmed what many in the scientific community have known anecdotally for centuries: our state of mind has a definite impact on our health and even our appearance. ­People suffering from depression, for example, often look older than their chronological age. They don’t appear healthy and vibrant, as the stress of coping with depression has accelerated the aging process and damaged their health.

Since the NICE network entered our vocabulary, dozens of other studies have been performed to confirm the powerful interplay between psychology and biology or, put simply, mind over matter. An analogy I like to use in my practice goes like this: If you’re walking down a dark alleyway at night and hear footsteps behind you, you might be alerted in uncomfortable ways, and your body will prepare to fight or flee. But if you then hear your friend’s voice, everything in your body’s physiology changes in that one instant. Yet the only thing that’s changed is your perception!

So going back to the question “Can depression be good for us?” Was depression once an adaptive response to the environment? I subscribe to the idea that the body doesn’t make mistakes after millions of years of evolution. A 2014 review in the Journal of Affective Disorders attempts to answer the question of why we get depressed, rather than just looking at how, and what to do about it. Often the best approach to root cause resolution of symptoms comes from an understanding of the reasons why the body is responding in the way that it is. Speaking to the concept of evolutionary mismatch, the authors of the paper state: “. . . modern humans exist in environments that are critically different from those in which we evolved, and that our new environments interact with our ancient genomes to lead to disorder . . .”³¹

The authors discuss how depression may have served a purpose at some point, but the nature and intensity of today’s modern-day triggers may be leaving more of us depressed (up to 41 percent of us!) more of the time than seems reasonable. This perspective encompasses the inflammatory model of depression, which posits that both psychological stress and bodily inflammation result in brain-based changes that would serve us if they were brief, but may kill us if they are persistent (something like that).

The researchers of the review go on to explain how antidepressants are missing the mark, and why their prescription should be reconsidered, citing side effects including:

. . . headache, nausea, insomnia, sexual dysfunction, agitation, sedation, hyponatremia, stroke, cardiac conduction defects, and increased risk of mortality. The long-term use of antidepressants may be associated with additional adverse effects. For instance, some antidepressants may be weakly carcinogenic or cause osteoporosis. Antidepressants have also been associated with an increased acute risk of suicide in younger patients while they may decrease the risk of suicide in older patients or with longer-term use. Also, all major classes of antidepressants have been associated with unpleasant (and sometimes dangerous) symptoms when they are discontinued abruptly. Discontinuation of antidepressants is associated with relapse and recurrence of MDD (Major Depressive Disorder). In a meta-analysis, this risk was shown to be higher for antidepressants that cause greater disruption to neurotransmitter systems . . . [And] there is a growing body of research suggesting that when they are used in the long term as a maintenance treatment, antidepressants can lose ­efficacy, and may even result in chronic and treatment-resistant depression. Such reactions may be due to the brain’s attempt to maintain homeostasis and a functioning adaptation in spite of the medication.

For someone like me, this is a profound summary of the perspectives I have curated since my departure from conventional practice. The call to action is to view depression as the vague descriptive term that it is. Put simply, depression is a sign for us to stop and figure out what’s causing our imbalance. Another way to appreciate this perspective is to say depression is an opportunity.

Many of my patients are initially surprised to experience my wrath about the prescribing that’s going on all around me. I don’t think New York is any different from Anytown USA in how heavy-handed the average practitioner, whether it’s a family practice doctor or an internist or psychiatrist, is with prescriptions. In my opinion, it has become reckless. Their patients have never consented to the long-term effects of these medications because pharmaceutical research is, by nature, short­ term.³² There’s no incentive on the part of the pharmaceutical companies to take a good look at what happens to the average individual when she takes a medication for a decade or so. That said, in recent years there’s been a spat of studies linking antidepressants to an increased risk of aggression, homicide, and suicide, as well as fingers pointed at these drugs for their involvement in school shootings, airplane crashes, and other unfortunate events often blamed on terrorists, gun access, or lack of treatment.³³

In one particularly alarming paper published in 2015 in no less an authority than the British Medical Journal, researchers from the Nordic Cochrane Centre, an independent drug safety analysis group based in Denmark, found that more than half a million ­people aged sixty-five and older in the West die every year from psych meds.³⁴ Using an impressive meta-analysis of placebo-controlled trials, these researchers discovered that more patients die from taking FDA-approved antidepressants than do patients who take no drugs or who use other unconventional treatment methods. Similarly, the all-cause mortality rate (translation: dying from any cause) was found to be 3.6 percent higher among patients who take newly approved antidepressants compared to patients who take no antidepressants. The study’s scientists highlighted the fact most industry-funded studies favoring psych meds tend to skew the sample groups and test data so much that the results end up becoming meaningless. Underreporting of deaths, according to the study’s authors, is another major problem in the clinical trial process. The Nordic group estimates that the suicide rate among antidepressant users is some fifteen times higher than what the Food and Drug Administration (FDA) reports publicly.

Studies like this that uncover our modern medical assault on humanity are just the tip of the proverbial iceberg. I could write a whole book on the high-profile research demonstrating that patients are held hostage by psychiatric medications, made sicker, and convinced that neither is true. They are more likely to experience a worsening of their depression, as these drugs have been proven in rigorous studies to be mood destabilizers (contrary to what conventional wisdom says).³⁵ I should also add that they’ve recently been labeled as carcinogens.³⁶ In a major review published by the Australian and New Zealand Journal of Psychiatry, a group of researchers from a variety of institutions including Tufts University, Harvard University, and the University of Parma in Italy reported that the vast majority of psychotropic drugs can cause cancer in animals.³⁷ Although the animal-based results are not enough to draw definitive conclusions in humans, these same animal studies are often used to justify drug and chemical safety, and therefore they are enough to warrant caution and appropriate informed consent. Unfortunately, these conversations are not happening.

Don’t panic if you’re taking an antidepressant now.

The information in this book will help you take control of this symptom once and for all, and if tapering is right for you, I’ll be sharing my personal guide for doing just that in Chapter 10. For now, accept the fact that we are all designed for depression as humans. It can be a warning sign that something isn’t right within. And just as we are designed to feel glum, we are also designed to self-heal and feel great.

DEPRESSION ISN’T GENETIC, IT’S EPIGENETIC

One of my favorite practice-changing papers was a 2003 case report of a lifelong vegetarian who experienced a month and a half of progressively worsening depression.³⁸ Eventually she began to hear voices and feel paranoid. The fifty-two-year-old postmenopausal woman ultimately became what’s called catatonic, which meant she was awake and alive but nonresponsive, and largely in an otherwise vegetative state. One would automatically assume this was a serious case of severe pathology. She was treated with electroconvulsive therapy and antipsychotics to no avail. And then she was transferred to another hospital, where they happened to test her levels of vitamin B₁₂. They found that she was a tad on the low side, and after receiving a vitamin B₁₂ injection, she fully recovered. Coincidence? I think not. While it may be one of the more extreme cases, it’s emblematic of how a simple but critical deficiency can be at the causal root of psychiatric manifestations. Later on, we’ll see how vitamin B₁₂ deficiency has long been implicated in the development of depression. It’s a classic example of how we are not just puppets at the mercy of our encoded DNA, but rather products of the complex interactions between our genes and our environment. And it’s now well established that our health outcomes are dominated more by our environment than our inheritance. As I like to remind my patients, depression is epigenetic, not genetic.

Even though genes encoded by DNA are more or less static (barring the occurrence of mutation), the expression of those genes can be highly dynamic in response to environmental influences. This field of study, called epigenetics, is now one of the hottest areas of research. Epigenetics, defined more technically, is the study of sections of your DNA (called “marks,” or “markers”) that essentially tell your genes when and how strongly to express themselves. Like conductors of an orchestra, these epigenetic marks control not only your health and longevity, but also how you pass your genes on to future generations. Indeed, the forces acting on the expression of your DNA today can be passed on to your future biological children, affecting how their genes behave in their lives and whether or not their children will face a higher risk of certain diseases and disorders, depression included. But, by the same token, these marks can be changed to read differently, making it fully possible to reverse certain diseases.

We in the scientific community believe epigenetic forces affect us from our days in utero until the day we die. There are likely many windows during our lifetime when we are sensitive to environmental impacts that can change our biology and have major downstream effects such as symptoms of depression. At the same time, the multitude of neural, immune, and hormonal actions that are controlled by the microbiome—­and that in turn command our entire physiology—­are susceptible to disruption and adaptation, especially by environmental changes.

One of the most important takeaways from this first chapter is to understand that depression is not about the brain per se. Of course, there are brain events and biochemical reactions occurring when a person feels depressed, but no research has ever established that a particular brain state causes, or even correlates with, depression. Many different physical conditions create psychiatric symptoms but aren’t themselves psychiatric. We think (because our doctors think) that we need to “cure” the brain, but in reality we need to look at the whole body’s ecosystem: intestinal health, hormonal interactions, the immune system and autoimmune disorders, blood sugar balance, and toxicant exposure. And we need natural, evidence-based alternatives to psychiatric medications—­treatments that target what’s really awry in our bodies. That means strategic dietary supplementation and noninvasive remedies like light therapy and cranial stimulation, but also smart (i.e., biologically compatible) food protocols and exercise choices, restful sleep, a detoxed environment, and meditation/relaxation practices. The best way to heal our brains is to heal the bodies in which they reside. Or, as I also like to put it, free your mind by healing your whole body. Hence the whole purpose of this book. The potential for lifestyle-based interventions and healing is immense.

When I get asked about the main triggers of depression, I often think of the three types of patients I generally see: the woman with blood sugar issues and nutritional deficiencies due to the standard American diet (high in sugar, low in healthy fats); the individual with a misbehaving thyroid, which plays into all matters of hormones that in turn affect mental health; and the person with either medication-induced depression (think statins, birth control pills, proton-pump inhibitors like Nexium and Prilosec, and even vaccines). We’re going to be exploring all of these potential triggers in detail in the upcoming chapters.

Although scientists are now trying to identify drivers of different types of depressive syndromes, the medical industry still offers a one-size-fits-all solution (read: one drug, one disorder model). This is akin to studying all the different sources of, say, back pain—­from a torn muscle or a herniated disc to cancer or a kidney infection—­but using the same treatment protocol on all cases. It doesn’t make sense, and there can be unintended consequences if that singular treatment entails risky drugs or surgery. And when it comes to using antidepressants for all signs of depression, this can be very tricky terrain, as the next chapter shows.