Depression and Anxiety

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By  Dr. Jason Porter - at  February 19, 2014    

Although depression and anxiety present differently between patients, many natural therapies used for one, are also used for the other. Each patient is treated individually as we seek to discover the underlying issues. At present, we will describe depression and anxiety together as mood disorders.

The natural approach to mood disorders

The natural approach to treating mood disorders is a valid alternative to the typical prescribing of antidepressants. The key to treating mood disorders is not more drugs, but more information. Although readily available, patients are not offered the available tests to determine current levels of neurotransmitters, MTHFR defects, candida overgrowth, hormone deficiencies, and environmental sensitivities. Our experience has been that current guidelines fail to test these underlying issues when patients visit with primary care and mood disorder specialists.

At our East Valley Naturopathic Clinic located in Mesa, we have a success rate of mood disorder treatment of greater than 95 percent. Two reasons for this success rate is because we test  for neurotransmitter levels, nutritional deficiencies, candida overgrowth, MTHFR, hormones , environmental toxins, and other imbalances as suggested by the personal intake before we treat. No guesswork is involved.

Secondly, we use  natural means to restore balance, eliminate deficiencies, reduce yeast, and provide precursor amino acids that raise neurotransmitter levels to optimal.  In some cases the addition of some medication may be indicated, but we are able to utilize one-fourth or less the typical dose, thus reducing any significant side effects.

Prescribing anti-depressants without doing baseline neurotransmitter testing and nutrient testing is like playing darts. We hope to hit the bullseye, but too often we can’t even hit near the target. Though some see some improvement most continue on with lagging symptoms and sleep disorders or just complete lack of empathy or emotion due to the high doses of antidepressants. Better results are  available with neurotransmitter testing.

 

Neurotransmitter Deficiencies

Medical research has established a definite link between neurotransmitters and a number of mood disorders. It has been concluded that deficient or excessive neurotransmitter levels may be at the root of many of these mood disorders. Therefore, the ability to assess the levels of various neurotransmitters offers a useful tool in addressing neurotransmitter-related conditions.

What does neurotransmitter testing show and how do we do it. Neurotransmitter testing is able to view the amounts of norepinephrine, epinephrine, dopamine, and serotonin both in the periphery and in the central nervous system or the brain. These labs are run through locals labs such as Sonora Quest or LabCorp from blood draws done in our Mesa Office. The expense of labs is generally covered under most insurance plans. Samples are drawn twice to compare results at baseline resting and under stress. After lying quietly for 20 minutes the first sample is taken, followed by five minutes of physical activity. Levels of norepinephrine and epinephrine are compared along with levels of serotonin to determine how the brain is handling stress and the causes of depression, insomnia, or anxiety.

Once treatment is initiated with the use of targeted amino acids and sometime low doses of antidepressants(typically 1/5th the average dose prescribed), labs can be repeated every 3-4 weeks to evaluate whether the targeted treatment has improved neurotransmitter levels and activity. Our high success rate of treatment of depression and other disorders of mood hinges upon exact evaluation of levels of the neurotransmitters involved in mood disorders. The guesswork is removed when we see the numbers. At that point we know what to do and what we can expect for positive outcomes as treatment is initiated.

Once a patient’s neurotransmitter levels are restored to optimal and balanced,  a maintenance protocol is designed to help the patient remain disease or symptom free. In most cases we are able to treat without the use of any medication at all, which is exciting for many due to the many side effects associated with typical antidepressants.

Why are selective serotonin re uptake inhibitors(SSRI’s) not guaranteed to work forever?

The answer is because they deplete the very neurotransmitters they are designed to enhance. The main cause of depression and in some cases even anxiety is low serotonin activity in the central nervous system or brain. SSRI’s work by taking a reduced work force as expressed in the low levels of serotonin in the brain and making them work longer. As an example, an individual may need 100 serotonin workers to maintain a normal mood. With depression the work force is reduced to say 50 workers. When serotonin workers drop to 50, a mood disorder may express. At this point a new  drug is introduced as a manger to improve the efficiency of the 50 workers.  Serotonin  worrkers acustome to working 40 hrs/week, now are working 80 hrs/week. to produce the volume of 100 workers.

You can only imagine what will eventually happen in time. The serotonin neurotransmitters are literally going to work themselves to death, thus depleting what little stores are available.  Eventually the work force is reduced to 10 or less and soon the new drug or manage has nothing to manage. Eventually the SSRI’s have too small of a work force to make a noticeable difference. And so begins the ever increasing doses of SSRI’s with all the side effects included. Sometimes this works, but it is short lived until the remaining serotonin is depleted.

A better way exists to improve serotonin levels. Give that which will increase the number of workers. Every neurotransmitter has an amino acid(protein) precursor. For serotonin it is tryptophan and 5-hydroxytryptophan(5-HTP). For norepinephrine, epinephrine, and dopamine, it is tyrosine. In addition Dopamine also can be raised by Mucuna Pruriens or “Dopa Bean”. The use of specific or targeted amino acid therapy is absolutely the best way to increase neurotransmitter levels in the brain and the periphery, and with the bonus of no side effects.

MTHFR

A large percent of the population carries a polymorphism in an enzyme called 5,10 methyltetrahydrofolate reductase or MTHFR. This polymorphism results in a decline in a number of events that require sufficient folic acid. The effect of this enzyme defect results in a decline of the MTHFR enzyme by approximately 60 percent, leaving the folic acid cycle very sluggish.

Folic acid comes in two common forms outside the body known as folate and folic acid. Folic acid status in the US has improved since 1998 when it was added to fortified foods, yet studies show that many people are still deficient in folic acid. Folic acid is essential for the synthesis of purines (the building blocks of DNA), the synthesis of methionine (important in methylation and over 100 reactions requiring SAMe), and the metabolism of homocysteine. Folic acid is absorbed by the gut and is converted to tetrahydrofolate which is converted to methylene tetrahydrofolate and than to methyltetrahydrofolate by the enzyme MTHFR. If the MTHFR polymorphism is present than the pathways reducing homocysteine, producing methionine, glutathione, phospholipids, and neurotransmitters is reduced by up to 60 percent.

Folic acid deficeincy has been linked in numerous studies with depression. It is estimated that 1/3 of all depressed patients have as the sole cause of their depression a folate deficiency. Studies which have added folic acid to the current antidepressant prescription also showed significant improvement in depression. In addition, studies have also found folic acid deficiency to cause low serotonin, which is the brains major antidepressant neurotransmitter.

The good news about the folate pathway, it is maintained simply by high doses of folic acid, which will drive the pathway, just like water spilling over a dam, or by taking the form of folic acid that bypasses the need for MTHFR, called 5 Methyltetrahydrofolate (5-MTHF). We recommend a little of both. Other co-factors that also help drive the folate cycle are essential and include vitamins B2 (riboflavin), B6 (pyridoxine), and B12 (cobalamin). Patients with depression without a MTHFR defect, who are folic acid deficient, will be benefited by taking additional folic acid as contained in a multi-vitamin mineral complex or folate vitamin. Those with the MTHFR are recommended to take a specifically formulated blend of folic acid and co-factors required to maximize folic acid pathways.

For so many patients who have lived years or decades without knowing they had a MTHFR defect, it is imperative to treat it correctly now. Those who have any symptom of MTHFR polymorphism should be tested and treated.

Candida overgrowth linked to depression.

Candida is of the fungus family and is not as easily eradicated as a viral or bacterial infection. Many patients diagnosed through their Naturopathic or Alternative Doctor as having candida, see improvement in mood and sleep as a benefit of following a candida cleanse or diet. We have seen this firsthand many times. It is hard to explain the relationship 100 percent, but there are some interesting correlations to where yeast predominantly grows and where serotonin is produced.

Candida is a normal inhabitant of the intestinal tract. Its  presence and expression is normally controlled by a clean diet, and naturally occurring probiotics as found in fermented foods. The use of antibiotics, stress, and soda result in the over expression or growth of candida in the intestinal tract. Candida has also been linked to fibromyalgia, chronic fatigue, and even some autoimmune conditions.

Interestingly enough, serotonin as measured in blood or urine sample is produced predominantly in the enterochromaffin cells of the small intestine where yeast can possibly dominate. It is my theory that yeast presence reduces total serotonin in circulation. This has been observed in lab work in which antibodies to candida are seen as well as low levels of serotonin in circulation in many of my candida diagnosed patients.

Candida is not easy to reduce in the intestinal tract and often requires strong prescriptions or aggressive natural medicines in order to eradicate. Most general practitioners do not recognize this relationship and will fail to support the use of antifungal therapy as a means to improve depression. Seek an alternative physician for professional guidance on how to treat candida and possibly improve depression, fatigue, and sleep disorders quickly.

Hormone Deficiencies

Many alternative physicians test and treat hormone deficiencies and imbalance as the sole cause of mood disorders. This approach to often leads to dissapointment when other factors such as neurotransmitters, MTHFR, and candida are ignored. When all factor are treated as previosuly described, hormone replacement, appropriatey done, can be the icing on the cake. In men and women, low testosterone levels can be linked to low libido, depression, and lack of energy. In women, low estrogen and progestorone may disrupt sleep, mood,  memory, and energy. The accurate assessment and treatment with natural or bio-identical hormone therapy allows for maximal benefits with reduced risks.

 Environmental toxicities and sensitivities

One the most recent emerging topics in natural medicine is the influence of environment on health. At our Mesa office we have noticed a significant correlation of mental health disorders with exposure to environmental toxins such as solvents and heavy metals. This was first noticed, while for a completely different health concern, we were chelating(removing toxic metals) in a patient with a history of anxiety, who reported after a single IV treatment, being anxiety free for 2 weeks. We repeated this treatment again and observed the same result.

We have also observed the same result in patients, who have been non-responsive to medication, when put on an aggressive liver and colon detoxification protocol, have both anxiety, depression, and even stress disorders improve 80 percent or more after 4-8 weeks. That is amazing, when considering that these patients do not need any medication at all, they are just toxic.

We live in an extremely toxic world and it is starting to take its toll on us all in different ways. Our approach often for patients with depression or anxiety is to balance neurotransmitters naturally through amino acid therapy, reduce candida growth in the gastrointestinal tract, and to follow an adequate detox regime to assist the body in removal of environmental toxins. This approach is the most comprehensive approach I know of and will result in better than 80% improvement in symptoms of depression, anxiety, panic disorders, and sleep disturbance.

Dr. Jason Porter

Dr. Jason Porter

Dr. Porter is a graduate of the Southwest College of Naturopathic Medicine in Arizona, and a member of the American Association of Naturopathic Physicians (AANP), the Arizona Naturopathic Medical Association (AzNMA), the Naturopathic Association of Therapeutic Injection (NATI), and the American College for the Advancement of Medicine (ACAM) where he is certified in chelation therapy. Dr. Porter is also a supervising physician at Southwest College of Naturopathic Medicine where he teaches Naturopathic Medical Students methods for treatment of chronic pain conditions and disease prevention for longevity and improvement in quality of life.

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