Fatigue, foggy thinking, flat affect, PMS, and constipation are often associated with anxiety or stress. But why are you feeling this way? What can we do to personalize a treatment plan so that it is unique to you? You can ask 10 patients who have the same symptoms about their life and their story, and they will all come up with a different set of contributing factors. Traditional medicine doesn’t have time to take this uniqueness into consideration.

The Gut-Brain Connection
70% of our immune system exists in the gut, and the interplay between the gut and the brain is a complex and profoundly important relationship to appreciate. We all recognize that anxiety or nervousness can impact our guts – most of us have had butterflies before a date or even diarrhea with extreme performance anxiety. The gut can also send a message to the brain causing anxiety or depression. This relationship between gut and brain goes both ways. The vagus nerve is the main highway that sends information along this bidirectional pathway. Inflammatory markers are the cars travelling down this highway. These inflammatory markers can be measured and altered with diet and lifestyle therapies. But where does inflammation come from, and why/how is it a driver of illness?

Inflammation stems from many sources including, but not limited to, the following:

  • Sugar. Sugar, particularly in the form of fructose and sucrose, spikes insulin and triggers release of inflammatory cytokines or “messages” and encourage the growth of yeast and “bad” bacteria.
  • Chemicals. Environmental pollution from industrial waste, soft plastics, fire retardants, and cosmetic additives all stimulate our immune systems to varying extents and disrupt optimal production of energy on a cellular level, particularly in vulnerable tissues like the thyroid.
  • Pathogens. Food sensitivities, gluten (for many people), genetically modified foods can all promote intestinal permeability, changes in our intestinal flora that can cause a growth of yeast and pathogenic bacteria.
  • Vitamin D deficiency. There has been a link seen between low vitamin D and inflammatory bowel disease. Increased inflammation in the intestines exacerbates the symptoms of leaky gut.

Stress, Cortisol and Inflammation
Stress triggers the release of cortisol. Cortisol helps to mobilize blood sugar so that you can run effectively and efficiently from that tiger chasing you. Elevated cortisol contributes to insulin resistance, which simply means that in this state, the insulin “key” can’t unlock the cell to let sugar in. So the sugar hovers around the cell rather than being absorbed. As a result, cells remain in a starved state. Insulin inhibits fat breakdown and instead encourages fat storage. Fat cells are really just inflammatory tissue as they secrete their own inflammatory signals and convert testosterone to estrogen causing estrogen dominance. Also in this high cortisol state we see high DHEA which converts to testosterone and estrogen and further increases this cycle. This causes acne, hair growth and irritability. Cortisol also keeps thyroid hormones “locked up” so that even though thyroid labs look normal, a person may have symptoms of hypothyroidism.

The Damaging Effects of Inflammation
Inflammation, once started, is a self-perpetuating cycle. It causes damage to tissues and increases stress-related chemicals rather than serotonin and melatonin which are calming neurochemicals. Depressive symptoms come to predominate such as fatigue, insomnia, low libido, and reduced appetite. In fact, patients with higher levels of inflammatory markers (like C-reactive protein) are less likely to respond to antidepressants, and more likely to respond to anti-inflammatory drugs.
Chronic illness like depression can be complex, reflecting a state of bodily disharmony. So why don’t we just start with antidepressants and call it a day? Because when the antidepressants don’t work, we end up adding additional medication to make it work more effectively. With patients like this it is crucial to do a comprehensive blood analysis to determine where hormones, thyroid function, inflammatory markers and vitamin D lie.

What Can We Do?
There is certainly a time and place for antidepressants, and they can be used to get a person out of the gloom while we make bigger lifestyle changes, but rarely should they be relied upon in isolation. We can approach modification of your system from many angles.

Here is a place to start:

  • Exercise, exercise, exercise!! Or movement or activity or whatever you want to call it. Find something you love that causes you to be out of breath to the point that you can’t hold a conversation, and do it daily for at least 30 minutes.
  • Meditation for 20 minutes a day. Meditation doesn’t have to be cross-legged with “Om” chants. There are many types of meditation and Transcendental Meditation has been the most studied. Sign up for a class and learn how, or just use a guided meditation tape!
  • Dietary changes. Reduce breads, sugars, coffee and other stimulants, and dairy. Have your food sensitivities checked, specifically IgG reactions. If you are sensitive to a certain food, it is causing inflammation, and most people have different foods that offend. The frequent offenders that I see are eggs, dairy, sugar, almonds, and gluten.
  • Strategic supplementation. Curcumin, vitamin supplementation, progesterone, omega fatty acids and adrenal support as well as optimizing hormones if in menopause. This protocol looks different for everyone and really is best tailored to the individual based on blood test results.

An understanding of the role of inflammation and immunity in driving hormonal imbalance, which directly impacts mood, energy, and wellness, is at the core of personalizing the definition of “depression”. You are an individual and need to be approached as one, especially with a complex diagnosis such as depression or anxiety.