Last year, I was seeing four different doctors: a psychiatrist for my mood disorder; an endocrinologist for my pituitary tumor and thyroid issues; a cardiologist for my aortic valve regurgitation; and a primary care physician for some digestive problems and fungus growth.
I suspected that all of my health problems were connected, but each doctor refused to look beyond her specialty to achieve a systemic, balanced perspective of how the conditions were related. I searched for an integrative doctor who could piece together all of my broken parts and help me determine underlying causes for all of the ailments. After spending a few months with a functional doctor who was very anti-medication, I finally — much like Goldilocks — found the right physician: an internist who was willing to look through my files from past doctors and X-rays that exist somewhere on the Internet in order to gain a holistic view at my health.
I believe the vast majority of persons who have been told their depression is treatment resistantcan benefit from working with an integrative doctor — someone who considers all of your biological systems and organs when trying to determine the reason why you don’t want to get out of bed in the morning. However, many integrative doctors are expensive and don’t take insurance, so I thought I would interview my doctor, Alan Weiss, MD (pictured above), to provide you with some ideas about next steps to take if you are stuck and not getting better.My biggest frustration with psychiatry is that most psychiatrists won’t consider any contributing factors below the neck. So when people like me don’t get better after 20, 30, 40, or 50 medication combinations, they aren’t sure what to do. They tell us we can try brain stimulation possibilities, like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). Or we will have to learn to live around our death thoughts and suicidal ideations.
Dr. Weiss serves as the medical director of Annapolis Integrative Medicine. He earned his bachelors degree from the University of Virginia and his medical degree from McGill University. He is board certified in internal medicine and is a fellow of the American Academy for Advancement in Medicine and the American College of Physicians. He has practiced medicine for more than 15 years. He had conducted studies and published articles relating to diabetes, chronic pain, fibromyalgia, and chronic fatigue syndrome. Weiss’ goal is to educate and treat his patients by incorporating the latest research in the areas of conventional and alternative medicine. He continues to pursue and educate himself in leading-edge methods of achieving wellness.
I’m pleased to share some of what I have learned from him with you.
TB: What are the primary underlying or accompanying causes of depression that you’ve encountered in your years practicing internal medicine?
AW: The top five underlying causes of depression that I see in my patients are a bad diet, leaky gut, sleep disorders, hypothyroidism, and low vitamin D and B-12.
1. Bad diet: I don’t think people truly understand the impact of what they eat on their mood. Processed foods, hydrogenated oils, sugar, and lots of bread and cracker-like snacks can certainly contribute to symptoms of depression and anxiety. For optimal mental health, I advise my patients to eat a clean, Paleo (also called primal or ancestral) diet: eating whole or nutrient-dense foods, and avoiding refined sugar, gluten, pasteurized dairy products, and processed factory foods like Fritos and Oreos. I also recommend taking fish oil supplements, vitamins B-12 and D, a multi-vitamin, and a multi-mineral.
2. Leaky gut: Leaky gut is clinically known as increased intestinal permeability or hyperpermeability, a condition in which food is allowed to pass through the small intestinal lining. Substances leak into the bloodstream that shouldn’t be there, causing bloating, gas, and sometimes mood disturbances.
3. Sleep disorders: We’ve always known that depression causes interruptions in sleep, and that a lack of sleep makes persons more susceptible to mood disorders. But studies now show that sleep problems can cause mood disorders and that sleep deprivation can rewire the brain’s emotional circuits.
4. Hypothyroidism: Since most psychiatrists and primary-care physicians don’t run a full thyroid panel, I see a number of patients who have undiagnosed hypothyroidism, an underactive thyroid, which causes symptoms of fatigue, apathy, and depression.
5. Low vitamin D and B-12: These are the two most common nutrient deficiencies for my patients who have depression symptoms. Both vitamin D and B-12 are essential for positive mood.
TB: Why don’t some people get better after working tirelessly with a psychiatrist?
AW: They may not be addressing root medical issues like the ones I mention above: hypothyroidism, leaky gut, sleep disorders, and vitamin deficiencies. Some people being treated with medications need cognitive behavioral therapy, as well, or vice versa. Patients can have food allergies and food intolerances that affect mood, or they have toxicities — such as mercury poisoning — that an antidepressant can’t treat. Addictions can prevent recovery from depression, or less-than-full disclosure about something like an addiction with a psychiatrist. And there are always some people who are just simply being treated for the wrong things.
TB: What are the best blood tests to have their primary care physician run? What should a person do who can’t afford to see a functional or integrative doctor?
AW: I would have your doctor run a full thyroid panel that should include TSH, Free T4, Free T3, Reverse T3, and Thyroid Antibodies. Test for deficiencies in vitamin D, B-12, ferritin, and iron. Rule out food allergies by doing an elimination diet. Simply remove specific foods from your diet for a few weeks that you suspect could be causing allergy symptoms (milk, eggs, nuts, wheat, and soy are typical triggers). Keep a food diary to record the foods you are eating and omitting, and if the symptoms disappear when you stop eating them. Slowly add back in the suspicious foods, one at a time (give yourself a week between each reintroduction). Record any allergic symptom you feel as you add each food in. That should help you confirm that the food is triggering the symptom.
TB: What recommendations or advice would you give a person who fights chronic depression or anxiety?
AW: My advice is to clean up your diet, exercise on a regular basis, optimize your hormones (for example, get a full thyroid panel done to be sure your thyroid isn’t underactive), clean up any integrity issues you may have in your life. If the depression continues, you may need to change something else in your life.