Ever since I started an online community for treatment-resistant depression — depression and anxiety that don’t respond to psychotropic medications — I’ve been inundated with mail from desperate people who have tried as many as 30 to 40 different kinds of antidepressants, and feel no relief.
I repeatedly hear from family members of folks who have tried everything, and are not getting better. I sense the utter frustration and despair in their words, and it pains me. I, too, felt hopeless after trying countless medication combinations and sitting through years of psychotherapy sessions, only to continue my death obsessions.
I wish I could respond to everyone individually — spend an hour on the phone with them, begging them not to give up because they won’t always feel this way. Unfortunately, I can’t (step six). So the next best thing is to outline these nine basic steps for people who are treatment-resistant, because these actions, more than any medication I have tried in the last seven years, have helped me emerge from the other side of depression.
I’m not anti-medication by any means. Drugs serve an important purpose. But with so many people not responding, or only partially responding (myself included), I felt compelled to list the other parts of my recovery that have been critical to my wellness — things that most doctors don’t discuss. These steps didn’t fix me for good: I still have a lot of work ahead of me, and I have plenty of bad days.
I believe everyone has a chance at recovery, even those who have been depressed and anxious most of their lives.
I wish you good health with all my heart.
1. Identify Any Underlying Conditions
I would venture to say that most people with treatment-resistant depression are also suffering from undiagnosed conditions. My list was long: Crohn’s disease, small intestine bacteria overgrowth (SIBO), hypothyroidism, low stomach acid (hypochlorhydria), adrenal fatigue, Raynaud’s phenomenon and connective tissue problems, pituitary tumor, aortic valve regurgitation, and certain nutrient deficiencies (iron, vitamin D, and vitamin B-12).
It’s really best to work with an integrative or functional doctor. Many are listed on the website for the Institute of Functional Medicine, but you need to proceed with caution, because some of them are very expensive and will run unnecessary tests if you’re not careful. At the very least, I would ask your primary care physician or psychiatrist to run these four blood tests: a complete blood count (CBC); comprehensive metabolic profile (CMP); a thyroid full panel, including TSH, free T4, free T3, and thyroid antibodies (read Dana Trentini’s important blog on this); and the 25-OH vitamin D test, as well as B-12 levels. It may also be worth finding out if you have a Methylenetetrahydrofolate reductase (MTHFR) gene mutation (present in 15 to 40 percent of the general population), because we need the MTHFR enzyme to convert folate to its active form, methylfolate — and folate deficiencies make it difficult for antidepressants to work. In fact, many studies link low folate levels to depression.
I have actually learned more about my various conditions from the people on my depression forums, and in books and articles, than I have from sitting in doctors’ offices. The folks on Project Beyond Blue and Group Beyond Blue are working with nutritionists, integrative doctors, gastrointestinal specialists, and other experts, and are experimenting with new things all the time and willing to share their experience with you for free. I’ve learned from them about certain supplements, protocols, and resources that have really helped mitigate some of my symptoms.
2. Eliminate Triggers of Inflammation
Certain foods and substances create inflammation in our bodies, including in our brains, which leads to depression. The usual suspects are sugar, gluten, dairy, caffeine, and alcohol. Some people, like my daughter, may have more dramatic reactions to dairy, whereas others, like my son, are more affected by gluten. Me? I can’t go near sugar if I don’t want the death thoughts to return. You won’t really know until you do an elimination diet and get rid of everything for a few weeks, and then gradually add them back in (that is, if you tolerate them fine). I will warn you, though: You can’t cheat for those few weeks, because your system has to be totally clean for you to identify the problem. A spike in cytokines, proteins that are pumped into our bloodstream when our immune system is fighting off a foreign agent, happens when people are depressed. The process looks the same as when a person is fighting an infection of any kind. Unfortunately, a lot of fun, processed foods that taste really good, like Twinkies and Doritos, can cause inflammation — but clearly some people are more sensitive to others. Here’s an easy rule to follow: If a food comes in a nicely marketed package (even with the words “gluten free,” “dairy free” and ESPECIALLY “sugar free”), and its ingredients contain a bunch of words that you don’t know how to pronounce, it’s not going to make you any saner.
And not to be a total killjoy, but it’s worth examining what other kinds of toxins you are immersed in daily. Those could be causing inflammation, too. Not until three months ago did I realize that swimming in chlorine a few times a week was probably contributing to my gut problems and thyroid issues, both of which are critical in establishing a stable mood. So I switched to hot yoga (step five), and I began to feel better.
3. Go Green
Dark, leafy greens like spinach, Swiss chard, and kale fuel every system in your body more completely than any other kind of food. They are nutrition powerhouses, packed with vitamins A, C, E, K, and folate; minerals like iron and calcium; carotenoids; fiber; antioxidants; omega-3s; and phytochemicals. They are also a major source of chlorophyll, which, according to Green for Life author Victoria Boutenko, “heals and cleanses all our organs, and even destroys many of our internal enemies, like pathogenic bacteria, fungi, cancer cells, and many others.”
I started to feel a little better when I swapped my sandwich at lunch for a salad full of greens, and made a conscious effort to eat mood-lifting foods during the day. But I began to really heal when I started drinking green smoothies. I realize I sound like an infomercial at this point, but the only way my body was able to easily absorb and process all the nutrients in the greens was when they were blended into very small pieces. Like most people who have been on medications for decades, my stomach acid was very low, so eating lots of raw vegetables and greens was producing bloating and gas. I was not happy when my husband spent $500 on a refurbished Vitamix, but it has proven to be one of the smartest investments we’ve ever made. Now I try to drink two smoothies each day, and I really believe it has made a substantial impact on my health.
4. Heal Your Gut
Embedded into the walls of our intestines is an intricate enteric nervous system, consisting of some 100 million neurons, that is often referred to as our second brain. In fact, the nerve cells in our gut manufacture 80 to 90 percent of our body’s serotonin. There’s also a complex collection of bacteria living in our guts that a substantial volume of research says impacts our mood. It’s fascinating stuff for people like me who have always suffered from gastrointestinal problems and never before connected the dots.
In my article 10 Ways to Cultivate Good Gut Bacteria and Reduce Depression, I outline some of the steps I have taken to clean up my gut. Among them, I believe it’s important to consume prebiotic foods, like garlic, onions, artichokes, leeks, and dandelion greens, and probiotic foods, like active-culture yogurt, kefir, pickles, and fermented foods. It’s also good to avoid the use of antibiotics as much as possible.
5. Do Yoga
Any kind of workout or movement lifts your mood — boosting our brain’s dopamine levels and providing endorphins — but some kinds of exercises are much more healing than others, especially for people who have been depressed for decades or have stress-related conditions like adrenal fatigue. Unlike other aerobic workouts, like running or CrossFit, that raise cortisol levels and essentially wear out your body, yoga lowers levels of this stress hormone that is critical to the maintenance of homeostasis and regulating immune responses, blood sugar, and central nervous system functions. Several studiesillustrate how yoga tames the stress response by priming the parasympathetic nervous system, and is therefore an effective therapy for depression and anxiety.
I have tried different types of yoga, but the one in which I feel the most benefit is Bikram, a sequence of 26 Hatha yoga positions, and two breathing exercises, designed to engage and heal all of the systems of your body. It’s not for everyone, as you’re stuck for 90 minutes in a room heated to 105 degrees (sweating helps flush out the toxins). But when I can get there on a regular basis (at least four times a week), I feel a profound, calming effect — and I’ve heard the same from several other people who struggle with chronic anxiety and depression.