INTEGRATIVE TREATMENT OF DEPRESSION

Dr Lily Tomas

Integrative Treatment

of Depression

ExerciseBodyimage

Social/ Spiritual

Neurotransmitters

V & M s

Hormones

EFAs

Drugs

Heavy Metals

Sleep

BSLs

Psycho logical

Homeo

pathy

Herbal

Environ. Influences

Diet

Purpose, Passion, Pleasure

Anti-Depressant Medications

Tricyclics : May block re-uptake of serotonin, noradrenaline, dopamine and histamine.

SSRIs and SNRIs : Block serotonin and noradrenaline uptake

MAO Inhibitors : Inhibit Monoamine oxidase, Type A blocks the breakdown of serotonin and noradrenaline

Type B blocks the breakdown of different neurotransmitters, including adrenaline, dopamine and noradrenaline

Nutritional Treatment Options for Depression

Important neurotransmitters include:

Serotonin

Dopamine, Adrenaline, Noradrenaline

GABA

Histamine

Neurotransmitters are derived from amino acids sourced from quality proteins.

Nutritional Treatment Options for Depression

Depression can be the result of imbalances in neurotransmitters- deficiency or excess

Determine neurotransmitter imbalances and/or specific amino acid deficiencies

Serotonin deficiency – Tryptophan, Vit B6 or zinc deficiency, malabsorption

Oxidative stress can increase serotonin requirements

Serotonin Pathways

Iron, Folate Vit. B6

Vit. C, Calcium Zinc

5 Hydroxy Serotonin

Tryptophan

Tryptophan Melatonin(from Food/ Supplement)

Vitamin B3

Dopamine Pathway

Iron, Folate Vit. B6

Vit. C

Tyrosine DOPA Dopamine(From Food/

Supplement) Vit. C

Copper

Adrenaline NorAdrenaline

GABA Pathway

Vit. B6, Taurine

Zinc

Glutamine Glutamate GABA( From Food/

Supplement)

Glutathione

Histamine Pathway

Vit. B6

Histidine Histamine ( From Food/

Supplement)

Tryptophan

Tryptophan (5HTP) 100-200mg bd

Vitamin B6 100mg or Activated B6(P5P) 25mg

Zinc 40mg nocte

Magnesium 250mg bd

B Complex

Tryptophan

Trial at this dose for 1 month, then reduce to half as per patient’s own judgement.

Do not use tryptophan with anti-depressant drugs unless under professional supervision.

Tyrosine

Precursor to Dopamine, Noradrenaline, Adrenaline

These neurotransmitters have a role in depression and drug dependence

Can be in excess, however, in schizophrenia

Tyrosine 500-100omgs coupled with co-nutrients (Predop ingredients)

Tyrosine also used to enhance thyroid function

Glutamine

Related to the neurotransmitter, GABA, our primary inhibitory neurotransmitter

Therefore aids in mental anxiety and relaxation

Glutamine 500mg-1000mgs coupled with co-nutrients (Pre-GABA ingredients)

Pfeiffer Treatment Centre

Health Research Institute, Illinois, US.

Extensive database of information regarding all mental health conditions

3500 patients with depression

Highly individualised nutritionally-based approach to treating depression and other health conditions (e.g. Autism, ADHD, Alzheimers etc)

Pfeiffer Treatment Centre

5 main biochemical subtypes of depression

High Histamine (Undermethylation)

Low Histamine (Overmethylation)

Pyroluria (Genetic condition resulting in Zinc, VitB6 deficiencies)

Hypercupraemia (High Copper- Excess Oestrogen)

Toxic Overload (High levels of Heavy Metals)

Histamine

High Histamine

Under methylated

Deficiency of methyl groups/ Neurotransmitters (Serotonin, Dopamine, Noradrenaline)

Generally a good response to SSRIs

May have adverse reactions from benzodiazepines

Histamine

High Histamine

Low methionine, zinc, Vitamin B6, calcium with high folic acid.

Benefit from SAMe, P5P, zinc, methionine, Vitamin C, calcium, magnesium

Potentially harmful supplement : folate

Improvement expectation: 8-12 months.

Histamine

Low Histamine

Over methylated

Excess of methyl groups/ Neurotransmitters (Serotonin, Dopamine, Noradrenalin)

Generally a good response to benzodiazepines

May have adverse reactions to SSRIs, anti-histamines, oestrogen

Histamine

Low Histamine

Low folate, Vitamin B12, B3

Benefit from folate, vitamin B12, B3,P5P, zinc, Vitamin C, E

Potentially harmful supplements : methionine, SAMe, tryptophan, tyrosine, St John’s Wort.

Improvement expectation : 3-6 months

Histamine, Methylation and SAMe

Histamine is intricately connected to the Methylation pathway.

The process of Methylation is a major factor in the synthesis of serotonin, dopamine and noradrenaline in the brain.

SAMe is the primary source of methyl for most reactions in the body

Methylation and SAMe

The primary way humans receive most of their methyl groups is from dietary methionine (egg white, halibut fish, orange roughy fish, salmon, tuna, ling, turkey)

SAMe : 400-800mg daily

Trial at this dose for 1 month

Essential Fatty Acids

Omega 3 fatty acids are essential components of brain cell membranes.

Alter signal transduction and electrical activity in brain cells, controlling the synthesis of chemicals such as eicosanoidsand cytokines which may have a direct effect on mood.

Humans do not make their own Omega 3 EFAs!

WE ARE WHAT WE EAT!

Essential Fatty Acids

Our change in diets (land animal fats and many vegetables oils) from 4:1 to 16:1 Omega6: Omega 3 ratio.

EFA levels can now be measured directly through blood tests performed in specialisedlaboratories.

Plethora of studies demonstrating the benefits of adequate EPA/DHA to our mental state.

Essential Fatty Acids

HOWEVER

There is a subgroup of people with depression that may get worse from EPA/DHA supplementation.

These are people who are deficient in arachidonic acid, an Omega 6 EFA – Evening Primrose Oil.

These are people who produce and excrete kryptopyrroles in their urine.

Kryptopyrroluria

Genetic disorder linked to depression, anxiety and mood swings

Approx 10% population produce KPs, indicating higher needs for Vitamin B6 and zinc .

Zinc and Vitamin B6 necessary to produce serotonin and GABA

Vitamin B6 necessary to produce dopamine, noradrenaline and histamine.

Kryptopyrroles

First discovered in late 1950s by Hoffer

1960’s : research on schizophrenics, “mentally retarded” and “disturbed” children and criminals

1970’s : Dr Carl Pfeiffer devised a simple quantitative urine test and demonstrated a reduction in kryptopyroles and clinical improvement with high doses of vitamin B6 and zinc.

Kryptopyrroluria

Pale appearance, white marks on nails, poor dream recall, heightened sensitivities –bothered by bright lights, loud noises, tags on clothes, skip breakfast, food/chemical allergies.

Testing by SAFE Laboratories in QLD.

Kryptopyrroluria

Tend to do better on Omega 6 EFAs (evening primrose oil) rather then Omega 3 EFAs (fish oils) secondary to low levels of arachidonicacid.

Beneficial supplements: zinc, P5P, Vitamin B6, Vit C

Improvement expectation: 1-3 months

Hormones and Depression

Progesterone – Like serotonin, another “Feel good” hormone.

Produced in the luteal phase

Most women are oestrogen dominant.

“How much of your depression do you relate to your hormones?”

Hormones and Depression

Oestrogen dominance is often associated with copper overload.

During pregnancy, blood copper levels more than double.

Soon after birth, copper levels return to normal.

Subgroup of people who have a genetic tendency for copper overload.

Excess copper leads to decreased dopamine and elevated noradrenalin in the brain.

Hormones and Depression

POST-NATAL DEPRESSION

Many women with PND exhibit an excess of copper and a deficiency of zinc.

The cause appears to be genetic; abnormal functioning of the metallothionein/ glutathione system resulting in an inability to regulate copper/zinc metals in the body.

Hormones and Depression

Serum copper and plasma zinc.

Stop pregnancy supplements containing copper.

Beneficial supplements: Zinc, Manganese, Vitamin B6, Vitamin C, Vitamin E.

Putting it all together: Case History

36 year old woman presents with history of depression and IBS for 2 years

Prescribed conventional anti-depressant 6 months ago, but wishes to wean.

Not suicidal

Full history and examination

Case History

Management:

Mental Health Care Plan (Item 2710)

Pathology testing

3 morning temps during periods

Case History

Management:

Probiotics

SAMe 400mg morning

Continue current anti-depressant

Review in 1 month

Review after 4 weeks

Feeling better wrt moods and digestion

36.2, 36.4, 36.5

Food Elimination Regime (not all IBS symptoms resolved)

Mental Health Care Plan (continued)

Continue probiotics and SAMe. May trial half dose of anti-depressant over next month.

Review after further 6 weeks

Realisation of gluten intolerance, resulting in bloating , fatigue and low moods associated with these symptoms.

Still depression 1 week prior to periods

Patient still keen to cease anti-depressant

Commencement of 3 month regime Magnesium 250mg twice daily, B Complex and Vitex agnes castes 1g twice daily

Regular exercise

Review after further 8 weeks

Feeling much better

Continuing to avoid gluten

SAMe reduced to 200mg morning

Future dosing of SAMe and probioticsaccording to patient’s judgement

After another month, may halve hormone balancing regime

Mental Health Plan Review