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I was sitting with a colleague yesterday discussing a future case of a patient with depression. I have written a number of times about how medicine often dismisses the psychology of the patient and its impact on disease processes. But the same oversight often occurs with psychologists treating conditions of the mind who overlook potential biological (body) drivers of disease.
What do you think causes depression?
Most people would say it’s a mental disease involving inadequate levels of neurotransmitters in the brain – particularly serotonin. According to the World Health Organization (WHO), depression is the leading cause of disability worldwide. The standard treatment involves psychotherapy plus an SSRI – selective serotonin reuptake inhibitor – which is a drug that prevents serotonin from being cleared as quickly from neuronal synapses in the brain. The theory being if the brain is low in serotonin, a drug that increases its availability should cure the disease.
Is this the only story of what drives and alleviates depression or has our compulsive need to separate the mind and body lead us to a half truth? It breaks my heart to see doctors overlooking the psychology of the patient and its contribution to biological changes in the body. However, psychologists who do not consider biological (body) causes of depression are equally blinded.
Is depression a diagnosis or is it a symptom of a body in distress?
Two conditions that classically present with the symptom of depression are hypothyroidism and anemia.
The thyroid gland is located at the base of the neck and is the chief regulator of energy metabolism in the body. When levels of thyroid hormone rise in the blood, reactions in the body speed up with the increase in energy. In the case of the autoimmune condition Hashimotos – the thyroid gland has been damaged by the immune system leading to inadequate hormone production. As a result, every metabolic process in the body slows down – including production of neurotransmitters. This slowed metabolic state is often experienced by the patient as depression.
Anemia is a condition of inadequate red blood cells, which are needed to carry oxygen to mitochondria in tissues throughout the body. Oxygen is the main driver of ATP production – the chief energy currency in cells. In anemia- fewer red blood cells carrying oxygen to tissues results in a decline in energy production throughout the body. Less energy slows all reactions in the body, including neurotransmitter generation. The patient describes this energy deplete state as depression.
These are two classic examples. In just five minutes of discussion, my colleague and I identified ten more that most psychologists are probably not considering when working with a patient with depression.
Low vitamin D
Mold Exposure (Chronic Inflammatory Response Syndrome or CIRS)
Hyperhistaminemia (high histamine levels)
Hyperhomocysteinemia (high homocysteine levels)
Epstein barr virus (EBV)
Low zinc levels
The mind and the body are not separate and until psychology and medicine inhabit both perspectives, causes of disease will continue to go unacknowledged. Are you currently experiencing depression? Schedule a visit. Let's explore what's underneath.