Depression; Why is it so complicated? Part I

                                             

   

I recently read news that you most likely won’t hear about, and that is that Robin Williams suicide may have been precipitated by the medications he was taking for both Depression and Parkinsons. The news reports are sketchy, and I don’t know if we’ll ever know what happened, or learn what Mr. Williams was taking, but it is true that for some, antidepressants can cause suicidal thoughts.

Depression is complicated, and the treatment can be too. Beyond complicated it can also be scary to the individual and to the people around them. We receive so many mixed messages about mental illness that some are still too ashamed to admit they need help, while friends and family members may be unsure as to how to help, or simply what to say. Who or what can we trust if even the medications don’t always work, or worse yet sometimes increase the symptoms?

Many times Depression can be traced to what many would simply refer to as lifes ups and downs. Have you ever gone through a lot of changes in your life? Have you lost a spouse, a friend, or had a cat or dog die? Have you ever had trouble finding a job? These and other situations can cause what is often referred to as Situational Depression. Most people would feel depressed having experienced these or other events, but for many the feelings are transient. What causes some people to become so depressed that they feel no hope whatsoever, or feel the only answer is to be take their own life? I believe that it’s often a combination of factors.

There are many causes of Depression, and therefore the diagnosis and screening is crucial. In some cases a thorough medical exam with blood work and other testing may be necessary. These are some factors that can lead to Depression.
1. Trauma, whether from a car accident, rape, sexual or emotional abuse as a child, spousal abuse, war, etc.
2. Hypothyroidism, which can be caused by Hashimoto’s Disease, Thyroiditis, tumors, a lack of iodine in ones diet, a car accident causing whiplash, etc.
http://www.stopthethyroidmadness.com/

http://thyroid.about.com/cs/depression/a/quiz.htm

3. Poor diet, or more specifically a deficiency in Essential Fatty Acids, Vit D, iodine and selenium can lead to symptoms of Depression. Though a poor diet can also lead to overall poor health, which too can cause Depression.
4. Drug use and alcohol abuse can exacerbate or lead to symptoms of Depression.
5. Mold Exposure and Chemical Toxicity can lead to brain, immune and nervous system dysregulation that can lead to symptoms of Depression.
http://chronicfatigueandnutrition.com/mold-toxicity/mold-depression/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072855/

 6. Stress, genetics and other situational factors like those discussed above can also contribute to the condition of Depression or depressive symptoms.

So if Depression is so complicated where do you go for help? There are some basic treatment options that will be helpful regardless of the cause, so I would start with these. Core treatments for Depression include finding a Counselor that you feel comfortable with and that will challenge you. A good diet and exercise program are an essential part of treating Depression and a healthy lifestyle. Next I would look for a complementary Doctor or a Nurse Practitioner who can do a general check up, and help you rule out thyroid issues, vit D deficiency, etc. Maybe this same practitioner or someone else can help you determine if mold/chemical exposures are a factor in your case. Finally I would suggest cleaning up your life/environment, and general detox. These two will be included in Part II.
#depression #thyroid #antidepressants #diet

PTSD (Post Traumatic Stress Disorder), Part I

There's been a lot of talk about PTSD recently because of so many Veterans returning from war.  

PTSD has been around for a long time, however, the label for this disorder and it's symptoms has changed names over the years.  The symptoms of PTSD are normal after a traumatic event. It only becomes diagnosable once the normal recovery process becomes stalled.  By stalled I mean the individual is not able to process the event or events into their views of themselves, others and the world around them.

Many people suffering with PTSD also have other related conditions.  These include Major Depressive Disorder, Anxiety and/or Panic Disorder, Personality Disorder, and Substance Abuse to name a few.  These can either precipitate the condition or develop because of it.  Often by treating PTSD many of the related conditions either improve or become resolved.

Symptoms of PTSD follow exposure to a traumatic event or series of traumatic events.  These symptoms fall into three catagories, emotional, behavioral, and cognitive.  Many individuals suffering with PTSD tend to avoid (behavioral) certain situations, people, and places that bring up feelings (emotional) or memories that are uncomfortable.  By using avoidance they try to protect themselves from re-experiencing these uncomfortable sensations.  Meanwhile the cognitive aspect also continues to keep people with PTSD stuck by creating thoughts that continue to manufacture emotions like those experienced through PTSD and others, such as guilt, shame, and blame.  Finally emotional symptoms can also include anxiety, hyperarousal, insomnia, hypervigilance, irritablity, moodswings, and difficulty concentrating, among others.

Fibromyalgia; Part I

An article written by a medical professional I read stated that everyone with Fibromyalgia has low thyroid function to some degree.  That’s a bold statement and yet I agree.  The question that remains is whether the problem is the thyroid or it’s related mechanisms, or something else affecting the thyroid or thyroid hormones.  Ultimately it may not matter, as treating with hormone replacement helps low thyroid function (LTF) regardless of the cause.

First, what does low thyroid mean?  Many think low thyroid means your blood work for thyroid appears abnormal.  When your doctor checks your thyroid function they usually look at three markers, TSH, T4, and T3.  There are other tests that can be done, reverse T3, anti-thyroid antibodies, as well as other types of tests that can be used to rule out other abnormalities if your doctor finds reason to believe something else is wrong.

There are serious medical conditions that can affect the different mechanisms and structures involved in the production of thyroid hormone.  These need to be ruled out by a qualified medical professional.  This information is NOT intended to be a substitute for such health care.  If, however, everything is ruled out and the blood work shows you have, or even if it doesn’t show you have low thyroid function, you may benefit from thyroid treatment.

TSH refers to Thyroid Stimulating Hormone, which is produced in your brain in the anterior pituitary.  TSH tells your thyroid to produce T4 which in turn breaks down into T3.  T3 is the active hormone used by the different systems of the body for metabolism regulation as well as many other functions.  (this is a simple version)

In most cases, Doctor’s including Endocrinologists prescribe T4 (Synthroid, Levothyroxine) for hypothyroidism.  The theory is that your body will break down the T4 into the needed T3 making you will feel better.  Many times, however, even though a patient’s blood work may look better, they continue to feel terrible.  Inevitably they are then prescribed even more T4, and the process continues.  More about this will be said in the section on reverse T3.

Symptoms of Low Thyroid

Depression Insomnia Constipation Neuropathy			no sex drive fatigue dry skin Fibromyalgia
Anxiety weight gain cold hands / feet			brittle nails hair loss
high cholesterol
restless legs
muscle / joint pains low body temperature (below 98.6)
mood swings (sometimes misdiagnosed as Bipolar)
lack of concentration and focus (sometimes misdiagnosed as ADHD)

That’s an incomplete list of symptoms one can experience with LTF.

What if you have hypothyroid symptoms but your blood work is normal?  Often times people will have hypothyroid symptoms yet their blood work remains normal.  In fact blood work for TSH levels only started to be used in the early 1970’s.  Before then doctors looked at clinical symptoms such as those above.  The main medication for treating LTF for years was Armour’s Thyroid, which is typically desiccated porcine thyroid which naturally contains both T4 and T3 in a ratio similar to what humans produce.  It has been around since the late 19^th century actually.  If you went to a doctor in 1910 then, feeling lethargic, gassy, constipated, and depressed your doctor may have prescribed Armour’s thyroid. 

Today no doctor would treat you unless your blood work, specifically your TSH, is abnormal.  Yet many people continue to have hypothyroid symptoms even though their blood work continues to fall in normal range.

What are other reasons for treating with Armour’s Thyroid?  If a patient who has been diagnosed with LTF continues to feel poorly despite being given a T4 preparation, most likely it’s because they don’t break down T4 properly or they tend to produce too much reverse T3 instead of the active T3.  Reverse T3 is something we all produce.  Most likely reverse T3 is an old evolutionary mechanism that we still carry that slowed our metabolism during times of hunger or injury until either food was found or we healed.  Once some people start producing reverse T3 they may have a problem turning the mechanism off.  Another theory that may explain the overproduction of reverse T3 is a lack of enzyme to break T4 down into healthy or active T3.  Reverse T3 as the name suggests doesn’t work like active T3, and if you have a tendency to producing too much of this, all the T4 in the world won’t make you feel better. 

The reasons why someone may produce too much reverse T3 are irrelevant.  The only option to taking only T4 is adding T3 to it in a ratio of 4:1, 3:1, 2:1, or even 1:2 of T4:T3.  This can be given as regular prescriptions of Synthroid / Levothyroxine and Cytomel.  Another option is to have them compounded.  And lastly another option is Armour’s Thyroid, Natur-Throid, or a synthetic T4:T3 formula.  I personally take only T3 every day, and every other day add T4 because I don’t feel well taking T4 on a daily basis.

I’ve Got Bipolar

How many times do I hear that? Daily, weekly, monthly. 

Bipolar has become the new ADHD, and everyone has come down with it. Why the sudden rise in Bipolar? And finally, could this be an epidemic?

First I don’t mean to make light of Bipolar, or any other mental health disorder. My goal in writing this is to take an objective look at Bipolar and provide a better picture of this complicated diagnosis.

In the medical field there is no explanation for the sudden rise of Bipolar. However, some might say that our ability to diagnose the disorder has improved, and therefore also the number of those being diagnosed. For someone in the field of Mental Health, a Counselor like myself, the answer is not as easy.

I have had years in the medical field, more specifically the Integrative Health Field because of my own chronic health problems in the past. During that time I studied many modalities of healing, Acupuncture, Nutrition, Herbology, Massage, CranioSacral Therapy, as well as others. I found that with any illness there are multiple causes. Think of it as a wheel, with each spoke on the wheel relating to a different area or factor. These include genetics, psychological/emotional issues, stress, chemicals in our air/water/foods (silver amalgam fillings, herbicides, pesticides, silicone breast implants, etc.), vitamin/mineral/amino acid deficiencies, viruses/parasites/bacteria, structural problems (spinal misalignment especially after trauma, accidents, etc.), hormonal abnormalities (hypothyroidism, menopause, etc.), and lastly allergies (pollens, foods, etc.).

The problem any time we make a diagnosis is that it’s complicated which becomes part of the problem. Western medicine tends to want to make things simple; often just treating the symptoms. Bodies are broken down to their individual parts and then we forget about the whole. You have one doctor who treats your knee, another who treats your colon, a third your heart, a fourth your brain, etc. We have made incredible advances at treating acute problems using this model; heart transplants, brain tumors, hip replacements, the list goes on. We are not so good at treating chronic problems.

This leads to my final point. In order for a Psychiatrist to give you meds he/she has to give you a diagnosis first. Most people have times they are angry, and moody. If you are someone who has used drugs you would have experienced these and other symptoms; extreme high feelings, anxiety, insomnia, etc. Maybe you’re just overworked, and running on adrenalin all day, you can’t sleep, are irritable, moody, and have times of depression and lack of concentration.

I share these examples because all of these can be Bipolar symptoms when viewed individually, but when taken in context and seen as part of the whole picture they can all be normal reactions to life’s stressors.

What if you were exposed to chemicals at work that caused you extreme anxiety, or if you lived in a building that had a mold problem, or you had hidden food allergies that caused you to become moody. Is that Bipolar? No. What if you had been sexually abused and traumatized as a child, and now had severe mood swings, and depression. Is that Bipolar? No.

Many of these are everyday examples of people that are either diagnosed or treated for Bipolar, when other underlying factors could be the cause for their problems.

If these examples don’t meet the criteria for Bipolar, what or who does? To have a diagnosis of Bipolar, you have had to have at least one Manic Episode which includes, besides anger and mood swings, feelings of grandiosity or an inflated self-esteem, decreased need for sleep, spending sprees, pressured speech, among other symptoms. And before you say, “that’s me”, these symptoms must last at least ONE FULL WEEK. Also being a rapid-cycler does NOT mean you go from being happy to sad a couple times a day. Rather it means you have had episodes of Mania that meet the previous criteria, as well as episodes of Depression that meet the criteria for that diagnosis, and have had 4 or more episodes in a 12 month period.

If you or someone you know meets the criteria for the Bipolar diagnosis, then I would advice treatment. If on the other hand you don’t, you may instead be suffering from Anxiety, Depression, adult ADHD, or some other health problem. Sometimes adults with ADHD look like they are in a Manic Phase, though on further evaluation, you find out they’re always like that. Other people suffer from Anxiety, either through heredity, or any number of other factors. This too may look like Mania at times. It’s important to separate out the symptoms into their individual categories, but then you have to view them within the whole picture. ADHD, Anxiety, and Depression, all can be treated with medications successfully if necessary without resorting to Bipolar medications.

If you are like many of us, either overworked, stressed, possibly harboring unresolved issues from the past, then before resorting to any medications, there are Counselors, Psychologists, Life Coaches, Fitness Trainers, Massage Therapists, Nutritionists, Chiropractors, Acupuncturists, as well as other professionals who can help you get on the right course by learning to take care of yourself. Prevention is often the best medicine in these cases, but if that’s not possible, don’t wait till it’s too late. Start taking care of yourself today.

There are also many self care techniques, tools, or modalities you can use as well, a hot bath with 2 cups of Epsom salts, a good book, a 20 minute walk, Yoga, Meditation, journaling, art, exercise, gardening. It all works; you just have to learn to take the time for yourself. What’s stopping you? What would others say if you started to take care of yourself? How would you feel if you started to take care of yourself?

If you think you have a medical condition that is contributing to your overall health or mental health problems, I would suggest seeing a doctor, or Nurse Practitioner. I have often found that NP spend more time with you then doctors, and in today’s world that can be a real plus. As I said earlier there can be many issues that cause us to feel unwell. In my time spent at a local Mental Health facility, the most common factors were structural abnormalities, caused by car accidents, and hormonal problems, most commonly hypothyroidism.