Case Study: Anxiety and Mild Depression
There are times when drugs are required and often beneficial. I believe that they should be reserved for times when all other options have been exhausted. This is due to the fact that drugs have a poor safety profile compared to other interventions such as diet and lifestyle modification, supplements, and body work.
I have many clients seek out my services because they don’t want to take a medication.
I cannot and do not tell my client whether they should or shouldn’t take a drug, but I do educate them on the mechanism of action (how the drug works), the side effects, and the alternatives. This empowers them to make their own informed decision.
John: Anxiety and Mild Depression
John (client’s name has been changed for confidentiality) came to me to seek out alternatives for his anxiety and depression. He had been to the doctor a couple of weeks prior and after a 5 minute visit John was prescribed an antidepressant.
Do Antidepressants Work? In a very detailed analysis published in the British Medical Journal, “Efficacy of Antidepressants in Adults,” two experts concluded “that selective serotonin reuptake inhibitors [i.e. Prozac, Celexa] do not have a clinically meaningful advantage over placebo” and “have not been convincingly shown to affect the long term outcome of depression or suicide rates.” – BMJ 331 (2005):155-157.
What John’s doctor might not have realized is that anxiety and depression are symptoms of an underlying imbalance in the mind and/or body. With John’s help we worked to determine what might be out of balance.
Some of the root causes we considered were:
- Hypoglycaemia (low blood sugar)
- Amino acid deficiency (amino acids are the material needed to make neurotransmitters)
- Poor digestion (inability to liberate amino acids)
- Sympathetic nervous system overstimulation (Fight/fight/fright response)
- High homocysteine
John was already living a healthy lifestyle and his diet was well balanced. After doing a full intake and gathering a detailed history, I suspected he might have trouble building important neurotransmitters such as serotonin, that make us feel happy.
The Functional Approach
I explained to John that high homocysteine levels can indicate a decreased ability to carry out an important process in the body called methylation. Methylation is required to make neurotransmitters and thus, poor methylation can lead to anxiety and depression. [1. Gu P, Defina LF, Leonard D, John S, Weiner MF, Brown ES. Relationship between serum homocysteine levels and depressive symptoms: the Cooper Center Longitudinal Study. J Clin Psychiatry. 2012 May;73(5):691-5. Epub 2012 Mar 20.]
John went to his homocysteine levels checked and his results were 9.4 umol/L. (See below)
As you can see, John was well within the normal reference range. However, John was not within the optimal reference range. The optimal reference range for homocysteine is below 7.0 umol/L. [2. Mclean RR, Jacques PF, et
al. Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med. 2004;350:2042-2049.]
We discovered a biochemical imbalance that was directly linked to his symptomatology. As a result, John went on a regimen of supplements that were important factors in the process of methylation.
Improving methylation: The key methylators are vitamins B6, B12, and folic acid.
The next time we checked his homocysteine levels they had gone down to 7.9 umol/L (see below). The most important result was that John’s anxiety and depression improved by 50% without taking a single drug. We still have some work to do, but John is moving in the right direction, and that’s all that matters.
The Bottom Line
The smallest thing could sometimes make the biggest difference. In John’s case, a simple blood test indicated that he was not producing neurotransmitters adequately. By supporting John’s methylation pathways we not only improved his anxiety and depression but we also decreased his risk for alzheimer’s disease [3. Kado DM, et al. “Homocysteine versus the Vitamins Folate, B6, and B12 as Predictors of Cognitive Function and Decline in Older High-Functioning Adults: MacArthur Studies of Successful Aging.” Am J Med. 118.2 (2005): 161-7.], heart disease [4. Cooke GE, Eaton GM, et al. Plasma atherogenic markers in congestive heart failure and posttransplant (heart) patients. J
Am Coll Cardiol
Am Coll Cardiol. 2000;36:509-516.], macular degeneration [5. Christen WG, Glynn RJ, et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. 2009;169:335-341.], and hearing loss [6. Gok U, Halifeoglu I, et al. Comparative analysis of serum homocysteine, folic acid and Vitamin B12 levels in patients with noise-induced hearing loss. Auris Nasus Larynx. 2004;31:19-22] (all associated with high homocysteine levels).