Depression is an interesting problem because of the way it’s typically seen in the medical world.

If you tell me you are depressed, you are telling me that you feel depressed, not that you havedepression. This might seem like a really nit-picky piece of syntax that only I would care about, but hear me out here. Saying that you have depression automatically puts it in the “disease” category. People say they have diabetes, heart disease, cancer, an ulcer, etc. Diseases can be traced back to one common dysfunction*, so they can be treated based on that underlying mechanism. Type 2 diabetes is caused by insulin resistance, therefore IR should be the target of your treatment(s). Rheumatoid Arthritis (RA) is caused by an autoimmune reaction* against your joints, therefore the immune system should be the treatment target.
*There are numerous causes of dysfunctional physiology, but that dysfunction is generally the same in each disease. Many, many things can cause the autoimmune attack that leads to RA, but the antibodies against the joints is the same in each individual.

I think part of it is the way depression has been looked at over the years and it’s evolution as a problem. My grandparents generation didn’t think depression was a real thing. When my grandmother was diagnosed with depression and put on medications I think it was really hard for she and my grandfather to wrap their heads around the diagnosis. Slowly, but surely, depression has become recognized as an actual problem- one that affects millions of Americans, can be devastating and life-changing, and needs serious attention.

But the thing is that depression isn’t a disease, but a symptom, and a symptom that can be due to numerous things. When the doctor tells you you have depression they’re not telling you anything new, nor are they giving you any idea as to why you have this symptom. I’m not saying that the use of SSRIs and other anti-depression medications isn’t merited from time to time, but wouldn’t it make more sense to figure out how you got to that point and go from there?

I start my workup by assessing two broad categories that can contribute to depression.

Overall Brain Health sounds like a really wishy-washy topic, but it’s surprisingly important. Neurons (brain cells) need three basic things to survive: Oxygen, fuel (glucose, ketones), and stimulation. This is why ruling out things like anemia, high blood pressure, excessively low blood pressure, blood sugar problems, and hemisphericity needs to be part of the work up for every depressed patient. Many hormones have the ability to globally affect brain function, so thyroid problems and hormonal imbalance should be checked for, too. Even inflammation, digestive problems, food sensitivities, and gut bacteria imbalances can have a tremendous impact on the brain and it’s ability to function.

Two Neurotransmitters, serotonin and dopamine, can cause one to become depressed. Obviously serotonin is much more widely recognized (this is the target of SSRIs), but it’s important to recognize that dopamine imbalance can cause depression, too. Once a neurotransmitter imbalance is identified it’s important to figure out why that pathway isn’t functioning. Hormones, blood sugar control, magnesium deficiency, iron deficiency, methyl donor deficiency, certain medications, and dietary intake of protein and carbs can all play a role in how well these pathways function. Only after all of the above has been ruled out would I consider supplementing with neurotransmitter precursors like 5-HTP and Tyrosine since such treatments would provide minimal (if any) benefit in such scenarios.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham “triangle” area.

In health,


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