From the Introduction:
In my psychiatric practice I used to spend a lot of time concentrating on psychological forces from childhood, and I believed in their continuing power to determine our mental health and disease. For depression to linger meant that a patient had not “worked through” some early psychological wound. I am no longer interested in pinpointing the blame for depression on your past, your parents, and, most of all, you! I now recognize that what happens in the mind is not separate from the body. The health of what we call the mind depends directly on the health of the body. A complex mix of factors—nutrients, hormones, genetics, stress—interweaves to affect how the mind works and how the individual responds to life events. The slings and arrows that best us in the world, in other words, are only one set of factors that determine whether we will be mentally healthy or suffer from depression.
From Chapter 2:
Depression Can Be Cured
In short, the psychiatric treatment of depression is inadequate for several reasons:
- We consider depression and related ailments to be purely psychological diseases with theoretical abnormalities in brain chemicals, unaffected by what’s happening in the patient’s body.
- We slice depression into several different DSM-defined diseases, but since we can’t find a brain-based reason for any of these forms, we prescribe medications on a nearly random basis.
- Not surprisingly, our success rate is poor, and even when we do consider a patient to be improved, there may be residual symptoms and frequent side effects.
Compounding these problems, we tend to blame patients for our failures. You can see our bias in the terms we use, saying a patient has “failed treatment” and is “treatment resistant.” But if a patient is taking medication prescribed by his physician and doesn’t recover, who has failed? I believe it’s time we stop failing millions of people who come to mental health professionals seeking relief from depression.
From Chapter 3:
Current Treatments are Less Effective Than We Think
I am not against medication. The problem is not the medicines themselves; it’s in the way they are researched, advertised, and used. Antidepressants can play a key role in restoring health when they’re used as part of an integrative approach that encompasses personalized medicine and nutritional biochemistry. This requires that we find just the right medicine in the right dosage for each individual patient. It requires a better understanding of the research and conflicts of interest between medicine and the pharmaceutical industry. As you will see, personalized medicine for the treatment of depression has finally become a reality for those struggling with depression.
From Chapter 8:
H: Hormones
I believe that everyone who is depressed, or is being evaluated for depression, should be checked for a thyroid deficiency. Testing should go beyond simply the TSH test, which is insufficient and can be misleading. Patients should find a physician who is knowledgeable about a comprehensive integrative approach that includes evaluating all symptoms of thyroid deficiency, measuring the basal metabolic temperature, and testing the levels of T3 and T4 in the blood. If there’s an indication of hypothyroidism, I recommend thyroid replacement therapy with T3 and T4. I have consistently seen better results with the addition of natural desiccated thyroid replacement therapy that includes T3 and T4.
From Chapter 9:
E: Exclude
Once considered a relatively uncommon problem afflicting young children, celiac disease is now recognized as a serious ailment that can strike at any age. It afflicts about 1 in 130 Americans, or about 2.25 million people. It begins as a “bad reaction” to a certain component of wheat and develops into a self-destructive assault on our digestive system, but the effects of celiac disease are not limited to the gastrointestinal system. The health consequences of celiac disease may affect every organ system, including the brain. In a depressed person with celiac disease, depression can only be resolved when the celiac disease is treated.
From Chapter 10:
Z: Zinc and Other Minerals
There is enough scientific evidence to convince me that zinc is essential to good mental health; it must be present in sufficient amounts at all times, and able to reach the areas of the brain associated with its antidepressant effects. Unfortunately, zinc research will continue slowly, at best, for no major pharmaceutical company will spend tens of millions of dollars studying a mineral it cannot patent and sell as a proprietary product. However, psychiatrists and patients interested in natural treatments for depression should understand how to assess and treat zinc deficiency.
From Chapter 14:
r: rEEG: A Breakthrough in Targeting Treatment for Depression
However, the rEEG gives us our first objective tool for targeting treatment. We can now select the medicines most likely to be effective and measure the results of treatment simply by looking at brainwave patterns. As an x-ray is to the body, the rEEG is to the brain: a way to “see” into the patient and devise a more effective treatment strategy.
From Chapter 17:
Beyond Biochemistry
The lack of a clear winner among styles of psychotherapy may be because a patient’s ongoing, trusting relationship with a therapist is more important than therapeutic content. Indeed, many researchers believe that this relationship is key to overcoming depression. While depression leads to passivity and social withdrawal, the act of participating in a therapeutic process can restore confidence and a sense of control. If interpersonal difficulties have been a factor in the depression, the opportunity to work some of these out with someone who does not react in the predictable and sometimes dysfunctional ways seen in family members can help the patient achieve a more positive resolution. Psychotherapy helps patients understand the meanings and dimensions of their depression and makes them partners in regaining health and recovery.
From the Conclusion:
Conclusion: Personalized Medicine
Elderly and young patients are particularly vulnerable to psychiatric medications. The use of these drugs is studied in young and middle-aged adults, not in adolescents and seniors. For seniors these drugs may interact with other medication they take to treat other chronic conditions.
For adolescents even greater dangers may be involved. Because antidepressant drugs can increase agitation and suicidal thinking in adolescents during the early phase of treatment, the FDA has required since 2004 that these drugs contain a “black box warning,” the most serious warning placed on medication labels. In addition, the effects of these powerful drugs on the developing brain are not fully understood. Most clinical trials assessing their effectiveness have been of short duration and have been conducted on small numbers of participants.
From the Epilogue:
The science is available to change the current model of trial-and-error prescribing. The science is available to correct nutritional and metabolic influences on mood. Right now we have the tools we need to identify and treat depression.
It’s time!