A Root Cause Medicine Approach to Depression

Depression is a medical condition that affects how we think, feel, and engage in important activities, such as maintaining relationships, enjoying hobbies, and working. When experiencing depression, life can feel challenging, and it may be difficult to experience joy, which is important for overall well-being.

Depression affects an estimated 25 million adults and teens each year in the U.S. If you or someone you care about is experiencing depression, you may understand how overwhelming it can feel. However, there are many approaches that may help manage depression, including pharmaceuticals, talk therapy, nutrition, functional medicine interventions, mindfulness therapies, and more. In this article, we'll explore some of the latest insights in functional medicine for depression to help support well-being.

What is Depression?

There are several different types of depression. According to the NIMH, they all affect how we think, feel, and perform daily activities such as working, taking care of ourselves, and sleeping.

Depression types include:

• Major depression, where symptoms last most of the time for at least two weeks
• Persistent depressive disorder or dysthymia, which presents as less severe symptoms of depression, but the symptoms last much longer, typically for at least two years
• Perinatal depression, when a person experiences major depression during pregnancy or after delivery (postpartum depression)
• Seasonal affective disorder that typically starts in late fall/early winter and disperses during spring and summer
• Depression with symptoms of psychosis, including delusions and hallucinations

Symptoms for each depressive disorder vary, and a specific diagnosis is rendered when symptoms present for at least two weeks. It's important to note that while many signs of depression appear to be mental health symptoms, depression is no longer considered a purely psychological disorder. The latest advances in depression research focus on the biochemical and physiological aspects of this condition. As a result, approaches to managing depression now include nutrition, lifestyle, and other strategies aimed at supporting bodily health. You can listen to an insightful Rupa podcast on this topic with one of the world's leading psychiatrists, Dr. Robert Hedaya, here.

Signs & Symptoms of Depression

Depression is as unique as your signs and symptoms; not everyone experiences every symptom. Severity, frequency, and duration provide clues about the condition's stage and guide functional testing and management strategies.

The National Center for Complementary and Integrative Health (NCCIH) notes these symptoms for different types of depression:

• Feeling sad or anxious most or all of the time
• Feeling irritable or restless
• No longer wanting to do activities that used to be enjoyable
• Trouble concentrating, making decisions, or remembering things
• Feeling worthless, guilty, or helpless
• Thinking about suicide or self-harm

Physical signs that can accompany depression include:

• Problems with sleep, including insomnia and hypersomnia
• Fatigue
• Changes in appetite
• Weight loss or gain
• Body pain

Possible Causes of Depression

There are as many possible causes of depression as there are signs and symptoms. According to the CDC, these factors could contribute to depression:

• Family history of depression
• Alcohol or drug use
• Traumatic or stressful events, including the death of a loved one, abuse, or financial stress
• Medical problems such as cancer, stroke, or chronic pain
• Certain medications

From a functional medicine perspective, we also consider the following to identify possible contributors to depression:

Micronutrient Deficiencies

There are more than 20 different nutrient deficiencies that may be linked to depression, including B vitamins like cobalamin (B12), folate (B9), pyridoxine (B6); minerals like zinc, selenium, magnesium, iodine, copper, and calcium; and other nutritional compounds like amino acids, antioxidants, vitamin D, and omega-3s. These nutrients play important roles in processes like neurotransmitter production, hormone regulation, and antioxidant activity.

A vitamin B6 deficiency, for example, may be associated with symptoms of insomnia and depression due to its role in the production of hormones like serotonin and melatonin. Having a mineral deficiency — like iron-deficient anemia (IDA), can be linked to cognitive impairment and other mental health symptoms, including depression.

Many Americans are significantly deficient in these nutrients, and nutrient deficiencies are common. Thirty percent of adults in the U.S. have at least one micronutrient deficiency.

Food Allergies and Sensitivities

In addition to deficiencies, food allergies and/or sensitivities may impact mood through altered blood flow to the brain. Food sensitivities like celiac disease can also affect digestion, potentially leading to nutrient deficiencies.

Minerals and Heavy Metals

Elevated levels of heavy metals like aluminum, lead, or mercury may interfere with electrical signaling in the nervous system and are linked with depression.

Hormone Disorders

Hormone disorders like hypothyroidism may be linked with depression because they can affect the metabolic processing of neurotransmitters, important biochemical processes like the control of inflammation, and more. Additionally, changes in hormone production throughout life are associated with an increased risk of depression. Some examples of these types of hormonal transitions include menopause, the postpartum period after giving birth, and puberty.

Hormones influence the development of neuronal circuitry in the brain. In puberty, for example, the central part of the brain that processes pain and emotional intensity undergoes changes that may increase the risk of not only depression but also anxiety. In menopause, rapid shifts in estrogen can affect the sensitivity of serotonin and other neurotransmitter receptors in the brain, which influence sleep, hunger, mood regulation, and more.

Genetics

Heredity and genetics are estimated to contribute to a 40-50% higher risk of developing severe depression. Certain genes influence the rate at which serotonin, gaba, norepinephrine, dopamine, and other neurotransmitters are produced and metabolized. Discovering what genetic phenotype you have can help you gain insight into how you'll metabolize pharmaceuticals and herbs that a clinician may choose to prescribe to help with your depression.

Functional Medicine Labs to Test for the Root Causes of Depression

Functional medicine testing enables your practitioner to explore potential root causes of depression.  

Testing for Micronutrient Deficiencies

Detecting nutrient deficiencies can be accomplished with at-home collection tests like blood spot tests, through blood draws and nutrient profiles examining cell contents, and others. Standard CBC and CMP tests from annual doctor visits can also offer clues to some vitamin and mineral deficiencies.

Testing for Food Allergies and Sensitivities

When assessing food allergies and food sensitivities, it’s important to note that you must have eaten the food in the last two weeks — ideally in the previous three days — for your body to make enough immunoglobulins to detect a reaction. This is relevant whether your practitioner orders blood spot or blood draw collection kits.

Testing for Minerals and Heavy Metals

There are several ways to check for heavy metal issues: hair, blood, urine, or a provocation challenge test. The latter involves ingesting a small dose of a heavy metal chelator and then checking how much of that metal is excreted into the urine. Mineral nutrient testing is also useful in identifying nutritional mineral deficiencies.

Testing for Hormone Disorders

Your practitioner can measure various hormones in saliva, urine, and blood, including at-home collection and blood draws for progesterone, testosterone, DHEA, cortisol, estrogens, and more. These can be powerful clues into why depression has set in.

Testing for Genetics and Neurotransmitter Production

Certain genetic tests can help you identify which medications may work better for you to address mood issues. Other assays may give you insight into which neurotransmitters you're producing more or less of to help guide pharmacotherapy and nutrition intervention choices.

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Conventional Treatment for Depression

Conventional treatment for depression generally includes a combination of talk therapy and medication. The specific treatment plan will depend on the type of depression diagnosed.

Common Medications:

• Antidepressants can help to improve the symptoms of depression and other mood disorders.
• Mood stabilizers can be helpful in conditions such as bipolar disorder, which can also accompany depression.
• Antipsychotics to help manage the symptoms of psychosis.

Therapy (also known as psychotherapy or talk therapy):

• Cognitive-behavioral therapy (CBT) helps individuals identify and change negative thought patterns and behaviors.
• Dialectical behavior therapy (DBT) helps individuals manage their emotions and improve their relationships.
• Interpersonal therapy (IPT) focuses on relationships and communication.
• Family therapy can be an important adjunct for people with mental illness to build close, supportive relationships with their loved ones and reduce stress in their familial relationships.
• Dance and art therapies can also help alleviate symptoms of depression.

Transcranial magnetic stimulation (TMS)

• Transcranial magnetic stimulation involves electrical stimulation to a part of the brain that may support improvement in symptoms of depression after several sessions.

Emerging Medications

• Frontiers in the psychiatric treatment of depression include the study of ketamine, psilocybin, and MDMA in psychedelic-assisted therapy and more.

Functional Medicine Treatment for Depression

Nutrition

In general, anti-inflammatory diets may support improvement in symptoms of depression. This may be due to these diets' increased antioxidant, vitamin, and mineral content, low glycemic index, and high contents of proteins, fibers, and more. Results from tests like a micronutrient panel, a food allergen and food sensitivities test, and others can help practitioners create a truly customized plan that nourishes clients while avoiding foods that trigger inflammatory reactions.

Exercise

Exercise is an option that may help manage depression, particularly when used in addition to therapy and medication. American Family Physician (AFP) notes that exercise is most effective for PTSD and even the most treatment-resistant forms of depression. One analysis specifically recommends exercise as an adjunct to medication in people with treatment-resistant depression who may not respond adequately to medications and treatment.

Yoga also shows positive effects on depression and certain anxiety disorders, such as panic disorder. The optimal frequency and duration are not clear, but studies have shown symptom reduction with one 60-minute session per week.

Mindfulness Therapies

Mindfulness-based meditation is a form of mental training that involves calming the mind to achieve a state of detached observation. Mindfulness is free and requires only you, your mind, and some training. It has been shown to have positive effects for people with depression that are comparable to standard therapies like SSRIs and that can last for six months or more! Mindfulness therapies are valued for being safe, effective, and empowering. People looking to get trained in mindfulness can find an MBSR (mindfulness-based stress reduction) program near them or visit a local yoga and meditation studio.

Herbal medicine

Herbs including black cohosh, chamomile, chasteberry, lavender, passionflower, saffron, and

St. John’s wort may help to alleviate symptoms of depression and could be as effective as certain antidepressants without the side effects typically associated with SSRIs. Herbs can also be used as a powerful food-as-medicine when included in food. Saffron, for example, can be used as a culinary spice. Lavender can be used in baked goods or as tea, as can chamomile.

Acupuncture

Acupuncture may support improvement in the symptoms of depression and postpartum depression. It can be effectively utilized alongside traditional treatments and does not interfere with pharmaceutical medications. Acupuncture may also help to alleviate many of the symptoms associated with depression, including insomnia and pain.

Homeopathy

Homeopathy is a field of alternative medicine that uses microscopic doses of natural materials to elicit a response in the immune system. Some studies suggest that homeopathic medication may be comparable to fluoxetine in its effectiveness in managing depression.

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Summary

Most functional medicine treatments can be safely used along with conventional treatment approaches to support optimal results. Your practitioner will evaluate your individual diagnosis and recommend any combination of functional medicine, conventional treatments, nutrition, and complementary alternative options to support your journey to well-being. You can see examples — and the positive outcomes they produced in managing depression — by reading the following over at the RUPA magazine.

• Alexandra's story of managing hypothyroidism and improving her mood
• How these top nutrients may impact depression and mental health
• How integrative approaches can support postpartum depression

A functional medicine approach to managing depression brings the puzzle pieces together into an individualized, comprehensive plan to help people thrive once again. The end result — a life filled with joy and happiness!