Anxiety and depression are the two most prevalent mental health conditions with high comorbidity. Those who have experienced either of these conditions know how debilitating they can be to the overall quality of life. Emerging research in this area shows a promising connection between the state of our body's physiology and that of our mental health.
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What is Anxiety?
Anxiety disorders characterize conditions that manifest in chronic worry, fear, panic, or rumination. The different categories of anxiety disorders include Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety, and Specific Phobia. The underpinning of these disorders is heightened, and often at times, irrational fear or panic. However, that is extremely real for the individual experiencing it, so much so that it affects other aspects of their life.
What is Depression?
Depression is a common and sometimes severe disorder that impacts how one thinks, feels, and behaves, as well as their activities of daily life, including sleep, appetite, work, and relationships. Worldwide, about 280 million people suffer from depressive disorders. Key features of depression include feelings of hopelessness and low mood and energy lasting for at least two weeks.
The different types of depression include Major Depression, Treatment Resistant Depression, Postpartum or Perinatal Depression, Seasonal Depression, and Dyshthima and Depression with Symptoms of Psychosis.
Symptoms of Depression and Anxiety
While symptoms of Depression and Anxiety may vary, the following symptoms have been commonly reported.
For depression, feelings of hopelessness are often evident, in addition to unexplained fatigue, sleeplessness, pains or digestive issues, feelings of persistent sadness, worthlessness, guilt, loss of interest or joy in activities that one used to enjoy, feelings of emptiness or numbness, difficulty concentrating, in addition to more concerning symptoms such as suicidal thoughts.
For anxiety, symptoms include excessive worry, difficulty controlling feelings of worry, constantly feeling wound-up and on edge, restlessness, difficulty concentrating, easily fatigued, unexplained body aches and pains, digestive issues, and feelings of panic, including racing heart, feelings of impending doom, trembling, sweating and chest pain.
How are Anxiety and Depression Connected?
Anxiety and depression can often go hand in hand and are noted to have substantial comorbidity. When one struggles with anxiety, depression is often also evident. Other similarities amongst these conditions have been suggested to be underlying inflammation, in addition to sharing several other possible etiological factors discussed below.
Possible Causes of Anxiety and Depression
The etiology of anxiety and depression is undoubtedly complex and multifaceted.
Adverse childhood experiences (ACEs), trauma, and attachments to caregivers have been found to have a role in addition to the following:
Biochemical Variation & Compromised Methylation
Biochemical (genetic) variation exists among all of us relative to how we respond to the foods we eat, our environments, and lifestyle factors, such as stress or exercise. Biochemical variation also may exist in enzymes that affect different body processes relative to digestion, methylation, inflammation, and amino acid metabolism. This can make one more prone to anxiety and/or depression. Compromised methylation (a process that can affect whether specific genes are turned on or off) can significantly affect mental health. Healthy methylation is necessary to produce neurotransmitters and several other regulatory processes for our mood.
Inflammation & Stress
Inflammation, in particular, has been suggested to have associations with depression and anxiety and can occur for various reasons, including nutrition and lifestyle factors. The emerging field of Psychoneuroimmunology (PNI) explores the interplay between stress, hormones, the nervous system, and immune function, with inflammation as a core underlying and modulating factor.
Chronic stress leading to increased production of cortisol can induce changes in the hypothalamic-pituitary-adrenal (HPA) axis, which contributes to depression and anxiety as this causes structural changes in the brain regions associated with mood.
Gut Microbiome Imbalances
The composition of the microbes in the gut microbiome plays a significant role in regulating mental health. The bacteria in the gut produce and release necessary enzymes and substances, such as vitamins, neurotransmitters, fatty acids, and amino acids, that all positively affect physiology and mood. Gut microbiome balance is also influential in regulating digestive health, inflammation, and the efficiency of the body's ability to synthesize or produce a range of neurotransmitters important for supporting mental health, such as GABA, Serotonin, and Dopamine.
Nutritional Deficiencies
Nutrition is vital for our mental health. The nutrients from the foods we eat modulate different processes that influence how we feel physiologically and psychologically. While all nutrients play a role, several specific nutrients are significant to our mental health. Among these include B Vitamins, Vitamin D, Zinc, and Magnesium.
If an individual is not getting sufficient amounts of B vitamins from their diet, the production of serotonin and several other vital neurotransmitters relative to mood health, such as GABA and Dopamine, can be diminished. B vitamins serve as cofactors for many amino acids necessary for neurotransmitter production.
Vitamin D supports the conversion of Tryptophan into Serotonin and also modulates inflammation which can affect mood health. Zinc is required for the conversion of 5-HTP, the intermediate of the amino acid Tryptophan in the production of serotonin. Magnesium also plays a critical role, aiding the conversion process of Tryptophan to Serotonin, modulating inflammation, and supporting nervous system health.
Amino Acid/Neurotransmitter Deficiencies & Imbalances
Amino Acids are the building block materials of proteins and are necessary for neurotransmitter synthesis, among other important processes in the body. If the diet doesn't provide adequate protein, one can feel sluggish, anxious, and depressed. Deficiencies can exist from poor diet or alterations in metabolism.
Insufficient amounts of GABA have been suggested to be a contributing factor in Anxiety Disorders, in addition to Tryptophan for Anxiety and Depression, as it is needed for Serotonin production.
Fatty Acid Deficiencies & Imbalances
Polyunsaturated fatty acids (PUFAs) are essential for mental health as they help reduce inflammation and strongly support brain health. The brain will not function correctly without fatty acids because they support neurotransmitter production. Research shows that the ratio favoring Omega-3 fatty acids to Omega-6 fatty acids is vital to mental health. One reason is that Omega-6 fats can promote inflammation, further compromising mental health.
Thyroid Hormone Imbalances
Thyroid hormone imbalances are known to have associated symptoms that mimic depression and anxiety. Having too much or not enough thyroid hormone can contribute to symptoms. For instance, hypothyroidism may manifest as symptoms of depression, whereas hyperthyroidism may manifest as anxiety symptoms.
Functional Medicine Labs to Test for Root Cause of Anxiety and Depression
There are several functional medicine labs to assess for underlying causes of anxiety and depression from a whole-body perspective.
Comprehensive Stool Test
The gut microbiome can play a significant role in mental health. This test provides information relative to the health and composition of our microbiome, the ability of our GI tract to digest and absorb nutrients properly, and includes markers assessing intestinal inflammation, all providing valuable indirect insight into our mental health.
Organic Acids
This test assesses urine metabolites, which can help uncover the causes of inflammation, which is critical for mental health symptoms. Elevated markers of Quinolinic Acid (QA), for instance, have been associated with increased inflammation and decreased production of serotonin, which are both important factors for the progression of anxiety and depression.
NeuroAdrenal Profile
This test measures the body's cortisol levels, giving a thorough look into the effects that chronic stress may be playing. It also analyzes nine neurotransmitters/amino acids significant in anxiety and depression, such as GABA, Serotonin, and Dopamine.
Thyroid Panel
This test evaluates a thorough panel of thyroid hormones to determine imbalances that can manifest in symptoms of anxiety or depression, as the thyroid regulates many essential processes relative to mental health.
Micronutrient Testing
This test evaluates deficiencies that can contribute to and exacerbate mental health symptoms. This panel analyzes an array of vitamins and minerals crucial for mental health. It also assesses fatty acids, including omega 3 and omega 6 levels in the blood, which can help detect whether the ratio is in a healthy balance, favoring omega 3.
3 x 4 Genetics
This test provides valuable insight into various measures of health related to inflammation, metabolism, methylation, detoxification, hormones, and mood. This improves knowledge of how one's body systems function and what areas they could use support relative to their mental health.
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Conventional Treatment for Anxiety and Depression
Selective serotonin reuptake inhibitors (SSRIs) are typically prescribed for the treatment of depression. Benzodiazepines may be prescribed to treat anxiety, such as in Panic Disorder. Both of these medications work by targeting specific neurotransmitters thought to be related to their etiology. SSRIs help to increase Serotonin levels in the brain, whereas Benzodiazepines help to enhance concentrations of GABA.
Functional Medicine Natural Remedies for Treatment of Anxiety and Depression
A functional medicine approach to treating anxiety and depression addresses imbalances in the body's biochemical processes that may be contributing to their symptoms. Below is a list of some approaches that may be implemented in functional medicine for supporting anxiety and depression.
Address Lifestyle, Stress, and Environment
Our lifestyle and our environment can have a strong influence on our mental health. Implementing self-care strategies is essential. For example, getting adequate quality sleep is associated with improving mental health. Symptoms of depression, brain fog, concentration difficulties, and fatigue are all associated with dehydration, implying that drinking plenty of water daily is vital to mental health. Regular exercise has been shown to reduce anxiety and improve depression. In fact, even 2.5 hours of walking per week can improve mental health symptoms.
Address Gut Microbiome Balance
Using the Microbiome Diet, an eating plan consisting of probiotic, prebiotic, and fibrous foods, is a powerful tool for healing and diversifying the microbiome, which will indirectly boost the healthy production of neurotransmitters required for mental health. Probiotic food examples include fermented foods like sauerkraut, yogurt, and kimchi. Prebiotics, the food that feeds the probiotics, include bananas, artichokes, garlic, and onions. High-fiber foods include beans, nuts, seeds, whole grains, fruit, and vegetables.
Address Inflammation, Methylation, & Thyroid Health
Inflammation is a driver of many chronic diseases, including depression and anxiety. Eliminating inflammatory foods via an anti-inflammatory diet decreases total inflammation and addresses factors associated with thyroid imbalances such as hypo or hyperthyroidism. Problems with methylation are also encouraged to be addressed as these can further drive mental health conditions. Ensuring optimal B vitamin and amino acid intake is important in supporting methylation.
Diet for Anxiety and Depression
A Mediterranean diet has been shown to support anxiety and depression as it has been suggested to downregulate inflammation and is abundant in fruits and veggies, as well as lean protein and healthy fats. In fact, in this 2022 randomized controlled study, those with moderate to severe depression showed significant improvements in their symptoms, as evidenced by a reduction of 20.6 points on an assessment called the Beck Depression Inventory Scale by adhering to a Mediterranean Diet for 12 weeks.
This diet also supplies adequate amounts of micronutrients necessary for mental health, such as B Vitamins (found in leafy greens, poultry, eggs, nuts, and seeds), Vitamin D (found in mushrooms, fortified milk, and fish/fish livers), Magnesium (found in legumes, nuts, seeds, and avocados) and Zinc (found in seafood, beans, nuts, eggs, and poultry).
Good sources of protein from this way of eating include salmon, chicken, beans, nuts, and seeds. Strong sources of omega-3 fats include wild fish, nuts and seeds, seaweed, algae, and eggs.
Supplements for Anxiety and Depression
It is recommended to share all of your supplements and medications with your practitioner, as many can have drug-nutrient interactions and potential side effects. The following supplements may be helpful for anxiety and depression.
Amino Acids
Amino acid supplements can be a beneficial addition to improving mental health. Tryptophan supplementation (0.14-3 g daily) for low levels of Serotonin or Tyrosine supplementation (150 mg per kilogram of body weight per day) for low levels of Dopamine has been shown to improve depression and anxiety.
Lysine has also been found to be an effective amino acid for reducing anxiety as it plays a role in modulating GABA receptors. A randomized controlled trial with 108 healthy individuals found that supplementation with Lysine significantly reduced anxiety.
Herbs
Saffron has been evidenced in the literature to support anxiety as it helps to modulate levels of neurotransmitters. The dose that was significant in research has been 1.65-1.75 mg 2 times per day.
Passionflower, Lavender, and Chamomile have also been shown to have benefits for anxiety and depression with their inducing anxiolytic and uplifting effects.
Curcumin, the principal constituent of turmeric, has strong anti-inflammatory properties that make it important to mental health. It has even been shown to be able to enhance the outcome of certain antidepressants when taken simultaneously.
B Vitamins
Vitamin B6 helps to promote serotonin and GABA synthesis, as well as regulate sleep cycles, in addition to supporting the body's methylation process.
Methylated B12 may benefit those struggling with depression and anxiety as this is the active form in the methylation cycle. Therefore it may further support mental health by aiding methylation.
Other Supplements
A recent meta-analysis showed the beneficial effects of Omega 3 supplementation on participants with Major Depressive Disorder, especially for those also taking antidepressants, by reducing and modulating inflammation.
Magnesium has been found to benefit depression and anxiety as it has a role in nervous system health, inflammation, and digestion, all of which support mental health.
The use of probiotics with specific strains relative to mental health, termed psychobiotics, has also been shown to be promising for mental health as these strains specifically help with the production of neurotransmitters.
Complementary and Integrative Medicine for Anxiety and Depression
A number of complementary and integrative medicine approaches have been cited in the literature relative to improving anxiety and depression.
Yoga, Meditation & Chiropractic have been found to positively affect mental health. The mechanisms include increased blood flow, improved vagal tone, and increased parasympathetic nervous system dominance.
A meta-analysis in 2020 of 55 randomized control trials indicated that music therapy, such as listening to music for therapeutic purposes, demonstrated a significant reduction in depression symptoms in comparison to the control group.
The use of biofeedback has been suggested to have promising effects on anxiety as it helps one to gain insight into how the body responds to and adapts to stress. For instance, Heart Rate Variability (HRV), the measure of variation in time between each heartbeat, is a type of biofeedback that can provide valuable insights into the state of one's stress.
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Summary
While struggling with mental health is difficult, it can be empowering to know that we can exert a powerful influence in improving our mental health by adapting a natural, whole-body approach to address imbalances that may manifest in symptoms.
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