The use of antidepressants has increased year on year across the globe since 2000. In the US, the leading antidepressant prescriber and the home of direct-to-consumer pharmaceutical advertising, more than 14 percent of the population takes a prescription antidepressant in a given month, including one in four women in their 40s and 50s. The UK fares better, but is on the rapid global depression incline nonetheless, ranking seventh behind the States for antidepressant use, with one in 11 Britons filling about 53 million prescriptions at last count in 2014—a one-quarter rise from three years before that.
This alarming growth rate is reflected in spending on psychiatric drugs. Between 1985 and 2007, American spending on antidepressants and antipsychotics alone multiplied nearly 50 times—from $503 million to more than $24 billion annually; the UK's National Health Service (NHS) spending on antidepressants rose by 33.6 percent in just one year to £282 million (about $465 million) in 2014.
While it looks as if there's a plague of psychiatric illness worldwide, a growing number of critics are laying the blame for the epidemic at the feet of psychiatry itself and the pharmaceutical industry in its marketing madness to sell psychiatric drugs. The most recent of these critics is New York psychiatrist Kelly Brogan, who specializes in treating women. Her recent book, A Mind of Your Own (Harper Wave, 2016), blasts her own profession for pushing the pharmaceutical industry's failed serotonin theory of depression and drugs to combat "chemical imbalances" in the brain, while ignoring the true physiological causes of mental ailments.
"Depression is not a disease," says Brogan, who practices psychiatry and integrative holistic medicine in Manhattan. "Depression is merely a symptom, a sign that something is off balance or ill in the body that needs to be remedied." The real underlying physiological cause of a woman's depression, malaise, anxiety, flatline libido and fatigue is far from being in her brain, she adds, but is more often an undiagnosed and untreated thyroid disorder.
For this reason, Brogan is dismissive of the conventional use of antidepressants and emphasizes that the 'chemical imbalance' theory has never been proven.
The serotonin story
The general story promulgated by drug companies since the late 1980s is that a deficiency of certain neurotransmitters (chemical messengers) at the synapses, or tiny gaps, between neurons interferes with the transmission of nerve impulses, leading to depression. The neurotransmitter serotonin has received the most attention, but others are blamed as well. It's a theory that much of the public—and apparently all of the doctors who prescribe more and more of the selective serotonin reuptake inhibitors (SSRIs), with names like Zoloft, Cipramil, Priligy and Lustral—believe.
In reality, however, as neuroscientist Joseph Coyle of Harvard Medical School told Scientific American in 2014, "Chemical imbalance is sort of last-century thinking. It's much more complicated than that."1
Because antidepressants can sometimes make people feel better, it confirms the impression from drug advertising that serotonin deficiency must be the cause. "But just because a drug reduces symptoms of a disease does not mean that those symptoms were caused by a chemical problem the drug corrects," notes the magazine. "Aspirin alleviates headaches, but headaches are not caused by a deficiency of aspirin."1
If depression was simply a chemical imbalance, then antidepressants would work a lot more effectively than they do. A 2009 review article by psychiatrist Michael Gitlin at the University of California, Los Angeles, found that a third of depressed individuals taking antidepressants don't feel better, and many of the remainder improve somewhat but remain depressed.1
In one US study, 65 percent of untreated depressed patients experienced complete recovery in around three months, whereas a group taking antidepressants took nearly twice as long to recover.2 And a World Health Organization screening study of depressive patients in 15 cities all over the world found that those who had not been exposed to psychiatric medicine "did significantly better" than those taking such drugs, with milder and fewer depressive symptoms.3
But Brogan is more concerned that "antidepressants have repeatedly been shown in long-term scientific studies to worsen the course of mental illness—to say nothing of the risks of liver damage, abnormal bleeding, weight gain, sexual dysfunction and reduced cognitive function that they entail."
A 2008 review of antidepressants' side-effects found that a whopping 86 percent of patients experienced at least one such side-effect.4
Ironically, one notorious antidepressant side-effect is related to suicide—which is so well documented that, following lawsuits against pharmaceutical companies for hiding data that showed an excess of suicides with every antidepressant licensed since 1987 compared with a placebo, the Food and Drug Administration in 2004 forced companies to carry a black-box warning that antidepressants "increase the risk of suicidal thinking and behavior in children, adolescents and young adults."
For Brogan, psychiatry's "dirtiest little secret of all" is the fact that antidepressants are more addictive and more difficult to get off of than alcohol or opiates. The Handbook of Chronic Depression describes this 'discontinuation syndrome' as the result of short-acting agents or abruptly stopping the drugs. It causes flulike symptoms like malaise, muscle pain, nausea, dizziness, headache and, sometimes, neurological symptoms such as unsteady gait, pain, burning or tingling on just a touch to the skin, tremulousness and vertigo.5
"The drugs create chemical imbalances in the brain, and this helps turn a first-time customer into a long-term user, and often into a buyer of multiple drugs," says Robert Whitaker, acclaimed author of Anatomy of an Epidemic (Crown, 2010). "At the same time," he says, "since psychiatric drugs perturb normal function, they regularly cause physical and psychiatric problems, and this greases the path to polypharmacy."
So, someone feeling blue is prescribed antidepressants, and then needs something to help her sleep at night.
Having witnessed the devastating impact of this paradigm on hundreds of her patients, Brogan urges women to find out if they are really mentally ill or if what's ailing them is possibly something else: What toxins are wreaking havoc with their hormones? Is their food nourishing them, or fanning inflammation and sapping energy and nutrients? Are there lifestyle factors that contribute to the problem, and what can be done about them?
While factors like grief and trauma can definitely tip emotional scales, we are equipped to recover from life events.
But when we don't, or when depression creeps into our lives, Brogan suggests looking at hormones, especially those from the butterfly-shaped thyroid gland at the base of the neck—which produces hormones that regulate metabolism and play a role in immunity, detoxification and cognition—and insulin, the hormone that regulates our blood sugar levels.
The role of the thyroid in brain health has been noted for well over a century, notes Brogan; an 1888 meeting of the Committee of the Clinical Society in London made the connection between hypothyroidism and delayed cognitive understanding, associated with insanity in the form of melancholia, chronic mania and dementia.6
Thyroid hormone receptors are concentrated in various parts of the brain and modify the expression of genes encoding myelin and other proteins involved in nerve development, function and signaling.7
So when thyroid hormones are off-kilter, patients experience an array of symptoms, including fatigue, constipation, hair loss, depression, foggy thinking, cold hands and feet, and muscle aches.
"How much of what we call 'mental illness' is actually thyroid-driven?" asks Brogan. The trouble is, she says, standard testing for thyroid-stimulating hormone (TSH) does not provide an accurate assessment of true thyroid function.
In one study from France, 'subclinical hypothyroidism' (where free hormone levels are low, but TSH is normal) was found in 52 percent of people with resistant depression, which confirms the importance of looking beyond levels of TSH.7
In a review of thyroid hormones in depressed patients, about one-fourth of them had higher-than-normal levels of thyroxine (T4), with a correlation between severity of depression and the amount of T4 in the blood.8
Also, up to one in five depressed patients have antithyroid antibodies (suggesting an autoimmune response involving the thyroid gland) compared with 5-10 percent of the general (non-depressed) population.9
And even when TSH levels are considered acceptable, the presence of thyroid autoantibodies raises the risk of postpartum depression as well as anger in pregnant women.10
What's more, Brogan points to six randomized placebo-controlled trials (RCTs) that concluded giving thyroid hormone supplements to women not responding to antidepressants improved the failing drugs' efficacy.
One such study found that triiodothyronine (T3), which produces T4, was just as effective as lithium in reducing symptom severity in depressed patients not responding to tricyclics, but without the side-effects of the drugs.11
Healing an overworked or underperforming thyroid gland is about adjusting the signals it receives from the body, says Brogan, which is not accomplished by adjusting a single neurotransmitter or even a bunch of them in the brain, but mainly by giving the body what it needs in terms of nutrient-dense food for healing while removing environmental stressors, such as chemical toxins.
Tests to take
A number of tests can determine whether you have underlying imbalances that can manifest as depressive and other mental symptoms.
Thyroid function is vital to overall health, yet most doctors don't test beyond a thyroid-stimulating hormone (TSH) test, which can miss many thyroid problems. Brogan advises having your thyroid function investigated deeper, which can reveal autoimmune attacks on the thyroid as well. The following tests are available in most clinical laboratories.
• TSH: optimal value less than 2 μIU/mL
• Free T4: optimal value more than 1.1 ng/dL
• Free T3: optimal value more than 3.0 pg/mL
• Reverse T3: optimal value less than 10:1 ratio of RT3:FT3
• Thyroid peroxidase antibodies (TPOAB): optimal value less than 4 IU/mL or negative
• Thyroglobulin antibodies (TGAB): optimal value less than 4 IU/mL or negative
Instead of taking synthetic thyroid drugs if you have a problem, Brogan suggests dietary modifications and asking your doctor about desiccated thyroid extracts from animals.
Serum B12. This vitamin is an all-star antidepressant that protects the brain and nervous system and regulates sleep cycles, mood and the immune system. Symptoms can look like an underactive thyroid, and a severe deficiency can cause depression, delusions, memory loss, loss of taste and smell, confusion, brain shrinkage and dementia. Two-fifths of us are deficient in vitamin B12, so it may be worthwhile asking your doctor to check your blood levels, which are considered low if they fall below 150-200 pg/mL. Brogan advises targeting an optimal 600 pg/mL or above.
Vitamin D. Most people are deficient in this critical 'sunshine vitamin'—and not just because they lack sunshine, but sometimes because of liver damage. Supplementing can help if your 25OH vitamin D test is below the optimal range of 50-80 ng/mL. If you have symptoms of depression, ask your doctor for the test, or order a mail-in finger-prick test kit from www.vitamindcouncil.org. The test costs $58 and is done in an accredited analytical laboratory.
C-reactive protein test. This measures inflammatory responses in the body and is commonly performed. Ideally, your level should sit between 0.00 and 1.0 mg/L.
Hemoglobin A1c test. The World Health Organization recommends this blood sugar test, which doctors offer to adults with diabetic symptoms. Results should fall in the 4.8-5.2 percent range (although anemia and dehydration can throw test results off).
A long list of supplements can help people combat depression and taper slowly off antidepressant drugs (which should be done carefully with medical supervision, using drugs in liquid form or even meticulously removing individual beads from capsules). The following are among Brogan's top for mental acuity.
Activated B complex. Look for one containing folate as 5-methyltetrahydrofolate or folinic acid, rather than folic acid, and B12 as methylcobalamin (or hydroxocobalamin or adenosylcobalamin). A large 2010 study from Rush University followed 3,503 older adults and found that higher intakes of vitamins B6, B9 and B12—through either foods or supplements—were associated with a lower likelihood of depression over a 12-year follow-up. 1
Suggested daily dosage: 50 mg B complex; B12 injection: 1-5 mg one to five times a week for two to four weeks
Minerals. Magnesium, zinc, iodine and selenium all have a big impact on mood.
Suggested daily dosage: 150-800 mg/day as magnesium glycinate (citrate
and oxide forms have laxative properties); 15-30 mg/day zinc; 200 mcg to 3 g/day iodine (with Atlantic kelp); 100-200 mcg/day as selenomethionine or selenium glycinate
Fatty acids. These are essential for the function of membranes, which cover each of the 100 trillion cells in our body, including neurons. Fish oils and cod liver oil contain omega-3 fatty acids, which decrease inflammation and boost brain regeneration. Evening primrose oil offers anti-inflammatory omega-6 gamma-linolenic acid (GLA).
Suggested daily dosage: 2 g/day omega-3 fatty acids (or fish oils); 500 mg twice-daily evening primrose oil
Glandulars. Made from mammal adrenal tissue and containing a host of enzymes, vitamins, amino acids and neurotransmitters, these provide support for adrenal fatigue. Brogan suggests taking both adrenal cortex and general adrenal glandular extracts from pastured animals twice a day for depressive symptoms. Also, between one and four hypothalamus glandulars can be taken twice a day for acute anxiety and agitation.
Suggested daily dosage: 100-300 mg/day
Digestive enzymes and betaine HCL. These assist digestion when enzymes are in low supply due to lifestyle factors and aging. Look for digestive enzymes that contain proteases (these digest proteins), lipases (these digest fats) and amylases (these digest carbohydrates).
Suggested daily dosage: Start with one capsule of betaine HCL with an only protein meal and increase up to three capsules. If you feel a 'heartburn' sensation with just one capsule, this isn't for you.
Many common chemicals present in medicines, household cleaning products and food additives can interfere with optimal thyroid function, says Brogan. Here are some of the items on her to-be-avoided list.
Birth control. Women often cite depression as the reason they quit taking the Pill. Besides the links to blood clots, high blood pressure and cancer, studies show that oral contraceptives are a major risk factor for mood disorders in some women—especially those with a personal or family history of psychiatric problems, those with previous premenstrual symptoms and those of younger age.12 Synthetic hormones are also linked to inflammation, low libido and insulin resistance.13 They've even been shown to deplete women of the vitamins, minerals and antioxidants essential for the healthy functioning of the neurotransmitters that regulate mood.14 Brogan urges women to ditch their hormonal contraceptives and opt for safer alternatives, including monitoring ovulation and the use of condoms.
Statins. The benefits of these drugs have been wildly exaggerated for marketing purposes, according to a 2015 review, which found that these cholesterol-busting drugs only reduce heart-attack risk in about 1 per cent of users.15 In another study, 17 per cent of patients taking them experienced statin-related adverse events.16
Since the early 1990s, studies have linked low cholesterol and suicide. Indeed, one small study found that depressed patients with either high or low cholesterol levels attempted suicide over a three-year follow-up period,17 whereas others have linked low cholesterol to depression and anxiety.18 This makes sense because cholesterol and other saturated fats are essential components of the cell membranes that maintain cell structure. In fact, 25 per cent of the body's total cholesterol is found in the brain—with as much as 70 per cent of that found in the insulating myelin protein sheaths encapsulating the nerves that conduct impulses.19 Deliberately lowering cholesterol, which is so vital to brain function, is something Brogan advises against.
Proton-pump Inhibitors. These drugs, prescribed for symptoms of acid reflux, can make you deficient in vitamin B12—which comes with well-documented and dramatic neuropsychiatric problems such as manic and schizophrenic-like states, hallucinations and depression.
The higher the daily dose of acid-blockers, the stronger the association with B12 deficiency.20
Painkillers. Many people don't think twice about popping a painkiller, but acetaminophen/paracetamol-containing drugs are not only the most lethal, but they've also been shown to blunt emotions—good and bad ones—within an hour of use.
In a recent study from Ohio State University, subjects who took acetaminophen felt less intense emotions when they saw both pleasant and disturbing photos than did those who took a placebo.21 Any drug that can cause this kind of 'zombification',as well as neurodevelopmental disorders and liver damage, should be on your no-fly list if you want to boost your mood, says Brogan.
Also, non-steroidal anti-inflammatory drugs (NSAIDs) are well documented to impact gut function and wreak havoc with hormones, inhibiting ovulation after just 10 days' use, according to one study.22 For bouts of osteoarthritic or menstrual pain, Brogan recommends 1-2 g of curcumin (extract of the spice turmeric), said to have powerful anti-inflammatory effects that rival those of NSAIDs.
Therapeutic drugs. A systematic review and meta-analysis of interferon, an antiviral treatment for chronic hepatitis C, showed that it can induce a "major depressive episode" in one in four hepatitis C patients.23
With the 'chemical imbalance' theory of depression out of favour, many researchers are looking at depressive syndromes as 'inflammatory' disorders, as found in most other chronic diseases.24 We're used to seeing inflammation when we injure ourselves, but chronic, silent inflammation in the brain, which has no pain receptors, can have an impact on mental wellbeing.
Depressive patients are known to have elevated levels of special proteins called 'cytokines'. As indicators of inflammation, they could help in not only diagnosing depressive disorders, but also in picking the best treatments as well.25
Vaccines. Vaccination, by its nature, provokes inflammatory immune responses in the body. In fact, aluminium salts, specifically added to vaccines to provoke an immune response, have demonstrated neurotoxicity in hundreds of clinical studies.
Other vaccine ingredients, such as foreign/animal DNA and the carcinogen formaldehyde, also naturally elicit immune responses, shown to vary widely between individuals.26 But they can also affect the brain. In one placebo-controlled trial, typhoid vaccine recipients "produced a robust inflammatory response . . . accompanied by a significant increase in fatigue, confusion, and impaired concentration".27 Many adverse events associated with vaccines involve neurological and brain impacts associated cognitive impairment and fatigue due to vaccine aluminium in the brain.28 All good reasons why Brogan suggests you're better off without them.
Let food be thy medicine
Brogan's first port of call for her depressed patients is their diet. Dietary changes affect the microbes and immune cells inhabiting the gut and this, in turn, influences gut-brain signalling.
Her specialized diet (summarized here) eliminates inflammation-causing processed food and common allergens that can provoke immune responses, while promoting high levels of nutrients from healthy fats and whole, natural foods.
Eliminate sugar. When sugar is eaten as a Mars bar, a bagel or a bowl of pasta, our blood sugar levels spike, followed by a spike in the hormone insulin to whisk the glucose out of the bloodstream and into storage. But if this happens repeatedly, cells become unresponsive to the flood of insulin, which causes more insulin to be produced. In turn, blood sugar crashes (hypoglycaemia), which can feel like nausea, a racing heart, jitters, edginess and low mood—all symptoms of mental distress. Most women crave refined carbohydrates for emotional wellbeing because they provide a quick boost to levels of the brain chemical dopamine, which is in charge of the pleasure-reward system. Brogan recommends the kinds of carbs that don't set your blood sugar yo-yoing, such as sweet potatoes, nuts and seeds.
Eliminate grains, gluten and other allergens such as soy, corn and dairy (for at least
Gluten can directly affect the brain through its opioid compounds, says Brogan. And it drives at least two pathologies—coeliac disease and Hashimoto's thyroiditis (autoimmune hypothyroidism)—both significantly associated with depression and other mental
Eliminate pesticides. Residues of glyphosate, the organophosphorus compound in Roundup herbicide, are found in most processed foods and have been linked to cancer, and shown to disrupt the microbiome and gut function. It also impairs vitamin D function, which can profoundly influence mood regulation, and depletes minerals and mimics hormones.
Eat fat. Healthy natural fats from ghee and olive, fish, flax and coconut oils, eggs and nuts nourish the brain and have anti-inflammatory effects; they are crucial for the wellbeing of the brain, which is 60 per cent fat.
Eat free-range eggs, wild fish and grass-fed meat. Meat, and especially skin and connective tissue, contain the amino-acid glycine, which can alleviate anxiety and insomnia as well as keep the joints, hair and skin healthy. Brogan suggests drinking cold water with an added tablespoon of tasteless grass-fed gelatine. Also, aim to eat organ meats (such as liver) twice a week. Or add it as a powder in a soup or smoothie to mask the taste.
De-stress. Finding ways to dial down your body's stress signals in today's hectic world is essential for mental wellbeing. Brogan's top three:meditation, sleep and exercise.
Meditate. Brogan points to a recent study where people achieved a "relaxation response" for 20 minutes a day through various types of meditation, yoga and repetitive prayer, and found quantifiable positive changes in gene expression. Just one session had an effect, although it increased with increasing relaxation responses.30
A pooled analysis of 12 studies of "mindfulness-based interventions" (involving cognitive therapy and stress-reducing techniques) confirmed that they can reduce the risk of a depressive relapse and reduce the severity of the depressive or anxiety attacks.31
Sleep. Sleeping for less than six hours can reduce daytime alertness by about a third in most people, and impair body function in the same way that alcohol does, says Brogan, citing a 2009 University of Texas.32 Not only does poor sleep throw hormones out of whack, but it can impair memory, decrease the ability to cope with stress, increase weight gain and, of course, cause depression. Therapy with SSRIs has serious effects on normal sleep patterns, as evidenced by insomnia and intermittent waking at night. "Virtually all of the SSRIs examined have been noted to suppress REM [deep] sleep," says Brogan—another reason to avoid them. Two homeopathic alternatives in her doctor's bag: Ignatia Amara, for feelings of distress and emotionality related to insomnia, and Arsenicum Album 30C, for waking up with anxiety between 1 and 3 am.
Exercise. This works better than drugs to prevent and treat depression, and probably has something to do with the fact that it also prevents blood sugar imbalances, promotes sleep, increases strength and energy, releases feel-good endorphins and decreases inflammation. A study of 156 men and women with clinical depression assigned them to either taking the standard anti-depressants, doing aerobic exercise for 45 minutes three times each week, or doing both. After four months, there was little difference in depressive symptoms among the three groups. But a year later, regardless of which group they had been assigned to initially, those who exercised regularly saw the greatest reduction in depressive symptoms.33