A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives

A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives Dr Kelly Brogan Depression is one of the UK’s leading causes of disability. One in four women in their 40s are prescribed antidepressant drugs BUT depression is a sign of malfunction of the body – not in the brain and it can be treated with simple lifestyle interventions.The UK’s mental well-being is in a state of crisis – psychiatric drugs are overprescribed and the causes of depression and anxiety oversimplified as a genetic and brain malfunction. This book debunks the myths and sets out a natural cure for depression, proving that low serotonin levels are not the primary cause of depression, but that inflammation is the root cause and this can be treated by way of lifestyle changes.The book explores the truth about depression, including the latest science and how our genes express themselves through the food choices we make, as well as Dr Brogan’s four-week plan with menus. Written in a lively style and laced with compelling scientific proof, this groundbreaking book proves that symptoms of depression are often markers of an underlying problem originating outside the brain which can be effectively treated without pharmaceuticals. Copyright (#ue94cbd17-15fb-54df-94b3-6550937de81a) This book contains advice and information relating to health care. It is not intended to replace medical advice and should be used to supplement rather than replace regular care by your doctor. It is recommended that you seek medical advice before embarking on any medical programme or treatment. All efforts have been made to assure the accuracy of the information contained in this book as of the date of publication. The publisher and the author disclaim liability for any medical outcomes that may occur as a result of applying the methods suggested in this book. Thorsons An imprint of HarperCollinsPublishers 1 London Bridge Street London SE1 9GF www.harpercollins.co.uk (http://www.harpercollins.co.uk) First published in the US by Harper Wave, an imprint of HarperCollinsPublishers This UK edition published by Thorsons 2016 FIRST EDITION © Kelly Brogan 2016 Cover layout design © HarperCollinsPublishers 2016 Cover photograph © Jonathon Kambouris/Gallery Stock A catalogue record of this book is available from the British Library Kelly Brogan asserts the moral right to be identified as the author of this work All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the nonexclusive, non-transferable right to access and read the text of this e-book on screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins e-books. Find out about HarperCollins and the environment at www.harpercollins.co.uk/green (http://www.harpercollins.co.uk/green) Source ISBN 9780008128005 Ebook Edition © February 2016 ISBN: 9780008128012 Version: 2016-02-22 To the legacy of Dr. Nicholas Gonzalez and to all of the light workers who illuminate the path for my daughters, and everyone’s daughters. Contents Cover (#ub6858f66-1306-57c9-add7-a342cbca8698) Title Page (#ud85bf2b4-c3bc-59de-9899-f34a3fbda657) Copyright Dedication (#ue0193417-52c5-5b68-b3c3-6849f5374e64) Introduction: Psych—­It’s Not All in Your Head PART I: THE TRUTH ABOUT DEPRESSION 1 Decoding Depression It’s Not a Disease: What You Don’t Know About This Syndrome and How It Manifests 2 Truth Serum: Coming Clean About the Serotonin Myth How You’ve Been Misled, Misdiagnosed, and Mistreated 3 The New Biology of Depression What Gut Microbes and Silent Inflammation Have to Do with Mental Health 4 The Great Psychiatric Pretenders Two Common, Resolvable Conditions That Can Lead to a Psychiatric Diagnosis 5 Why Body Lotions, Tap Water, and OTC Pain Relievers Should Come with New Warning Labels Common Exposures and Drugs That Can Lead to Depression PART 2: NATURAL TREATMENTS FOR WHOLE-BODY WELLNESS 6 Let Food Be Thy Medicine Nutritional Recommendations to Heal Your Body and Free Your Mind (Without Feeling Like You’re on an Impossible Diet) 7 The Power of Meditation, Sleep, and Exercise Three Simple Lifestyle Habits That Can Enhance Mental Health 8 Clean House How to Detoxify Your Environment 9 Testing and Supplementing Supporting the Healing Process 10 4 Weeks to a Natural High A 30-Day Plan of Action Closing Words: Own Your Body and Free Your Mind Recipes Notes List of Searchable Terms Acknowledgments About the Author About the Publisher INTRODUCTION (#ue94cbd17-15fb-54df-94b3-6550937de81a) Psych—­It’s Not All in Your Head (#ue94cbd17-15fb-54df-94b3-6550937de81a) All along the history of medicine, the really great physicians were peculiarly free from the bondage of drugs. —­Sir William Osler (1849–1919) If you’ve picked up this book, then chances are you can relate to any of the following: persistent distress, malaise, anxiety, inner agitation, fatigue, low libido, poor memory, irritability, insomnia, sense of hopelessness, and feeling overwhelmed and trapped but emotionally flat. You might wake up most mornings unmotivated and uninspired, and you drag yourself around all day waiting for it to end (or waiting for a drink). Maybe you feel a sense of dread or panic without knowing why. You can’t silence the negative thoughts, which puts you on edge. Sometimes it seems like you could let loose an endless stream of tears, or perhaps you can’t remember the last time you cared enough about something to cry. All of these descriptions are symptoms that typically fall under a diagnosis of clinical depression. And if you were to seek help through conventional medicine, even if you don’t consider yourself “depressed,” you’d likely be handed a prescription for an antidepressant, joining the more than 30 million users in America. You might already be part of this community and feel like your fate is now sealed. It doesn’t have to be. Over the past twenty-five years, ever since the FDA approval of Prozac-type medications, we’ve been taught that drugs can improve the symptoms of or even cure mental illness, particularly depression and anxiety disorders. Today they are among the most prescribed, best-selling drugs. This has led to one of the most silent and underestimated tragedies in the history of modern health care. I am a practicing psychiatrist with a degree in cognitive neuroscience from MIT, an MD from Weill Cornell Medical College, and clinical training from NYU School of Medicine, and I care deeply for women struggling with their well-being. I’m compelled to share what I’ve learned from witnessing the corruption of modern psychiatry and its sordid history while investigating holistic methods that focus on nutrition, meditation, and physical activity—­what some practitioners are calling lifestyle medicine because the approach involves changes in everyday lifestyle habits, not the use of pharmaceuticals. While such drug-free methods are entirely evidence-based, they are virtually unknown in this age of the quick fix. Let’s get a few facts straight from the get-go. I’m not a conspiracy theorist. I’m not even that politically minded, but I do like to think for myself. I’m a natural skeptic and pragmatist. These days, there are a ­couple of issues in my line of work that are making my blood boil, and I’m working to connect the dots between them to help establish a framework for a truth in science “sniff-test.” For one, symptoms of mental illness are not entirely a psychological problem, nor are they purely a neurochemical issue (and, as we’ll see shortly, not a single study has proven that depression is caused by a chemical imbalance in the brain). Depression is merely a symptom, a sign that something is off balance or ill in the body that needs to be remedied. And two, depression is a grossly misdiagnosed and mistreated condition today, especially among women—­one in seven of whom is being medicated. (For reasons we’ll be exploring, women experience more than twice the rate of depression as men, regardless of race or ethnic background. One in four women in their forties and fifties use psychiatric drugs.) Although I was trained to think that antidepressants are to the depressed (and to the anxious, panicked, OCD, IBS, PTSD, bulimic, anorexic, and so on) what eyeglasses are to the poor-sighted, I no longer buy into this bill of goods. And after reading this book, you too may think twice about all you thought you understood about the causes of depression. We owe most of our mental illnesses—­including their kissing cousins such as chronic worry, fogginess, and crankiness—­to lifestyle factors and undiagnosed physiological conditions that develop in places far from the brain, such as the gut and thyroid. That’s right: you might owe your gloominess and unremitting unease to an imbalance that is only indirectly related to your brain’s internal chemistry. Indeed, what you eat for breakfast (think whole wheat toast, fresh OJ, milk, and multigrain cereal) and how you deal with that high cholesterol and afternoon headache (think Lipitor and Advil) could have everything to do with the causes and symptoms of your depression. And if you think a chemical pill can save, cure, or “correct” you, you’re dead wrong. That is about as misguided as taking aspirin for a nail stuck in your foot. While it’s well documented that multiple forces—­such as a tragic life event or the fallout from hormonal shifts—­can trigger symptoms labeled (and treated) as depression, no one has explained the potential for antidepressants to irreversibly disable the body’s natural healing mechanisms. Despite what you’ve been led to believe, 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. The dirtiest little secret of all is the fact that antidepressants are among the most difficult drugs to taper from, more so than alcohol and opiates. While you might call it “going through withdrawal,” we medical professionals have been instructed by Big Pharma to call it “discontinuation syndrome,” which is characterized by fiercely debilitating physical and psychological reactions. So unlike most psychiatrists, I’m not one to diagnose a “permanent” condition, write a prescription, and send my patient on her merry way—­the knee-jerk gold standard in my field today. Nor do I have her sit on a couch and talk about her problems endlessly. Much to the contrary, my first item of business is to discuss her medical and personal history, including questions that give me a sense of her life’s exposures since birth, from noxious chemical encounters to whether or not she was born through the birth canal and breast-fed. I also order lab tests that help me take in the bigger picture of her total biology; these are noninvasive screenings that most psychiatrists and general practitioners don’t even think about doing (and in this book you’ll be learning about these easy-to-obtain tests as tools to help you personalize your path to healing). While I acknowledge my patient’s past experiences, I also focus on what’s unfolding today from a cellular standpoint and the potential impairment (“dysregulation”) of her immune system. The medical literature has emphasized the role of inflammation in mental illness for more than twenty years. I listen closely and ask her about her current lifestyle, a dismissed and neglected variable in conventional medicine. I reflect on her entirety, considering factors like how much sugar she consumes and other dietary habits, how well her gut and its microbial communities are collaborating, hormone levels such as thyroid and cortisol, genetic variants in her DNA that can put her at a higher risk for symptoms of depression, her beliefs about health, and her intentions for our work together. (And, yes, this takes hours.) All of my patients share similar goals: they want to feel physically vibrant and emotionally balanced, which I believe is everyone’s birthright—­not perpetually drained, unsettled, mentally foggy, and unable to enjoy life. Under my guidance, they achieve these goals through very simple and straightforward strategies: dietary modifications (more healthy fats and less sugar, dairy, and gluten); natural supplements like B vitamins and probiotics that don’t require a prescription and can even be delivered through certain foods; minimizing exposures to biology-disrupting toxicants* (#ulink_00c029c7-88d0-5b14-9cbd-e4fe1c1b6f6d) like fluoride in tap water and fragrances in cosmetics; harnessing the power of sufficient sleep and physical movement; and practicing behavioral techniques aimed at promoting the relaxation response. These basic lifestyle interventions facilitate the body’s powerful self-healing mechanisms, and there’s plenty of science to support these protocols. This isn’t New Age medicine; I will prove my claims and back my recommendations with current peer-reviewed studies from the world’s most esteemed publications. I do not deny that I have developed a sometimes belligerent relationship with much of conventional medicine over the past several years. After having witnessed the devastation this paradigm has wrought upon the lives of hundreds of my patients, I’m convinced that the pharmaceutical industry and its bedfellows, concealed behind official titles such as certain medical societies and associations, have created an illusion of science where none exists, in the ser­vice of profit over professional responsibility. I will myth bust just about everything you think you know about the role of drugs in the treatment of depression and anxiety. It’s time to turn the lights on in this dark room. Let’s open up this conversation and embrace a perspective on depression that radically challenges mainstream assumptions and theories. If I do my job well, you’ll never look at another ad for an antidepressant again in quite the same way. Admittedly, I haven’t always been militant about my now unshakable, passionate belief in the effectiveness of holistic, drug-free medicine to heal women’s minds, moods, and memory. I’ve crossed over from the other side in many ways, having once been a dyed-in-the-wool allopathic doctor. I’m from a family that regards conventional medicine as a guiding light. I was always interested in neuroscience and the promise of understanding behavior and pathology, and I pursued psychiatry for that reason. My inner feminist wasn’t totally satisfied, however, until I began to specialize in women’s health. There’s a growing field in psychiatry called perinatal or reproductive psychiatry that focuses on the risk-benefit analysis of treating women during their reproductive years. This is a uniquely vulnerable time period, particularly if a woman is contemplating taking drugs while simultaneously planning a pregnancy or is already pregnant. I soon began to feel constrained by the medication and/or talk therapy model of treating depression, and I delved into how to cultivate better options for not just women in their reproductive years but all women across the entire life cycle. The further I stepped away from traditional psychiatry, the more I started to ask questions few others in my field were raising, principally “Why?” Why have the body and mind become dysfunctional in so many millions of women? Are we inherently broken? Why have we gotten so much sicker in the past century when our DNA—­the same DNA we’ve had for millions of years—­hasn’t changed? Or are doctors just getting better at labeling symptoms under the wastebasket diagnosis that is depression? These are among the many questions addressed in this book; the answers pave the way to a revolutionary—­and by that I mean extremely self-empowering!—­new approach to well-being. I’ve seen extraordinary turnarounds in health. Take, for instance, the fifty-six-year-old woman who entered my office complaining of low energy, pervasive pain, dry skin, constipation, weight gain, and forgetfulness. She was taking an antidepressant and a cholesterol-lowering statin but feeling progressively worse and desperate for answers. Within months, she was off all meds, her cholesterol level optimized, and her “depression” vanished. Or consider the thirty-two-year-old woman with a history of premenstrual syndrome (PMS) for which she’d taken birth control pills until trying to become pregnant. When she came in to see me, she was on an antidepressant for her flat mood and fatigue and was unable to conceive despite two years of trying. What followed next was not a miracle but rather something I witness every day in my practice. With a few easy changes to her diet and a combination of other lifestyle strategies—­the same ones outlined in this book—­she was soon prescription-free and pregnant. She also was symptom-free for the first time in her life. You’ll be meeting many women in this book whose stories speak for themselves and are emblematic of millions of others who live with unnecessary, life-depleting depression. And I trust that you’ll relate to one or more of them. Whether you’re currently taking antidepressants or not, this book has something for every woman who struggles to feel like the radiant self she deserves to be. I see a lot of patients who have “tried everything” and have been to the country’s top doctors. In fact, a good percentage of my practice involves treating other physicians and psychiatrists. Many women credit me with the initiation of life transformation. Because I believe passionately in the power of lifestyle medicine to produce changes that are greater than the sum of their parts—­bigger, bolder shifts in how we relate to life, spirituality, the environment, and even authorities—­I see myself as an ambassador to a new way of experiencing health and well-being. This way of being may be built on the ashes of suffering, but may be the way to rise up, phoenix-like, emboldened, and stronger than ever. That strength and resilience is yours, and it follows you everywhere you take it. I’ve divided the book into two parts. Part 1: “The Truth About Depression,” takes you on a tour of your mental health’s friends and enemies, from everyday foods to common prescription and over-the-counter medications. You’ll soon be consuming more saturated fat and cholesterol and shopping differently in the grocery store and drugstore. In compelling detail, backed by science, I’ll expose the stunning relationship between your gut’s health and mental health. And I’ll do so within the context of inflammation, an overused buzzword today that most ­people still don’t truly comprehend, especially when it comes to its critical role in depression. I will prove that depression is often a result of chronic inflammation—­simple as that. I also will explain the underlying responsibilities of your immune system in orchestrating all matters of mental health. Part 1 includes an overview of the latest research on how we can dramatically alter our genetic destiny—­how our genes express themselves, including those directly related to mood—­through the everyday choices we make in food and activities. The goal of Part 1 is to prep you for the program you’ll embark on in Part 2: “Natural Treatments for Whole-Body Wellness.” This is where I guide you through my program, a program designed both for women not taking medications and those who are and perhaps are dreaming of tapering off. Included is a four-week plan of action, complete with menu plans and strategies for incorporating new lifestyle habits into your day. For support and ongoing updates, you can go to my website, www.kellybroganmd.com (http://www.kellybroganmd.com). There you’ll be able to read my blog, watch my instructional videos, access the latest scientific studies, and download materials that will help you tailor the information in this book to your personal preferences. Once you apply to your life what you learn in these pages, you will reap more than the reward of mental stability. My patients often list the following “side benefits” to my program: feeling in control of their lives and bodies (including effortless weight management); clarity of mind and spirit; enhanced energy; and an unwavering tolerance for distress. Who wouldn’t want these results? The time has come for you to have a mind of your own. Let’s get started. * (#ulink_0fd2bb81-642e-5863-bc19-8ab515170500) A toxicant refers to any toxic substance, though it’s often a term used to indicate substances made by humans or introduced into the environment by human activity. The term toxin, on the other hand, refers to toxicants produced naturally by a living organism. PART ONE (#ue94cbd17-15fb-54df-94b3-6550937de81a) THE TRUTH ABOUT DEPRESSION (#ue94cbd17-15fb-54df-94b3-6550937de81a) CHAPTER 1 (#ulink_d07019ed-b665-507d-aea7-a0f1214abbb5) Decoding Depression (#ulink_d07019ed-b665-507d-aea7-a0f1214abbb5) It’s Not a Disease: What You Don’t Know About This Syndrome and How It Manifests Depression can result from bodily imbalance rather than brain chemical imbalance. _____ The medicalization of distress obliterates meaning and creates profit. When I talk about medicine and mental health to large audiences, I often start with the following imagery and facts: think of a woman you know who is radiantly healthy. I bet your intuition tells you she sleeps and eats well, finds purpose in her life, is active and fit, and finds time to relax and enjoy the company of others. I doubt you envision her waking up to prescription bottles, buoying her way through the day with caffeine and sugar, feeling anxious and isolated, and drinking herself to sleep at night. All of us have an intuitive sense of what health is, but many of us have lost the roadmap to optimal health, especially the kind of health that springs forth when we simply clear a path for it. The fact that one in four American women in the prime of their life is dispensed medication for a mental health condition represents a national crisis. Humans have used mind-altering substances to try to dull and deaden pain, misery, sorrow, and suffering since time immemorial, but only in the last few decades have ­people been persuaded that depression is a disease and that chemical antidepressants are the remedy. This is far from the truth. Many of my patients have been to multiple doctors, bumping up against the hard ceiling of what conventional medicine has to offer. Some have even tried integrative medicine, which aims to combine both traditional medicine (i.e., prescriptions) with alternative treatments (e.g., acupuncture). After all, they are told that there are great natural complements to all the wonders pharmaceutical products have to offer. But the reason they can’t find a solution is because nobody has asked why. Why are they unwell? Why are their bodies creating symptoms that manifest as depression? Why didn’t they stop to ask this important and obvious question the first time they experienced a flat mood, anxiety, insomnia, and chronic exhaustion? Before I even get to the answers, let me be the first to tell you that the only path to a real solution is to leave the medical world you know behind. This, the journey I will take you on, is not just about symptom suppression, it’s about health freedom. First let me tell you that I was once a typical doctor, not to mention a typical American who loved pizza, soda, birth control, and ibuprofen. My message is from a personal journey and thousands of hours of research that has compelled me to share the truth about prescription-based care: we’ve been duped. Yes, my entire training was based on a model of disease care that offers patients only one tool—­a drug—­and never a shot at true wellness. We’ve handed over our health to those who seek to profit from it, and we’ve been buying into a paradigm based on the following notions: ? We are broken. ? Fear is an appropriate response to symptoms. ? We need chemicals to feel better. ? Doctors know what they are doing. ? The body is a machine requiring calibration (via drugs). A little too much of this, too little of that. I call this collective set of notions the Western Medical Illusion. It sets up a vicious system that ushers you into life­long customer status, dependent and disempowered. As you can likely guess by now, I love to rant. But I do so with the best evidence science can offer, and there’s a lot we know today about the real root causes of depression—­and how to treat the ­condition safely and successfully—­without a prescription pad. If there’s one lesson I will drive home, it’s this: shed the fear, take back your inner compass, and embrace a commitment to your best self, medication free. Even if you don’t already take a prescription drug, I bet you still doubt living the rest of your life prescription free and reliant on your own inner intuition to know what’s best for you. The idea of supporting your body’s innate wisdom may sound quaint at best, or like dangerous hippie woo-woo at worst. From now on, I want you to embrace these new ideas: ? Prevention is possible. ? Medication treatment comes at a steep cost. ? Optimal health is not possible through medication. ? Your health is under your control. ? Working with lifestyle medicine—­simple everyday habits that don’t entail drugs—­is a safe and effective way to send the body a signal of safety. How can I make these statements, and what do I mean by lifestyle medicine? You’re going to find out in this book, and I’ll be presenting the scientific proof to answer questions you may have and to satisfy the doubtful. When I meet a woman and her family, I speak about how to reverse her anxiety, depression, mania, and even psychosis. We map out the timeline that brought her where she is and identify triggers that often fall under one or more of the following categories: food intolerances or sensitivities, blood sugar imbalances, chemical exposures, thyroid dysfunction, and nutrient deficiency. I forge a partnership with my patient and witness dramatic symptom relief within thirty days. I do this by teaching my patients how they can make simple shifts in their daily habits, starting with the diet. They increase nutrient density, eliminate inflammatory foods, balance blood sugar, and bring themselves closer to food in its ancestral state. It’s the most powerful way to move the needle, because food is not just fuel. It is information (literally: “it puts the form into your body”), and its potential for healing is a wonder to me, every single day. Achieving radical wellness takes sending the body the right information and protecting it from aggressive assault. This isn’t just about mental health; it’s about how mental health is a manifestation of all that your body is experiencing and your mind’s interpretation of its own safety and power. It’s also about how symptoms are just the visible rough edges of a gigantic submerged iceberg. Note that none of these concepts connects with substances in the brain that might be “low.” If you had to define depression right now, before reading further, chances are you’d say something about it being a “mood disorder” or “mental illness” triggered by a chemical imbalance in the brain that probably needs to be fixed through a medication like Prozac or Zoloft that will lift levels of brain chemicals associated with a good mood. But you would be mistaken. So many patients today who are being shepherded into the psychiatric medication mill are overdiagnosed, misdiagnosed, or mistreated. Indeed, they have “brain fog,” changes in metabolism, insomnia, agitation, and anxiety, but for reasons only loosely related to their brain chemicals. They have all the symptoms that are mentioned in a Cymbalta advertisement that tells them to talk to their doctor to see if Cymbalta is right for them. But it’s like putting a bandage over a splinter in the skin that continues to stir inflammation and pain. It’s absolutely missing an opportunity to remove the splinter and resolve the problem from the source. And it’s an iconic example of how conventional medicine can make grave mistakes, something the pharmaceutical industry is more than happy to encourage. In holistic medicine, there are no specialties. It’s all connected. Here’s a classic case in point: Eva had been taking an antidepressant for two years but wanted to get off it because she was planning to get pregnant. Her doctor advised her not to stop taking the drug, which motivated her to see me. Eva explained that her saga had begun with PMS, featuring a week each month when she was irritable and prone to crying fits. Her doctor prescribed a birth control pill (a common treatment) and soon Eva was feeling even worse, with insomnia, fatigue, low libido, and a generally flat mood dogging her all month long. That’s when the doctor added the Wellbutrin to “pick her up,” as he said, and handle her presumed depression. From Eva’s perspective, she felt that the antidepressant helped her energy level, but it had limited benefits in terms of her mood and libido. And if she took it after midnight, her insomnia was exacerbated. She soon became accustomed to feeling stable but suboptimal, and she was convinced that the medication was keeping her afloat. The good news for Eva was that with careful preparation, she could leave medication behind—­and restore her energy, her equilibrium, and her sense of control over her emotions. Step one consisted of some basic diet and exercise changes along with better stress response strategies. Step two involved stopping birth control pills and then testing her hormone levels. Just before her period, she had low cortisol and progesterone, which were likely the cause of the PMS that started her whole problem. Further testing revealed borderline low thyroid function, which may well have been the result of the contraceptives—­and the cause of her increased depressive symptoms. When Eva was ready to begin tapering off her medication, she did so following my protocol. Even as her brain and body adjusted to not having the antidepressant surging through her system anymore, her energy levels improved, her sleep problems resolved, and her anxiety lifted. Within a year she was healthy, no longer taking any prescriptions, feeling good—­and pregnant. I require my patients and I implore you to think differently about health-care decisions and consumerism. Part of my motivation in writing this book was to help you develop a new watching, questioning eye that you can bring to every experience. For my patients to be well, I know they will need to approach their health with an extreme commitment to the integrity of their mind and body. Personally, I have no intention of ever returning to a lifestyle that involves pharmaceutical products of any kind, under any circumstances. Why? Because we are looking at the body as an intricately woven spiderweb—­when you yank one area of it, the whole thing moves. And because there is a more powerful way to heal. It’s so simple that it could be considered an act of rebellion. You might think of yourself as averse to conflict—­someone who wants to keep the peace, keep your head low, and do what’s recommended. To be healthy in today’s world, however, you need to access and cultivate a reliance on yourself. And you’re going to do that by first shifting your perspective forever. Look behind the curtain and understand that medicine is not what you think it is. Drug-based medicine makes you sick. I will go so far as to say that hospital care makes you sick; though estimates vary, it’s reasonable to say that hospital care claims tens if not hundreds of thousands of lives annually due to preventable medical mistakes such as wrong diagnoses and medications or surgical errors, infections, and simply screwing up an IV. The Cochrane Collaboration, a London-based network of more than 31,000 researchers from more than 130 countries, conducts the world’s most thorough independent analysis of health-care research. Based on data from the British Medical Journal, the Journal of the American Medical Association, and the Centers for Disease Control, it has found that prescription drugs are the third leading cause of death after heart disease and cancer. And when it comes to psychotropic drugs, the Cochrane Collaboration’s conclusions are compellingly uncomfortable. In the words of the Collaboration’s founder, Dr. Peter Gotzsche, “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.” By and large, doctors are not bad ­people. They are smart ­individuals who work hard, investing money, blood, sweat, and tears into their training. But where do doctors get their information? Whom are they told to trust? Have you ever wondered who’s pulling the strings? Some of us in the medical community are beginning to speak up and to expose the fact that our training and education is, for the most part, bought. “Unfortunately in the balance between benefits and risks, it is an uncomfortable truth that most drugs do not work in most patients.” Before I read this quote in the prestigious British Medical Journal in 2013, I had already begun to explore the evidence that there really isn’t much to support the efficacy of most medications and medical interventions, particularly in psychiatry, where suppressed data and industry-funded and ghostwritten papers hide the truth. Another 2013 study published in the equally respected Mayo Clinic Proceedings confirmed that a whopping 40 percent of current medical practice should be thrown out. Unfortunately, it takes an average of seventeen years for the data that exposes inefficacy and/or a signal of harm to trickle down into your doctor’s daily routine, a time lag problem that makes medicine’s standard of care evidence-based only in theory and not practice. Dr. Richard Horton, the editor ­in ­chief of the much-revered Lancet at this writing, has broken rank and come forward about what he really thinks about published research—­that it’s unreliable at best, if not completely false. In a 2015 published statement, he wrote: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” In 2011 the British Medical Journal performed a general analysis of some 2,500 common medical treatments. The goal was to determine which ones are supported by sufficient reliable evidence. The results: ? 13 percent were found to be beneficial ? 23 percent were likely to be beneficial ? 8 percent were as likely to be harmful as beneficial ? 6 percent were unlikely to be beneficial ? 4 percent were likely to be harmful or ineffective The treatments in the remaining 46 percent, the largest category, were found to be unknown in their effectiveness. Put simply, when you visit a doctor or hospital, you have only a 36 percent chance that you’ll receive a treatment that has been scientifically proven to be either beneficial or likely to be beneficial. Such results are strikingly similar to those of Dr. Brian Berman, who analyzed completed Cochrane reviews of conventional medical practices, finding that 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.” Are there exceptions? I would like to argue that there aren’t. This is because the whole pharmaceutical approach is predicated on wrong-headed information. Pharmaceutical products as we know them have not been developed or studied with modern science’s most relevant principles in mind, such as the complexity and power of the human microbiome, the impact of low-dose toxic exposures, autoimmune disorders as a sign of environmental overstimulation, and the fundamental importance of individual biochemistry. Because medicine operates under the now antiquated one gene, one illness, one pill rubric, efficacy will be measured through a skewed lens, and safety cannot be accurately assessed or discussed with ­individual patients. Many of us move through life with a sneaking fear that the other health shoe could drop at any moment. We can easily fall prey to the belief that our breasts are ticking time bombs, that infections are just a cough or handshake away, and that life is a process of adding more medications and drugs to put out small fires as we age. Before I stopped prescribing, I had never once cured a patient. Now ­people are cured every week in my practice. As I mentioned, my patients are my partners. We collaborate, and they work hard. They work hard at a time when they feel they can’t even lift a finger—­when the prospect of walking to the drugstore with a slip of paper twinkles like the North Star in their dark sky. They follow my lead because they feel inspired by my conviction and hope in this new model—­one that asks the question “Why?” and has the goal of not only symptom relief but an incredible boost in their vitality. I realize that many of you reading this book may fear the change that will happen if you take my advice seriously. But no situation has ever been more easily resolved, better handled, or supported by freaking out. Responding with fear leads us to make decisions that are myopic. Some of these decisions may ease our sense of disorder, but they simultaneously engender new and more complex problems. Instead, when you have a symptom—­when you feel cloudy, sad, sore, gassy, weepy, tired, or unnecessarily anxious—­bring some wonder to it. Ask why and try to make the connections. Your body’s symptoms are telling you something about equilibrium. Your body is trying to tell you that it has lost balance. Stand back and appreciate the infinite complexity of your organism. Know that fear will only drive you to treat your body like a robotic machine that needs oil and gear changes. We are so much more than buttons and levers. So it’s time to put on some new glasses and start to study your body. Start to think critically about what you buy, the medical advice you take, and what the media tells you to worry about. Let light shine on every dark corner of your beliefs about health. This critical thinking will liberate you to realize your full potential as a parent, spouse, or friend, and within your own sphere of existence. As one of my favorite quotes goes: “Everything you’ve ever wanted is on the other side of fear.” In the rest of this chapter, we’re going to take a tour of what depression is—­from its true definition and biology to its myriad causes and the colossal failure of the pharmaceutical industry to treat this health challenge that has swiftly become the leading cause of disability in America and the rest of the world. This will help ease your fears about the change that you’re about to make and set the stage for the balance of the book. And I’ll start with one of the most pervasive and harmful myths about depression. DEPRESSION IS NOT A DISEASE Psychiatry, unlike other fields of medicine, is based on a highly subjective diagnostic system. Essentially you sit in the office with a physician and you are labeled based on the doctor’s opinion of the symptoms you describe. There are no tests. You can’t pee in a cup or give a drop of blood to be analyzed for a substance that definitely indicates “you have depression” much in the way a blood test can tell you that you have diabetes or are anemic. Psychiatry is infamous for saying “oops!” It has a long history of abusing patients with pseudoscience-driven treatments and has been sullied by its shameful lack of diagnostic rigor. Consider, for example, the 1949 Nobel Prize winner Egas Moniz, a Portuguese neurologist who introduced invasive surgical techniques to treat ­people with schizophrenia by cutting connections between their prefrontal region and other parts of the brain (i.e., the prefrontal lobotomy). And then we had the Rosenhan experiment in the 1970s, which exposed how difficult it is for a doctor to distinguish between an “insane patient” and a sane patient acting insane. Today’s prescription pads for psychotropic drugs are, in my belief, just as harmful and absurd as physically destroying critical brain tissue or labeling ­people as “psychiatric” when really they are anything but. My fellowship training was in consultation-liaison psychiatry, or “psychosomatic medicine.” I was drawn to this specialization because it seemed to be the only one that acknowledged physical processes and pathologies that could manifest behaviorally. I noticed that psychiatrists in this field appreciated the role of biological actions such as inflammation and the stress response. When I watched fellow psychiatrists consult on surgical patients in the hospital, they talked about these processes much ­differently from when they saw patients in their Park Avenue offices. They talked about delirium brought on by electrolyte imbalance, symptoms of dementia caused by B deficiency, and the onset of psychosis in someone who was recently prescribed antinausea medication. These root causes of mental challenges are far from the “it’s all in your head” banter that typically swirls around conversations about mental illness. The word psychosomatic is a loaded and stigmatized term that implies “it’s all in your head.” Psychiatry remains the wastebasket for the shortcomings of conventional medicine in terms of diagnosing and treating. If doctors can’t explain your symptoms, or if the treatment doesn’t fix the problem and further testing doesn’t identify a concrete diagnosis, you’ll probably be referred to a psychiatrist or, more likely, be handed a prescription for an antidepressant by your family doctor. If you are very persistent that you still need real help, your doctor might throw an antipsychotic at you as well. Most prescriptions for antidepressants are doled out by family doctors—­not psychiatrists, with 7 percent of all visits to a primary-care doctor ending with an antidepressant prescription. And almost three-quarters of the prescriptions are written without a specific diagnosis. What’s more, when the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health did its own examination into the prevalence of mental disorders, it found that “Many individuals who are prescribed and use antidepressant medications may not have met criteria for mental disorders. Our data indicate that antidepressants are commonly used in the absence of clear evidence-based indications.” I’ll never forget a case I consulted on several years ago that involved “psychosomatic” facial burning in a woman. Her story is insightful. She complained of an intense burning sensation in her face, though there was no explanation for it other than it being “all in her head.” Her symptoms were so disabling that she was barely able to function. I was still prescribing psychotropics at the time, but a voice inside of me knew there was something real going on, and it wasn’t at all in her head. But unfortunately the Western medical model had already labeled her as being a psychosomatic case, which called for psychiatric medication and couldn’t appreciate or even begin to understand the complexity of her condition. Antidepressants and benzodiazepines (tranquilizers including Valium or Xanax) didn’t help her. What ultimately did was dietary change, supplementation, and rebalancing of her bodily flora. Was this all a placebo effect? Clearly she wanted to feel better with such intensity that she would have done anything. But traditional medication didn’t cure her. At the heart of her pain and distress was an immune and inflammatory process that could not be remedied via antidepressants and antianxiety drugs. It was fixed through strategies that got to the core of her problem—­that yanked the nail out of her foot and let the injury heal. The idea that depression and all of its relatives are manifestations of glitches in the immune system and inflammatory pathways—­not a neurochemical deficiency disorder—­is a topic we will explore at length throughout this book. This fact is not as new as you might think, but it’s probably not something your general doctor or even psychiatrist will talk about when you complain of symptoms and are hurried out of the office with a prescription for an antidepressant. Nearly a century ago, scientific researchers were already exploring a connection between toxic conditions in the gut and mood and brain function. This phenomenon was given the name auto intoxication. But studying such a wild idea fell out of fashion. By mid-century no one was looking into how intestinal health could affect mental health. Instead, the thinking was quickly becoming the reverse—­that depression and anxiety influenced the gut. And as the pharmaceutical industry took off in the second half of the twentieth century, gut theories were ignored and the brilliant researchers behind them were forgotten. The gut was regarded as the seat of health in ancient medical practices for centuries; now we can finally appreciate the validity of such old wisdom. Hippocrates, the father of medicine, who lived in the third century BCE, was among the first to say that “all disease begins in the gut.” A multitude of studies now shows an undeniable link between gut dysfunction and the brain, chiefly by revealing the relationship between the volume of inflammatory markers in the blood (i.e., signs of inflammation) and risk for depression. Higher levels of inflammatory markers, which often indicate that the body’s immune system is on high alert, significantly increase the risk of developing depression. And these levels parallel the depth of the depression: higher levels equates with more severe depression. Which ultimately means that depression should be categorized with other inflammatory disorders including heart disease, arthritis, multiple sclerosis, diabetes, cancer, and dementia. And it’s no surprise, at least to me, that depression is far more common in ­people with other inflammatory and autoimmune issues like irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insulin resistance, and obesity. All of these conditions are characterized by higher levels of inflammation, a topic we’ll get into in Chapter 3 (#u3ee4227e-2da8-5b13-b30d-73799d008e0e). To really grasp the fact that depression is not a disorder primarily rooted in the brain, look no further than some of the most demonstrative studies. When scientists purposefully trigger inflammation in the bodies of healthy ­people who exhibit no signs of depression by injecting them with a substance (more on this shortly), they quickly develop classic symptoms of depression. And when ­people with hepatitis C are treated with the pro-inflammatory drug interferon, as many as 45 percent of those individuals develop major depression. So when ­people ask me about why we’re suffering from what appears to be an epidemic of depression despite the number of ­people taking antidepressants, I don’t think about brain chemistry. I turn to the impact of our sedentary lifestyles, processed food diets, and unrelenting stress. I turn to the medical literature that says a typical Western diet—­high in refined carbs, unnatural fats, and foods that create chaos in our blood sugar balance—­contribute to higher levels of inflammation. Contrary to what you might assume, one of the most influential risk factors for depression is high blood sugar. Most ­people view diabetes and depression as two distinct conditions, but new scientific findings are rewriting the textbooks. One game-changing study published in 2010 that followed more than 65,000 women over a decade showed that women with diabetes were nearly 30 percent more likely to develop depression. This heightened risk remained even after the researchers excluded other risk factors such as lack of physical exercise and weight. Moreover, diabetic women who took insulin were 53 percent more likely to develop depression. Certainly you can draw the same conclusions that I’ve made: the rates of diabetes have skyrocketed alongside those of depression in the past two decades. And so have the rates of obesity, which is also correlated with increased inflammatory markers. Studies show that obesity is associated with a 55 percent increased risk of depression, and it cuts the other way too: depression is associated with a 58 percent increased risk of developing obesity. In the cogent words of a group of Australian researchers in a 2013 paper: “A range of factors appear to increase the risk for the development of depression and seem to be associated with systemic inflammation; these include psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut [function], [allergies], dental [cavities], sleep and vitamin D deficiency.” In 2014 Scottish researchers addressed the gap between what the science says about the causes of depression and what patients experience when they find themselves caught in the default web of psychiatric care. In their paper they highlight the value of what I practice: psychoneuroimmunology. Indeed, it’s a mouthful of a word, but it simply refers to examining (and respecting) the complex interplay between various systems and organs of the body, especially those that syncopate the nervous, gastrointestinal, and immune systems in a brilliant dance that in turn affects mental well-being. These researchers point out that many patients who are told they have psychiatric conditions originating in their head or related to some (fictitious) brain chemical deficiency actually share real biological imbalances related to their immune-inflammatory pathways. These patients show elevated levels of inflammatory markers in their blood, signs that their body is on the defensive, activating processes that can result in unexplainable physical symptoms and that are diagnosed as psychiatric rather than biologic. And rather than treating the underlying biology, they are instead relegated to a lifetime of therapy and medication, to no avail. The conditions examined by these researchers were depression, chronic fatigue, and “somatization,” the latter of which is what we call the production of symptoms with no plausible organic cause. These diagnoses have a lot in common in terms of symptoms: fatigue, sensitivity to pain, inability to concentrate, flu-like malaise, and cognitive issues. Isn’t it interesting that each of these conditions is often diagnosed as a separate illness and yet they share so much in common from a biological standpoint? As the authors state: “If psychiatry is to rise to the challenge of being a science, then it must respond to the [existing] data in reconceptualizing boundaries. As such, the data reviewed here challenge the organizational power structures in psychiatry.” Personalized lifestyle medicine that accounts for the role of the environment in triggering inflammation and the manipulation of the immune and endocrine systems is the most sensible way to approach those individuals who would otherwise be candidates for multiple medications. It turns out that it may not all be in your head—­but rather in the interconnectedness among the gut, immune, and endocrine systems. In upcoming chapters, we’re going to be exploring all of these connections—­the indelible links between your gut and its microbial inhabitants, your immune system, and the orchestra of hormones that course through your body in sync with a day-night cycle. These connections influence the state of your entire physiology and, as important, your mental health and overall sense of well-being. While it may seem odd to talk about the gut-based immune system in terms of mental health, the latest science reveals that it may be the body’s—­and mind’s—­center of gravity. Just as I write this, yet another new study has emerged that overturns decades of textbook teaching about the brain and immune system. Researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by lymphatic vessels we didn’t know existed. That we had no idea about these vessels given the fact that the lymphatic system has been so thoroughly studied and charted throughout the body is astonishing on its own. And such a discovery will have significant effects on the study and treatment of neurological diseases, from autism and multiple sclerosis to Alzheimer’s disease and, yes, depression. It’s time we rewrite the textbooks. And it’s time we treat depression for what it really is. So if depression isn’t a disease, then what is it? As I briefly mentioned in the introduction, depression is a symptom, a vague surface sign at best that doesn’t tell you anything about its root cause. Consider, for a moment, that your toe hurts. Any number of things can cause a toe to hurt, from physically injuring it to a bunion, blister, or tumor growing inside. The hurting is a sign that something is wrong with the toe, simple as that. Likewise, depression is the hurting; it’s an adaptive response, intelligently communicated by the body, to something not being right within, often because things are also off in our environment. Depression doesn’t always manifest with feelings of serious melancholy and sadness or the urge to sit on the couch all day brooding. I can’t even remember the last patient I saw who was like the person you see on a TV commercial for an antidepressant. All of my patients experience anxiety—­an inner kinetic discomfort, restlessness, unease, and a lot of insomnia. In fact, most cases of depression involve women who are very much on the go and productive, but they are also anxious, scatterbrained, overly stressed out, irritable, forgetful, worrywarts, unable to concentrate, and feeling “wired and tired” at the same time. And many of them have been dismissed by the medical system; their psychiatric problems were created by mistreatment as they fell into the vortex of endless prescription medications. Take, for another example, a forty-two-year-old patient of mine we’ll call Jane, who fell into this black hole after being treated for irritable bowel and acne with drugs, including the now discontinued Accutane (isotretinoin). Jane experienced a depressed mood, a common side effect of Accutane, and was then put on an antidepressant as she stopped the medication (isotretinoin is a retinoid, a strong medication used to treat severe acne; it causes birth defects in babies born from mothers who take it during pregnancy, so it’s carefully regulated and only available in its generic form under a special program). After the death of her parents, which triggered more symptoms of depression, Jane was diagnosed with a thyroid problem, and her doctor at the time prescribed radioablation therapy, which destroys thyroid tissue with radioactive iodine 131. This led to her having acute panic attacks, and she soon began taking Xanax. Symptoms of more thyroid problems, including brain fog, extreme fatigue, and physical pain, culminated in a diagnosis of fibromyalgia. Jane was then treated with birth control pills and an antibiotic and soon developed chronic yeast infections, bloating, and abdominal pain. By the time she came to me, Jane had a twenty-four-hour home health aide. Jane’s experience reflects that of so many ­people labeled as depressed and sent away with yet another prescription. The system creates patients who are otherwise healthy and just need to recalibrate their bodies using simple lifestyle interventions, mostly around diet—­not drugs. After all, it is through diet that we communicate with our environment. It’s a dialect that we’ve forgotten how to speak. AN EVOLUTIONARY MISMATCH Take a look around you and appreciate the world we live in today with its technologies and conveniences: computers, cars, cell phones, and supermarkets. But also consider the mismatch between this scenario and the days when we had to forage for our food and sleep under the stars. Our caveman days are still very much a part of our DNA because evolution is slow; what seems like ages in cultural time (20,000 years ago) is but a blink of an eye in biological time. Which brings me to ask the question: Is all this depression simply a sign of an evolutionary mismatch? This is the term that encompasses the source of most modern ills. We are engaged in lifestyles that are not compatible with what our genome has evolved over millions of years to expect. We eat a poor diet, harbor too much stress, lack sufficient physical movement, deprive ourselves of natural sunlight, expose ourselves to environmental toxicants, and take too many pharmaceuticals. Our wayward departure is marked by two specific revolutions in the history of mankind: the Neolithic, or agricultural, Revolution and the Industrial Revolution. For 99 percent of our existence, we followed the so-called Paleolithic diet, which is devoid of inflammatory and “insulinotropic” foods like sugar, grains, and dairy. Our body’s microbial ecology has been one of the primary victims of this shift—­the 90 percent of our cells that are non-human in nature and that account for the majority of our body’s activities, which in turn impact the expression of our genes. I’ll be going into greater depth about the human microbiome in Chapter 3 (#u3ee4227e-2da8-5b13-b30d-73799d008e0e), but I’ll give you a short primer here because this discussion is important and will be carried throughout the book. Although we’ve learned to think of bacteria as agents of death for the most part because certain strains can cause lethal infections in compromised hosts, new science is compelling us to consider how some of these microscopic bugs are fundamental to life—­and mental health. As you read this, some 100 trillion microbes are colonized in your intestines alone. They outnumber your own cells by a factor of about ten, covering your insides and outsides. And they contain estimates of more than 8 million genes of their own, which means that fully 99 percent of the genetic material in your body is not your own. It belongs to your microbial comrades. These microbes not only influence the expression of our DNA, but research reveals that throughout our evolution microbial DNA has become part of our own DNA. In other words, genes from microbes have inserted themselves into our genetic code (mitochondrial DNA being the prime example) to help us evolve and flourish. A great many of these invisible creatures live within your digestive tract, and while they include fungi, parasites, and viruses, it’s the bacteria that appear to hold the proverbial keys to the kingdom of your biology, as they support every conceivable feature of your health. In the future we’ll likely see how the other microbes contribute at least as much to our health as bacteria do. The microbiome is so crucial to human health that it could be considered an organ in and of itself. In fact, it has been suggested that since without it we could not live, we should consider ourselves a “meta-organism,” inseparable from it. This inner ecology helps you digest food and absorb nutrients, supports the immune system and the body’s detoxification pathways, produces and releases important enzymes and substances that collaborate with your biology (including chemicals for the brain, such as vitamins and neurotransmitters), helps you handle stress through its effects on your endocrine—­hormonal—­system, and even ensures you get a good night’s sleep. Put simply, your microbiome influences practically everything about your health, including how you feel both emotionally, physically, and mentally. What compromises a healthy microbiome? Not surprisingly, your microbiome is vulnerable to three antagonizing forces: exposure to substances that kill or otherwise negatively change the composition of the bacterial colonies (these substances include everything from environmental chemicals and drugs like antibiotics to ingredients such as artificial sugars and processed gluten-containing foods); a lack of nutrients that support healthy, diverse tribes of good microbes; and unrelenting stress. I’ve devoted an entire section to the amazing features of the microbiome, so you’ll gain plenty of knowledge about how it plays a role in your physical and mental well-being and how you can maintain an optimal colony of tribes. We have coevolved with these microorganisms throughout our journey on this planet, and we must respect them for what they are: the body’s—­and brain’s—­best friend. And they are as much a part of our survival and mental well-being as our own cells are. DESIGNED FOR DEPRESSION Have you ever stopped to wonder if depression has benefits? I know, it sounds a little outlandish to even suggest such an idea. But it’s an excellent question to ask and an even better one to answer. This conversation, however, is best couched within the topic of stress in general. So let’s go there next. Most of us can recognize the symptoms of stress. We feel it inside and out. We become irritable, our heart races, our face may feel hot, we get a familiar headache or upset stomach, our mind is incessantly chattering, there’s a sense of impending doom, and we’re annoyed by the smallest things. For some ­people, stress has little outward effect. For these individuals, what they feel at the surface is internalized and sometimes expressed as disease. In fact, many of these ­people don’t believe they experience stress—­but they do; they just don’t consciously recognize it until it builds up to a certain point and seeps out in other ways. The term stress as it is used today was coined by one of the founding fathers of stress research, Hans Selye, who in 1936 defined it as “the non-specific response of the body to any demand for change.” Selye proposed that when subjected to persistent stress, both humans and animals could develop certain life-threatening afflictions such as heart attack or stroke that previously were thought to be caused by specific pathogens only. This is a crucial point, because it demonstrates the impact that everyday life and experiences have not only on our emotional well-being but also on our physical health. The word stress as it relates to emotions became part of our vocabulary in the 1950s. Its use became common with the onset of the Cold War, which was an era when fear ruled. We were frightened of atomic war, so we built bomb shelters. As a society, we could not say we were afraid; instead, we used the word stress. Today we continue to use the word to describe anything that disrupts us emotionally—­we’re stressed, stressed out, under stress, and so on. Stress can also be described as the thoughts, feelings, behaviors, and physiological changes that happen when we respond to demands and perceptions. And if those demands placed on us overwhelm our perceived ability to cope, we experience “stress.” In our frenzied minds, we begin to pant silently like an animal and look for an escape. Since Selye, researchers have broken stress down into several subcategories. Stress physiology has come a long way in the last fifty years in particular, and so have the stressors. A key concept to enter the medical vernacular more recently is what is known as allostatic load. Your allostatic load refers to environmental challenges—­the “wear and tear” on the body—­that cause it to begin efforts to maintain stability (allostasis, also known as homeostasis). It also represents the physiological consequences of adapting to chronic stress that entails repeated activation of the body’s stress response machinery involving many systems—­immune, endocrine, and neuronal. Researchers Bruce McEwen and Eliot Stellar coined this term in 1993 as a more precise alternative to the term stress. The key players of the stress response, cortisol and epinephrine (adrenaline), have both protective and adverse effects on the body depending on when and how much they are used. On one hand, these hormones are essential for the body’s ability to adapt and maintain balance (homeostasis), but if they are flowing for a prolonged period or needed relatively frequently, they can accelerate disease processes. The allostatic load, as it’s called, becomes more harmful than helpful. This load can be measured in physiological systems as chemical imbalances in the activities of the nervous, hormonal, and immune systems. It can also be measured by disturbances in the body’s day-night cycle (what’s called the circadian rhythm, another concept we’ll explore later), and in some cases, changes to the brain’s physical structure. Stress is actually a good thing, at least from an evolutionary and survivalist perspective. It serves an important function: to protect us from real danger by equipping us with a better means to escape a life-threatening situation or face it head on. But our physical reaction doesn’t change according to the type or magnitude of a perceived threat. Whether it’s a truly perilous stressor, or just the to-do list and an argument with a colleague, the body’s stress response is the same. Let me give you a quick lesson on what goes on when your body senses stress so we can come full circle back to, dare I say, the secret value of depression. First, the brain sends a message to the adrenal glands that results in the release of adrenaline, also called epinephrine. This triggers your heart rate to increase as blood is directed to your muscles in the event you need to flee. When the threat is gone, your body normalizes again. But if the threat doesn’t go away and your stress response intensifies, then a series of events take place along what’s called the HPA axis, short for hypothalamic-pituitary-adrenal axis, and which involves multiple stress hormones. The hypothalamus is a small but key governing region of the brain that has a vital role in controlling many bodily functions, including the release of hormones from the pituitary gland housed inside. It’s often referred to as the seat of our emotions because it commands much of our emotional processing. The moment you feel nervous, anxious, extremely overwhelmed, or simply worried that you can’t deal with life, the hypothalamus releases a corticotropin-releasing hormone (CRH), a substance that starts a cascade of reactions, ending with cortisol flowing into your bloodstream. While this process has been well defined for a long time, newer research reveals that perceptions of stress trigger inflammatory signaling from the body to travel to the brain, priming it for hyper-response. You’re probably already familiar with cortisol, the body’s main stress hormone that aids in that famous fight-or-flight response. It also controls how your body processes carbohydrates, fats, and proteins. Because it’s the hormone responsible for protecting you during times of stress, its actions increase your appetite, promote more fat storage, and break down complex molecules and tissues that can be used for quick forms of energy, including muscle. For this reason, continual exposure to excess cortisol over time can lead to increased abdominal fat, bone loss, a suppressed immune system, fatigue, and a heightened risk for insulin resistance, diabetes, heart disease, and full-blown depression. Cortisol does, however, serve a positive role. It directs and buffers the immune system and primes the body for attack. This would all be great if the attack were short-lived and easily resolved. The attack of our modern-day lifestyles is unrelenting. The scientific study of the impact of stress on the body from the inside out, and even the outside in, has made tremendous advances in the fifteen years starting in 1998 when Harvard University researchers conducted a joint study with several Boston-area hospitals designed to examine the interactions between the mind and the body, specifically the skin. They called their discovery the NICE (neuro-immuno-cutaneous-endocrine) network. In plain speak, it’s a giant interactive network consisting of your nervous system, immune system, the skin, and your endocrine (hormonal) system. All of these are intimately connected through a dialogue of a complex array of biochemicals. The Boston researchers studied how various external forces influence our state of mind, from massage and aromatherapy to depression and isolation. What they discovered confirmed what many in the scientific community have known anecdotally for centuries: our state of mind has a definite impact on our health and even our appearance. ­People suffering from depression, for example, often look older than their chronological age. They don’t appear healthy and vibrant, as the stress of coping with depression has accelerated the aging process and damaged their health. Since the NICE network entered our vocabulary, dozens of other studies have been performed to confirm the powerful interplay between psychology and biology or, put simply, mind over matter. An analogy I like to use in my practice goes like this: If you’re walking down a dark alleyway at night and hear footsteps behind you, you might be alerted in uncomfortable ways, and your body will prepare to fight or flee. But if you then hear your friend’s voice, everything in your body’s physiology changes in that one instant. Yet the only thing that’s changed is your perception! So going back to the question “Can depression be good for us?” Was depression once an adaptive response to the environment? I subscribe to the idea that the body doesn’t make mistakes after millions of years of evolution. A 2014 review in the Journal of Affective Disorders attempts to answer the question of why we get depressed, rather than just looking at how, and what to do about it. Often the best approach to root cause resolution of symptoms comes from an understanding of the reasons why the body is responding in the way that it is. Speaking to the concept of evolutionary mismatch, the authors of the paper state: “. . . modern humans exist in environments that are critically different from those in which we evolved, and that our new environments interact with our ancient genomes to lead to disorder . . .” The authors discuss how depression may have served a purpose at some point, but the nature and intensity of today’s modern-day triggers may be leaving more of us depressed (up to 41 percent of us!) more of the time than seems reasonable. This perspective encompasses the inflammatory model of depression, which posits that both psychological stress and bodily inflammation result in brain-based changes that would serve us if they were brief, but may kill us if they are persistent (something like that). The researchers of the review go on to explain how antidepressants are missing the mark, and why their prescription should be reconsidered, citing side effects including: . . . headache, nausea, insomnia, sexual dysfunction, agitation, sedation, hyponatremia, stroke, cardiac conduction defects, and increased risk of mortality. The long-term use of antidepressants may be associated with additional adverse effects. For instance, some antidepressants may be weakly carcinogenic or cause osteoporosis. Antidepressants have also been associated with an increased acute risk of suicide in younger patients while they may decrease the risk of suicide in older patients or with longer-term use. Also, all major classes of antidepressants have been associated with unpleasant (and sometimes dangerous) symptoms when they are discontinued abruptly. Discontinuation of antidepressants is associated with relapse and recurrence of MDD (Major Depressive Disorder). In a meta-analysis, this risk was shown to be higher for antidepressants that cause greater disruption to neurotransmitter systems . . . [And] there is a growing body of research suggesting that when they are used in the long term as a maintenance treatment, antidepressants can lose ­efficacy, and may even result in chronic and treatment-resistant depression. Such reactions may be due to the brain’s attempt to maintain homeostasis and a functioning adaptation in spite of the medication. For someone like me, this is a profound summary of the perspectives I have curated since my departure from conventional practice. The call to action is to view depression as the vague descriptive term that it is. Put simply, depression is a sign for us to stop and figure out what’s causing our imbalance. Another way to appreciate this perspective is to say depression is an opportunity. Many of my patients are initially surprised to experience my wrath about the prescribing that’s going on all around me. I don’t think New York is any different from Anytown USA in how heavy-handed the average practitioner, whether it’s a family practice doctor or an internist or psychiatrist, is with prescriptions. In my opinion, it has become reckless. Their patients have never consented to the long-term effects of these medications because pharmaceutical research is, by nature, short­ term. There’s no incentive on the part of the pharmaceutical companies to take a good look at what happens to the average individual when she takes a medication for a decade or so. That said, in recent years there’s been a spat of studies linking antidepressants to an increased risk of aggression, homicide, and suicide, as well as fingers pointed at these drugs for their involvement in school shootings, airplane crashes, and other unfortunate events often blamed on terrorists, gun access, or lack of treatment. In one particularly alarming paper published in 2015 in no less an authority than the British Medical Journal, researchers from the Nordic Cochrane Centre, an independent drug safety analysis group based in Denmark, found that more than half a million ­people aged sixty-five and older in the West die every year from psych meds. Using an impressive meta-analysis of placebo-controlled trials, these researchers discovered that more patients die from taking FDA-approved antidepressants than do patients who take no drugs or who use other unconventional treatment methods. Similarly, the all-cause mortality rate (translation: dying from any cause) was found to be 3.6 percent higher among patients who take newly approved antidepressants compared to patients who take no antidepressants. The study’s scientists highlighted the fact most industry-funded studies favoring psych meds tend to skew the sample groups and test data so much that the results end up becoming meaningless. Underreporting of deaths, according to the study’s authors, is another major problem in the clinical trial process. The Nordic group estimates that the suicide rate among antidepressant users is some fifteen times higher than what the Food and Drug Administration (FDA) reports publicly. Studies like this that uncover our modern medical assault on humanity are just the tip of the proverbial iceberg. I could write a whole book on the high-profile research demonstrating that patients are held hostage by psychiatric medications, made sicker, and convinced that neither is true. They are more likely to experience a worsening of their depression, as these drugs have been proven in rigorous studies to be mood destabilizers (contrary to what conventional wisdom says). I should also add that they’ve recently been labeled as carcinogens. In a major review published by the Australian and New Zealand Journal of Psychiatry, a group of researchers from a variety of institutions including Tufts University, Harvard University, and the University of Parma in Italy reported that the vast majority of psychotropic drugs can cause cancer in animals. Although the animal-based results are not enough to draw definitive conclusions in humans, these same animal studies are often used to justify drug and chemical safety, and therefore they are enough to warrant caution and appropriate informed consent. Unfortunately, these conversations are not happening. Don’t panic if you’re taking an antidepressant now. The information in this book will help you take control of this symptom once and for all, and if tapering is right for you, I’ll be sharing my personal guide for doing just that in Chapter 10 (#litres_trial_promo). For now, accept the fact that we are all designed for depression as humans. It can be a warning sign that something isn’t right within. And just as we are designed to feel glum, we are also designed to self-heal and feel great. DEPRESSION ISN’T GENETIC, IT’S EPIGENETIC One of my favorite practice-changing papers was a 2003 case report of a lifelong vegetarian who experienced a month and a half of progressively worsening depression. Eventually she began to hear voices and feel paranoid. The fifty-two-year-old postmenopausal woman ultimately became what’s called catatonic, which meant she was awake and alive but nonresponsive, and largely in an otherwise vegetative state. One would automatically assume this was a serious case of severe pathology. She was treated with electroconvulsive therapy and antipsychotics to no avail. And then she was transferred to another hospital, where they happened to test her levels of vitamin B . They found that she was a tad on the low side, and after receiving a vitamin B injection, she fully recovered. Coincidence? I think not. While it may be one of the more extreme cases, it’s emblematic of how a simple but critical deficiency can be at the causal root of psychiatric manifestations. Later on, we’ll see how vitamin B deficiency has long been implicated in the development of depression. It’s a classic example of how we are not just puppets at the mercy of our encoded DNA, but rather products of the complex interactions between our genes and our environment. And it’s now well established that our health outcomes are dominated more by our environment than our inheritance. As I like to remind my patients, depression is epigenetic, not genetic. Even though genes encoded by DNA are more or less static (barring the occurrence of mutation), the expression of those genes can be highly dynamic in response to environmental influences. This field of study, called epigenetics, is now one of the hottest areas of research. Epigenetics, defined more technically, is the study of sections of your DNA (called “marks,” or “markers”) that essentially tell your genes when and how strongly to express themselves. Like conductors of an orchestra, these epigenetic marks control not only your health and longevity, but also how you pass your genes on to future generations. Indeed, the forces acting on the expression of your DNA today can be passed on to your future biological children, affecting how their genes behave in their lives and whether or not their children will face a higher risk of certain diseases and disorders, depression included. But, by the same token, these marks can be changed to read differently, making it fully possible to reverse certain diseases. We in the scientific community believe epigenetic forces affect us from our days in utero until the day we die. There are likely many windows during our lifetime when we are sensitive to environmental impacts that can change our biology and have major downstream effects such as symptoms of depression. At the same time, the multitude of neural, immune, and hormonal actions that are controlled by the microbiome—­and that in turn command our entire physiology—­are susceptible to disruption and adaptation, especially by environmental changes. One of the most important takeaways from this first chapter is to understand that depression is not about the brain per se. Of course, there are brain events and biochemical reactions occurring when a person feels depressed, but no research has ever established that a particular brain state causes, or even correlates with, depression. Many different physical conditions create psychiatric symptoms but aren’t themselves psychiatric. We think (because our doctors think) that we need to “cure” the brain, but in reality we need to look at the whole body’s ecosystem: intestinal health, hormonal interactions, the immune system and autoimmune disorders, blood sugar balance, and toxicant exposure. And we need natural, evidence-based alternatives to psychiatric medications—­treatments that target what’s really awry in our bodies. That means strategic dietary supplementation and noninvasive remedies like light therapy and cranial stimulation, but also smart (i.e., biologically compatible) food protocols and exercise choices, restful sleep, a detoxed environment, and meditation/relaxation practices. The best way to heal our brains is to heal the bodies in which they reside. Or, as I also like to put it, free your mind by healing your whole body. Hence the whole purpose of this book. The potential for lifestyle-based interventions and healing is immense. When I get asked about the main triggers of depression, I often think of the three types of patients I generally see: the woman with blood sugar issues and nutritional deficiencies due to the standard American diet (high in sugar, low in healthy fats); the individual with a misbehaving thyroid, which plays into all matters of hormones that in turn affect mental health; and the person with either medication-induced depression (think statins, birth control pills, proton-pump inhibitors like Nexium and Prilosec, and even vaccines). We’re going to be exploring all of these potential triggers in detail in the upcoming chapters. Although scientists are now trying to identify drivers of different types of depressive syndromes, the medical industry still offers a one-size-fits-all solution (read: one drug, one disorder model). This is akin to studying all the different sources of, say, back pain—­from a torn muscle or a herniated disc to cancer or a kidney infection—­but using the same treatment protocol on all cases. It doesn’t make sense, and there can be unintended consequences if that singular treatment entails risky drugs or surgery. And when it comes to using antidepressants for all signs of depression, this can be very tricky terrain, as the next chapter shows. CHAPTER 2 (#ulink_004bcebb-059c-5504-9802-ff205758bd27) Truth Serum: Coming Clean About the Serotonin Myth (#ulink_004bcebb-059c-5504-9802-ff205758bd27) How You’ve Been Misled, Misdiagnosed, and Mistreated There’s no such thing as an antidepressant. _____ The chemical imbalance theory of depression is heavily promoted but remains unfounded. Do you take antidepressants? Do you know someone who does? Maybe you even have friends and family members who swear they have been lifesaving. Antidepressants might seem like a reasonable option, particularly if things are dire. But do you know the whole story? At the risk of sounding extreme, let me give you an example from my own case files that sets the tone for this chapter. Kate had never been on an antidepressant and never suffered from depression, but she felt overwhelmed and frazzled after the birth of her first baby. At her six-week postpartum follow-up appointment, her obstetrician prescribed Zoloft. Within one week of starting it, she had written a suicide note and was planning to jump off of her fifteenth-floor Manhattan balcony. She said to me, “It just made sense at the time. And I felt really detached about it, like it was nothing.” Kate’s experience is not an outlier. She is among millions of women who are reflexively prescribed medication for symptoms of distress. She’s also among those who have serious side effects that may seem like part of the depression—­not a result of the drugs. Rather than examining the sources of her postpartum plight, Kate found herself in dangerously unfamiliar territory in the name of treatment. If only she had known the whole story before deciding to fill that prescription. The ease with which these medications are dispensed is partly why so many take them: 11 percent of all Americans, 25 percent of whom are women in their forties and fifties. The use of antidepressants has increased almost 400 percent from 1998 to 2008, making them the third most commonly prescribed drugs across all ages. The sharp increase does not necessarily signify a depression epidemic. Through the early 2000s pharmaceutical companies aggressively tested antidepressants for a variety of disorders, which led to an explosion of FDA-approved uses, from depression to premature ejaculation. Believe it or not, we are spending more on antidepressants than the gross national product of more than half of the world’s countries. Sixty percent of ­people on antidepressants stay on them for more than two years, and 14 percent do so for more than a decade. By a conservative estimate, 15 percent of pregnant women take psychiatric medication today, a rate that has tripled in just the last ­couple of years. The medical industry isn’t selling a cure. They are selling sickness. SELLING SICKNESS Is there a connection between the profligate use of antidepressants and increasing rates of disability? Before antidepressants became so widely used, the National Institute of Mental Health (NIMH) ­assured ­people that recovering from a depressive episode was common and that experiencing a second episode was uncommon. But then how do we explain soaring rates of disability and ­escalating prescriptions? Robert Whitaker, a notable critic of modern psychiatry and author of Anatomy of an Epidemic and Mad in America, has compiled and analyzed data showing that days of work lost are not decreased by medication treatment. Much to the contrary, they are increased by drug treatment, and so is long-term disability. He also has reported on studies showing that ­people treated for the illness are three times more likely than the untreated individuals to suffer a “cessation” of their “principal social role,” meaning that they function less optimally. And they were nearly seven times more likely to become “incapacitated.” Moreover, 85 percent of unmedicated patients recover in a year, with 67 percent doing so by six months. From my perspective, that’s an enviable statistic. What’s going on here? In the past half century, the Diagnostic and Statistical Manual—­the DSM, the bible of diagnosable disorders in psychiatry—­has lengthened to more than three hundred diagnoses in its fifth edition. In 1952 the DSM was a slim 130 pages and outlined 106 illnesses. Today’s version is a colossal 886 pages and includes 374 diagnoses. It encompasses a general consensus by a committee consisting of practitioners with profound conflicts of interest and pharmaceutical enmeshments. As Dr. Allen Frances of Columbia University and author of Saving Normal states: “Wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment—­a bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.” Dr. Frances is the psychiatrist who chaired the task force that produced the fourth edition of the DSM and has been critical of the latest tome. In 2013, Frances rightfully said that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests.” When you look at the impossibly long list of symptoms and maladies for which antidepressants can be prescribed, it’s practically farcical. These drugs are indicated for classic signs of depression as well as all of the following: premenstrual syndrome, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, anorexia and binge eating, pain, irritable bowel, and explosive disorders fit for anger management class. Some doctors prescribe them for arthritis, hot flashes, migraine, irritable bowel syndrome, and panic disorder. The fact that antidepressants can be prescribed to treat arthritis, an inflammatory disease of the joints, undermines any beliefs about their ability to precisely correct a chemical imbalance at the root of everything from phobias to bulimia and melancholic depression. The condemning 2015 paper by researchers at Johns Hopkins Bloomberg School of Public Health that I discussed in the previous chapter clearly states that antidepressants are used willy-nilly. In their study, the authors conclude that most ­people who take antidepressants never meet the medical criteria for a bona fide diagnosis of major depression, and many who are given antidepressants for conditions like OCD, panic disorder, social phobia, and anxiety don’t actually have these conditions. Let’s not forget the use of these medications in young ­children. And they are prescribed not only for depression but behavioral issues such as inattention, temper tantrums, tics, autism, and impaired thinking. How did we ever come to think that this could be a safe and effective treatment for two-year-olds still in diapers who don’t even speak in full sentences yet? For starters, consider Study 329, which cost GlaxoSmithKlein $3 billion for their ­efforts to promote antidepressants to youngsters. This drug ­company manipulated data that hid signs of increased risk of suicide. The company also falsely represented Paxil as outperforming a placebo. Among the most celebrated and respected thought leaders in my field is Joanna Moncrieff. She is a senior lecturer in psychiatry at University College London and co-chair of the Critical Psychiatry Network, a group of psychiatrists who dispute the generally accepted model of depression and seek alternative approaches to psychiatry. In a seminal 2006 paper, “Do Antidepressants Cure or Create Abnormal Brain States?” Moncrieff and her coauthor write: “Our analysis indicates that there are no specific antidepressant drugs, that most of the short-term effects of antidepressants are shared by many other drugs, and that long-term drug treatment with antidepressants or any other drugs has not been shown to lead to long-term elevation of mood. We suggest that the term ‘antidepressant’ should be abandoned.” At this point, you might be wondering: Where did antidepressants come from and how did they get so popular? A MEME IS BORN The predominant theory behind modern antidepressants (SSRIs, or selective serotonin reuptake inhibitors) is that they work by increasing the availability of serotonin, a neurotransmitter famously associated with mood, in the gaps between cells of the brain. In fact, if you were to quiz someone on the street about the biology of depression, they would likely parrot “chemical imbalance” in the brain and go so far as to say a “serotonin deficiency.” This hypothesis, referred to as the monoamine hypothesis, grew primarily out of two main observations made in the 1950s and ’60s. One was seen in patients being treated for tuberculosis who experienced mood-related side effects from the anti­tubercular drug iproniazid, which can change the levels of serotonin in the brain. Another was the claim that reserpine, a medication introduced for seizures and high blood pressure, depleted these chemicals and caused depression—­that is, until there was a fifty-four person study that demonstrated that it resolved depression. From these preliminary and largely inconsistent observations a theory was born, crystallized by the work and writings of the late Dr. Joseph Schildkraut, who threw fairy dust into the field in 1965 with his speculative manifesto “The Catecholamine Hypothesis of Affective Disorders.” Dr. Schildkraut was a prominent psychiatrist at Harvard who studied catecholamines, a class of naturally occurring compounds that act as chemical messengers, or neurotransmitters, within the brain. He looked at one neurochemical in particular, norepinephrine, in ­people before and during treatment with antidepressants and found that depression suppressed its effectiveness as a chemical messenger. Based on his findings, he theorized broadly about the biochemical underpinnings of mental illnesses. In a field struggling to establish legitimacy (beyond the therapeutic lobotomy!), psychiatry was desperate for a rebranding, and the pharmaceutical industry was all too happy to partner in the effort. This idea that these medications correct an imbalance that has something to do with a brain chemical has been so universally accepted that no one bothers to question it or even research it using modern rigors of science. According to Dr. Joanna Moncrieff, we have been led to believe that these medications have disease-based effects—­that they’re actually fixing, curing, correcting a real disease in human physiology. Six decades of study, however, have revealed conflicting, confusing, and inconclusive data. That’s right: there has never been a human study that successfully links low serotonin levels and depression. Imaging studies, blood and urine tests, postmortem suicide assessments, and even animal research have never validated the link between neurotransmitter levels and depression. In other words, the serotonin theory of depression is a total myth that has been unjustly supported by the manipulation of data. Much to the contrary, high serotonin levels have been linked to a range of problems, including schizophrenia and autism. Paul Andrews, an assistant professor of psychology, neuroscience, and behavior at McMaster University in Canada, is among the vocal experts challenging the traditional depression model. In a 2015 review, he declares that the science behind antidepressant medications appears to be backward: serotonin is a downer, not an upper. He argues that serotonin is almost like a first responder to stress. When our bodies are under duress, serotonin helps to reallocate resources at a cellular level. This further shows that we really have no idea what’s going on when it comes to looking at one simple chemical. Andrews brings up a good point in a recent review: we can’t measure serotonin in a living human brain yet, so it’s impossible to know exactly how the brain is releasing and using serotonin. What scientists must do instead is rely on evidence about levels of serotonin that the brain has already metabolized, and by studying seratonin in animal models. To date, the best available evidence indicates that more serotonin—­not less—­is released and used during depressive episodes. This natural surge of serotonin helps the brain adapt to depression; it forces the body to spend more energy on conscious thought than to areas such as growth, development, reproduction, immune function, and the stress response. Andrews also happens to be an evolutionary psychologist, and has asserted in previous research that antidepressants leave individuals worse off after they stop taking them. He agrees that even though depression can be a painful, troubling experience, most forms of depression are normal adaptations to stress. According to Andrews, when patients on SSRI medication improve, it appears that their brains are actually overcoming the effects of antidepressants, rather than being helped by them. The drugs are interfering with the brain’s own mechanisms of recovery. This is an important point, because time and time again ­people ask me how antidepressants appear to be helpful in the short term. Perhaps, in the rare instance that their effects are adaptive, it is by virtue of the brain’s own powers trying to combat the assault of the antidepressants—­not the other way around. But over time, as the assault continues, the brain is functionally compromised under the constant force of the incoming drugs. One critical review of the serotonin hypothesis concludes: “ . . . there is no direct evidence of serotonin or norepinephrine deficiency despite thousands of studies that have attempted to validate this notion.” And in a scathing review on major depression published in the New England Journal of Medicine in 2008, the researchers write: “. . . numerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably.” In the cogent words of Dr. Daniel Carlat, author of Unhinged, “We have convinced ourselves that we have developed cures for mental illnesses . . . when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors.” Indeed, the brain orchestrates a delicate interplay among some one hundred neurotransmitters, including fourteen different types of serotonin receptors. To think we can cherry-pick one brain chemical and cure all and every behavioral disturbance is a gross oversimplification and downright absurd. The brain is much more complex than the serotonin model can describe. To be clear, SSRIs block the removal of serotonin from the junctions between nerve cells (synapses) in the brain so there’s increased firing of serotonin nerves. But when serotonergic nerves are overstimulated, they become less sensitive in a bid to establish equilibrium again. In science speak this is called downregulation. And such downregulation doesn’t return to normal after the drug is stopped. We in the scientific community still don’t know if the downregulation can become permanent, but a cadre of my colleagues and I believe this poses a serious risk to the brain. It’s no surprise to me that in the first twelve years after its initial marketing blitz, Prozac was named in more than 40,000 reports of adverse effects submitted to the FDA. No other drug comes close to such a history. Even if we accepted the proposition that these drugs are helpful for some ­people, extrapolating a medical cause from this observation would be akin to saying that shyness is caused by a deficiency of alcohol, or that headaches are caused by a lack of codeine. And what about a genetic vulnerability? Is there such thing as a depression gene? In 2003, a study published in Science suggested that those with genetic variation in their serotonin transporter were three times more likely to be depressed. But six years later this idea was wiped out by a meta-analysis of 14,000 patients published in the Journal of the American Medical Association that denied such an association. Dr. Thomas Insel, director of the National Institute of Mental Health, commented with the following: “Despite high expectations, neither genomics nor imaging has yet impacted the diagnosis or treatment of the 45 million Americans with serious or moderate mental illness each year.” Dr. Carlat speaks the truth in his own words: “And where there is a scientific vacuum, drug companies are happy to insert a marketing message and call it science. As a result, psychiatry has become a proving ground for outrageous manipulations of science in the ser­vice of profit.” Suffice it to say the data has poked so many holes in the serotonin theory that even the field of psychiatry itself is putting down its sword. In a 2005 essay for PLOS Medicine by Drs. Jeffrey R. Lacasse and Jonathan Leo, the authors gathered sentiments from influential thinkers in the field, including conventional clinicians and researchers who have expressed doubt on the entirety of what psychiatry has to offer around antidepressants (see tables on the following pages). The medical-pharmaceutical complex has constructed quite a few houses of cards, and far too many of its treatments—­very profitable treatments—­are offered without solid evidence to support doing so. In fact, only two studies are required for FDA licensure of most pharmaceuticals, essentially leaving the population to participate in a post-marketing experiment in which adverse effects—­causalities—­are monitored passively. It’s a fabrication of science to think these drugs have a place in medicine, what is meant to be the art of healing. It could be argued that antidepressants are the new tobacco, and, like the tobacco industry, Big Pharma can wield a lot of power through clever marketing to seduce and influence us in stealthy, seemingly benign ways that are anything but. DIRECT-TO-CONSUMER ADVERTISING Sadly, direct-to-consumer advertising (DTCA) in America has allowed pharmaceutical companies to “teach” the public about brain chemical imbalances and serotonin deficiencies via sound bites and cleverly worded taglines that escape FDA policing. I have patients who come in believing that the solution is in a pill—­what they’ve learned essentially from commercials. It’s been calculated that DTCA advertising is responsible for nearly half (49 percent) of requests for drugs. And fully seven out of ten times doctors prescribe based on appeals made by patients who learned through their computers and televisions that they have an “imbalance” that must be fixed with a pill. “Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse,” Behavior Therapist 38, no. 7 (October 2015): 206–213. Reprinted with permission. In the ten-year period between 1999 and 2008, DTCA tripled, from $1.3 to $4.8 billion, their efforts at educating patients about their need for psychiatric medication. The modern drug business has been built on “brain” medicines. Valium was the first blockbuster, selling 2 billion tablets in 1978. Then in the 1990s came Prozac, which defined the industry. The pharmaceutical industry spent $4.53 billion on direct-to-consumer advertising in the United States alone in 2014, up 18 percent from the previous year. The flagrant disconnect between the advertisements and scientific literature has been written about for more than a decade now, but you probably haven’t read about it. It was clearly stated by Drs. Lacasse and Leo in their 2005 paper: “These advertisements present a seductive concept, and the fact that patients are now presenting with a self-described ‘chemical imbalance’ shows that the [advertising] is having its intended effect: the medical marketplace is being shaped in a way that is advantageous to the pharmaceutical companies.” As far back as 1998, at the dawn of consumer advertising of SSRIs, Professor Emeritus of Psychology and Neuroscience Elliot Valenstein of the University of Michigan summarized the scientific data by concluding, “What physicians and the public are reading about mental illness is by no means a neutral reflection of all the information that is available.” The United States and New Zealand are the only countries in the world that allow advertisement on television for prescription drugs. In 1997, a change to an FDA regulation opened the floodgates on direct-to-consumer advertising, allowing drug makers to promote their wares on television. This also paved the way for celebrities, athletes, models, and aging baby boomers to dominate those ads. Given these forces, along with the number of symptoms listed under antidepressant use, it’s really no surprise that more than $11 billion is spent each year on these medications. Pharmaceutical companies have more than six hundred lobbyists, and they finance more than 70 percent of FDA trials. They court physicians, toss them copious free samples, pay consultants to speak at scientific meetings, advertise in medical journals, fund medical education, and ghostwrite, selectively choosing and redundantly submitting data for publication. Psychiatric studies funded by Big Pharma are four times more likely to be published if they report positive results. Only 18 percent of psychiatrists disclose their conflicts of interest when they publish data. Their studies allow for all kinds of indiscretions, such as removing ­people who are likely to respond to placebo before the study to strengthen the perceived benefit and using sedative medications with the study’s medications, thereby skewing results in favor of the drug (more on this shortly). A now famous 2008 study in the New England Journal of Medicine led by Dr. Erick Turner at Portland VA Medical Centers sought to expose the extent of data manipulation. Through valiant efforts to uncover unpublished data, he and his team determined that from 1987 to 2004, twelve antidepressants were approved based on seventy-four studies; thirty-eight were positive, and thirty-seven of these were published. Thirty-six were negative (showing no benefit), and three of these were published as such, while eleven were published with a positive spin (always read the data, not the author’s conclusion!), and twenty-two were unpublished. The FDA requires only two studies for drug approval, so you can see how these companies are tossing the coin over and over again until heads comes up and hoping no one is looking when it’s tails. To get a sense of just how misleading the pharmaceutical industry can be, consider the largest study to date funded by the National Institute of Mental Health, conducted at the University of Texas in 2006. It cost the public $35 million for researchers to follow more than four thousand patients who were treated with Celexa over twelve months. This was not a double-blind placebo controlled study, so the ­people knew what they were getting. Half of them reportedly improved at eight weeks. Those who didn’t were switched to Wellbutrin, Effexor, or Zoloft or “augmented” with Buspar or Wellbutrin. Guess what? It didn’t matter who took what, because the same percentage of the group allegedly improved (18 to 30 percent) no matter what drug they were on. Only 3 percent of patients were supposedly in remission at twelve months. Now here’s where the story gets interesting. In February 2012, a suit was filed against Celexa’s maker, Forest Pharmaceuticals, alleging that the company paid a bribe to the principal investigator of this particular study to fix the results in favor of Celexa. The suit was settled out of court, and it came on the heels of the company having to pay a criminal fine of $150 million and forfeit assets of $14 million for suppressing and misrepresenting data on the negative effects of using their drug to treat adolescents. Celexa was only approved to treat adults, but in pursuit of selling more drugs and increasing profits, the company targeted doctors who treated children and teens. It’s a foregone conclusion: these practices sabotage the accuracy of data and convey information that corrupts a doctor’s delivery of care and endangers patients. The tragic cost of this data manipulation is the loss of true informed consent. Physicians cannot adequately share with their patients the risks and benefits if the benefits are fabricated and the risks are not uncovered or are unacknowledged. What’s more, these drugs are no more effective than a placebo. As far back as 1984, the National Institute of Mental Health was quoted as saying: “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” The good old placebo effect likely explains any perceived short-term effects from the antidepressants. SHORT-TERM EFFICACY: THE POWER OF THE PLACEBO EFFECT Despite Big Pharma’s efforts, the truth about these brain bombs is emerging. In 1998, the year direct-to-consumer advertising took off, Harvard psychologist and researcher Dr. Irving Kirsch, an established and respected expert on the placebo effect, published a landmark meta-analysis of nearly three thousand patients who were treated with antidepressants, psychotherapy, placebo, or no treatment. The results of the study became front-page news and received widespread attention—­and criticism. Kirsch found that placebo duplicated 75 percent of the drug’s effect, that non-antidepressant medications had the same effect as antidepressants, and that the remaining 25 percent of the apparent drug effect was attributable to what’s called the “active placebo effect.” Kirsch uses this term to refer to the effect of the mere belief in antidepressants—­a belief that is triggered by the experience of side effects such as nausea, headache, and dry mouth. What happens in a trial is that subjects are put in either the placebo group or the medication group without knowing which group they were assigned to. Because the placebo is without side effects (an inactive placebo), when they develop side effects, all of those commercial-inspired beliefs about their brain’s chemical correction are kicked into high gear, and at least a quarter of these ­people begin feeling better because of it. So how much can we thank the placebo effect when we experience fewer symptoms while taking an antidepressant? The backlash to Kirsch’s study inspired him to continue exploring the power of the placebo. By 2008 he’d published another compelling meta-analysis study that further stirred up an incendiary response from critics. This time he leveraged the Freedom of Information Act to access unpublished studies and found that when these unpublished studies were included, antidepressants outperformed placebo in only twenty of forty-six trials. That’s less than half! What’s more, the overall difference between drugs and placebos was 1.7 points on the 52-point Hamilton Rating Scale for Depression, used to rate depression in clinical research. Put simply, this small increment is clinically insignificant, and likely accounted for by minor side effects (such as activation and sedation). The response to this publication led Kirsch to come out with another paper that clearly laid out the facts, counterchallenged his critics, and further demonstrated the power of the placebo. In his concluding thoughts, he writes: “Without accurate knowledge, patients and physicians cannot make informed treatment decisions, researchers will be asking the wrong questions, and policymakers will be implementing misinformed policies. If the antidepressant effect is largely a placebo effect, it is important that we know this. It means that improvement can be obtained without reliance on addictive drugs with potentially serious side effects.” When Kirsch’s book The Emperor’s New Drugs: Exploding the Antidepressant Myth came out in 2010 with proof that antidepressants do not have a clinically meaningful advantage over placebo, his analysis was acknowledged by researchers as a valid albeit provocative contribution to medical literature. But it didn’t change clinical psychiatry or the number of antidepressants prescribed, and it continued to incur the criticism and even rage of prescribing psychiatrists desperate to pick apart his findings to defend their now baseless practices. It’s hard to blame them—­they put a lot of time, money, and effort into learning mistruths around antidepressants! The irony in Kirsch’s findings is that the results came from studies that were underwritten and designed by the drug companies themselves. These studies were conducted in a way that would give the drugs an advantage, yet they still didn’t outperform the placebo. In order for a drug to be approved, it must be shown to be superior to placebo. As you can imagine, drug companies despise placebo effects. They will do everything in their power to minimize the impact of placebo in their studies. That the FDA allows them to use these techniques is wrong, another example of Big Pharma’s shameless misconduct. Because the FDA database contains all of the data from initial trials, both published and unpublished, analyzing its data is exceptionally useful. Keep in mind that drug companies normally don’t publish negative results. They prefer to file away those studies in a drawer where they will never be found; hence the “file drawer” phenomenon. A fascinating 2014 study published in the Journal of Clinical Psychiatry, one of my field’s most respected journals, explored—­and exposed—­the real power of belief in psychiatric treatment. A group of researchers at Columbia University analyzed data from two large, multicenter discontinuation trials encompassing 673 ­people diagnosed with major depressive disorder and who were taking fluoxetine (generic Prozac) for twelve weeks. After those three months, they were told that they’d be randomized to either a placebo or continued fluoxetine. So while they all knew they were taking the antidepressant in the first three months, they didn’t know if what they were given afterward was an active antidepressant or a sugar pill. The results spoke for themselves: both groups—­the ones still taking the fluoxetine and those on the placebo—experienced a worsening of depressive symptoms. This outcome suggests two significant interpretations: (1) the initial effect during the first three months was attributable to placebo, as all patients knew they were receiving treatment; and (2) the worsening of symptoms upon the mere possibility of getting just a placebo is indicative of the undoing of the placebo effect, what’s sometimes called the nocebo effect. Identifying a tremendous placebo effect has been further echoed by other meta-analyses. The power of belief and the expectation of healing cannot be dismissed when medical treatments appear to work. In my opinion, the use of medications associated with serious short- and long-term side effects and which primarily ride the placebo effect represents an ethically questionable practice. I work with the placebo effect every day in my office because I aim to inspire a different set of beliefs. Even ­people who claim to be suicidal can experience the placebo effect under my care. The decision to consider taking your own life is not a trait that would have been selected for over the millennia of human evolution. It’s more logical to assume it has roots in physiological imbalances, which is where I like to spend my time searching for solutions with my patients. I look for problems like nutrient deficiencies, endocrine disruption, and autoimmunity. The first and most important thing I like to convey to patients is that they are in charge. They have agency. This sensibility can go a long way, because they’re coming to me thinking I have what they don’t have—­a quick fix. A quick fix is a lovely idea, and if one existed, it could be great. Unfortunately, the weight of the data suggests that it doesn’t and that we may be doing more harm than good by collectively pretending it does. The challenge is that it’s human nature to feel better after doing something we think will make us feel better. But sometimes inaction is the best medicine. LONG-TERM SIDE EFFECTS: MORE MEDS, MORE DEPRESSION, MORE DISABILITY . . . AND DEATH? But you might ask, “What if these drugs are in fact working some of the time for some ­people?” They still wouldn’t be worth the consequences for the placebo effect, particularly given their side effects, which are notoriously hidden from the lay public. I find it outrageous that drug companies can use any number of tactics to establish efficacy, including the suppression of data, and then use those tactics to legitimize long-term prescribing with no thought or attention to the real side effects over time. When I lecture on the futility and perils of antidepressants, I like to employ the following analogy courtesy of Dr. David Healy, an internationally respected psychiatrist based in the UK: Let’s say you’re somebody who experiences a lot of social anxiety. You have a ­couple glasses of wine at a party as a preemptive strike. A sense of calmness washes over you and your symptoms evaporate. Through deductive reasoning, you could say, “Well, I must have an alcohol deficiency, so I should continue to consume alcohol every time I have this symptom, and I might want to drink regularly to prevent it altogether.” This analogy is emblematic of the practice of dishing out antidepressants without any consideration of their long-term consequences. We’ve arrived at a place in psychiatry’s abuse of antidepressants where we have a half-baked theory in a vacuum of science that the pharmaceutical industry raced to fill. We have the illusion of short-term efficacy and assumptions about long-term safety. The potential emerging side effects are nothing short of horrifying, from suppressed libido and sexual dysfunction, abnormal bleeding, insomnia, migraine, weight gain, and blood sugar imbalances to risk of violent, irrational behavior and suicide. Before I get to the ugliest of side effects and withdrawal complications, let’s focus on how your ability to function long ­term in the world with depression is significantly sabotaged by treating that first episode of depression with medication. This too has been expertly explored by Robert Whitaker, whose website (www.madinamerica.com (http://www.madinamerica.com)) is a virtual library of published data and thoughtful reviews of multiple long-term studies that have followed large groups of ­people taking antidepressants. Time and time again these studies demonstrate poor functional outcomes for ­people treated with antidepressants relative to those with minimal to no medication treatment. They are at greater risk for all the acute side effects I’ve already listed, as well as increased risk of relapse, cognitive impairment, secondary diagnosis and medication treatments (first a depression diagnosis followed by a bipolar one), and recurrent hospitalization. A breathtaking 60 percent of patients are still diagnosed with depression one year into treatment, despite temporary improvement within the first three months. Two prospective studies in particular support a worse outcome in those prescribed medication. In one such British study, an unmedicated group experienced a 62 percent improvement by six months, whereas the drug-treated patients experienced only a 33 percent reduction in symptoms. And in another study of depressed patients conducted by the World Health Organization (WHO) in fifteen cities across the UK, it was found that at the end of one year, those who weren’t exposed to psychotropic medications enjoyed much better “general health,” their depressive symptoms were much “milder,” and they were less likely to still be “mentally ill”! Now let’s consider the more serious possible side effects of violent behavior, relapse, and crippling withdrawal among those who try to escape their grip. Antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top ten most violence-inducing drugs have been found to be antidepressants. Over the past three decades there have been hundreds of mass shootings, murders, and other violent episodes that have been committed by individuals on psychiatric drugs. Big Pharma spends around $2.4 billion a year on their direct-to-consumer television advertising for drugs like Zoloft, Prozac, and Paxil. The networks can’t afford to run negative stories about prescription drugs, as they would lose tens of millions of dollars in ad revenue (no wonder the connection is habitually downplayed or ignored entirely). The Russian roulette of patients vulnerable to these “side effects” is only beginning to be known and may have something to do with how their bodies (and actions of their unique genetic code) metabolize these chemicals and preexisting allostatic (stress) load. Dr. Healy has worked tirelessly to expose data implicating antidepressants in risk of suicide and violence, maintaining a database for reporting, writing, and lecturing about cases of medication-induced death that could make your soul wince. And what about our most vulnerable: new mothers of helpless infants? I have countless patients like Kate in my practice who report never-before thoughts of suicide within weeks of starting an antidepressant for postpartum depression. In a population where only a few randomized trials have examined the use of antidepressants for postpartum depression, I have grave concerns for women who are treated with drugs before more benign and effective interventions such as dietary modification, thyroid treatment, and addressing their sleep habits during this period when sleep deprivation runs high are explored. We already know that “low mood” is likely to resolve on its own within three months without any treatment, and upward of 70 percent of ­people will be free of depression without any medication whatsoever within a year. Yet we reflexively turn to these drugs and their unpredictable effects that can rob us of the ability to find permanent relief through the body’s own powerful systems, even though, by their own claims, they take six to eight weeks to “take effect.” In 2004, the U.S. Food and Drug Administration (FDA) revised the labeling requirements for antidepressant medications with a warning that: “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.” The FDA was pushed to revise the labeling following a bevy of lawsuits in which pharmaceutical companies were forced to reveal previously undisclosed drug data. You’d think such labeling would give ­people—­and parents—­pause. But since 2004, antidepressant use has only increased among both children and adults. I am routinely helping women who want to have a baby either avoid or taper from antidepressants, despite having been “specially trained” to prescribe for this population. For many of them, the first step is simply accepting the fact that they’ve been lied to about the value of antidepressants and their alleged benefits. Meanwhile, their downsides are not only downplayed but actively concealed. All you have to do is spend a few minutes on SurvivingAntidepressants.org (http://SurvivingAntidepressants.org), BeyondMeds.com (http://BeyondMeds.com), or SSRIstories.org (http://SSRIstories.org) to appreciate that we have created a monster. Millions of men, women, and children the world over are suffering side effects, including complicated withdrawal routinely dismissed by their prescribing clinicians. Contrary to what Big Pharma would have you believe, weaning off antidepressants is extremely difficult, so choosing to take them could be signing up for a lifetime of medication use that creates and sustains abnormal states in the brain and entire nervous system. As a clinician who once believed in these medications, I have been humbled by what they are capable of. In fact, even when I have tapered women off of Celexa at extremely low increments of .001 mg a month, it can be hard to imagine another class of substances on earth so potentially complicated to discontinue. I first became aware of the habit-forming nature of these medications when I worked with a patient who wanted to become pregnant in the coming year to taper off of Zoloft. She experienced about six months of protracted withdrawal that began at about two months after her last dose. My training did nothing to prepare me to deal with that. The truth is that we have very little idea about what these medications are actually doing! At the same time, though, we need to acknowledge that the complexity of neurophysiology is overwhelming. Although the appeal is to think that we’ve cracked the code on human behavior and all of its intricate physiology, we’re far from it. For example, ten years ago we didn’t even know that the brain had an immune system, and two years ago we didn’t know it had lymphatics—­basic anatomy. We used to think that immune activity in the brain only happened under certain pathological circumstances. But now we’ve identified microglia—­billions of cells that play a specific role in managing inflammatory responses in the brain based on perceived threats from the rest of the body. And it’s not just about tinkering with chemical levels in the brain or the body for that matter. We like to cling to simple explanations, but even the categorical name of the various antidepressants, selective serotonin reuptake inhibitors, is misleading. They are far from selective. In September 2014, an alarming new study from the Max Planck Institute in Leipzig, Germany, showed that even a single dose of an antidepressant can alter the brain’s architecture within three hours, changing the brain’s functional connectivity. The study, published in the journal Current Biology, was shocking not only to the health journalists who reported on it, but also to the doctors who prescribe these drugs. An important analysis by the former director of the NIMH and published in the American Journal of Psychiatry shows that antidepressants “create perturbations in neurotransmitter functions,” causing the body to adapt through a series of biological events that occur after “chronic administration,” leading to brains that after a few weeks function in a way that is “qualitatively as well as quantitatively different from the normal state.” In other words, the brain’s natural functionality is assaulted by the medication to the point that it can become permanent. That said, everything we will explore in this book speaks to the body’s tremendous and almost unstoppable resilience when properly supported. Dr. Paul Andrews of the Virginia Institute for Psychiatric and Behavioral Genetics demonstrated through a careful meta-analysis of forty-six studies that a patient’s risk of relapse is directly proportionate to how disruptive the medication is to the brain. The more disruptive the medication, the higher the risk of relapse upon discontinuation. He and his colleagues challenge the whole notion of relapse, suggesting that when you feel terrible upon stopping an antidepressant, what you’re experiencing is withdrawal—­not a return of your mental illness. And when you choose the medication route, you’re actually extending the duration of your depression. Andrews writes: “. . . unmedicated patients have much shorter episodes, and better long-term prospects, than medicated patients . . . [T]he average duration of an untreated episode of major depression is twelve to thirteen weeks.” In a retrospective ten-year study in the Netherlands, 76 percent of those with unmedicated depression recovered without relapse relative to 50 percent of those treated. Unlike the mess of contradictory studies around short-term effects, there are no comparable studies that show a better outcome in those prescribed antidepressants long term. Harvard researchers have also concluded that at least 50 percent of drug-withdrawn patients relapsed within fourteen months. In the words of one team of researchers led by Dr. Rif El-Mallakh from the University of Louisville: “[L]ong-term antidepressant use may be depressogenic . . . it is possible that antidepressant agents modify the hardwiring of neuronal synapses [which] not only render antidepressants ineffective but also induce a resident, refractory depressive state.” Dr. El-Mallakh and his colleagues wrote this bold statement in a letter to the editor of the Journal of Clinical Psychiatry in 1999. Then, in 2011, they published a new paper including eighty-five citations proving that antidepressants make things worse in the long run. (So when your doctor says, “You see, look how sick you are, you shouldn’t have stopped that medication,” you should know that the data suggests that your symptoms are signs of withdrawal, not relapse.) In Anatomy of an Epidemic, Robert Whitaker summarizes the matter succinctly: We can now see how the antidepressant story all fits together, and why the widespread use of these drugs would contribute to a rise in the number of disabled mentally ill in the United States. Over the short term, those who take an antidepressant will likely see their symptoms lessen. They will see this as proof that the drugs work, as will their doctors. However, this short-term amelioration of symptoms is not markedly greater than what is seen in patients treated with a placebo, and this initial use also puts them onto a problematic long-term course. If they stop taking the medications, they are at high risk of relapsing. But if they stay on the drugs, they will also likely suffer recurrent episodes of depression, and this chronicity increases the risk that they will become disabled. The SSRIs, to a certain extent, act like a trap in the same way that neuroleptics [tranquilizers] do. More than twenty years have passed since clinicians and researchers started collecting evidence against antidepressants. Although these drugs may offer relief in the short term thanks to the placebo effect, they lead to chronic, persistent depression that resists treatment when taken for an extended period of time. In some ­people, stopping the drug can cause a slow and gradual lightening of the mood, but this doesn’t always occur, and depression can become more or less permanent. Remember the alcohol effect. Not surprisingly, the powers that be in my field have not looked into this matter or launched a serious investigation. And yet the studies keep emerging. In early 2015, yet another headline hit that Big Pharma turned a blind eye to. It read “Stopping SSRI Antidepressants Can Cause Long, Intense Withdrawal Problems” and referred to the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications. A team of American and Italian researchers found that withdrawing from SSRIs was in many ways comparable to trying to quit addictive benzodiazepine sedatives and barbiturates. They also discovered that withdrawal symptoms aren’t fleeting; they can last months or even years. Moreover, entirely new, persistent psychiatric disorders can surface from discontinuing SSRIs. The authors analyzed fifteen randomized controlled studies, four open trials, four retrospective investigations, and thirty-eight case reports of SSRI withdrawal. Paroxetine (Paxil) was found to be the worst, but all the SSRI antidepressants were documented as causing a wide range of withdrawal symptoms from dizziness, electrical shock sensations, and diarrhea to anxiety, panic, agitation, insomnia, and severe depression. They write: “Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse.” In their conclusions, they state what should be the obvious: “Clinicians need to add SSRIs to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.” An accompanying editorial to their paper notes that “This type of withdrawal consists of: (1) the return of the original illness at a greater intensity and/or with additional features of the illness, and/or (2) symptoms related to emerging new disorders. They persist at least six weeks after drug withdrawal and are sufficiently severe and disabling to have patients return to their previous drug treatment. When the previous drug treatment is not restarted, post-withdrawal disorders may last for several months to years.” The editorial also states that “With SSRI withdrawal, persistent postwithdrawal disorders may appear as new psychiatric disorders, in particular disorders that can be treated successfully with SSRIs and SNRIs. Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.” This bit of news is extremely unsettling to current practices in psychiatry. According to the current American Psychological Association treatment guidelines for major depressive disorder, “During the maintenance phase, an antidepressant medication that produced symptom remission during the acute phase and maintained remission during the continuation phase should be continued at a full therapeutic dose.” Such a guideline merely promotes more drug sales, and more crippling side effects. DON’T GO DOWN THE RABBIT HOLE We need to break out of the spell that the pharmaceutical industry has put us under. Psychiatry’s swan song has been sung; listen for its plaintive wail. We must reject the serotonin meme and start looking at depression (and anxiety, and bipolar disorder, and schizophrenia, and OCD) for what they are: disparate expressions of a body struggling to adapt to a stressor. There are times in our evolution as a cultural species that we need to unlearn what we know and change what we think is true. We have to move out of the comfort of certainty and into the freeing light of uncertainty. It is from this space of acknowledged unknowing that we can truly grow. From my vantage point, this growth will encompass a sense of wonder—­both a curiosity about what symptoms of mental illness may be telling us about our physiology and spirit and a sense of humbled awe at all that we do not yet have the tools to appreciate. For this reason, honoring our coevolution with the natural world and sending the body a signal of safety through movement, diet, meditation, and environmental detoxification represents our most primal and most powerful tool for healing. We also need to identify vulnerabilities and chemical exposures and support basic cellular function, detoxification, and immune response. This is, ultimately, personalized medicine. To me, the worst part of the misguided mess we’ve made of mental health care is that we are missing out on the potential for true resilience and self-healing. Safe, effective alternatives to help us through these passages in life do indeed exist. Perhaps most concerning to a holistic physician is data that suggests that long-term antidepressant treatment actually compromises the benefits of exercise! The effects of exercise have been shown to be comparable to Zoloft but can be diminished when combined with Zoloft; patients relapse at higher rates than they do with exercise alone. I’ll be going into much greater detail about exercise in Chapter 7 (#litres_trial_promo), and I’ll share why I think this is the case. Exercise is an antidote to depression best used without antidepressants. Mental health will always be grounded in whole body health. When you discover the real imbalances underlying all your symptoms—­physical and mental—­and take steps to address them, you can restore your health without resorting to problematic drug treatments and endless psychotherapy. The next question to answer is: What kind of “imbalances” come under the veil of depression? We’ll find out in the next chapter. CHAPTER 3 (#ulink_6e5deae3-4aa4-5c1c-b923-5eb3818ba69b) The New Biology of Depression (#ulink_6e5deae3-4aa4-5c1c-b923-5eb3818ba69b) What Gut Microbes and Silent Inflammation Have to Do with Mental Health Depression is often an inflammation-driven condition, not a neurochemical deficiency disease. _____ The most powerful path to our brain—­and peace of mind—­is through our gut. Pick up any health or diet book published recently and you’ll likely read about the ills of chronic inflammation and the blessings of the human microbiome. The two have been the science buzzwords of late, and for good reason. These concepts reflect the zeitgeist of the modern patient because we have reached a point in our collective evolution where our health is being outpaced by lifestyles that are not aligned with how we are biologically designed to live. We are idle when our bodies want to move, we eat foods that are unrecognizable to our systems, and we expose ourselves to environmental factors that assault our cells. This incompatibility is creating serious internal conflict and driving rampant levels of chronic inflammation like an alarm that won’t shut off. Inflammation is often described as underlying virtually every chronic condition and illness, from obesity, heart disease, and diabetes to degenerative illnesses including dementia and cancer. I’ve already mentioned inflammation dozens of times already, because science is telling us that depression is also an inflammatory condition. In this model, depression is a general fever that tells us little about what is actually causing the body to react and protect itself in this way. The body is “hot,” and we need to understand why. Depressive symptoms are merely the manifestation of many downstream effects on hormones and neurotransmitters, but if we were to swim up to the source, we would find a river of inflammatory markers coursing by. The source itself may be a single culprit, such as a dietary ingredient to which the body adversely reacts or a collection of culprits that have indirect effects on the internal workings of the brain because of their impact on the immune system and stress response. In fact, the relationship between depression and inflammation is so compelling that researchers are now exploring the use of immune-altering medications to treat depression. Researchers are desperately searching for the next frontier because the current model is in crisis. As you have seen, modern psychiatry has served as a repository for the diagnostic and therapeutic limitations of conventional medicine. When a patient’s symptoms of malaise, “brain fog,” lethargy, inattention, insomnia, agitation, and flat mood slip through the cracks of the discrete territories of specialty medicine, the patient is referred for psychiatric treatment. When she is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), statins, acid blockers, antibiotics, and birth control pills, the effects of these medications are poorly grasped by prescribers, complaints are dismissed, and she is again referred for psychiatric care. What happens when psychiatric care itself is predicated on medication treatment, with placebo-driven short-term effects and worse functional outcomes in the long term? Perhaps it is time to acknowledge the failures of this paradigm. Now that the scientific literature has demolished the serotonin model of depression, it can no longer stand on its own, and throwing more and more medications at a perceived false target is doing more harm than good. It’s fitting that psychiatry would follow the investigative path of other chronic diseases such as arthritis, asthma, certain cancers, diabetes, autoimmunity, Alzheimer’s disease, and heart disease—­all of which can be the result of lifestyle barbs that drive inflammation. Today the concept of psychoneuroimmunology has supplanted the myopic serotonin premise in the primary literature. This new model reveals the interconnectedness of multiple systems—­the gut, brain, and immune systems—­and takes us out of a one-gene, one-ill, one-pill narrow perspective. The field of psychiatry has known about the role of the immune system in the onset of depression for nearly one hundred years. But only recently, thanks to better technology and large, long-term studies that reveal the impact of the relationship between immunity, inflammation, gut flora, and mental health, have we really begun to understand the relevant connections. Given our new awareness of the complexity of these connections, including the role of the microbiome, biology as we know it must come under revision, especially when applied to its direct human application in medical interventions. No longer can we say “she was born with it”—­the dismissive meme that dominated a large part of twentieth-century medicine. Nor can we say that the same exposure causes the same illness in all ­people. According to conventional medicine, different genetic problems or infectious exposures cause different diseases for which there are distinct, one-pill solutions. And out of that “broken and vulnerable body” theory came the “me versus the microbial world” mentality. Ren? Dubos, the famous microbiologist and early pioneer in the developmental origins of health and disease as well as the one to develop the first clinically tested antibiotic, warned us of the dangers of classical germ theory half a century ago: [M]an himself has emerged from a line descent that began with microbial life, a line common to all plant and animal species . . . [he] is dependent not only on other human beings and on the physical world but also on other creatures—­animals, plants, microbes—­that have evolved together with him. Man will ultimately destroy himself if he thoughtlessly eliminates the organisms that constitute essential links in the complex and delicate web of life of which he is a part. Awareness of the role of microbes in our day-to-day life has brought us to a radical new understanding of the indelible fusions between the functions of the gut and brain. In fact, the role of the brain-based immune system has only been elucidated in the past ten years, and while many questions remain, the facts are swiftly building up to make an incontrovertible case against pharmaceuticals and for wholly natural approaches to wellness. In the words of Drs. Paula Garay and A. Kimberly McAllister of UC Davis, who address so-called immune molecules (the cells and their substances that respond to internal and external threats): . . . the sheer number of immune molecules that could be important for nervous system development and function is staggering. Although much progress has been made in the past 10 years in our appreciation that immune molecules play critical roles in the healthy brain, the large majority of immune molecules have not yet been studied for their presence and function in the brain. For the immune molecules that we know are important, almost nothing is understood about their mechanisms of action. Why hasn’t this message made it to those who still believe we can safely manipulate human behavior through psychotropic drugs or that we shouldn’t be concerned about the effects of immune-disrupting substances in our environment, from ingredients in foods to vaccines? Drug products were developed without even basic knowledge of this relevant physiology, let alone the implications for the role of the immune system in neurology. Only recently have scientists begun to look at how certain antipsychotics, including antidepressants, change the native tribes of bacteria in the body and render patients vulnerable to other health conditions. The drug desipramine, for example, has been shown to alter the composition of microbes in the mouth, causing dry mouth and gingivitis. Another example: olanzapine changes the microbial balance with results including metabolic injury and weight gain—­especially in women. Remember, not until 2015 did we even know that the brain has a lymphatic system with a primary purpose of connecting it to the immune system. As the authors of that 2015 Nature paper stated: “The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.” It’s time for that reassessment. It’s time for disciplines like psychoneuroimmunology to take shape and provide a more accurate context for our understanding—­those that honor the known and unknown complexities of the human organism in its environment. So with all that in mind, let’s deconstruct what is known about depression as it relates to inflammation and the gut-brain dance. I’ll start with some basics about inflammation. THE INFLAMMATORY MODEL OF DEPRESSION As we all know, the immune system is essential to human health and well-being. It helps coordinate the body’s response to its environment, from chemicals and medications to physical injuries and infections, essentially maintaining the critical divide between what is “self” and what is “other.” At the heart of a healthy immune system is an ability to experience appropriate forms of inflammation, which I’ll assume you’re familiar with from a rudimentary level—­the inflammation, for example, that accompanies a paper cut or sprained ankle. These reflect inflammatory responses we can actually feel and sometimes see (such as redness, swelling, and bruising). In this instance, inflammation is part of a necessary biological cascade enabling the body to defend itself against something it believes to be potentially harmful, and subsequently recalibrate. When the trigger for inflammation becomes chronic, the effects can be directly toxic to our cells. Unlike the inflammation that follows bruising your arm or skinning your knee, this more silent, ongoing inflammation deep inside has a meaningful connection to your mental health. The brain lacks pain receptors, so when we’re showing signs of depression we can’t feel inflammation in the brain like we do in a laceration or arthritic hip. Nonetheless, scientific research has clearly demonstrated over and over again that inflammation underlies the development of depression (and most other chronic diseases). Several messengers relay information about inflammation between the brain and the body. A variety of inflammatory markers—­chemical messengers called cytokines that tell us inflammation is occurring—­are elevated in those with depression. These include markers like C-reactive protein and cytokines such as interleukins one and six (IL-1 and IL-6) and tumor necrosis factor alpha (TNF-?). Elevated cytokines in the blood have not only been shown to relate directly to a diagnosis of depression, but they are predictive of depression. In other words, the inflammation may be the trigger of rather than the response to depression. As I briefly mentioned in Chapter 1 (#ub28fb01d-f61f-54db-8eaf-582e3408146e), one of the most predictable side effects of interferon therapy for hepatitis C is depression. In fact, 45 percent of patients develop depression with interferon treatment, which appears to be related to elevated levels of inflammatory cytokines IL-6 and TNF. But there’s also compelling literature suggesting that even stress, specifically psychosocial stress, can cause this inflammation by mobilizing immature immune cells called macrophages from your bone marrow to start the inflammatory process. So you can see how inflammation lies at the heart of a vicious cycle; the process can trigger depression just as it can be aggravated by depression. Researchers have further found that in melancholic depression, bipolar disorder, and postpartum depression, white blood cells called monocytes turn on pro-inflammatory genes that lead to the release of cytokines, while leading to decreased cortisol sensitivity. Cortisol, you’ll recall, is the body’s chief stress hormone; it’s also a buffer against inflammation. When your cells lose their sensitivity to cortisol, they become resistant to cortisol’s message, and the result is prolonged inflammatory states. It helps to keep in mind that broadly speaking, the stress response largely dictates the inflammatory response and its perpetuation. Once triggered in the body, the inflammatory agents transfer information to the central nervous system, typically through stimulation of major nerves such as the vagus, which connects the gut and brain (more on this shortly). Specialized cells in the brain called microglia represent the brain’s immune hubs and are activated in inflammatory states. In activated microglia, an enzyme called IDO (indoleamine 2, 3-dioxygenase) stimulates the production of biomolecules that can result in symptoms such as anxiety and agitation. These are just some of the changes that may conspire to let your brain in on what your body may know is wrong. Researchers have also observed that ­people with higher levels of these inflammatory markers are more likely to respond to anti-inflammatories than to antidepressants; this helps explain why curcumin (the golden-colored antioxidant in turmeric), a powerful anti-inflammatory made by nature, has been found to be superior to Prozac and especially effective when medication isn’t. One of the most important takeaways from the new information gained about the role of inflammation in depression, in particular a continuous state of low-grade inflammation and the stress signals associated with it, is that in many cases it tends to be generated from an unlikely source: the gut. In millions of ­people today, the gut is largely disrupted due to something called intestinal dysbiosis. Let me explain. LEAKY GUTS FANNING THE FLAMES OF INFLAMMATION AND DEPRESSION First, some basic anatomy. Your gastrointestinal tract, the tube that goes from your esophagus to your anus, is lined with a single layer of epithelial cells. It’s the largest mucosal surface, and this intestinal lining has three main functions. It’s the means through which you obtain nutrients from the foods you eat. It prevents potentially harmful particles, chemicals, and organisms from getting into your bloodstream. And it’s the home to specialized cells that patrol and present to the immune system suspected invaders. The immune system provides chemicals called immunoglobulins that bind to foreign proteins to protect the body from them. The body uses two pathways to absorb nutrients from the gut. One moves nutrients through the epithelial cells (transcellular); the other moves nutrients between the epithelial cells (paracellular). The connections between cells are called tight junctions, and as you can imagine, each of these complex, exceedingly small intersections is regulated. If they somehow become compromised and overly permeable, a condition called “leaky gut” develops. And because these junctions act as gatekeepers—­keeping potential threats that will provoke the immune system out—­they greatly influence levels of inflammation. We in the medical community now know that when your intestinal barrier is damaged, a spectrum of health challenges can result, not the least of which is depression. What happens is that when these tight junctions are compromised, undigested food particles, cell debris, and bacteria components can sneak by to stir trouble in the bloodstream with downstream effects that manifest in depressive symptoms. To quote one team of researchers from Belgium: “There is now evidence that major depression (MDD) is accompanied by an activation of the inflammatory response system and that pro-inflammatory cytokines and lipopolysaccharide (LPS) may induce depressive symptoms.” Later on, we’ll see how ingredients like gluten, sugar and artificial sweeteners, casein proteins (dairy), and processed vegetable oils can activate the immune system and result in pro-inflammatory cytokines coursing through your system. But let’s look at what LPS alone could be doing. This is an interesting area of study just coming into view. THE LPS BOMB Lipopolysaccharide (LPS) is not only a mouthful of a word, but it’s among the most villainous of biological threats. It flips on inflammatory pathways in the body like a switch. LPS is a combination of lipids (fat) and sugars, and is found on the outer membrane of certain bacteria that are naturally found in the gut, representing as much as 50 to 70 percent of the intestinal flora. LPS serves to protect these bacteria so they are not digested by bile salts from the gallbladder. LPS is not supposed to travel beyond the interior of the gut, however, but it can if the gut lining is somehow compromised. LPS induces a violent inflammatory response in humans—­so violent that it’s also termed endotoxin, meaning a toxin that comes from within. It’s used experimentally in laboratory research to instantly create inflammation in animal models to study the full array of illnesses rooted in inflammation, from inflammatory bowel disorders, diabetes, lupus, rheumatoid arthritis, and multiple sclerosis to depression, Parkinson’s disease, Alzheimer’s disease, and even autism. In a healthy individual whose intestinal lining is intact, LPS cannot gain entrance into the bloodstream by those tight junctions. But when the cells lining the intestines (remember: the intestinal wall is only one cell thick) are damaged or become impaired and those junctions are compromised, LPS is able to pass into the systemic circulation, where it sets off an alarm and triggers inflammation. Levels of LPS in the blood are in fact indicative of both leaky gut and inflammation in general. Researchers around the world are finally looking at LPS as playing a pivotal role in depression. After all, inflammatory markers correlate with depression, and LPS increases the production of these inflammatory chemicals. And here’s where the science really shouts out to me: LPS not only compromises the gut by making it more permeable, it can also trespass the blood-brain barrier, bringing the pro-inflammatory message there as well. In 2008, the same Belgian researchers I quoted above documented a significant increase in the level of antibodies in the blood against LPS in individuals with major depression. Interestingly, the authors commented how major depression is often accompanied by gastrointestinal symptoms. And it’s one of the most logical explanations given the latest science is the fallout from a disrupted gut community. This is why we must focus on gut permeability and the tribes within the gut that are supposed to be protecting that intestinal lining. Конец ознакомительного фрагмента. Текст предоставлен ООО «ЛитРес». Прочитайте эту книгу целиком, купив полную легальную версию (https://www.litres.ru/dr-brogan-kelly/a-mind-of-your-own-the-truth-about-depression-and-how-wome/?lfrom=688855901) на ЛитРес. 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