Nutrition Not Prozac!Hyla Cass, MD
Let food be thy medicine, and medicine be thy food. —Hippocrates
We know that the brain can be greatly influenced by what we eat, and researchers are beginning to understand why. The very makeup of brain cells depends on the presence of specific nutrients. Omega-3 fatty acids, for example, are an integral part of the cell membranes. Neurotransmitters, the chemical messengers that regulate our thoughts, actions, and moods, are made from amino acids, using vitamin and mineral co-factors. Lack of some of these nutrients can then lead to various emotional and mental disorders.
Diets high in refined foods, sugars, and unhealthy fats can also interfere with normal brain chemistry, leading to depression, as can nutritional deficiencies. People with depression are commonly found to have low levels of zinc, magnesium, B vitamins, essential fatty acids, and amino acids. Indeed, the last few years have seen increasing numbers of studies finding that specific nutrients can successfully treat depression, anxiety, ADD/ADHD, schizophrenia, and even bipolar (manic-depressive) illness. A groundbreaking study from Harvard found that omega-3 fatty acids, used both in conjunction with medication, and alone, worked so powerfully on bipolar illness that the study was interrupted so all the subjects could take them.1,4
Psychiatry, for the most part, still focuses on symptom reduction with medication, rather than looking at the biochemical underpinnings of depression for a more organic solution. Seeing the shortcomings of standard psychiatry early on, I developed my own approach, which is to start by evaluating the patient in a number of ways—emotionally, physically, and biochemically. Then I supply specific natural prescriptions, which include dietary supplements and foods, often in tandem with exercise, natural hormones, and mind-body techniques. Here is a fairly typical case:
At 45, Angela felt like she was falling apart. Sitting across from me in my office, she recounted a familiar story: “I’m totally exhausted, depressed, and cranky. Just moving through my day is a challenge. I’m not sleeping well, and I have headaches and no sex drive at all. I’m not as sharp as I was, and my memory is foggy, too. I’m a mess!”
A clinical social worker by profession, Angela recognized that some of her symptoms pointed to depression. As any psychiatrist would, I asked Angela how she was feeling emotionally, but my questioning took a broader view. Angela soon found herself detailing what she ate, how and when her energy and moods shifted throughout the day, and how well she slept. This was in addition to the questionnaire that I have all new patients fill out in advance. I ordered a battery of blood, urine, and saliva tests, including screenings for anemia, low blood sugar, and thyroid dysfunction, all factors that can contribute to depression. I also checked her levels of various hormones, as well as minerals, including toxic ones like mercury, lead, and cadmium.
After analyzing the results, I prescribed a regimen of supplements, including chromium to maintain blood sugar levels, magnesium to relax her nerves and muscles as well as regulate her heart rate, and B vitamins for neurotransmitter (mood) support. For hormonal balance, I prescribed herbs to raise her low progesterone and testosterone levels, and adaptogenic, or stress-fighting, herbs to help restore adrenal function. Well-researched herbs such as rhodiola and Eleutherococcus senticosis, and reishi mushroom extract support the adrenal glands without overstimulating. Later, I added bio-identical progesterone—not synthetic progestin, which can have serious side effects, such as water retention, depression, migraines, and blood clots.
Within a week or two of following this program, she was feeling much better, since nutrients don’t generally have the time lag that medications do. By six weeks, her mood swings and anxiety were basically gone. Two years later, she remains depression free and is still taking supplements to control her moods and maintain her energy. We adjust them every six months or so, with the core being two daily packets that provide the following: specific amino acids for brain neurotransmitter support (phenylalanine, tyrosine, glutamine, 5-HTP, L-theanine), a multivitamin, fish oil, antioxidants (vitamins A, C, and E; N-acetyl cysteine; alpha lipoic acid, or ALA), liver support nutrients (ALA, milk thistle), and nutrients for blood sugar balance (glutamine, chromium, ALA). She also takes specific nutrients for memory—ginkgo biloba, acetyl-l-carnitine, phosphatidyl choline, and phosphatidyl serine—as well as adaptogenic herbs for her adrenals, and bio-identical hormones. I’m happy to say that she continues to do well, consults with me periodically, and expects to stay on some of the supplements indefinitely. We all have our unique biochemistry with specific requirements, even if we are eating a healthy diet.
For those accustomed to the notion that therapy means talking through problems and/or getting a prescription for antidepressants, this may seem an unusual approach. But as a board-certified psychiatrist and an expert in nutritional medicine, I long ago became convinced that no form of psychotherapy can be fully effective if the brain isn’t functioning properly. And to do that, the brain needs optimal nourishment, something that is increasingly hard to come by with the standard American diet (or SAD, for short).
Often, people suffering from depression—particularly tired, overweight women—are told they need antidepressant medication. In fact, what they may really need is a steady supply of real food and supplements—not a drug that causes side effects such as weight gain, low libido, nausea, anxiety, and more depression.
There are dozens of books on the topic, along with increasing acceptance in recent years that nutritional intervention can treat many behavioral and mental conditions that we used to think were untreatable. Why so much interest? Experts say nutritional therapy is catching on, in part due to growing disillusionment with antidepressants. Physicians are realizing these are not as effective long-term as was once hoped, and they often have difficult side effects, leading many to simply quit taking them.
Interestingly, a recent study published in the Journal of the American Medical Association found that the majority of mild to moderately depressed people did just as well on a placebo as on antidepressants—without the negative side effects.2 I’d say, let’s invest in studying this amazing ability of the body to heal itself. Then, adding healthful foods and supplements can provide the substrate for building a healthy body and brain.
If you are experiencing depression that is still unexplained after nutritional intervention, consult a medical professional, since it might be the result of a medical issue, from hypothyroidism to a heart problem or even cancer. I check all of this in my own patients, since many people on antidepressants, even in psychiatric hospitals, are suffering from medically caused and treatable depression.
Specific Nutrients to Treat Depression
To maintain adequate levels of natural antidepressant chemicals in the brain, I recommend eating plenty of vegetables and fruits, whole grains, and lean protein. Drink lots of water, get adequate sleep, and exercise regularly. Research shows that exercise can work as well as medication for mild to moderate depression.3 Instead of negative side effects, all of these solutions offer side benefits!
People often find that the natural approach can ultimately be more effective and satisfying than medication. Even small changes—like eliminating processed foods or adding daily fish oil capsules—can make a big difference. And once started, the process can develop its own momentum. When people start eating better or taking a few supplements, they often feel better. Without much effort, they find themselves eliminating sugar, caffeine, alcohol, or whatever they were using for mood control. A balanced brain is a happy, non-craving one!
For more information on natural approaches to brain and mood imbalances, as well as scientific references on the use of individual nutrients, see the following books, arranged by year of publication:
A Mind of Your Own by Kelly Brogan (Harper Collins, 2016)
Holistic Solutions for Anxiety & Depression by Peter Bongiorno (Norton 2015) and his later books as well
The Addicted Brain and How to Break Free by Hyla Cass (Better Balance Books, 2015)
The UltraMind Solution by Mark Hyman (Scribner, reprinted 2010)
8 Weeks to Vibrant Health by Hyla Cass and Kathleen Barnes (McGraw-Hill, 2005)
The New Optimum Nutrition for the Mind by Patrick Holford (Basic Health Publications, 2004)
Natural Highs by Hyla Cass and Patrick Holford (Avery/Penguin Putnam, 2002)
ABOUT THE AUTHOR
Hyla Cass, MD, DABPN, ABHIM, is board-certified in both psychiatry and in integrative and holistic medicine. She is an internationally acclaimed innovator in the field of integrative medicine, with an emphasis on natural approaches to mental health, women’s health, and hormonal balance. She frequently appears on national radio and television, and in national print media. She is also the author of several popular books, including Natural Highs, 8 Weeks to Vibrant Health, The Addicted Brain and How to Break Free, and Supplement Your Prescription. For more information, see www.cassmd.com. Submit your name and email on her home page for her newsletter with health education and updates.
References, with more in the recommended reading list above especially Peter Bongiorno’s book.
- Stoll AL, Severus WE, Freeman MP, et al. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999; 56:407-12.
- Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010; 303(1):47-53.
- Dunn AL, Trivedi MH, Kampert JB, et al. Exercise treatment for depression: efficacy and dose response. Am J Prev Med. 2005 Jan; 28(1):1-8.
- Freeman MP Omega 3 fatty acids in psychiatry: A review. Annals of Clinical Psychiatry, 2000; 12,159-165