Can Vitamins Replace Prozac?
Let food be thy medicine, and medicine be thy food.
–Hippocrates
A Different Way
With tears in her eyes, Angela, a 45-year-old divorced mother of two teenagers, was in despair, as she sat across from me in my office.” I’m totally exhausted, depressed, I’m not sleeping well, I have headaches, and no sex drive at all. I’m not as sharp as I was, and my memory is foggy, too. I yell at my kids who really don’t deserve it. Just getting through the day is a challenge. I feel I’m not performing well at work (as a bank manager) either. I’m a mess! My family doctor told me I was just stressed and depressed, and offered a prescription of Prozac. No thanks! I’ve seen friends of mine not get better on it, and then couldn’t get off it, so here I am, looking for a more natural approach. I sure hope it can work!”
As any psychiatrist would, I took a detailed personal and family history, and asked about her social and emotional life, However, my questioning also took a broader view. Angela soon found herself detailing what she ate, her digestion, physical symptoms, how and when her energy and moods shifted throughout the day, and how she slept.
Then, for starters, I prescribed a healthy diet of fresh vegetables, sufficient high quality protein (wild caught fish, grass-fed meats, poultry, pastured eggs, though vegans will make adjustments here), good fats as in avocados and salmon, and to eliminate processed foods and simple carbs (sugar, white flour). I recommended shopping the periphery of the supermarket, avoiding food that comes in packages and have long chemical names listed in the ingredients. I also recommended 7 – 8 hours of sleep, exercise at least 3 times a week, and some time out for herself. Even without a clear diagnosis, these are all lifestyle practices that form the basis of good mental and physical health, and generally lead to some positive gains fairly quickly.
Looking Under the Hood
I ordered a number of lab tests, including screenings for anemia, low blood sugar, and thyroid dysfunction, all factors that can contribute to anxiety and depression. I included checking her levels of various hormones, as well as minerals, including toxic ones like mercury, lead, and cadmium.
Getting Results
Within ten days of following this program, she was back in my office and feeling much better, since nutrients don’t generally have the time lag of a several weeks that medications do. By this time, I had a number of her lab results back, upon which 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 specific herbs to raise her low progesterone and testosterone levels, adaptogenic herbs to help restore adrenal function and energy, and later added bio-identical progesterone (ie not the synthetic and potentially unsafe progestin).
By six weeks, her mood swings and anxiety were basically gone. Two years later at her annual visit, she remained feeling well, still taking a few supplements to control her moods and maintain her energy. “I can’t believe how great I feel, after being such a wreck when I first saw you. My kids are doing better too, since first of all, I calmed down and now relate much better with them. We’ve also changed how we’re eating.”
Her core supplements were a high potency multivitamin-mineral, specific amino acids for brain neurotransmitter support, fish oil, antioxidants, and a probiotic to maintain a healthy gut microbiome. She also had adaptogenic herbs for her adrenals to take when she feels stressed, and bio-identical hormones as she is perimenopausal. She expects to stay on some of the supplements for some time.
The Natural Approach
Shortly into my psychiatric practice, I found that the standard “couch and Prozac” combination of talk therapy and pharmacology went only so far. Over time, I developed the approach I use today, 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 supplements and food, often in tandem with exercise, natural hormones, and mind-body techniques.
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 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, it needs optimal nourishment, something that is increasingly hard to come by with the Standard American Diet (or SAD for short).
The “Standard of Care”
Depressed, anxious, tired, overweight women are often told they need SSRI’s (selective serotonin reuptake inhibitors) such as Prozac or Lexapro. Psychiatry for the most part still focuses on symptom reduction with medication, rather than looking at the biochemical underpinnings and natural solutions. What we really need for mental health maintenance is a steady supply of real food, with specific supplements as indicated — and not a drug that causes side effects such as weight gain and low libido, and can even aggravate the anxiety and depression.
Supporting Brain Chemistry
We know that the brain can be greatly influenced by what we eat, and the science is able to explain why. Our very own inner pharmacy takes the food and supplements and turns them into brain and body fuel. Neurotransmitters or chemical messengers, such as serotonin, dopamine and GABA which control thinking, actions, and mood are made from amino acids, such as tryptophan, tyrosine and GABA (both an amino acid and a neurotransmitter) derived from the protein we ingest. Then certain vitamins and minerals, as co-factors, also play a critical role in their formation.
The very makeup of brain cells also depends on nutrients. When a person’s diet is deficient in some of these nutrients, neither neurotransmitters nor brain cells are made correctly, resulting in various emotional and mental disorders. Low blood sugar can contribute to depression and anxiety, as can low levels of zinc or chromium. Omega-3 fatty acids are part of every brain cell membrane. (Yes, we are fat-heads!) Because, as a population, we’re not big fish eaters, we’re often deficient.
Over the years I have seen nutritional therapy become increasingly popular, in part due to growing disillusionment with psychiatric medications. Both physicians and their patients are realizing that they’re not as effective long-term as was once hoped, and they often have challenging side effects, such as loss of libido, nausea weight gain, “chemical brain,”and even suicidal thinking. Both antidepressant and anti-anxiety medications are also addictive, and are very hard to discontinue. As a result, I have developed protocols that help people taper off medication more easily, with the help of targeted nutrients.
The Placebo Effect
A 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, or fake pill — but without the side effects (JAMA. 2010;303(1):47-53). The latter is why at least half of those on the medications quit. In fact, the placebo is preferable since it confers positive results without the negative side effects. Let’s invest more in studying this amazing ability of the body to heal itself! Then, healthful foods and supplements provide the substrate for building a healthy body and brain.
Eating for Brain Health
Much interest is also coming from patients themselves. As more people realize they need to pay attention to what they eat in order to feel well, they are asking their doctors for nutritional advice. They didn’t teach me any of this in medical school or psychiatric residency, so I had to learn it on my own. I urge other physicians to do the same, and even have their patients work with a trained holistic clinical nutritionist.
Some medical schools may be incorporating this information, but I haven’t seen a serious shift in any way toward allowing the patient’s own inner pharmacy to work its magic when given the right substrates and circumstances.
Underlying Medical Issues
Many of the patients, like Angela, who stick to the program, recognize that it is well worth the effort. If your mood issues are unexplained, they might be the result of a medical issue, such as anemia, hypothyroidism, specific food intolerances, hormonal issues, or high levels of toxic metals or chemicals, to mention a few. And instead of just covering over symptoms with medication, you should consider consulting an integrative medical professional to look under the hood. I certainly check all of this in my own patients, since many people on these medications and even, in psychiatric hospitals, are suffering from physically caused and once diagnosed properly, medically treatable depression.
Conclusion
This approach requires that the individual be a full partner in their care. However, not everyone is motivated enough or capable of making what may be pretty daunting lifestyle changes, including shopping for organic food, preparing meals without using a lot of additives, preservatives, sugar, and unhealthy fats, and taking a variety of supplements. Sometimes the best option may be medication, particularly with acute and severe cases of depression, which is not to say that serious depression can’t also be greatly helped with natural means, but they may not be functioning well enough to deal with a new program. The most important goal is always to help the patient. That said, I have seen patients start on medications, then, once stable, come to me for a more holistic approach and eventually safely and slowly taper off their meds. This approach is used in other countries as opposed to the US and much of the western world where once you’re on medication, it is continued indefinitely. The fact is there is less relapse in the others. [ref:Finland vs Sweden]
Those that give the natural approach a chance find that it is ultimately more complete and satisfying, and with more lasting results. A common comment is, “I feel myself again!” Or from a family member, “I have my (son, daughter, spouse) back!”
Even small changes, like cutting out 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 dropping 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. At this point they are fairly old but still quite relevant.
- Natural Highs by Hyla Cass & Patrick Holford (Avery-Penguin Putnam 2002)
- 8 Weeks to Vibrant Health (Mind Publishing, 2014) by Hyla Cass & Kathleen Barnes
- The UltraMind Solution by Mark Hyman (Scribner, Reprinted 2010)
- Optimum Nutrition for the Mind by Patrick Holford (Basic Health Pub, 2009)
