I just wrapped up an amazing weekend of lectures at the Institute for Functional Medicine “Energy” conference and one of the more interesting lectures was on a Functional Medicine approach to depression by Dr. Rich Panico.
Did you know that depression is predicted to be the second largest contributor to the global burden of disease by 2020? This is a very disheartening statistic. As part of my medical training I completed a dual residency in both Internal Medicine and Psychiatry, however, for the past 5 years I have worked as a Hospitalist and have done little to utilize my psychiatry training. This is mostly because the primary focus of my psychiatry training was psychopharmacology and medication management, which is an approach I do not whole heartedly believe in. If you really dissect the studies on antidepressants you will find that in mild to moderate depression they are only slightly more efficacious than placebo. To make things worse, along with the low efficacy comes a high rate of side effects. In fact, up to 70% of patients taking antidepressants are non compliant and the number one reported reason why was unwanted side effects. Now there are some cases where I believe antidepressants are necessary however that is more so the exception than the rule.
In my first several years after residency I started to wonder if I had wasted my time with a 5 year dual program when I could have completed a pure Internal Medicine residency in 3 years. That all changed when I discovered Integrative and Functional Medicine. Spending time in the Integrative/Functional space led me to study things such as the gut microbiome and its link to mental illness. I have learned about the hypothalamus-pituitary-adrenal-thyroid-gut axis in a way that is completely different than the way it was originally taught to me. I have learned that you cannot divide the body into silos (ore medical specialties) and make recommendations based on one body system alone. It is said in the world of Functional Medicine that “everything causes everything” and I am finding that to be true. Disease names do not mean nearly as much to me as they used to as I prefer to focus on the upstream dysfunction that set the body astray. When Thomas Insel, MD stepped down after 13 years as the director of the National Institute of Mental Health he had this to say regarding the treatment of depression: “The bottom line is that these medications [antidepressants] appear to have a relatively small effect in patients broadly classified as having depression. At a biological level, depression likely comprises scores of different disorders.” When thinking about depression in this way the serotonin theory of depression just doesn’t make sense. In my opinion, factors such as inflammation, oxidative stress, adrenal dysfunction, mitochondrial dysfunction, gut dysbiosis (improper balance of gut bacteria) and intestinal permeability (leaky gut) play a primary role in depressive symptoms. The fact that Functional Medicine has given me a model to assess and address these imbalances has completely awoken my passion for treating these types of conditions. When thinking about depression in this way it becomes clear why things like dietary changes, exercise, meditation and focused supplementation provide such a dramatic improvement in depressive symptoms and over all quality of life.
If you are interested in taking and Integrative and Functional Medicine approach for the treatment of your depression and anxiety symptoms then consider coming to see us at Premier Integrative Health.
Visit our website at www.pihkc.com for more information regarding our practice or to schedule a free 20 min phone consultation to see if we are a good fit for you.