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Ultra Low Dose Enzyme Activated
Immunotherapy (LDA)
Post Traumatic Environmental Stress Disorder
Peace of
Mind: Holistic Approaches to Anxiety and ADD
(on "New Life
Journal" Website)
Bipolar Disorder Can Be Treated With Medication
and Naturally
ALLERGY REDUCTION:
Improving Mood and Energy
Hidden Factors Behind Your
Persistent Illness
Adult
ADD:
To Medicate or Go Natural
Cancer
–
Finding Your Best Advisor
Overweight - The Risk and the Remedy
Loss
of Sexual Interest
Approaches in Helping Bipolar Sufferers
Help
for Panic and Anxiety Sufferer
Seasonal
Affective Disorder: The Winter Blues
Depression
Relief Speeds Health Recovery
Amino Acids
& Other Considerations in Depression Evaluation
Integrative
Medicine & Psychiatry
Blood
Pressure -
A Wake up Call
Addictions
- Breaking the Cycle
Spirituality:
The Core of
Healing in Integrative Psychiatry
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Amino Acids
& Other Considerations in Depression Evaluation
Ronald
R. Parks, MD
Clinical
depression has been estimated to affect 14 million people in
this country. Fifteen to twenty percent of people will
experience depression sometime during there life. The rate of
depression, if you have a significant medical illness, has
been estimated to be in the range of 30% to 50%. The incidence
of depression in women is one in four and twice as common in
men.
It is well
documented that depression, caused by both biological and
psychosocial factors, is drastically under-diagnosed and
inadequately treated in most clinical settings. In the
modern-day practice of medicine and psychiatry, the evaluation
and treatment of depression can be narrow in scope and a
disservice to the depressed person. Usually after a brief or
sometimes longer diagnostic interview, a decision is made
about the nature of the symptoms and about what medication to
use. The decision is based on the clinician's knowledge about
how the particular medication will work in terms of the
patient’s suspected needs, which is in regards to deficiencies
of brain chemical regulators or neurotransmitters. Common
signs of depression are seen when brain chemical
neurotransmitters are deficient.
Commonly
used anti-depressants have different and sometimes complex
modes of action on the many now discovered neurotransmitters
as Serotonin, Dopamine, Epinephrine, Nor-Epinephrine and
GABA. The selection of medications can become a game of trial
and error. The more expert and knowledgeable the clinician is,
in regards to the complex actions of a given medication and
his/her estimate of the patient’s neurotransmitter needs, the
greater the possibility of a positive therapeutic effect.
In order
for the practitioner to guide the selection of diagnostic
testing, treatment and type of work-up will strongly depend on
the practitioner’s training, orientation, prior clinical
experience and talents for careful listening and elicitation
of vital information. The amount of investigational testing,
or the referral of a patient to someone with more background
and experience as a mental health professional, varies widely
from clinician to clinician. People that receive medication
treatments from practitioners, who spend little time listening
and doing limited investigational work-up for underlying or
contributing factors, often end up with poor or only partial
response to treatment. Sometimes people will go through
multiple treatment trials or have many different drugs layered
one on top of another. This can lead to exorbitantly high
drug costs, significant side effects and only partial
remission of symptoms. A high percentage of patients on SSRI
antidepressants, such as Paxil, Zoloft or Celexa will have
side effects of weight gain and sexual dysfunction.
The factors
affecting mood are many: deficiencies of thyroid, adrenal or
sex hormones (as DHEA, estrogen, testosterone); sleep
deprivation (as from sleep apnea); elevated stress levels
with excess cortisol shutting off melatonin and deregulation
of sleep cycle; systemic effects of toxic chemicals and
metals; deficiencies of amino acids, essential fatty acids,
minerals and vitamin cofactors (as B12/Folic Acid);
deficiencies of neurotransmitters and loss of their reciprocal
regulation of each other; environmental stressors including
family, marital, career and interpersonal problems; prior
trauma as significant personal losses; impaired personality
development; chronic infections as fungal intestinal yeast
infections or chronic viral infections; environmental
allergies as to mold or foods; co-morbid illnesses or
conditions (as drug/alcohol addictions, ADHD, chronic fatigue,
fibromyalgia, arthritis, heart disease, cancers, Parkinson’s
disease, diabetes, post partum depression, PMS); and side
effects of medications.
Selection
of diagnostic tests ideally come after doing a comprehensive
history, mental status and physical examination. Use of
depression questionnaires as the “Beck Depression Rating
Scale,” getting information from old records and talking to
family or significant others can be extremely helpful. Some
helpful home tests for patients are: keeping a mood and
symptom chart; doing an elimination diet if any allergy,
irritable bowel or food intolerance type of symptoms are
present; and the Barnes protocol of checking axillary
temperatures in looking for additional signs of
hypothyroidism.
According
to the patient’s wishes and the direction suggested by the
initial evaluation, first carefully choose the most critical
and essential lab tests. An example would be to do a
combination of blood chemistries to check the status of
kidneys; liver; adrenals; parathyroid; thyroid function with
free T3, free T4 and TSH; B12; folic acid; and iron reserves
with ferritin levels. Hair analysis is an inexpensive
screening test for toxic metal exposure and for mineral
deficiencies. If there is any evidence of intestinal yeast or
Candida symptoms – such as depression, fatigue, irritable
bowel, gas, bloating, digestive or nutritional problems – a
comprehensive stool analysis and parasitology is invaluable
for detection and guidance of treatment. As mineral
deficiencies are often seen in depression – as zinc, copper,
magnesium – getting an accurate appraisal of mineral status
with a red blood cell element test is recommended. If there is
a current exposure to toxic metals as lead, mercury, cadmium
or arsenic – it will also show up in this test. To look for
more chronic exposure of toxic elements and for the resulting
elevated body burden levels, the recommendation would be to do
a DMSA or DMPS chelation provocation test followed by a six
hour urine test for toxic elements. If indicated, additional
allergy testing can also be helpful.
A 24 hour
urine amino acid test is one of the best tests to evaluate
nutritional factors contributing to depression. If this is not
feasible, a first morning urine collection or a plasma amino
acid done fasting in the AM would be alternatives. The urine
amino acid will reflect digestive issues in the gut that are
interfering with proper digestion of protein and the
absorption and assimilation of amino acids. “Comprehensive
stool analysis and parasitology” is a good companion test when
digestive problems become apparent by an abnormal urine amino
acid pattern. The finding of other abnormal amino acid
patterns can be a guide to the identification and treatment of
vitamin and mineral deficiencies, which can be causal to
metabolic and cellular biochemistry impairments.
Looking for
deficiencies in amino acid precursors of neurotransmitters can
be of great value, such as L-Tryptophan, which makes 5-HTP,
which in turn makes the important neurotransmitter Serotonin.
Common signs of Serotonin deficiencies are restless or
impaired sleep, depressed mood most of day, reduced pleasure
in activities, fatigue, negative and obsessive thoughts,
irritability, anxiety, difficulty concentrating and making
decisions, feelings of worthlessness and guilt, suicidal
thoughts, and carbohydrate craving. L-Tyrosine can also be
measured. This forms the Catecholamines (Dopamine,
Nor-Epinephrine and Epinephrine) and thyroid hormone. Common
signs of Catecholamine deficiencies are feeling easily bored,
apathetic, low energy most of time, difficulty focusing and
poor concentration, tendency to put on weight easily, drawn to
uppers as caffeine for energy, loss of enthusiasm, and
depressed mood.
The amino
acid analysis report comes with a suggested amino acid
replacement formula that can be compounded for the patient by
using easily absorbed crystalline amino acids. If levels of
amino acids fall in the normal range, but the patient presents
with evidence of Serotonin or Catecholamine deficiencies, one
can add additional amounts of L-Tyrosine or 5-HTP to the
formula. A larger percentage of 5-HTP gets to the brain and
is converted to Serotonin; where as the larger percentage of
L-Tryptophan is utilized outside of the brain. As there
appears to be a reciprocal relationship between
neurotransmitters in maintaining a balance and equilibrium, to
help build up Serotonin you may need to also add Catecholamine
precursors as they seem to be needed to help the body retain
Serotonin. Adequate Serotonin levels are also needed to
regulated Catecholamine levels. Much depends on the patient’s
symptoms and presentation in making these decisions. If signs
of catecholamine excess, as increased anxiety, sleep
difficulties or excessive stimulation, GABA enhancers as
Taurine and Glutamine, along with necessary vitamin and
mineral co-factors can be added.
Other
tests, currently in research and development, measure the
amount of excreted neurotransmitter levels in the urine. This
is felt to be an indirect indicator of systemic and brain
levels, and also a possible guide to amino acid replacement.
Organic acids testing will measure the metabolites of
neurotransmitters in the urine, but it is hard to relate this
to what the actual brain levels might be as most Serotonin for
example is made in the gut. Correcting neurotransmitter
imbalances with amino acids – alone, or in combination with
the correction of other identified contributing factors or
sometimes in conjunction with medication – has the potential
for relief of other conditions in addition to anxiety and
depression such as obesity, migraines, insomnia,
obsessive-compulsive problems, PMS, attention deficit disorder
(ADD), fatigue and fibromyalgia.
Ronald R.
Parks, MD, MPH practices Integrative Medicine and Psychiatry
in Asheville, North Carolina and directs
Macrohealthmedicine.com and is a clinical consultant for
Doctors Data Laboratory. He is specialty trained in
Psychiatry, Internal, Family & Preventive Medicine, with a
background in nutrition, and other natural healing arts. He
acts as a bridge between the best of conventional Western
medicine and the innovative approaches of Integrative Medicine
and Psychiatry. For consultations call: (828) 225-1812.
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