A Functional medicine Approach to Anxiety, Depression & Related Mood Disorders
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by Dr. Daniel
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In This Article
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Mental illness and Brain Based disorders have become increasingly common in our modern world.
Especially in a COVID19 and likely Post-Covid pandemic, robust mental health may be challenging to care for and maintain.
During the current pandemic, effects from social distancing and isolation combined with increases in stress and anxiety result in short and long-term mental health consequences. [1]
According to the National Alliance on Mental Illness, one in five American adults currently experiences mental illness, and 17 percent of U.S. adolescents have a mental illness. [2]
Before diving into an in-depth discussion on the Functional Medicine approach to mood & brain based disorders, let’s briefly discuss some of the most common mental illnesses experienced.
Common Mental Health Disorders
Depression
More than 19 million U.S. adults, or 8% of the population, have experienced a depressive episode over the past year, making depression one of the most common mental illnesses.
Symptoms of Depression can vary from person to person but most commonly includes:
- Changes in sleep habits
- Changes in appetite
- Lack of energy
- Lack of interest in activities
- Hopelessness or guilty thoughts
- Physical aches and pains
Left untreated, depression begins to significantly impact our physical health, functionality, and relationships. While some people may experience just one depressive episode in their lives, more often than not, depression recurs.
Women are twice as likely as men to experience major depression.
Women also experience types of depression related to fertility hormones including: [4]
- Premenstrual dysphoric disorder
- Postpartum depression
- Postmenopausal depression
The conventional treatment for depression includes the prescription drugs known as selective serotonin reuptake inhibitors (SSRIs).
However, research indicates that the clinical response to SSRIs is inadequate at best, with only 40 to 60 percent of people experiencing symptomatic relief and a mere 30 to 45 percent experiencing remission. [5]
SSRIs and other antidepressants also have side effects that can in turn contribute to depression, including: [6][7]
- Weight gain
- Sexual dysfunction
- Depletion of beneficial gut bacteria
- Withdrawal symptoms upon discontinuation
More concerning is the fact that 25 percent of people on SSRIs, have taken them for over a decade and there are no SSRI safety studies have lasted for more than two years. [8]
Anxiety
Anxiety disorders are the most common mental illness in the U.S. impacting more than 40 million adults ages 18 and older.
People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. [9]
The vast majority of people diagnosed with an anxiety disorder will be prescribed SSRIs. In addition, another common prescription includes benzodiazepines which in turn have their own side effects including cognitive dysfunction, sexual dysfunction and increased anxiety and depression. [10] [11] [12]
Bipolar Disorder
Bipolar disorder, also known as manic-depressive disorder, is characterized by dramatic highs and lows in mood, energy and activity levels that go on to influence an individuals ability to function. It's estimated that 2.8 percent of American adults have experienced bipolar disorder in the past year, and 89 percent of people with bipolar disorder are seriously impaired, unable to carry out the activities of daily living. [13]
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) affects people from all walks of life, including former soldiers, victims of sexual abuse, and people who were bullied as children.
PTSD is generally the result of acute trauma (combat trauma, witnessing death, natural disasters and severe car crashes or accidents).
Complex PTSD on the other hand is the result of repetitive and prolonged trauma including ongoing physical (sexual) abuse, neglect, domestic violence and exploitation. [14]
Eating Disorders
Eating disorders encompass an array of food- and body-image-related disorders, including:
- Anorexia nervosa
- Atypical anorexia nervosa (severe food restriction and other anorexic behaviors without low body weight)
- Bulimia
- Binge eating disorder
- Purging disorder
- Night eating syndrome
Mental Illness Theories
When it comes to asking WHY mental health issues occur, there are 2 leading theories:
- The evolutionary mismatch theory
- The pathogen-host theory
Mental Illness as an Evolutionary Mismatch
I've spoke and written extensively regarding modern health and the evolutionary mismatches that contribute to chronic disease. Mental illnesses are certainly part of this process.
Mental illness is not a natural disease. It's also not an inevitable part of being human. Like many other diseases, mental illness can be viewed as a disease of civilization.
It’s a disease caused by a high-stress, industrialized, modern lifestyle that is incompatible with our genetic evolution.
Our bodies were selected for animals that lived in completely different environments than the one we are living in today.
Our bodies expect specific dietary and lifestyle inputs. And when these inputs are missing, our bodies respond with abnormal, dysfunctional outputs.
Depression as a disease of modern life is based on the increasingly overfed, malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated lifestyles we now commonly experience. [15]
Mental Illness as a Byproduct of Infections and Inflammation
Another theory as to what drives mental illness is that of inflammation as a cause of depression and other mental health disorders. [16]
According to the pathogen-host theory when our ancestors developed an acute infection, their bodies launched an inflammatory response to combat pathogens and the unintended consequence of inflammation was depression. This served to slow us down and allow for recovery.
However, as human civilization grew and our immune systems changed, this once-adaptive mechanism ceased to be useful. Instead, humanity began to experience chronic inflammation and, subsequently, chronic mental illnesses.
Underlying Causes of Anxiety, Depression and Mood Disorders
Taking into account both theories of mental illness, we can begin to create a clinical hierarchy of underlying causes in mental illness.
The major underlying causes of anxiety, depression and mood disorders include:
- Infection and Immune Dysregulation
- The standard American diet
- Blood Sugar Dysregulation
- Sedentary Lifestyle
- Impaired neurogenesis
- Gut-Brain Communication
- Circadian Rhythm Disruption
- Trauma
- Loneliness
- Environmental triggers
Infection and Immune Dysregulation
Most people think of infections as acute or of immediate onset. However, today, many people deal with chronic low-grade stealth infections including viral, bacterial, fungal and parasitic infections. Chronic infections lead to chronic inflammation, which enhance the conversion of amino acids and metabolites that can have neurotoxic and neuroinflammatory effects. [17][18]
A number of infections have been directly connected to mental disorders including Lyme Disease [19], Group A Streptococcus [20], Viral infections [21] and parasitic infections [22].
It's clear that micro-organisms can have significant effects on not only our brains, but our behavior!
The Standard American Diet
The standard American diet is considered one of the worst dietary templates in the modern world and has been linked to poor health for many years.
Epidemiological studies have demonstrated that ultra processed foods are associated with depression. [23] [24]
High refined carbohydrates have been found to induce neuroinflammation and anxiety like behavior in mice. [25]
Blood Sugar Dysregulation
More than 100 million U.S. adults are now living with diabetes or prediabetes and blood sugar dysregulation has been linked to depression and bipolar disorder. [26]
Insulin is one of the most important hormones that helps the body to regulate blood sugar. Insulin also impacts neuronal circuits and synaptic transmission, both of which influence the central nervous system.
If your blood sugar is imbalanced (always high or low), then mood disturbance and psychosocial stress will be negatively impacted.
Sedentarism
There's no question that consistent physical activity is linked to good health. There's also a considerable amount of medical research to suggest that a sedentary lifestyle is linked to anxiety and depression of all ages. [27][28]
Impaired Neurogenesis
Neurogenesis is the process by which neurons grow and develop. The scientific literature suggests that impaired neurogenesis is a foundational problem in mental illness. [29][30]
Factors that can influence neurogenesis include:
- HPA Dysfunction (cortisol imbalances)
- Low production of neurotrophic factors (BDNF)
- Chronic Inflammation
- Changes in the Microbiome
- Traumatic Brain Injuries
Gut-Brain Communication
The Gut-Brain axis allows for a bidirectional communication pathway between the enteric nervous system (Digestive Nervous System) and the central nervous system.
Every single psychiatric or psychological dysfunction can be influenced by the gut-brain axis. [31]
We now know that several types of gut bacteria produce neurotransmitters that in turn influence how we feel. [32] And disruptions in our microbiome contribute to not only decreases in these “feel good” compounds, but also increase the risk of infections and inflammation (which negatively impact mood).
Circadian Rhythm Disruption
Our circadian rhythms (biological clocks) strongly influence not only our physical health, but mental and behavioral health as well. Our modern-day lifestyles result in sun exposure deficiency during the day and artificial light exposure at night.
This combination of abnormal biological cues results in altering our circadian rhythms and having adverse downstream effects on our mental health. [33]
Trauma and Adverse Childhood Events
Trauma and/or Adverse Childhood Events are well-known triggers for mental illness.
Adverse childhood events strongly predict an individual’s future risk of mental health disorders, possibly by activating the HPA axis and altering its function over the long term. [34][35]
Even childhood bullying, which is all too common, has been found to predict chronic systemic inflammation well into adulthood. [36]
Loneliness
Even prior to the COVID19 Pandemic, we were experiencing a dramatic increase in separation and loneliness.
The roots of loneliness and mental illness can be traced back to the habits of our ancestors.
Early hunter–gatherers lived in communal settings, where social isolation would have occurred only if someone became separated from the group, perhaps through wounding. As a result, social isolation (aka loneliness) became associated with a potent pro-inflammatory immune response designed to target the types of pathogens to which an individual would have been exposed in such a situation. [37]
Modern studies on insolation and inflammation have demonstrated that loneliness produces higher blood levels of pro-inflammatory cytokines that in turn promote mental illness. [38][39]
Environmental Triggers
There are strong environmental triggers that can influence our health and mental well being.
The most common triggers include mold and mycotoxins, air pollution and electro-magnetic frequencies (EMFs).
There's a strong connection between people who work in moldy environments and depression. Exposure to indoor mold and mycotoxins can trigger neuropsychiatric symptoms by increasing inflammatory cytokines. [40]
Air pollution is now a leading cause of death and cancer in the world. Air pollution is also linked to an increase in the risk of depression and bipolar disorder by upregulating neuroinflammation. [41]
Finally, out of all the environmental triggers that could be influencing mental health, non-native EMFs are the least acknowledged.
Non-native EMF refers to EMFs that have been manufactured by humans, and that are emitted from items such as cell phone towers, routers, and smartphones.
A slow and steady accumulation of EMF research is starting to indicate that non-native EMFs may contribute to depression and other neuropsychiatric issues by altering the activity of voltage-gated calcium channels in the brain, which govern neurotransmitter release. [42][43]
Final Thoughts
As discussed in this article, there's obviously more to mental health and mood disturbance than chemical imbalances such as low serotonin or dopamine.
Although this doesn’t mean that chemical imbalance is not a factor in depression or mental health disorders, it does suggest that it’s not the only one.
An increasing body of evidence suggests that inflammation may be the underlying issue in many cases of mood disturbance.
People who suffer from mental health disorders all have the cardinal features of inflammation, including reduced levels of anti-inflammatory chemicals and higher levels of pro-inflammatory chemicals in their blood.
When inflammatory cytokines are administered to healthy people over time, they develop symptoms of depression and respond to antidepressant therapy.
Finally, major depression is associated with a range of changes in the brain that promote inflammation. So assessing for the cause of inflammation, nutrient imbalances and even gut health should be considered.
Contrary to what the conventional medical paradigm has led us to believe, mental illness is not a life sentence. With the identification of critical underlying causes and the implementation of Functional Medicine-based interventions, it is entirely possible to improve your mental health and overall quality of life.
