Depression Solution: Addictive Street Drug or Nutrition?

August 7, 2017 | Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Depression Solution: Addictive Street Drug or Nutrition?
The August 7, 2017 cover story for Time magazine, The Anti Antidepressant, features the drug, ketamine as an up-and-coming wonder drug for treatment resistant depression. In response to the vast failure of antidepressant medications to relieve debilitating depression in millions across the globe, the medical research establishments are turning to ketamine and new ketamine-like drugs. It has gained the attention of desperate patients and heralded as the next breakthrough in antidepressant treatment, but is this what the brain needs for healthy function?

Ketamine is an FDA approved drug used as a surgical anesthesia. It is also a street drug/club drug known as “Special K” which is a psychedelic agent that is used to make people hallucinate and dissociate. It is an addictive drug and is one of the top drugs abused in Asia. Because ketamine is FDA approved, physicians can prescribe it off-label for any concern that they think it may help, including depression.

Medicine is looking for treatment regimes that are fast acting to help those with treatment resistant depression who respond poorly to current antidepressants. Individuals injected or infused with ketamine may experience almost instantaneous relief of depression, a sort of “high”, but it isn't a perfect response each time. It's an expensive treatment at about $600 per infusion. The effects last about 7-14 days as opposed to traditional antidepressants that take weeks to take effect, if at all.

Drug companies like Johnson & Johnson and Allergan are fast tracking new medications that work like ketamine and expect the FDA to start reviewing these meds as early as next year according to the Times article. This will undoubtedly lead to the push for ketamine drug treatment as means of trying to help individuals with severe depression and treatment resistant depression. Dr Gerald Sanacora, director of Yale School of Medicine and researcher on ketamine, stated that “I still think it's the most exciting treatment to come in mood disorders, probably of the last 50 years.”

Researchers point out that they really don't know how the drug works to relieve depression. They do think that ketamine changes brain neuroplasticity, which acts like an alarm clock signaling to nerves to grow and become activated due to the trigger. Many things trigger brain plasticity, including exercise and learning, but ketamine does it forcefully and quickly. It also affects physiology for days after the medication has initially worn off.

Dr. Friedman of the Weill Cornell Medical College describes one concern with ketamine as it affects neuroplasticity and may even stimulate opioid receptors in the brain. “If you stimulate that receptor – which is what Percocet and oxycodone and morphine and heroin do – you will relieve pain and make people feel high and euphoric”.

Researchers don't know what chronic low dose ketamine treatment will do to those with depression. Even after over 50 years of research on ketamine, scientists agree that much is still to be learned, but some of the known ketamine effects include influential changes on levels of several neurotransmitters, neurochemicals like NMDA, and multiple sites of gene expression, ion channels, and cell homeostasis even after the drug is out of the system.   When a street drug with a well-known history of abuse and addiction comes into play as medical treatment, it certainly poses the question if this is the next addictive prescription drug. If you change the brain to require repetitive hits with ketamine or other ketamine like drugs to obtain a sensation or dissociation, is this helping or creating another problem? There is no doubt to the level of hurt and distress individuals with treatment resistant depression experience, but is ketamine treatment truly the answer with such a high risk and cost?

In the June 2015 article, When SSRI's Fail: Causes of Depression, Nutrition for Your BrainI discussed some of the emerging findings of ketamine drug treatment, depression mechanisms, and what one can do to help with stubborn depression. There is no quick fix for major or clinical depression even though ketamine may appear to offer quick temporary relief. Medicine will continue down this road, but at what cost? The casualties of treatment resistant depression with failed SSRI treatment are already high. We already have an opioid and gabapentin/Lyrica addiction problem started by well-meaning physicians and desperate patients. Will more occur with ketamine?

Contributing Causes to Depression

In order to restore health, it is vital to understand that depression is more than serotonin and dopamine neurotransmitter levels. Depression is loss of resiliency in response to stress and inflammation. Numerous factors like those listed below and more lead up to the development of depression and treatment resistant depression. Contributing causes include:
•   Microglial cell inflammation and over-activity
•   NMDA stress
•   Glutamate/GABA balance
•   Cell membrane integrity
•   Methylaton defects
•   Mitochondria stress
•   Gut flora imbalances and leaky gut syndrome
•   Heavy metal toxicity (Aluminum, cadmium, mercury etc.)
•   High and low cortisol and DHEA adrenal hormone levels
•   High blood sugar, low blood sugar
•   Anemia (due to lack of iron, zinc, copper, B vitamins, vitamin C, potassium, etc.)
•   Estrogen/progesterone/testosterone imbalances 
•   Thyroid dysfunction
•   Stress and inflammation
•   Circadian rhythm dysregulation
•   Mold Lyme disease, Epstein Barr virus, or Candida, dental infections
•   Gluten intolerance/food intolerance/food allergies

Nutrient Insufficiencies that Cause Depression

Numerous vitamin and mineral deficiencies and imbalanced fatty acids/essential fats occur with depression and other mood disorders. Lack of several nutrients can lead to depression. These include insufficient B vitamins (B1, B2, B3, B5, B6, B9/biotin, B12, and folate), vitamin C, vitamin D, iron, zinc, copper, biotin, calcium, magnesium, iodine, choline, coenzyme Q10, carnitine, essential fatty acids (EPA/DHA/GLA), potassium, sodium, and glutathione.

Other Factors That Cause Depression

Low antioxidant status, low cholesterol, chronic dehydration, insufficient protein, and leptin resistance also lead to depression. Dietary habits of depression patients often contribute and then further worsen depression. Many struggle to eat nutrient dense foods. Meals are skipped, limited in quality, or are filled with processed, high sugar, and high fat foods. Depression can also occur as the result of other diseases and can be a side effect of some medications.

GMO's, glyphosate/Roundup applications, antibiotics, high stress, food intolerances, and even over-training as an athlete are some factors that change gut health which impacts brain stress and inflammation, nutrient levels, mitochondria, and neurotransmitter formation and function. The health and stress levels of the mother while pregnant can predispose and wire the child's brain for altered stress responses. This in itself can dramatically increase the risk for depression and a higher need for daily nutrients and a well-balanced diet.

No single drug like Prozac or ketamine can address these concerns that add up and cause depression. To truly recover from treatment resistant depression and to maintain stability, often several of these issues must be systematically and thoroughly addressed.  Management must focus at the stressors present that lead to inflammation causing the mood changes, essentially peeling away at an onion. The traditional psychiatrist rarely spends more than just a few minutes with patients with the treatment focus on prescriptions. When was the last time your provider looked at any of these concerns?  Using a drug like ketamine seems to me like dropping a hand grenade into the brain and hoping for the best. It will create an effect. Practitioners and depression sufferers grasp at the newest drugs, or look for a quick-cureall, a magic pill to alleviate the misery. As ketamine research tumbles to the forefront of mainstream media who report on the sensational allure of it, it is important to note that the brain runs on nutrition. The concept that the brain runs on nutrition will never change. It is integral to recovery.  

Tools to Help Depression

When in this state of depression or as a caregiver for someone who may struggle with it, the challenge to help them may seem daunting and insurmountable. Focus on some of the basics with sleep support. Follow The Leptin Diet to help support healthy leptin with several daily servings of richly-colored organic fruits and vegetables, organic meats, and fats from cold water fatty fish, raw seeds and nuts, coconut oil, avocados, etc.

Remove alcohol, pop, fast food or anything processed or packaged from the diet. Gluten intolerance is a major brain and gut stressor for many and may need to be completely eliminated. Aerobic exercise has been proven to be an effective treatment for depression. HIIT – high intensity interval training has shown remarkable benefit without requiring significant amounts of time.

Nutritional Highlights – Severe Depression, ALC, Cordyceps, Holy Basil, Magnesium, Probiotics, and DHA

Several nutrients are extraordinarily important for depression, nutritional replenishment, and brain health. Here are some highlights. A November 2016 research publication on major depression, PTSD, and suicidal behavior focused on severe and/or chronic stress, abnormal early morning cortisol, and oxidative stress that caused damage to mitochondrial function and damaged fatty cell membranes within the brain and the role of nutrition.

They focused specifically on magnesium, zinc, vitamin B12, folate, and vitamin C. Their concluding statement, “A growing body of studies suggests the intriguing possibility that regular consumption of these nutrients may help prevent the onset of mood disorders and suicidal behaviors in vulnerable individuals, or significantly augment the therapeutic effect of available antidepressants. These findings have important implications for the health of both military and civilian populations.”

A 2013 animal study showed that the amino acid acetyl-l-carnitine caused rapid relief of depression symptoms within 3 days of starting to supplement the nutrient. It also provided long-lasting relief without drug withdrawal when it was compared to the drug chlorimipramine/Anafranil. In elderly adults with depression, it was found that acetyl-l-carnitine provided relief from depression in one week as compared to Prozac which took weeks longer.

Cordyceps, which is an adaptogenic herb, helps stabilize microglial cell over-activity, reinvigorate the body, and provide antioxidant support for mitochondria. It has been shown to help restore resiliency when exhaustion, burn-out and debilitation occurs.

Holy basil, another adaptogenic herb like cordyceps, has a long-standing history of support for restoring stress resiliency and improving mood. In a study on depression and anxiety, holy basil helped improve both debilitating mood symptoms. It is considered the elixir of life within traditional Indian Ayurvedic Medicine.

Magnesium and probiotics combined proved to provide relief from depression. Patients who failed standard SSRI antidepressant therapy were given magnesium and probiotics for treatment resistant depression. At the end of the 8-week intervention, nearly all of the participants had substantial improvement in depression and quality of life.

A study published in the journal PharmaNutrition 2014 studied adolescents with SSRI-resistant major depressive disorder. In the study, it was found that adolescents with treatment resistant depression had very low levels of omega-3 DHA in their red blood cells. EPA levels were within normal limits. Study participants received 10 weeks of either a low dose DHA (2.4 gram/day) or high dose DHA (16.2 grams/day). Complete symptom remission occurred in 100 percent of the adolescents treated with high dose DHA. Those treated with the low dose had a 40 percent remission. Treatment was well-tolerated.

Basic supplements that are a must for anyone with depression include B vitamins, magnesium, omega-3 DHA, vitamin D, coenzyme Q10, and probiotics. Acetyl-l-carnitine, cordyceps, holy basil, and antioxidants like curcumin, grape seed extract, fisetin, blueberry extract, and PQQ can easily be added in. Other nutrients may be needed if they are insufficient, as discussed earlier.

The Time magazine article featured a 21-year-young man who struggled with severe depression for 6 years. He had failed to find any relief with numerous antidepressants, yet was desperate enough to try ketamine. He had a mixture of positive and negative reactions to the ketamine. It is my hope that he and others like him find other resources as discussed in the article. The brain requires daily nutrition to manage its enormous 24/7 duties. The brain can heal but needs proper nourishment and to de-stress. Have you fed your brain today?

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