Mary's
Childhood Depression: Outcome of an alternative treatment paradigm
I just saw Mary about an hour ago for her annual check-up. Mary is 18, and a freshman at college. She is doing great, but when I first saw her that was not the case. Mary was 12 years old and already on the psychopharmacology bandwagon. Since 4th grade, she had been taking two antidepressants to combat what was diagnosed as seasonal depression. The diagnosis, done by a competent psychiatrist took 45 minutes, and after a few medication trials, she and her parents settled on a regiment of Wellbutrin and Celexa. Mary and her parents decided to look deeper into the matter, as the depression seemed to have been increasing, she was having trouble falling asleep, staying asleep, and her energy was so low that she was falling asleep in the middle of class.
I am a psychopharmacologist. I am not against medication for psychiatric problems. But I am against the excessive, reflexive knee-jerk, and mindless use of medication for adults, and I am appalled at the growing indiscriminate use of medication in our young people. How dare we consign our children to a life-time of medication when we don't know the long term consequences (there are virtually no multi year follow up studies) on their health, their physiology, their brain function? Don't we all deserve a thorough look at the processes underlying the depression, before we conclude that medication is the only way?
As it turns out, a careful history, neuropsychological testing, and physical exam showed that Mary is a very well adjusted young woman, whose primary problem is her very low energy. Her medical work up revealed a number of problems that contributed to her energy and mood problems. Each one of these problems was disturbing brain function and energy. You can read more about these problems in future blogs, and in my second book-the Anti-depressant Survival Program. Here they are:
As a result of her diet, which, like the diet of her peers, was loaded with refined carbohydrates, Mary was on the edge of type II diabetes. She was overweight, and her girl friends made fun of her (when she wasn't deriding herself). The boys showed no interest. Her identity and self-concept, which was being developed at this critical age, was being twisted by her physiology (which was itself being twisted by her nutrition, which itself was being twisted by the corporate profit motive-sugars are easier to sell than vegetables).
Her pancreas was not making enough digestive enzymes (pancreatic elastace was low), and so her ability to breakdown her food and absorb it was impaired. Her levels of key nutrients-(L-tryptophan, zinc, magnesium, energy related amino acids, fat soluble vitamins such as CoQ10, Vitamin E, and Vitamin D) were all low. Her hormones were severely affected-she was hypothyroid, and her adrenal system was severely under-functioning.
Mary had an infection-probably acquired via her pets or a tick (she lived in tick infested area of the country), and as a result of the infection and her diet and hormonal problems, she had a lot of inflammation in her body. Several markers of inflammation were elevated indicating immune system dysregulation. When the immune system is over activated it makes hormones called cytokines which cause fatigue, depressed mood, anxiety and memory problems.
Finally we identified a gene that affects the levels of dopamine in Mary's frontal cortex. The result of this is that Mary is sharp as a tack, but she has inherently more anxiety and risk for depression, ADHD, alcoholism, and manic depression than most people. The good news here is that we can modify the function of these genes via diet and supplements, and only if necessary a specific dopamine inhibiting medication (not an anti-depressant).
So my question to you is this: Given all of these physiologic abnormalities, should Mary be treated with anti-depressants? Clearly this is a no brainer. Lets give her a shot at health by improving and treating these problems. If she still needs an anti-depressant, then so be it.
As it turned out (as it does with many of the children and adults I see), Mary did not need her medication. With the support of her parents she lost weight, corrected her diet, and hormones, and we treated her infection. She began to exercise and learned Yoga.
Will Mary ever need medication? Perhaps. Based on her genetics, and family history, she is at greater risk than most. But for now, she is healthy, vibrant, has a good self-concept, has a sense of control over her health, and is medication free. Isn't this the kind of health care we all deserve?
