"Why do I stand up here? Anybody?
I stand upon my desk to remind myself that we must constantly look at things in a different way."
– Robin Williams as Mr. Keating in Dead Poets Society
I was finishing my junior year of college when Dead Poet’s Society came out into the theater. That movie changed my life. It was one of the first times I considered importance of being myself, and following my passion. Robin Williams’ Mr. Keating brought to my world the idea of finding and following what I loved about life – whether it made sense to the rest of the world, or not. Ultimately, that mode of thought allowed me to practice ‘carpe diem,’ and follow the ‘road less travelled’ that led me to become a naturopathic physician. I am grateful to Mr. Williams' brilliance, and his passion for his art.
While I do not know the details of Robin Williams’ death nor the immediate factors that led to this tragedy, most reports discuss pretty significant recurrent depression, and a life which included a history of addiction to drugs and alcohol. Robin Williams’ children spoke out saying that they “can’t understand how he could take his own life, when he was loved by so many.”
Well, that's the problem with depression – sometimes it is completely irrational. One can seemingly have everything there is to be happy about, and still feel completely depressed. The brain generates thoughts and feelings based on an infinite number of different factors, which come together to change the function of the brain.
In those who attempt suicide, genetics and environment intersect in the most deadly way, resulting in 39,000 suicide deaths each year. While relatively low compared to the 22 million with depression, this is still way too many deaths.
This risk is one of the reasons we need to heed Mr, Keating’s advice and constantly “look at things in a different way” when it comes to depression, and to do our best to bring more naturopathic thinking and holism to psychiatry. We need to work more on underlying factors which can affect our thoughts and mood.
Modern medicine tends to focus on neurotransmitters (the molecules responsible for our emotion) by using drugs that alter them. Focusing on neurotransmitters and drugs, more often than not, is not enough. In fact, this tact works for 30%, to maybe 50%, of patients at the most. And for a large percentage of those patients for whom it helps, after 1 to 2 years, it stops working anyway.
Do not misunderstand me – drugs can be absolutely life saving in certain severe situations. So, we need to keep this option on the table in severe depression. However, for the long term, we still need to ultimately “look at things in a different way” to help fix the problem. That what the holistic approach is about.
Holistic Care for Severe Depression
Severe depression needs every level of care – both modern pharmacology and holistic healing. The following steps are my suggestions to keep in mind when dealing with severe depression. The first two steps represent current conventional care, which are certainly the appropriate first steps when there is a clear possibility of harm:
1 – Monitoring the Patient and Finding the Right Drugs: The first step in very severe depression is to assess for safety, and set up active monitoring of the patient (hopefully, with close family and friends involved if possible). While I am not an advocate of drugs in mild to moderate cases of depression, severe depression cases may need to find antidepressant, especially if monitoring the patient closely is not possible.
If the antidepressant is effective, and the urgency has calmed we can start more holistic and natural therapy. If it seems the medications tried are clearly making matters worse, then moving on to more holistic methods while monitoring the depression sufferer closely is best. I think often times conventional care is limited here: drugs are started, the patient feels better (or doesn't), and no other holisitic care is brought in. In time, even drugs that work eventually stop working, or create a side effect that requires stopping them, leaving the patient in the same situation, and often worse, as these drugs can leave the neurotransmitter system more unbalanced than before.
By the way, if you are reading this, and are thinking about hurting yourself, there is a wonderful resource of caring people at the National Suicide Prevention Center Lifeline at 1-800-273-TALK (8255) – they want to help. Please call them.
2 – Psychotherapy: Psychotherapy is proven to work. Being able to express feelings in an environment that feels safe is critical. In that healing space, the right practitioner can help that person change the destructive messages a depressed person tells him or herself. Working with Cognitive Behavior Therapy or other message changing work is invaluable to help teach someone to work through some of the feelings in a healthy way, instead of spiralling downward.
3 – Sleep: In most depression cases, there is usually poor sleep. Psychiatry is starting to notice, as new research shows the strong correlation between poor sleep and mood disorder. Addressing the causes of poor sleep, and starting a regimen to help may include sleep-benefitting rituals before bed, like shutting bright light sources, journaling thoughts, and possibly using supplements like melatonin, passion flower or tryptophan to help retrain sleep patterns.
4 – Basic vitamins: Every patient with depression should take a good quality multiple with plenty of vitamin D (at least 1000iu), a fish oil and a probiotic. Each of these have substantial research showing benefit for the nervous system, and to support healthy neurotransmitter production.
5- Laboratory testing: checking under the hood for vitamin D status, nutrients, red blood cells, iron, food sensitivities, and hormonal balance can help. Each of these can play a role in brain and mood function and are easily addressed with the right lifestyle and supplement changes.
6 – Sunlight and Exercise: both are extremely powerful antidepressant strategies - these are essential to healthy brain and body. While some patients reasonably tell me “ if I wasn’t depressed, I would go exercise,” other patients will start a regimen of movement, despite how they feel. It is important to start gently with something that is fun and feels good. Even a short walk everyday can have a positive impact on mood.
7 - Look Into and Treat Other Factors: There are many other factors that may be involved as well. For instance, Robin Williams had a history of heart disease, early Parkinson’s Disease, and drug addiction.
Regarding the cardiovascular disease, the underlying inflammation that causes heart disease can also play a significant role in depression. For Robin Williams, addressing inflammation that affected the heart vessels may have been a helpful addition to stopping inflammation in the brain, and can help stave off depression that is associated with heart issues.
Parkinson’s Disease patients have challenges in brain areas that make dopamine, a neurotransmitter that is needed for balanced mood. Studies using natural supplements like SAMe (s-adenosyl methionine) have been shown to help patients with Parkinson’s Disease raise their mood. Other supplements like green tea and macuna bean can also be helpful.
While depressed people sometimes turn to substance abuse as a way to get away from the feelings of depression, alcohol and drug addiction itself can rewire the stress system and predispose people to longer term mood problems. Chronic alcohol and drug use can also cause severe imbalances and deficiencies in nutrients that play a role in brain health. For example, the depletion of certain nutrients like zinc and B vitamins can block medications from working properly. Adding these have been shown to help patients respond to their drugs.
Finally, I wanted to mention how digestion and food choices are also important factors. Most neurotransmitters are made in the digestive tract. Known as the ‘second brain,’ naturopathic medicine generally treats the gut in order to balance the brain and mood. Keeping healthy digestion and eating a diet rich in omega fats, protein, and nutrients are shown to prevent depression, and help treat it. The Mediterranean Diet, which consists of fish, olive oil, nuts, whole grains, and legumes is an excellent diet for brain health. Supplemental curcumin and saffron are also shown to help depression, and may help through their affect on the digestive tract.
In conclusion, I recommend we learn from Robin Williams case as much as we can, and remember to include all forms of holistic care, both conventional care as well as the holistic steps listed above, to really create the best chance for a person to heal.
I send my profound condolences to Mr. Williams’ family and to all of us who enjoyed his brilliance. I know his work certainly changed my life for the better. Let’s pray we can learn from this tragedy to help more people deal with severe depression.
“No matter what people tell you, words and ideas can change the world.”
–Mr. Keating, Dead Poets Society
Dr. Peter Bongiorno is a naturopathic doctor and acupuncturist in New York. He is president of the New York Association of Naturopathic Physicians and authored How Come They’re Happy and I’m Not? The Complete Natural Program for Healing Depression for Good. He can be reached through www.InnerSourceHealth.com and www.drpeterbongiorno.com