ANXIETY AND DEPRESSION
The British Medical Journal (BMJ) in 2022 highlighted the rising incidence of anxiety and depression in the post Covid era. Anxiety and depression are two of the most common symptoms in long-term sickness. This has a devastating effect on personal lives, families and the country’s economy. However, something can be done about it.
Find the Root Causes
In Functional Medicine, we want to look for the root causes of a condition rather than just squashing symptoms. This is not just a cool-sounding thing to do. If you don’t address the root causes, the condition will keep coming back, no matter what the treatments given. Let’s take a look at the some of the potential underlying real physical causes of anxiety and depression.
Low Energy and Depression
The brain uses a lot of the body’s energy. At rest it consumes 20% of the total energy generated by the body. Poor energy to the brain from damage to cells by viruses, bacteria and toxins, results in ‘brain fog’, depression and anxiety.
The body is a bag of biochemistry. A substance called ATP is the currency of body energy. It is made in the energy factory of the cells called the mitochondria. ATP is not just an energy molecule. It also functions as a neurotransmitter (a brain chemical). Other brain chemicals such as dopamine, serotonin, GABA and acetylcholine don’t work unless ATP is present. When ATP is low, this can result in low mood and depression.
Low Energy and Anxiety
Anxiety is triggered when someone knows they don’t have enough energy to meet the demands of life. This includes unexpected demands. The result is more demand on energy which creates more anxiety. Anxiety and depression are like brakes imposed by the brain to stop you expending energy which you don’t have. When you are happy and relaxed you want to go and do things.
What Causes Low Energy?
Anything that damages the ability of the mitochondria to produce energy (ATP). This includes:
Infections - bacterial, viral, fungal, parasitic, mould, dental, tonsil, gut, sinuses, urinary tract etc. This is one reason why anxiety and depression have been on the rise with Long Covid and other chronic infections.
Toxins - heavy metals including dental mercury fillings, environmental toxins like pesticides, aluminium, toxic chemicals in foods etc.
Certain medications. Ironically, psychiatric drugs like antidepressants and mood stabilisers which are widely prescribed for anxiety and depression, can adversely affect ATP production, resulting in more anxiety and depression.
Poor food choices.
Lack of sleep.
Unrelenting stress.
Severe oxidative stress - all the above things cause oxidative stress. Oxidative stress is a chemical reaction that causes unstable molecules (free radicals) that can damage your DNA and trigger diseases, including cancer. The body makes some some free radicals as part of its normal metabolic processes. However, severe oxidative stress is a state where the body is overwhelmed by free radicals like toxins, radiation, infections, air pollution etc.
Looking for the Underlying Causes
When someone has symptoms of anxiety and depression, always look for real physical underlying causes before reaching for psychiatric medications which come with the severest Black Box warnings. A Black Box warning is a serious warning given by the FDA (Food and Drugs Administration) for drugs that may cause serious harm or death. They have serious side effects including death. Informed consent should always be given for these types of medications. This means your doctor should go over the possible side effects of these medications with you before gaining your agreement to try them.
In the clinic, when I look for underlying causes, I start with the following:
Thorough case history.
Review of diet (there are a number of commonly eaten foods that may trigger anxiety and depression, like gluten and cows’ milk products).
Lab tests depending on case history.
Key lab tests would include:
Immune function
Infections (systemic, dental, gut etc.)
Metabolic tests depending on case history
Full Thyroid panel
Adrenal stress profile
Thyroid, anxiety and depression
The thyroid gland is a key player in energy production and metabolism. Thyroid function is so important for overall health. If your thyroid isn’t working properly, your whole body will suffer. Your metabolism is the rate at which energy/heat etc. is made in the body and is mainly under the control of the thyroid. Your metabolism can work too slowly because your thyroid gland isn’t putting enough hormones into the system to give messages to the individual cells to work properly. If there is not enough signal from the thyroid hormones, the body doesn’t have enough mitochondria and will be chronically fatigued. Symptoms of an underactive (hypo) thyroid include: sluggishness, fatigue, depression, anxiety, cold hands/feet, thinning hair, hair loss, headache in the morning, digestive dysfunction, constipation, high cholesterol, dry, itchy, scaly skin, fungal toes, goitre (swelling of the thyroid), fungal toes (lack of nutrient flow to extremities), recurrent infections (there is a direct relationship between underactive thyroid and systemic dental infections), heart, gallbladder diseases, brain fog/inability to make decisions.
Sometimes it goes the other way with too high an output of thyroid hormone. When the thyroid is too revved up, and TSH goes very low, this is a hyperthyroid or overactive thyroid situation. The symptoms include: nervousness, anxiety, fidgety, hair loss, weight loss, poor sleep, bulging of the eyes.
For both hypo and hyperthyroid conditions, a full thyroid panel is needed. From the above, you can also see that liver and gut health is important for thyroid function, therefore a holistic approach is required.
Evaluating Thyroid Function
The right thyroid lab tests are vital for anyone with anxiety or depression. In conventional medicine the assumption is that if TSH (Thyroid Stimulating Hormone) is within range, the thyroid is working ok. That is not correct. Thyroid dysfunction is the most under-diagnosed disease state because of the prevalent false information regarding diagnostic criteria. In order to properly check your thyroid health, it is necessary to do a private thyroid panel if in the UK.
Full Thyroid Panel
A full thyroid panel consists of the following:
TSH (Thyroid Stimulating Hormone) - produced by the pituitary gland in response to circulating thyroxine (T4 thyroid hormone) in the blood stream. When thyroxine levels drop, the pituitary has to work extra hard to send a signal to the thyroid gland to produce more thyroxine and so TSH rises.
Free T4 (thyroxine)
Total Thyroxine
Free T3 - This is the more active thyroid hormone converted from T4. 80% of this conversion takes place in the liver, 20% in the gut. If you neglect to test for Free T3 and conversion is impaired, you may miss an important reason why someone feels the symptoms of hypothyroidism, even though their TSH and T4 are in a normal range.
Reverse T3 - an inactive hormone that the body can produce instead of active T3. This puts the brakes on someone spending more energy that the body doesn’t have. It is often seen in a chronic infection/high stress scenario.
Thyroid autoantibodies. If these are elevated, this means that the immune system is being tricked into attacking thyroid tissues. Gluten and infections like Epstein Barr Virus are major autoimmune triggers.
Iodine with any thyroid panel as thyroid hormones are made from iodine molecules. Having deficiencies in the raw materials hormones are made from means low hormones!
Temperature tests - these form an important piece of the detective work along with blood tests and how a person feels. Dr Broda Barnes who studied the thyroid extensively for over 30 years, advocated doing an underarm temperature before getting out of bed in the morning. If it is consistently below 97.8 F (36.5C), this indicates a body cooler than it should be and points towards low thyroid function.
Adrenals, Anxiety and Depression
The adrenal glands sitting just above each kidney are the glands that produced the hormones that deal with stress - cortisol and adrenaline. They also produce the hormone aldosterone which regulates potassium and sodium levels and DHEA, a precursor to sex hormones and the so-called ‘youth’ or anti-aging hormone. The cortisol to DHEA ratio is a key risk factor for all cause mortality. Stress turns off DHEA and turns on cortisol which turns on inflammation and depresses the sleep hormone melatonin. Giving DHEA as a supplement can sometimes bring someone out of depression. Sustained high stress levels or being on high alert for too long damages tissues. If a person’s body is stressed beyond their ability to deal with whatever is going on, the gland is unable to meet their needs and starts to get tired. Adrenal fatigue then leads to burnout. The resulting exhaustion means more anxiety and depression.
Symptoms of adrenal fatigue include: fatigue, mood swings, anxiety, low sex drive, low blood pressure, especially postural hypotension (drop in BP on standing), aches/pains, hair loss, poor ability to cope with stress, blood sugar issues, brain fog, poor sleep, listlessness, apathy, hopelessness, high or low heart rate, don’t feel like getting out of bed in the morning, can’t sleep at night, chronic infections, sometimes autoimmunity, perk up during pregnancy (riding on the back of baby’s adrenals, then crash after birth). As the adrenals play an important role in menopause, depleted adrenals can make menopause symptoms much worse.
Evaluating Adrenal Function
Identifying and treating adrenal overdrive, fatigue or burnout is vital for anyone suffering from stress or anxiety. Conventional medicine recognises the two extremes of the adrenal dysfunction spectrum - Addison’s and Cushing’s diseases but not the myriad gradations in between. Saliva testing for adrenal hormones, not blood is more accurate in finding out what is going on inside the cells.
Adrenal Stress Index
The saliva Adrenal Stress Index gives a snapshot of adrenal hormone output over the course of a day. Cortisol output should be robust in the morning to wake you up and get you out of bed and should gradually wane throughout the day. Cortisol should be at its lowest at night when melatonin rises to get you to sleep. In many people this is totally skewed. The cortisol to DHEA ratio has been called the most important risk factor for all cause mortality as stress turns off DHEA (the hormone of youth) and turns on Cortisol (fight or flight stress hormone). Excessive adrenaline can trigger inflammation leading to cancers and metastases. As cholesterol is the raw material from which hormones are made, having low cholesterol is a train wreck for adrenal dysfunction.
What Affects Adrenals The Most?
Thinking fearful thoughts! Everything that ever happens to you happens in the mind. If you are anxious or fearful, you are not existing fully in the moment but are either stuck in some past incident or anticipating something unpleasant happening in the future. This makes the adrenals react.
Drugs - psychiatric drugs like antidepressants, stimulants like caffeine.
Chronic infections.
Eating the wrong toxic or allergic foods.
Alcohol - good for embalming but toxic to the brain and adrenals. Not a good way to destress.
Sugar pick me ups - these trigger a more violent roller coaster.
Poor sleep - this can be exacerbated by too much overstimulation before bedtime from TV, Wifi, social media, loud music, not exercising enough, sugar, alcohol, not being in Nature or sunshine.
Toxic relationships.
Look After Your Adrenals
Once you are aware that something can be done about anxiety and depression, there are some changes in life that may need to be made:
Sleep - have fixed bedtime and wake-up times.
Diet - anybody can improve their diet. Stop eating processed chemical foods and start eating real foods.
Go out in the sunshine for at least 15 minutes a day.
Drink adequate clean water.
Aim for a daily bowel movement.
Take some basic supplements i.e. Vitamin D, fish oil etc.
Find your basic purpose in life (not someone else’s) and pursue it.
Let go of toxic relationships and choose your friends wisely.
Don’t seek to be liked or admired but follow your own goals.
If you need help getting to the root causes of anxiety and depression, please get in touch with the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment. Please note that an Enquiry Call is not a consultation but an exploratory call to see if this a clinical approach you wish to pursue.
To your very good health,
Suzanne Jeffery (Nutritional Medicine Consultant)
M.A.(Oxon), BSc.(NMed), PGCE, MNNA, CNHC
The Good Health Clinic at The Business Centre, 2, Cattedown Road, Plymouth PL4 0EG
Tel no: 07836 552936/ Answer phone: 01752 774755
Disclaimer:
All advice given out by Suzanne Jeffery and the Good Health Clinic is for general guidance and informational purposes only. All advice relating to other health professionals’ advice is for general guidance and information purposes only. Readers are encouraged to confirm the information provided with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by other practitioners and physicians. Suzanne Jeffery and the Good Health Clinic will not be liable for any direct, indirect, consequential, special, exemplary or other damages arising therefrom.