That feeling that you can’t settle. You can’t eat. You can’t relax. Your muscles are tense.
Not all is right with the world. Many people who live with chronic low-grade anxiety don’t even realize it’s there.
I see this all the time in my patients who experience panic attacks (when a couple of straws “break the camel’s back” so to speak, the “backs” being a nervous system that is already tightly wound up), or dissociation, even depression, or chronic exhaustion.
Chronic low-grade anxiety can occur if something happens to us that our nervous systems don’t yet understand. I was babysitting a dog for a few days and she and my dog got into a fight. It was nasty and it rattled my nervous system.
I found myself feeling wound up… needing to be soothed, to be settled, for someone to tell me that it wasn’t going to happen again. My response is to go into “information” mode, to poll people, to get an authority’s perspective.
But, of course, it’s impossible to have certainty in this world. And so, my nervous system was asking for something: either that the situation wouldn’t happen again, or that I would know how to handle it and make things alright if it did.
Those with a history of childhood trauma may live in a state of hypervigilence and chronic anxiety–for you it might be your default state, like oxygen, anxiety is always there, at the very baseline of your experience.
The experience of low-grade anxiety is terrible. You’re always vigilant. You’re obsessing, you can’t relax. Your startle reflex is completely uptight.
You have nightmares, you don’t feel hungry. And yet you suddenly feel light-headed and starving.
Everything feels like too much.
Symptoms of chronic low-grade anxiety:
brain fog
overwhelm
disrupted sleep
feeling jittery or shaky
nausea
lack of hunger
extreme hunger
tense, sore muscles
digestive issues, IBS, bloating, diarrhea
generalized sense of dread
shortness of breath, or difficulty getting a full breath
sweating
fatigue
and so on
How do you heal it? Well, it’s tough because ultimately the nervous system wants you to REASSURE it that the world is a SAFE PLACE.
And… it’s not.
Shit happens.
It’s a bumper sticker for a reason.
Shit happens and when it does we need resources.
These resources come in the form of physical nutrition: literally salt, glucose and water. They come from stable hormones (related to blood sugar, a properly functioning circadian rhythm), managed inflammation.
They come from restorative practices: exercise and rest, time where you feel into your body. And they come from understanding the situation: storying it.
In the case of the dogfight, it helped me to learn about dogs, to know how to keep them calm and happy, to understand their particular language and establish myself as the dog leader (also lots and lots of exercise and a bit of CBD oil).
Once they were calm I was calm too.
In the case of childhood trauma it might involve working with the story through the support of a trusted therapeutic relationship, and maybe after working on building resources and engaging in stabilizing practices that help you feel embodied.
Therapies to treat chronic low-grade anxiety:
nutritional practices focused on obtaining essential nutrients like fat and protein and stabilizing blood sugar
support circadian rhythms, sleep and cortisol responses in the body
support neurotransmitters and cell membranes
trauma-informed therapy, or Cognitive Behaviour Therapy
movement
meditation and self-compassion
breathwork
emotional regulation, self-soothing and other embodiment practices
time in nature
plenty of rest
regular routines and self-care-informed habits
plant medicines that can help access deeper seated trauma or regulate the nervous system, hormonal systems and brain chemistry.
And so on.
Our nervous systems are beautiful things. They’re trying to tell us something.
A nervous system on edge is telling us that all is not harmonious with the world: perhaps our internal world, or our external one.
One of the reasons I love dogs so much is that we share a fundamental understanding: walking is healing. I love walking. My body craves walking. I walk to strengthen my lower body, to stretch my psoas (hip flexors), to stabilize my core. I walk to self-soothe, to process emotions, to move anxiety. I walk to boost my circulation, to stimulate lymphatic flow, to lay down bone density. I walk to think, to dream, to create. I walk to roam. Our hunter gather ancestors walked 12-18 km per day (approximated from studies on the modern Hadza). Walking is probably the most therapeutic practice (besides sleeping) that there is. I start every day with a walk to prime my brain for cognitive and emotional work. In the winter it feels particularly therapeutic as it exposes me to cold, to fresh air and to sunlight. Exposing my body to cold helps to regulate my temperature, and prevent Seasonal Affective Disorder (not to mention the sun exposure, on a sunny day, which provides light therapy). I’ve been prescribing walking to many of my patients. To calm anxiety, to heal depression, to regulate the nervous system and to stimulate dopamine–our body’s “seeking” chemical. Many of us have noticed our worlds contract: we’re not travelling, we’re not roaming. Long walks help us feed the roaming instinct that we share with our canine companions. They fill our need to explore, to see people, to experience. Winter walks, while initially uncomfortable help our bodies transition to the colder climate. Cold exposure is also extremely anti-inflammatory, boosts our body’s natural antioxidants and stimulates feel-good chemicals in the brain that support our mood, cognitive function, and energy. I walk when I’m sad. I walk when I’m anxious. I walk when I’m bored. I walk when I’m restless. I walk in silence, with music, with a podcast, while recording voice audio to a friend. I walk alone. I walk with others. I walk with Coco. My body has begun to crave walks. Coco’s body never stopped craving a walk. I walk to reunite with my wild self.
She told me that lately, all the children she works with have a label. “Meredith can’t attend your online class because it’s her first day of school and she can’t handle more than two things because of her anxiety”, one mother wrote in an email as she backed out of a private class my friend had created by special request.
“Everyone is nervous on their first day of school”, my friend remarked, as she recounted the story to me.
“I need everyone’s microphones muted”, a 10-year old student exclaimed during an online class, “I have sensory overwhelm and attention deficit disorder and can’t handle background noise”.
My friend spent three years teaching in a rural school at the edge of a volcano in Guatemala. She worked in a private girls’ school in Colombia. And she taught grade 1 at an outdoor jungle school on the Pacific Coast of Mexico. “I’m not used to these North American kids”, she reflected.
“I wonder what diagnoses we’d have gotten in university?” I mused. I remember our Revolutionary Wall–pictures of Noam Chomsky, Victor Jara and Ghandi plastered on the wall that welcomed us into the entrance of our dirty apartment.
That year we’d worn our sweaters backward because it “felt right” to rest your chin on your hood, stopped washing our hair to “let the oils moisturize our roots”, and spent a week on a 1000-piece puzzle instead of going to class.
It was our last year. We were done.
My other friend was diagnosed with cancer, which would soon turn terminal. I was suffering from some sort of unacknowledged eating disorder–there were no body positivity Instagram feeds at the time. I could have used some.
It was a painful year.
For those and many more reasons, I’m sure, I was depressed.
I remember at some point during that year heading to a walk-in clinic because I was gaining weight, depressed, exhausted and completely shutdown. The walk-in clinic doctor told me “it wasn’t my thyroid” and to “eat less” so that I would lose weight.
I never got a diagnosis.
I was never offered an antidepressant.
I remember feeling hopeless. Desperate for an answer, but most of all, a solution.
If she had offered me an antidepressant, I’m certain I would have taken it. In fact, I did end up taking one about a year later for a brief period when living in Colombia (before the side effects made me stop).
I escaped a label.
My journey forked in the road and I took the one less traveled that led me towards naturopathic medicine.
Before that, though, I saw my own natural doctor who listened to me and put together the puzzle of my symptoms (who knew that skipping class to put together our 1000-piece puzzle would figuratively prepare me for my future career).
Rather than diagnose me, he listened to me and told me the underlying causes of my symptoms–not just what they were called.
And then, because we knew the cause, we also had a solution. And I soon felt better.
Of course, when I started naturopathic school, another 4-year full-time program with full days of classes (sometimes 10+ hours a day) and millions of exams and assignments, the underlying hormonal conditions that drove the original depressive episode I experienced at the end of my undergrad resurfaced.
I ended up seeing a fourth year naturopathic intern and she put me on something called adaptogens.
Adaptogens are class of plants. They support our Hypothalamic-Pituitary-Adrenal (HPA) response, which orchestrates the stress response. They are studied in rats who, when given adaptogens can perform longer on swim tests, producing less cortisol (our stress hormone) in the process.
These rats can tread water longer, without as much stress hormone and therefore, with less damage from stress. Depression is one of those side effects from the damage of psychosocial stress.
Stress leads to shutdown, inflammation and further hormonal imbalance, causing a wide variety of symptoms that seem disconnected but arise from the same source.
After all, isn’t depression, anxiety and burnout just us trying to keep our heads above water?
Oh man, did I ever wish I’d known about adaptogens in undergrad!
If I could have, I would have shouted about them from the rooftops, thrown bottles of them out of a plane, put them in the water supply.
I can’t do those things, but I can put many of my patients on them. Many of my patients suffering from depression and anxiety, caused by problems with their HPA axises, end up taking adaptogens.
I prescribe them when those I work with experience things like low mood, fatigue, sleep issues, inflammation (pain and swelling), hormone imbalances, particularly PMS or peri-menopause, sugar and salt cravings, delayed muscle recovery, tension, panic attacks and anxiety, dizziness and weakness, low motivation, and other oh-so-common symptoms often labelled as Major Depressive Disorder or other psychiatric illnesses.
Did I ever wish I’d known about adaptogens when I was in undergrad.
Instead I remember taking a crappy B vitamin complex from the local drugstore that a roommate’s mom gave me because I was on the birth control pill and “you need B vitamins on the birth control pill”. (Which is true: you need more vitamin B6 on the pill, but probably not one from a local drugstore multivitamin).
It didn’t do much.
I really really wish someone, a fairy godmother, the walk-in clinic physician, a man on the street, an article somewhere on the internet (like this one), had told me, “You have these symptoms because you are suffering from HPA axis dysfunction, as a result of significant psychosocial stress. This makes you suffer from the symptoms you’re dealing with, depression not being a condition of its own, but just another symptom of this condition.
“Adaptogenic herbs can help you get through this, as well as some important foundational lifestyle pieces that someone like a naturopathic doctor can help you with.
“There is a reason for your suffering. A context behind it. There is a cause we can identify.
“And, most importantly, there is a solution.”
But, I didn’t have anyone to tell me that.
I really wish someone had told me about adaptogens, but I haven’t ever wished that someone had diagnosed me with depression.
Now, a diagnosis can be extremely validating for some.
It can be lifesaving.
Medical intervention can also be really helpful for some people. But, like adaptogens (I should add), medications aren’t a one-size-fits-all solution.
We don’t know what causes depression and anxiety (likely many factors, HPA axis dysfunction being one of them), but we do know it’s not caused by a chemical brain imbalance.
And medications are designed to correct the brain imbalance that doesn’t exist, which is why they don’t work in everyone.
However, they do do something in some. Because, even though they don’t really solve the problem they’re supposed to (at least not in that simplistic way), they might be doing something else, which solves a problem in a few people.
The problem is, antidepressants make some people feel worse. In others they do nothing. And, in some of the people they do help, they don’t do enough. We’re still suffering.
And labels, while they can be helpful and lifesaving in some cases, can do damage in others.
Take my friend’s student with anxiety. What if her story of “I get stressed out on the first day of school because I have anxiety” turned into:
“I get stressed out on the first day of school because a lot of people do. It’s normal to feel nervous and anxious on the first day of school and want everything to go right.”
Now, of course, I don’t want to insinuate that anxiety isn’t a real thing. Of course it is!
There are many of us who suffer from anxiety disorders–a higher amount of anxiety than is common. Rather than first-day jitters, they might experience severe panic and complete dysfunction that make life miserable.
However, in the first example, the power is out of this student’s hands. It lies in her identity. In her dysfunction.
In her label.
In the second, it becomes a shared human experience, which she might be able to externalize and work with. Because it’s a common experience, she might find support, kinship, and understanding in those who experience the same.
Of course, I don’t know her case specifically. Maybe her diagnosis has helped her. Maybe her anxiety is well labelled and managed. Maybe she doesn’t need help. Maybe she is doing just fine.
All I know is, I wonder what I would have been diagnosed with, with my sweater on backwards, my hair full of grease, my body heavy like lead, a million puzzle pieces spewed all over the kitchen table in my dirty apartment with the revolutionary wall.
I have no idea what my diagnosis would have been, but I’m personally glad I never got one.
Instead, I wish I had had the permission to go through what I was going through.
I wish I’d had context for my suffering.
I wish I’d been given hope that things would get better.
I wish someone had empowered me through understanding the underlying causes of my symptoms and, of course,
I talk with Dr. Kara and Dr. Dave of That Naturopathic Podcast, rated in the top 6 Canadian Medicine podcasts, about taming the tiger of anxiety. Click to learn about your HPA Axis, the stress response and how we can “tame the tiger” by providing our body and mind with the assurance that we’re safe. Listen on Spotify.
I talk to Taylor Morozova of the Weird Waves Podcast about how I became a naturopathic doctor, surfing, immunity, vitamin D, and how to stay safe in the age of Corona. Listen on Spotify.
In September of 2019, Jakobsen, Gluud and Kirsch published a review in the British Medical Journal: Evidence-Based Medicine entitled “Should antidepressants be used for major depressive disorder?” (1)
Their conclusion was this:
“Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.”
Now, before we move on with what drove them to make this seemingly radical conclusion, I want to be clear:
I am not stigmatizing medication.
All of those who take medication for depression have asked for help.
Asking for help is important.
Asking for help is brave.
And, whatever help works for you is the right kind of help.
But imagine this; imagine you are a pretty decent swimmer.
You’ve practiced swimming all your life. You’ve gotten lots of experience swimming in pools, lakes, and oceans. You know how to swim, just like you know how to cope with turmoil. But, despite your strength, one day you find yourself drowning.
“No, I’m not drowning,” you might say at first. “I can’t be drowning. I know how to swim! If I’m drowning, it means I’m a failure…
“What will everyone think?”
And so you continue to splash around a bit, until it becomes undeniable. You gasp some water-filled air. Your head submerges and you think, indeed, “I’m drowning.”
When you get your head above water you call for help.
This takes a lot.
It’s not easy to admit that you need help.
It’s not easy to overcome that little voice that tells you that asking for help is troubling other people, admitting defeat, showing weakness—and whatever else that darned little voice thinks it means.
“HELP!” You exclaim, louder this time—little voice be damned.
“HEEELP!”
And someone on shore sees you. They have a life-preserver in their hands and they throw it your way.
Your shame is peppered with relief—and gratitude: there’s an answer to all this suffering. You thrust your hand towards the life preserver, grasping it with a firm bravery.
Only, it starts to sink. It’s full of holes.
“What’s the matter?” The person waiting on the shore exclaims, as you continue to struggle, “Don’t you want help?”
The shame returns. Hopelessness joins it.
I advocate for mental health awareness. I advocate for perpetuating the message that it’s ok to talk about mental illness. It ok to admit you need help.
I believe the following:
Depression is not a a sign of weakness.
It’s not a sign that you are defective.
It’s not a sign that you haven’t learned proper coping skills, or that your coping skills are defective, or that you’re fragile.
It’s also not fixed by simple solutions like eating salad, running or putting “mind over matter”.
Depression happens to a lot of us.
It affects 300 million people globally. It is the leading cause of disability world-wide, with a lifetime prevalence of 10 to 20%. This means that 1 in 5 people will experience depression in their lifetimes.
We all know someone who suffers. Maybe you suffer.
And a lot of people ask for help. The National Health and Nutrition Examine Survey (NHANES) in 2017 found that 1 in 8 people over the age of 12 are taking an anti-depressant, a 65% increase over the last 15 years.
This means that 65% more of us are asking for help.
That’s a lot of life preservers.
So, just how effective is this help?
First, we need to understand how the efficacy of anti-depressants are measured.
The symptoms of depression are subjective. This means they are not observable. There is no imaging that shows if someone is depressed. There are no blood tests for depression. There are no physical exams.
Therefore, to assess the presence and severity of depression, clinicians use questionnaires. The most commonly used depression questionnaire is The Hamilton Depression and Rating Scale (HDRS), a 52-point checklist that assesses various symptoms of depression and rates them on a scale of no-depression to severe.
When patients with depression first see a family doctor or psychiatrist they are often issued the HDRS and given a score.
Let’s use Janet’s story as an example. Janet first came to see her psychiatrist two years ago. She wasn’t sleeping and yet felt sleepy all the time. She’d gained weight but had no appetite. Her entire body was sore, as if she had the flu. She’d lost interest in all of the activities that used to fire her up. She’d lost interest in everything.
After a few weeks of feeling progressively worse, Janet began to be plagued by thoughts of suicide. This scared her. She went to her family doctor, who referred her to a psychiatrist.
Janet’s HDRS score was 25. This meant she was moderately to severely depressed.
Janet was given an anti-depressant, a Selective Serotonin Re-uptake Inhibitor (SSRI). She was told it would correct her “brain imbalance”, and treat the cause of her symptoms. Janet was relieved that there was a solution.
If an anti-depressant can decrease the HDRS by 3 points, then the medication “works”. Or at least the results are statistically significant.
However, if Janet’s symptoms improve by 3 points, from a score of 25 to, say, a score of 22, how does she feel?
Not much different, it turns out.
To experience “minimal improvement”, a decrease in symptoms that someone with depression would notice, say an increase in energy, an improvement in sleep, or a change in mood, a patient’s HDRS score would need to decrease by at least 7 points.
This means the Janet would need to bring her HDRS down to 18 or lower before she starts to feel noticeably better.
Studies show that anti-depressants, on average, don’t do this.
Some randomized control trials do show that anti-depressants decrease the HDRS score by at least 3 points, which is still registered by patients as having no perceptible effect, but the results are mixed.
A large 2017 systematic review showed that anti-depressants only decreased patients’ HDRS by about 1.94 points (2) and another large study published in the Lancet (3) also failed to show that anti-depressants produce a statistically significant effect, let alone a clinically significant one.
In addition to the minimal changes in symptoms, anti-depressant research is also polluted with for-profit bias. Most studies are conducted or funded by the drug companies.
This makes a difference: an analysis showed a study was 22 times less likely to make negative statements about a drug if the scientists worked for the company that manufactured it (4).
Studies at high-risk of for-profit bias were also more likely to show positive effects of a drug (5).
Another limitation of anti-depressant trials is the lack of active placebo control. In Randomized Control Trials, participants are sorted into two groups: an active group, in which they receive the medication, and a placebo group, in which they receive an inert pill.
The goal of this process is to control for something called the “meaning response”, or “placebo effect” where our expectations and beliefs about a therapy have the potential to affect our response to it.
Remember that depression, as I mentioned before, is a condition made up of subjective symptoms.
If I asked you to rate your energy on a scale of 1 to 10, how would you rate it? What if I asked you tomorrow? What if I asked you after giving you a drink of something that tastes suspiciously like coffee?
Because of its subjective nature, and the subjective questionnaires, like the HDRS, that measure it, depression is very susceptible to the placebo response.
Therefore, it’s important to control for the placebo response in every trial assessing anti-depressants.
But it might not be enough to just take a sugar pill that looks like an anti-depressant.
SSRI medication produces obvious side effects: gastrointestinal issues, headaches, changes in energy, and sleep disturbances, to name a few.
When a patient taking a pill (either placebo or active treatment) starts to feel these side effects, they immediately know which group they have been randomized to, and they are no longer blinded.
This can be solved by giving an “active placebo”: a placebo that produces similar side effects to the active medication. Unfortunately anti-depressant trials that use active placebo are lacking.
But what about the people who DO benefit from anti-depressants?
Janet knew a few. She had a cousin who also suffered from depression. He took medication to manage his symptoms. He’d told her many times that he just wasn’t the same without it.
Perhaps you, reading this article have found benefit from an anti-depressant medication. Perhaps you know someone who has: a family member, or a friend. Maybe it was their lifeline. Maybe it’s yours.
According to Jakobson et al., there are indeed some people who benefit from anti-depressants. Anecdotally we know this to be true. However, the results of large studies show minimal to no benefit from medication, on average.
This means that some people might benefit; we know that some do. It also means that an equal number of people are harmed.
In order for the net effect of anti-depressant medication to be close to zero, an equal number of people experience negative effects that outweigh the positive effects seen in others.
So, while some may have already tried medication and benefited from it, those considering medication won’t know if they’ll be in the group who benefits, or the group who is harmed.
The side effects of anti-depressant medication are often underrepresented. In the Lancet study, adverse effects were neither recorded nor assessed (3).
The most common side effects include gastrointestinal problems, sleep disturbances, and sexual dysfunction. More serious side effects, like increased risk of suicide, are also possible. Some of these effects may persist even after the medication is stopped.
Anti-depressant trials are short-term. Most trials assess patients for 4 to 8 weeks, while most people take anti-depressants for 2 years or longer.
Anti-depressants also put people at risk of physiological dependence and withdrawal.
Withdrawal symptoms can occur a few days, or even weeks, after tapering anti-depressant medication. They sometimes last months.
Withdrawal symptoms are often mistaken for depressive relapse. This can make it difficult, or even impossible, for patients to come off medication. This is worrisome considering the lack of research on long-term medication use.
It is sometimes argued that anti-depressants are more effective, or even essential, for severe depression, however the evidence for this is lacking (4).
In their paper, Jakobson, Gluud and Kirsch conclude that, based on the evidence, anti-depressants show a high risk of harm with minimal benefit.
Before prescribing them, Jakobson et al recommend more non-biased, long-term studies that use active placebo, and honestly assess the negative effects of the medications.
They recommend that studies use improved quality of life and clinically meaningful symptom reduction, not just statistical significance, as standards for treatment success.
Despite these conclusions, SSRIs remain a first-line treatment for major depressive disorder. They are also prescribed for conditions like severe PMS, IBS, anxiety, grief, and fibromyalgia, or other pain conditions. 1 in 8 adults in North America are taking them.
As a clinician who focuses in mental health, I am not against medication.
I have seen patients benefit from SSRI or SNRI medications. Sometimes finding relief with medication when nothing else worked.
My clinical practice keeps me humble.
If a patient comes into my practice on medication, or considering medication, I listen. I ask how I can support them. I answer questions to the best of my ability. I trust my patients.
Patient experience trumps clinical papers.
However, for every patient who benefits from medication, just as many experience negative side effects, or no effect. I trust their experiences too.
I also trust the experiences of the patients who have been trying for months, or years, to wean off medications.
Let me repeat it again: depression is real. Asking for help is hard. And it’s important.
Depression is a multi-factorial condition.
This means that it stems from hundreds of complex causes. This is why it’s so difficult to treat. This is why so many people suffer.
Let me also repeat: depression is not easily fixed.
There is no one solution, and there are certainly no ONE-SIZE-FITS-ALL solutions.
So, if you or someone you care about is suffering from depression, what can you do?
First, get help. This is not something you can get through alone.
Second, seek lots of help: gather together a team of professionals, family and friends. You can start with one person: your family doctor or a naturopathic doctor, and then assemble your support network.
Choose people you trust: people who listen, provide you with options, and seek your full informed consent.
It is important to work with a healthcare team who take into account the factors that may be contributing to your symptoms: brain health, gut health, life stressors, nutrition, inflammation levels, presence of other health conditions, sleep hygiene, family history, contributing life circumstances, such as grief, trauma, or poverty, and who lay out various treatment options while filling you in on the risks, benefits and alternate therapies of each.
Medication may be part of this comprehensive treatment plan, or it may not.
It is brave to ask for help.
And I believe that bravery should be rewarded with the best standard of care—with the best help.
References:
Jakobsen JC, Gluud C, Kirsch IShould antidepressants be used for major depressive disorder?BMJ Evidence-Based Medicine Published Online First: 25 September 2019. doi: 10.1136/bmjebm-2019-111238
Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatr2017;17:58
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet2018;391:1357–66
Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med2008;5:e45.doi:10.1371/journal.pmed.0050045
Ebrahim S, Bance S, Athale A, et al. Meta-Analyses with industry involvement are massively published and report no caveats for antidepressants. J Clin Epidemiol2016;70:155–63.doi:10.1016/j.jclinepi.2015.08.021
Hannah Hepworth, of the Anxiety Revolution Podcast, and I team up to discuss a natural and functional approach to managing anxiety.
In our talk, featured in her 2019 Anxiety Revolution Summit, a series of talks with integrative mental health practitioners and experts, we discuss circadian rhythms, the body’s stress response and the HPA (hypothalamic pituitary adrenal) axis, and blood sugar, and their role in anxiety.
Click the link to listen to this 30-minute interview. Let me know what you think!
I appeared on the Rebel Talk Podcast with Dr. Michelle Peris, ND. Dr. Michelle writes,
“Not a week goes by that I do not discuss mental health with patients in my office. Rates of depression and anxiety are on the rise. So I really wanted to unpack this important topic for you, giving you relevant information and diving deep into interventions that can help optimize mental health. ⠀
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In this episode, Dr. Talia details how our brains work while suffering from depression, anxiety and stress. Her deep knowledge of neuroscience is combined with mindfulness practices and also with microdosing, an approach that consists in taking low doses of psychedelic drugs, such as LSD or psilocybin-containing “magic” mushrooms, in order to prevent and treat symptoms of depression. ⠀
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Dr. Talia talks about mental and physical barriers, that can holds us back from making the changes needed for a healthier and more balanced life. Listen to this podcast and be inspired by this out-of-the-box conversation about neuroscience, mental health and mindfulness.”
My friend Nelson (not his real name) was depressed.
Depression frequently came in and out of Nelson’s life, but this last bout was the worst.
Severe job stress compounded by issues with his relationship sent Nelson into a downward spiral, leaving him broken, sobbing and exhausted after engaging in the simplest of tasks.
Sadness and a feeling of doom rushed in to greet him at the end of each sleepless night. Nelson gained weight, despite never truly feeling hungry. His face appeared sunken and swollen. Despite sleeping 14 hours a day, dark circles hung under his eyes.
Since focusing and concentrating on work was impossible, he asked his psychiatrist to help him apply for mental health leave. Nelson was granted sick leave, as well as a prescription for Effexor, and a recommendation to get as much rest as possible.
After a year, Nelson felt worse. When rest and the medication weren’t working, he started exercising vigorously. He hired a nutritionist who cleaned up his diet, and he started taking fish oil and a B complex, among other supplements.
Even then, he still struggled. The hopelessness was still there. Returning to work at this point seemed impossible.
Nelson opened up to a friend about his struggles.
“I went through a similar thing a few years ago,” Nelson’s friend confessed. “And the thing that helped the most was micro-dosing.”
Micro-dosing, taking small doses of psychedelic substances, like LSD or psilocybin-containing “magic” mushrooms, entered the public consciousness in early 2015, after James Fadiman, PhD and author of The Psychedelic Explorer’s Guide, appeared on the Tim Ferris Podcast.
It involves taking a “sub-perceptual” dose of a hallucinogen, like LSD or Psilocybe cubensis “magic” mushrooms, that contain the hallucinogen psilocybin. A sub-perceptual dose means that, while these substances still exert effects, they don’t produce a noticeable hallucinogenic “high”.
According to Paul Austin at the The Third Wave, people micro-dose for two main reasons: to remove negative mood states, such as depression, anxiety, PTSD, addiction, and ADD; and to increase positive mood states such as flow, creativity, improved productivity and focus, and sociability.
Micro-dosing has been used experimentally in individuals trying to quit smoking and to heal depression.
After listening to the podcast and reading some of the articles his friend sent him, Nelson managed to obtain capsules containing 200 mg of dried psilocybin mushrooms. Procuring these substances is still illegal, but Nelson figured he had nothing to lose.
When I caught up with Nelson, he was already a few weeks into his micro-dosing regimen. I asked him how he was doing.
“I’m actually feeling better than I have in months,” he told me, smiling. “I’m not passing out on the couch anymore. I wake up at 7 every morning without an alarm. I feel optimistic for the first time in months. And it seems to be consistent!
“This week I’ve managed to attend three social events and I seem… more motivated. My workout game improved too. Also, I’m not sure I’m ready to go back to work just yet but I’ve noticed my motivation has picked up. So much so that I’ve started taking free programming courses online. I—I can’t really believe it.”
Research on Psychedelics for Depression
Unfortunately, we can’t draw any sound conclusions from Nelson’s experience; scientific data from randomized control studies is still lacking. However, the growing collection of anecdotes on the benefits of micro-dosing for mental health and well-being has caught the attention of researchers.
Thomas Anderson, a PhD candidate at the University of Toronto, polled almost one thousand participants on social media channels and message boards, like Reddit, to gather some initial data on the benefits and drawbacks of micro-dosing hallucinogens.
The micro-dosers that Anderson and his team polled reported higher levels of creativity, and improved mood and focus. They claimed to notice a reduction in depression and anxiety symptoms, increased motivation to eat right and exercise, cognitive enhancement, improved self-efficacy and heightened social functioning.
They reported that the main drawback they experienced was obtaining these substances, which are currently illegal in The US and Canada.
Although interesting, this self-reported data isn’t hard science. To increase objectivity, Anderson and his team presented the participants with tests of creativity (finding out how many uses they could find for common objects, for instance) and questionnaires that measured wisdom. The micro-dosers scored high on both these metrics. They also scored lower in tests that measured negative emotion.
Anderson and his colleagues plan to publish these preliminary findings in a series of papers. They are currently in the process of obtaining Health Canada approval for a controlled study.
Psychedelic research was terminated in the 1960’s, leaving a massive knowledge gap of their therapeutic potential. But now, with the publication of Fadiman’s Psychedelic Explorer’s Guide and Michael Pollen’s even more recent How to Change Your Mind, psychedelics are receiving a fresh surge of interest, particularly for their mental health benefits.
One of the prominent names in this new-wave research community is Robin Carhart-Harris, PhD, at Imperial College London, who is investigating psilocybin as a treatment for severe depression.
Published in a 2016 issue of Lancet Psychiatry, Carhart-Harris administered two doses (one small and one moderate) of psilocybin, spaced one week apart, to twelve patients with Major Depressive Disorder. The doses were administered in a controlled, therapeutic setting, and symptoms were rated immediately after therapy, and then again at one and three months.
The study results were remarkable. Five of the twelve patients dropped from “severe depression” to “no depression” immediately after receiving the second dose. All of the study participants experienced an overall reduction in symptoms with five of the study participants remaining depression-free after three months.
Roland Griffiths, Phd, at John Hopkins, is involved in a number of studies examining psilocybin’s ability to induce mystical experiences in terminally ill patients.
In a 2016 randomized, double-blind, placebo-controlled crossover trial published in the Journal of Psychopharmacology, he and his team found that administering high-dose psilocybin to terminally ill cancer patients increased mood, quality of life and optimism, and decreased death anxiety. These benefits were sustained at the six month follow-up. Over 80% of the study participants claimed to experience greater life satisfaction and feelings of well-being.
How Psychedelics Work to Boost Mood
LSD, psilocybin, and other psychedelics, work like serotonin in the brain by acting on serotonin receptors, specifically the 5HT2A serotonin receptors.
Like psychedelics, anti-depressant medications, like SSRI and SNRI medications (Selective Serotonin and Selective Serotonin and Norepinephrine Re-uptake Inhibitors), Cipralex and Effexor, respectively, also work on serotonin pathways. However, these medications’ effects are limited: some people improve on them, while others feel no different, or even worse.
SSRI and SNRI medications activate 5HT1A receptors. According to Carhart-Harris, this makes a difference. In his paper on the “Bipartite Model of Serotonin Signalling” he proposes that these receptor pathways help people cope differently.
5HT1A receptors, acted on by anti-depressants, help with “Passive Coping”. They help individuals with depression tolerate the stress in their lives, be it a toxic work environment or destructive relationship—nothing has changed about the situation, you can just deal with it better.
Psychedelic stimulation of 5HT2A receptors activate pathways involved in “Active Coping”: identifying and directly addressing sources of stress. Active coping might mean asserting boundaries at work or applying to new jobs. It might look like ending an unhealthy relationship.
In other words, 5HT2A receptors stimulate neural pathways that reveal previously elusive solutions to problems. They do this by increasing a chemical called Brain-Derived Neurotropic Factor, or BDNF.
BDNF promotes the growth of new brain cells and neural pathways in the brain. These processes, called “neurogenesis” and “neuroplasticity” , are essential for learning, creativity and memory. Research shows that increased neuronal plasticity benefits mood.
Psychedelics also work by disconnecting the brain’s Default Mode Network. The Default Mode Network, or DMN, connects frontal areas of the brain, such as the Medial Prefrontal Cortex, with lower brain areas like the Posterior Cingulate Cortex.
When we’re daydreaming, stuck in traffic, sitting in a waiting room, or otherwise not actively engaged in a mental task, our DMN lights up. In these quiet moments, we lapse into a state of reflection and self-referential thinking. In other words, our minds wander.
If we’re in a good mood, this mind-wandering creates narratives, daydreams and fantasies about the future. If we’re depressed, it leads to rumination, negative over-thinking, and self-criticism, which worsens mood.
Disrupting the DMN allows old thought patterns to fall away, opening up novel possibilities.
Activating Flow States
Shutting off the DMN can help us enter a state of Flow. Flow states occur when we are completely immersed in an activity so worthwhile that our sense of time and self cease. When in flow, we toe the limits of our talents, making these states incredibly rewarding and enriching. They are the antithesis to depressive and anxious mood states.
Psychedelic substances, along with other practices like meditation, help put us in a state of flow. These states are characterized by elevated levels of serotonin and dopamine and calming and focussing alpha brain wave oscillations. When in them, we become capable of incredible things.
In The Psychedelic Explorer’s Guide, James Fadiman writes about “Clifford”, a premed student. Clifford shares,
“I was taking a biology course to prepare for medical school, and we were studying the development of the chick embryo…I realized that in order to stay alert, a tiny dose of LSD could be useful.
“With that in mind, I licked a small, but very potent, tablet emblazoned with the peace sign before every class. This produced a barely noticeable brightening of colours and created a generalized fascination with the course and my professor, who was otherwise uninteresting to me.”
Due to some health issues, Clifford ends up missing the final exam. His professor agrees to a make-up. Before the exam, Clifford pops the rest of the now-tiny LSD tablet into his mouth.
The make-up exam consists of drawing the complete development of the chick from fertilization to hatching—the entire course.
“As I sat there despondently, I closed my eyes and was flooded with grief. Then I noticed that my inner visual field was undulating like a blanket that was being shaken at one end. I began to see a movie of fertilization!
“To my utter amazement, I was able to carefully and completely replicate the content of the entire course, drawing after drawing, like the frames of animation that I was seeing as a completed film!
“It took me an hour and a quarter drawing as fast as I could to reproduce the twenty-one-day miracle of chick formation. Clearly impressed, my now suddenly lovely professor smiled and said, ‘Well, I suppose you deserve an A!’ …the gentle wonder of life was everywhere.”
While impressive, Clifford’s account, like Nelson’s, is merely an anecdote. Far more research is warranted.
Micro-Dosing for Mood
Micro-dosing allows individuals to tap into the 5HT2A receptor-stimulating, BDNF-increasing, DMN-uncoupling, and flow state activating benefits of psychedelics, without the mind-stabilizing effects.
At a sub-perceptual doses there are no weird colours and visuals, alternate realities, or ego deaths. Micro-dosers report that the world merely appears brighter, or that they feel “sparklier”—they experience greater well-being. Otherwise, they can proceed with their lives normally.
Fadiman’s micro-dosing protocol consists of taking a tenth of a full dose, about 10 to 20 mcg of LSD, or 200 to 500 mg of dried-weight psilocybin mushrooms, every three days. This means that if the first dose is taken on Monday (Day 1), then the second dose is taken on Thursday (Day 4). According to Fadiman, spacing doses avoids tolerance, keeping the doses effective.
Participants are encouraged to engage in their daily activities: working, eating, sleeping and exercising normally.
Fadiman recommends participants keep a record of mood, cognition, motivation and productivity. People often report that they feel the best on Day 2, the day after taking a micro-dose.
Drawbacks to Micro-Dosing
In my role as a naturopathic doctor, I can’t recommend or counsel on the use of psychedelic substances for the treatment of any health condition. While the scientific interest in their use as therapeutic agents is growing, these substances are illegal to obtain and possess, and there is a lack of solid research on their safety and efficacy.
As of right now, the only way to legally access psychedelic therapies is through research. MAPS, the Multidisciplinary Association for Psychedelic Studies, often lists recruitment opportunities for ongoing studies. Thomas Anderson, at the University of Toronto, is in the stages of obtaining Health Canada approval for a randomized control trial on the benefits of micro-dosing in healthy volunteers.
Like all therapies, there are risks to taking these substances, even at low doses. While LSD and psilocybin confer a low risk for addiction and are ten times less harmful than alcohol (the harm scores of LSD and psilocybin are 7 and 5, respectively, compared to 72 for alcohol), they are not completely benign.
Psychedelics can aggravate schizophrenia, psychosis, dissociation, severe anxiety, and panic. They can also interact with medications and supplements that act on serotonin pathways. Their effects at high doses can be disorienting and oftentimes unpleasant: in the studies that showed positive benefit, they were administered under careful supervision, in a therapeutic set and setting.
Our society’s mental health is in crisis. As a clinician who focuses on mental health, I am always excited to learn of new therapies that have the potential to heal mood. With Canada’s 2018 legalization of cannabis, gateways are opening for future uses of psychedelics as medicine. Perhaps with more research and advocacy, we’ll one day see micro-dosing of psychedelic substances as a safe and effective mainstay therapy for promoting mental and emotional well-being.
When it comes to improving mood, most of us will do anything, including taking boatloads of pills.
One of the challenges I face as a naturopathic doctor is choosing which supplements to prescribe my patients; in the realm of natural medicine we have what seems like an infinite amount of options.
I can prescribe herbs for regulating the stress response, calming inflammation, or Zen-ing out the brain. I can prescribe amino acids, like 5HTP, which help regulate chemicals in the brain. I can recommend the hottest new products, like collagen, or a greens powder, or the newest Superfood. There are also a host of nutrients that the brain and body need for optimal functioning.
I try to keep my list of supplement recommendations to a maximum of 5, letting diet and lifestyle do the rest of the heavy-lifting. This means that I work in layers. When I see a new patient, I start by prescribing nutrients that fill in nutritional gaps. Perhaps my patients are showing signs of deficiency, based on their health histories, diet diaries or blood results; Or perhaps they just need a bit more nutrient support in the face of physical, mental, emotional and environmental stressors. After they start to notice improvement, we might move on to clearing more layers using herbs or therapies, like acupuncture or Mindfulness-Based Cognitive Therapy.
Naturopathic medicine does not believe in one-size-fits all treatment plans. If I see two patients with depression on the same day, both may receive entirely different plans. I base my recommendations on the person and her unique biography and biology, not the condition. However, because I try to keep my supplement suggestions to a minimum, when I work with patients with depression, I find these 5 nutrients continue to appear on my list.
1. Fish Oil
While most anti-depressant therapies target the brain, we know that depression isn’t simply a brain disorder. Depression is a complex condition impacted by our genes, physical health, social and physical environments, early childhood traumas, current stressors, nutrients status, and many other factors. Our minds and bodies are connected and therefore depression is as much a product of the health of our bodies and our environments, as it is of our brains.
Mounting evidence shows that inflammation in the body plays a major role in depression. Since the 90’s, scientist have found inflammatory cytokines (immune system molecules that cause inflammation), like IL-6 and TNF-a, elevated in depressed individuals.
When pro-inflammatory substances, like lipopolysaccharide (LPS) or interferon-a, traditionally used to treat hepatitis C, are injected into healthy individuals they cause symptoms of depression like lack of motivation and pleasure, and feelings of sadness.
Anti-inflammatory substances are effective anti-depressants. The omega-3 fatty acid eicosapentaenoic acid, or EPA, found in fatty fish like salmon and sardines, is a well-known anti-inflammatory nutrient. One study found that supplementing with EPA prevented depressive symptoms in individuals who were injected with interferon-a.
Fish oil contains the omega-3 fatty acids EPA and docosahexaenoic acid, or DHA. Both of these marine omegas are found in certain fatty fish, which can be remembered by the acronym SMASH: sardines, mackerel, anchovy, salmon and herring (also trout). Fish oil supplements combine EPA and DHA. DHA is a component of our brain mass. It is needed for developing the brain and nervous system of growing babies, and is indicated in pregnant and breastfeeding women. EPA confers the anti-inflammatory benefits.
A meta-analysis composed of 15 randomized control trials involving almost 1000 participants, found that fish oil was an effective therapy for treating depression as long as the fish oil contained over 60% EPA relative to DHA.
Another review of three studies, showed that omega-3 fish oil supplementation reduced depressive symptoms in children and adults by 50%.
When it comes to supplementing with fish oil for depression, it’s the EPA that counts, not the DHA. Also, more fish oil seems to be better than less. Studies that showed the best anti-depressant actions dosed participants with at least 1 gram of EPA per day. Some studies gave patients 2 grams of EPA or more per day. Supplements that showed the most benefit contained higher amounts of EPA relative to DHA.
A 100-gram serving of wild Atlantic salmon contains about 400 mg of EPA, while farmed Atlantic salmon, surprisingly contains more: 700 mg of EPA per 100 grams. While consuming fatty fish, like sardines, and pasture-raised, rather than grain-fed, animals can increase our dietary ratio of omega 3 to omega 6, which has general health benefits, supplementation with a high-EPA fish oil is probably necessary to supply the 1 to 2 grams of EPA per day that have been shown to reduce depression.
2. An Active B Complex
B vitamins are cofactors for thousands of reactions in the body. Cofactors are “helpers”. They help enzymes and cellular process work—without these helpers, important jobs just don’t get done. This can have major implications for our mental health.
For example, the vitamins B6 and folate are needed to convert the amino acids tryptophan and 5HTP to serotonin, the “happy hormone”. Serotonin is a neurotransmitter responsible for managing mood: soothing depression and anxiety; and regulating appetite, memory, and sexual desire. Serotonin is the main target of conventional anti-depressant therapies, SSRI (selective serotonin reuptake inhibitor) medications, which raise brain levels of this chemical.
Both B12, which is important for energy production and neuronal health, and folate, which is important for DNA repair, detoxification and reducing inflammation, have been found to be low in patients with depression. A B12 deficiency, resulting in fatigue, memory loss and low mood, can also mimic the symptoms of depression.
It’s important to supplement with an active form of the B vitamins. This means buying and consuming a B complex or multivitamin that contains B12 and folate in their active forms: methylcobalamin and methyl-folate (or 5-methyltetrahydrafolate, or 5-MTHF), respectively.
Individuals who have a genetic mutation that prevents them from efficiently converting folic acid (a synthetic vitamin found in cheap supplements and fortified grains, like wheat and rice) to active folate, are highly represented in the major depressive disorder population. This gene is called MTHFR C677T and is associated with lower blood levels of folate and an increased risk of depression. To learn more about folic acid and MTHFR mutations, read my article here.
B vitamins are also needed by the mitochondria, the “powerhouses” of our cells. By helping our mitochondria work properly, they help reduce inflammation, boost energy production and promote antioxidant synthesis.
We can find B vitamins in egg yolks and liver. The only dietary sources of B12 are found in animal foods, making it difficult for vegans and vegetarians to get without supplementing. Folate is abundant in leafy greens.
Physical, mental, emotional and environmental stressors create a higher demand for the B vitamins. The B vitamins are water soluble, excreted in the urine and not stored. Therefore, to support neurotransmitter synthesis and energy levels in my depressed patients, I often prescribe a good-quality B complex supplement to complement their diets.
3. Magnesium
Because my clinical focuses are mental health, hormones and digestion, I prescribe magnesium to virtually every patient I see—magnesium is an important nutrient for all of these conditions.
Like the B vitamins, magnesium is a cofactor. It’s involved in helping with over 800 chemical process in the body that simply won’t get done without it. We need magnesium to make cellular energy in the mitochondria, to produce neurotransmitters, like serotonin, and to repair DNA, among many other jobs.
Due to soil deficiency, low intake, stress and decreased absorption, it’s estimated that about 40 to 60% of North Americans are magnesium deficient. Only 1% of the magnesium in our bodies is present in blood. Blood levels don’t reflect the body’s magnesium stores, and so testing for deficiency is unreliable.
Magnesium is a potent muscle relaxer. Deficiencies show up wherever muscles are contracted, rather than relaxed: this can include constipation because of poor intestinal motility, muscle aches and pains, frequent urination due to contracted bladder muscles, menstrual cramps, and headaches and high blood pressure from constricted blood vessels. Insomnia, anxiety and sensitivity to loud noises can also all be signs of a magnesium deficiency. PMS, insulin resistance and sugar cravings are all further indications for magnesium supplementation.
Magnesium can be obtained from leafy greens like spinach and chard. However, most individuals need to supplement to stock up their magnesium levels, particularly if experiencing stress, fatigue, anxiety or depression. Like the B vitamins, magnesium is water soluble, excreted in the urine in response to stress.
A 2017 randomized control trial published in PloS One, found that 248 mg of magnesium chloride decreased the PHQ-9 score of those with mild-moderate depression by almost 5 points. This result compares to standard anti-depressant medications. Despite the relatively low dose and inferior form of magnesium, the effects were well-tolerated and benefits were seen in 2 weeks.
I prescribe magnesium glycinate, a much better-absorbed form, before bed to help patients sleep better. This means starting with 100 to 200 mg per night and increasing by that amount every 3 to 4 days or until patients are having a bowel movement on waking—this is called “prescribing to bowel tolerance”.
A side effect of taking too much magnesium is loose stools, or soft stools that fall apart in the toilet on flushing, which can be corrected by lowering the dose. I personally take about 900 mg of magnesium at night to manage my stress, mood, energy levels and muscle tension.
4. Vitamin D
About 70 to 90% of North Americans are deficient in vitamin D, which acts like a steroid hormone rather than an actual vitamin, and regulates over one thousand genes in the body. Our skin makes vitamin D when it comes into contact with UVB radiation from the sun. Those of us who live in northern climates with limited sun exposure don’t make enough vitamin D and need to supplement, especially during the Winter months.
Vitamin D is needed to regulate the gene Tryptophan Hydroxylase 2, which converts the amino acid tryptophan (a component of protein that can only be obtained from diet and is found in foods like turkey and pumpkin seeds) to serotonin in the brain.
Low vitamin D concentration has been associated with depression, however researchers aren’t sure if the relationship is causal: does low vitamin D status put someone at risk for developing depression? Or do depressed individuals have low vitamin levels in their bodies because of some other factor?
Studies have failed to show that taking vitamin D supplements impacts depression. I also haven’t found vitamin D to impact my patients’ moods as a solo therapy. It’s likely that nutrients like vitamin D acts as part of a network, in conjunction with other vitamins, like magnesium, which is responsible for converting supplemental vitamin D into the active form. Vitamin D is a fat-soluble vitamin, and taking it in chalky tablet form may not raise levels. I prescribe vitamin D3, the active form of the vitamin, in drop form. Vitamin D drops are suspended in fats like coconut or flax oil, which makes them easier for the body to absorb.
Whether a case of the chicken or the egg, when it comes to vitamin D and mood, we know that supporting vitamin D status is essential for achieving optimal health, managing immune function, reducing inflammation, reducing the risk of osteoporosis, and regulating mood, given vitamin D’s role in serotonin synthesis.
The Framingham study found that patients who had low levels of vitamin D had poorer mental functioning and reduced volume of a brain region called the hippocampus, which is responsible for memory formation and mood regulation. Reduced hippocampal volume is a risk factor for and consequence of major depression.
There is a “sweet spot” to optimal vitamin D levels; because it’s a fat-soluble vitamin and can be stored, too much vitamin D may be as bad as too little. Therefore, I like to measure my patients’ blood levels in the Fall to determine the right dose for supplementation. 4000 IU a day is a good, safe dose for most people during the Winter months.
5. Zinc
Zinc is the catalyst for hundreds of enzymes in the brain, including making serotonin, norepinephrine and dopamine, all of which are brain chemical targets of anti-depressant therapies.
There is a major concentration of zinc in the hippocampus, a brain region affected by depression. Studies show that zinc plays a role in supporting neurogenesis (the creation of new brain cells) by stimulating Brain Derived Neurotrophic Factor (BDNF). BDNF creates new brain cells and boosts mood. Anti-depressants may work by increasing brain levels of BNDF, protecting the brain against stress.
Plasma zinc concentrations are lower in major depressive disorder. Animal studies also show that depleting zinc can lead to major depression.
Zinc supplementation has been shown to boost mood. A study of 50 overweight or obese patients were assigned to receive either 30 mg of zinc or placebo. After 12 weeks, the group who received zinc experienced a greater reduction in the severity of their depression and an increase in the levels of BDNF in their brains.
Zinc is also an important nutrient for supporting the immune system and managing inflammation.
Besides depression, other signs of zinc deficiency include skin issues, like dry skin and acne, infertility, issues with gut membrane integrity (leaky gut), hair loss, low testosterone, poor immune function and fatigue.
Dietary sources of zinc are harder to come by for vegans and vegetarians, who are at a higher risk for developing a zinc deficiency. Zinc can be found in red meat, shellfish, lentils and pumpkin seeds.
I typically prescribe zinc the way I prescribe iron, in pulse doses: I recommend that patients work their way through a bottle of zinc (taking 30 to 100 mg per day), while we assess whether symptoms improve. Unlike iron (which we can measure more accurately by looking at its storage molecule ferritin), zinc can’t be accurately measured in blood. Like magnesium, zinc deficiency in the body’s tissues may be present long before low zinc levels show up in blood.
While this list can be a great tool for anyone interested in supporting their mood through boosting nutrient status, keep in mind that this information is not a substitute for medical advice.
I believe it’s essential to work with a naturopathic doctor, or a functional medical doctor, who can make the appropriate recommendations for your individual health needs. A personalized consultation that assesses your diet, blood work, health history and specific symptoms, can help you hone your list to come up with a dynamite nutrient plan that’s specifically tailored to you.
