Read this before taking antidepressants or if you are already taking them.
Have you seen your doctor with a list of symptoms, some perhaps vague, that include fatigue, brain fog, weight gain, sleep issues, lack of libido and been told something like:
“There is nothing wrong with you; you are just depressed”.
This is often determined without a thorough exam or in-depth labs to rule out various conditions. Before accepting what may just be a default diagnosis, we recommend patients get a thorough workup by starting with some very basic tests usually covered by most insurance plans.
This is not to say Depression is not a very real experience for many people, just that there may be more to it than an inherently broken brain which we are often led to believe. Below is a short list of must do tests when evaluating for this common condition:
1)Vitamin D
It is deemed the “Sunshine” Vitamin for a reason because it functions as more of a pro-hormone and pro-neurotransmitter than just a typical vitamin. Adequate levels are necessary for regulating dozens of processes in the body including upregulating serotonin, testosterone, and insulin receptors and assimilation of several other nutrients. We test almost every patient for Vitamin D and most are deficient.
Optimal number is between 55 and 85.
2)A Full Thyroid Panel- TSH, Free T4, Free T3, Thyroid Antibodies – anti TG/ TPO
These tests measure how well the Thyroid gland is working and goes deeper than a simple screening to look at the active hormones along how the thyroid is interacting with the immune system. As the major regulator of metabolism, people with weight problems, depression, brain fog, and constipation may likely have impaired thyroid function.
3) Highly sensitive CRP
C-reactive protein (CRP) is an excellent marker of both vascular and systemic inflammation. Blood levels of CRP should be under 1.0 mg/L. Studies analyzing thousands of people have shown that elevated CRP is associated with both anxiety and depression. Bringing down systemic inflammation can lower self-reported depression scores dramatically.
4) Homocysteine
This is another marker of vascular inflammation. It is also considered an indicator of how our body is ‘methylating” (a key process in the synthesis of neurotransmitters and several detoxification pathways). People with MTHFR genetic mutations among others are much more likely to have elevated homocysteine and depression or anxiety. We want to see this number under 8.
5) Vitamin B12/ folate
Good levels of Vitamin B12 are essential for brain health but close to 40% of Americans are deficient. There are many causes to this but gut inflammation, poor digestion, and medications like acid blockers suppress the absorption of this and other nutrients.
Folate is also important in the methylation and other processes to synthesize several hormones and neurotransmitter as is B6. Some people need to take very specific or “methylated” forms of these vitamins to correct their deficiencies.
6) Adrenal function panel- Pregnenolone, Cortisol, DHEA
Periods of chronic stress whether physical or mental lock us into fight or flight ultimately depleting us and leaving us feeling anxious or flat. Accurately identifying how adrenal fatigue is manifesting in our body guides us on how to correct it, understand the importance of employing stress adaptation tools from meditation to herbal remedies to get some pep back in our step.
7) Hormones: Testosterone, Estrogen, Progesterone
Symptoms of hormone imbalance: low libido, irregular cycles, weight gain, poor sleep, poor muscle maintenance accompanied by feelings of depression can definitely be attributed to low or high levels of certain hormones. This can affect us at any age, not just middle age or menopause. Often correcting these imbalances through a functional approach that may include bio-identical hormone replacement to elevates or stabilize moods.
8) Ferritin levels
Ferritin is out bodies storage form of iron. It is a much better indicator of anemia than a hematocrit or CBC and yet most doctors don’t check it. Patients can often have a low “normal” hemoglobin or red blood cell count yet very have low ferritin.
When our ferritin stores are low, our body goes into conservation mode and does not as readily replace circulating iron in the red blood cells with fresh iron and therefore it carries oxygen less efficiently. Low ferritin can occur from gastrointestinal malabsorption (medications like PPIs), excessive loss through heavy periods, or lack of good sources in the diet. Levels below 50 have been clinically correlated with fatigue and possibly depression.
9) Genetic panel- MTHFR, COMT, and Others.
Genetic variations may dramatically affect how our bodies function, ranging from how we make serotonin, dopamine, and progesterone, to how we detoxify harmful metabolites. Most of us have heard of 23 and Me which gives a few useful factoids, but most people don’t know we can then run that data through a program, such as Strategene that gives us highly valuable information, allowing us to employ epigenetics.
This deeper layer of information can help us make informed choices on how you can use nutrition, supplementation, and other supportive measures to optimize your genes and feel your best.
10) Bonus test: Comprehensive Gastrointestinal Stool Test
Though the above-listed labs are routine blood work and often covered by insurance. A comprehensive GI test is considered “alternative” and may be totally or partially out of pocket.
The price is usually worth it.
The one we often use looks at the markers for digestion, leaky gut, bacterial dysbiosis and your entire microbiome. If we go back to the premise that all disease and inflammation start in the gut, getting a detailed peek at the inner working of this can give invaluable information to base your healing protocols on. The gut-mind connection is very real.
90% of our bodies neurotransmitters are made in the gut, this fact has been well established for several decades now.
It is important to remember most conventional lab values are set too low, so consulting with a functional medicine or integrative doctor to review your labs in a personalized context is important.
In addition, it is necessary to recognize how several of these physiological factors may layer together with emotional, spiritual, and environmental elements to create the perfect storm of “dis-ease” and that disease could simplistically be called “Depression”. Unraveling the layers to create long term health and healing means seeing each person as an intricate system, not just someone with a broken brain or nervous system that a pill can fix.
If your doctor is not willing to listen, ask the right questions and order the right tests it may be time to find someone who will. Naturopathic or Functional medicine doctors are more likely to understand this framework and help you optimize your total physical and mental wellness for the long term.
If you are feeling depressed and think it might be something more schedule a free 15 minutes consult with one of our docs to learn more about our whole-person approach to wellness.
