One of the main reasons why antidepressants are ineffective in large-scale studies is that most physicians have been taught that depression is a single or simple disorder: “Feel depressed, take an SRRI.” After I started looking at the brain 22 years ago, I came to realize that this form of thinking is just wrong. Giving the diagnosis of depression is exactly like giving someone the diagnosis of chest pain. Doctors don’t give people the diagnosis of chest pain because it has too many different causes and wildly different treatments. It can be caused by such diverse things as heart attack, an arrhythmia, pneumonia, an ulcer, anxiety, grief and gas. Giving everyone the same treatment for chest pain is crazy.
Yet depression is the same way. It can be caused by loss, grief, low thyroid, pancreatic cancer, brain trauma, toxins, obesity, diabetes, sleep apnea and more (untreated thyroid problems or sleep apnea are not helped with SSRIs). It is estimated that nearly 30% to 40% of all depressions have underlying medical causes. Without a thorough workup, it is impossible to know what.
At our clinics, we use a more natural approach whenever possible. Two of the underlying principles of our work is “First do no harm” and “Use the least toxic, most effective treatments.” The brain imaging work led us to use natural treatments, such as diet, exercise, and nutritional supplements, as many of the medications seemed to make the brain scans of our patients look worse. For example, benzodiazepines, such as alprazolam or diazepam, caused overall low blood flow states in the brain and caused the scans to look like many of our alcoholic patients. Recently, it was discovered that this class of medication has been associated with an increased the risk of dementia.[iii]
So, what is the “sane” way to treat anxiety and depression?
If you feel anxious or depressed and it lasts more than two weeks, make sure to get a thorough medical workup, including comprehensive blood work that includes a detailed look at your thyroid. Before trying medication, unless your condition is severe, try some simple interventions, such as:
- Exercise (walk like you are running late for 45 minutes a day)! In a study comparing exercise to antidepressants, they were equally effective at 12 weeks, and exercise was more effective at 10 months.
- A healthy, anti-inflammatory diet. Lose the processed foods and sugar, and foods that quickly turn to sugar. A Mediterranean Diet was shown to have antidepressant effects.
- Start taking fish oil to boost omega-3s, especially in the form of EPA. I usually recommend starting with 3,000 mg of fish oil a day.
- Work with a therapist to kill the ANTs (automatic negative thoughts) that fuel depression. Negative thinking patterns provide the gas for anxiety and depression.
- Investigate a new type of treatment called TMS (transcranial magnetic stimulation), which was recently FDA approved for depression with few side effects.
The typical way most physicians diagnose and treat depression looks like this:
Symptoms of depression = diagnosis of depression, leading to largely ineffective treatment and poor outcomes.
Amen Clinics Method
Symptoms of depression + brain SPECT imaging + specific laboratory studies = more targeted treatment and more successful outcomes.
In 1991, my team and I at Amen Clinics started looking at the brain using a study called SPECT imaging. SPECT is a nuclear medicine study that looks at blood flow and activity patterns in the brain. From the first year of doing scans, it became very clear that anxiety and depression were not single or simple disorders, and each patient needed individualized treatment plans. Giving everyone the same treatment was never going to work. SPECT helped us understand why certain people were made worse on antidepressants and why others improved.
At the end of six months, 75% of our complex patients were better across all measures, and 85% had an improved quality of life.[iv] As far as we know, these are the best outcome statistics in our field.
In a scientific study about to be published, using our method, we followed 500 consecutive patients who came to our clinics, using detailed assessment tools. On average, our patients were complicated; they averaged four diagnoses (such as depression, anxiety, ADD and addictions), failed to get better after seeing 3 different medical or mental-health specialists, and had no success with 6 medications. To learn more about our brain SPECT imaging work or other treatments, visit us at AmenClinics.com.
By Daniel G. Amen, MD