Fighting Depression Safely and Effectively - Online Conference Transcript

Natalie is the RealMentalHealth.com moderator

The people in blue are audience members

Natalie: Good evening. I'm Natalie, your moderator for tonight's Depression chat conference. I want to welcome everyone to the RealMentalHealth.com website. We are fairly new on the internet, but already we have several thousand people in our social network. The social network is a place for people with mental health conditions as well as their family members and friends to meet each other, maintain blogs and provide and get support, and it's free to join.

Tonight, we are going to discuss how to fight depression safely and effectively.

Dr. Michael B. Schachter, our guest tonight, is a board-certified psychiatrist and author of the book: What Your Doctor May NOT Tell You About Depression: The Breakthrough Integrative Approach for Effective Treatment. Dr. Schachter graduated magna cum laude from Columbia College and received his medical degree from Columbia in 1965. He has been involved with alternative and complementary medicine since 1974 and is a recognized leader in orthomolecular psychiatry and nutritional medicine.

Dr. Schachter maintains that you can effectively deal with depression through healthy living and eating habits as well as by using supplements, vitamins, minerals and other non-prescription treatments.

Good evening, Dr. Schachter and thank you for joining us. What is it that your doctor may NOT tell you about depression?

Dr. Schachter: Many factors may contribute to a person’s depressed state and many of them are not considered by conventional physicians or psychiatrists. Among these factors are: one’s diet, toxic factors (such as artificial sweeteners), suboptimal levels of vitamins and minerals like the B complex, magnesium and zinc, hormonal imbalances, deficiency of various neurotransmitters (such as serotonin or dopamine), lack of activity and exercise, adverse effects of many medications (such as blood pressure medications and even antidepressants) and diseases (such as Lyme disease). All of these things should be considered when evaluating a depressed patient, but the typical response of most conventional physicians and psychiatrists is to write a prescription for an antidepressant medication.

Natalie: I think many people believe that depression really results from two things: 1) a bad situation the person may be in, or 2) something is wrong with their neurotransmitters. Are you saying there's more to depression than that?

Dr. Schachter: Yes, many other factors need to be considered, such as hormone imbalances, diet, nutritional deficiencies, toxicity etc..

Natalie: A lot of people, medical professionals and patients alike, maintain that “alternative or complementary medicine, things like nutritional supplements, vitamins and diet regulation, are a lot of bunk and just don’t work when it comes to treating something as serious as depression. Using these natural methods of treatment, what results have you seen?

Dr. Schachter: Our results in treating depressed patients are excellent. It is almost like solving a jig saw puzzle trying to figure out which of the many factors mentioned previously are playing a significant role in this particular patient’s depression. Once you get the right combination, patient’s improve without the significant potential side effects of medication.

Natalie: So what does a typical exam for a patient presenting with depression look like when they come to your office?

Dr. Schachter: In our practice, we occasionally prescribe antidepressant medication, but generally as a last resort, rather than a first option. We usually will try various natural treatment first. If these are not sufficient, we will usually add an antidepressant to the program, using as low a dosage as possible to try to avoid adverse effects. Frequently, when using various non-drug adjuncts, the dosage of antidepressant can be much lower.

Natalie: How do you determine what is causing the person's depression?

Dr. Schachter: We recommend a thorough evaluation with a full medical and psychological history, including what medications have been taken recently, a dietary evaluation, a variety of tests that may include: various vitamin levels (like vitamin D and B12 and others), a search for mineral toxicity (such as mercury), and mineral deficiencies, a urine test to measure neurotransmitters (like serotonin and dopamine), a saliva test to measure various hormones (such as DHEA, cortisol, sex.) From this assessment, the treatment evolves. However, we have some general rules about avoiding sugar, caffeine, alcohol and tobacco and do give each patient a list of things to avoid and other things that are desirable.

Natalie: I noticed that you mentioned earlier that you do give patients antidepressants on occasion. Do you believe they are effective in treating depression and in what instances would you recommend a patient take them?

Dr. Schachter: In our practice, we occasionally prescribe antidepressant medication, but generally as a last resort, rather than a first option. We usually will try various natural treatment first. If these are not sufficient, we will usually add an antidepressant to the program, using as low a dosage as possible to try to avoid adverse effects. Frequently, when using various non-drug adjuncts, the dosage of antidepressant can be much lower. Also, in some very serious depressions, we might start the medication right away along with other measures we might use.

Natalie: Are there different treatments for the different symptoms of depression?

Dr. Schachter: Yes. The symptoms often give clues as to what a person needs. For example, a person who is lethargic, has dry skin, has gained weight and is constipated, may be suffering from an essential fatty acid deficiency as well as a low functioning thyroid gland. One who is anxious and agitated as well as depressed, may have excessive neuroexcitatory neurotransmitters along with a deficiency of serotonin. These need to be corrected starting with trying to correct the excitatory symptoms first.

Natalie: One of the things you focus on in the book is eating the proper foods. Why is that important?

Dr. Schachter: Proper eating is important to treat depression and any other chronic conditions. Within our body, we have trillions of cells and an almost infinite number of biochemical reactions occurring each minute. In order for these biochemical reactions to work properly, the building blocks must be present. These building blocks come from our food. For example, our neurotransmitters (the messages that are transmitted from one nerve cell to another) are made from certain amino acids (like tryptophan or tyrosine). These amino acids come from protein. If a person has insufficient protein in his diet, he may become depleted of serotonin or dopamine and thus become depressed. Other examples may include deficiencies of the essential fatty acids necessary to build the membranes of our nerve cells. A person that eats and drinks primarily a junk food diet will be deficient in vitamins, minerals and other important nutrients. The importance of a good diet cannot be overemphasized.

Natalie: Will a poor diet eventually lead to depression or rather is it a symptom of depression?

Dr. Schachter: A poor diet may certainly contribute to depression in many people. But, a person who is depressed may tend to gravitate to a poor diet for many reasons. For example, a depressed person will frequently want sugary foods or caffeine to get a quick fix. Unfortunately this may lead to stress on the adrenal glands and an overall worsening of the condition.

Natalie: You break foods down into 2 lists: "Positive Foods" and "Foods to Avoid." Can you please briefly outline some in each category?

Dr. Schachter: We suggest whole foods (as opposed to processed highly refined foods). Use organic foods as much as possible. Eat lots of vegetables, legumes, some fruits, good protein (including meat, fish and poultry), healthy organic nuts and seeds, organic whole grain grains and pure water. Organic dairy products are fine for some people, but the diet must be individualized somewhat. Stay away from or greatly limit sugary foods, fried foods, cakes, candies, ice cream, white breads, bagels, white pastas and refined carbohydrates in general.

SMD84: How do you correct an imbalance in the neurotransmitters?

Dr. Schachter: Neurotransmitters are made from amino acids. For example, tryptophan or 5 HTP is converted to serotonin in the body. The amino acids Phenyl alanine and tyrosine are converted to dopamine and norepinephrine. By ingesting the amino acid of the neurotransmitter that is low, you can reestablish balance.

There are basically 2 classes of neurotransmitters. They are either excitatory or inhibitory. An excess or deficiency of either class can cause problems. There are also a variety of substances that can modulate both the inhibitory and excitatory. The major inhibitory neurotransmitter is GABA, while the major excitatory neurotransmitter is glutamate. Serotonin usually enhances GABA activity, while norepinephrine tends to be involved with enhancing excitatory activity.

When treating depression, it is usually best to first enhance inhibitory activity to quiet the system down. After a few weeks, we focus on enhancing neuroexcitatory activity.

cocoa 1: David Burns suggests there is no clear indication that serotonin causes depression. He says there is not one study in the world that convinces him of that and that is his area of expertise. what convinces you that it does?

Natalie: David Burns is the author of "When Panic Attacks"

Dr. Schachter: Well, I'm not sure exactly what he means, but our experience in doing urine neurotransmitters is that when serotonin is low (compared to a norm for healthy non-depressed people, there frequently is depression. When we administer 5HTP which stimulates serotonin, the person frequently improves and the serotonin in the urine increases. We have hundreds of cases to show this and the lab that does this testing, has thousands of case histories and lab results to support this. I wouldn't say that "serotonin causes depression", but a deficiency in it seems to contribute to depression in many cases.

jdiamond: Do you have any recommendations about which natural health products have had effective results? Any types which are not an appropriate product used to manage depressive symptoms? (ex. vitamins, or prepared homeopathic remedies)

Dr. Schachter: There are many so-called natural products that are beneficial. These may include: targeted amino acids, essential fatty acids, certain herbs like rhodiola and St.John's Wort, minerals like Magnesium Taurate, essential fatty acids as contained in fish oil, flaxseed oil and evening primrose oil. Also, a variety of homeopathic remedies may be useful. When dealing with depression, the homeopath needs to be well trained and be aware of the dangers of aggravation that may occur. We have chapters on each of these areas in our book "What Your Doctor May Not Tell you About Depression." Regarding supplements to avoid, I would stay away from supplements that contain artificial coloring or flavoring (which some people react to) and be aware if he fact that it is possible to create imbalances with natural substance also.

Natalie: One of the things I'm gathering from our conversation and your book is that treating depression EFFECTIVELY is more than just taking an antidepressant or even vitamins or supplements. It's really an entire lifestyle issue too.

Dr. Schachter: Yes. I believe this is correct. For example, exercise is extremely important. Some studies show exercise to be more effective and longer lasting than antidepressants. Fresh air and sunshine also appear to be important. Looking at one's eating habits, exercise patterns, supplements, exposure to sunlight and fresh air all are important in an overall approach to managing depression.

karenblibra: How does a person find a trained professional like yourself who can treat depression naturally / holistically?

Dr. Schachter: Our book has an appendix which lists some resources. Many well trained naturopathic physicians and integrative physicians use the approach we discuss in our book. We also mention some websites that list practitioners who try to practice using these principles. One organization that I have been involved with for more than 30 years is the American College for Advancement in Medicine (ACAM). You can go to their website at: www.acam.org, click on find a physician and put in your zip code. Various physicians will come up and there will be codes indicating the kind of work they do.

Natalie: Dr. Schachter, what about people who have been on antidepressants for many years, 5+ years. Can they possibly be taken off the antidepressant and put on your regimen and have it be effective?

Natalie: Dr. -- one audience member wanted to know if your book also talks about the causes of depression as well as the treatment recommendations?

Dr. Schachter: That is the subtitle. The Major Title is: What Your Doctor Many Not Tell You About Depression (Warner Books). The book is all about the possible causes and how to evaluate them. It begins with a few chapters where questionnaires are used to help determine what causes may be present. It is important to think about depression in a multidimensional way. Is it related to fatty acid deficiency? Could a low functioning thyroid (even with normal thyroid function tests be involved? Is the adrenal gland weak and stressed leading to depression? Could the toxic mineral mercury either from dental fillings or too much sushi playing a role in the depression? The book tries to address all of these factors and helps the reader to recognize what factors may be important

Natalie: Our time is up tonight. Thank you, Dr. Schachter, for being our guest, for sharing this information on safely and effectively treating depression and for answering audience questions. We appreciate you being here.

Dr. Schachter: Thank you.

Natalie: I encourage everyone to sign up for our newsletter. It's free and we'll notify you of events happening on the www.RealMentalHealth.com website: and you can sign up for the first and only social network for people with mental health conditions as well as their family members and friends.

 Thank you everybody for coming. I hope you found the chat interesting and helpful.

Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Reviewed: 02/2007