The Holistic Treatment Of Depression
The Resilience Medicine Approach
Holistic Depression Treatment Overview
Intro To Holistic Depression Of Treatment
Depression is a complex illness and no one person’s depression is exactly the same, which is why standard drug approaches are ineffective in 29-46% of cases. For example, we know that many people do not respond to SSRIs, especially if there are elevated biomarkers of inflammation.
Two people with the same diagnosis of depression may respond completely differently due to having different depression triggers, genes and epigenetic changes and life experiences. Depression is a final common pathway rather than a single illness
Chronic Illness & Depression
Depression often comes alongside other symptoms and conditions too such as chronic pain conditions, neurological conditions, connective tissue disorders including EDS (elhers danlos syndrome), chronic fatigue/ME and long covid. These conditions can also cause depression and anxiety or worsen it. Depression can often set in after years of coping with a chronic illness, even if you weren’t depressed before due to the disruption of life caused by your illness.
When you have multiple health problems, these symptoms can start to overlap and be confusing to tease apart, especially since standard specialists only treat symptoms in their area and rarely consider cross-field research.
This often leads to multiple ineffective or high side effect drugs and fragmented care. Chronic pain or chronic fatigue can also cause brain patterns of ‘retreat and avoid’ due to the brain trying to go into protective mode, leading to depression on top.
So treating these causes of depression holistically at the same time is really important, especially for the ‘brain fog’ and fatigue components of depression that conventional medications rarely help with. Depression in the context of chronic illness is often under-recognized and under treated and this negatively affects overall quality of life.
Without addressing these things together, it can be a frustrating cycle of worsening mood, feeling your life getting smaller and feeling less hopeful of getting better as time goes on. This often comes along with trying and researching multiple treatments on your own which can be exhausting and confusing. An evidence-based holistic approach can help connect the dots and remove overwhelm so you can find your path back to health again.
The Integrative Medicine Understanding of What Causes Depression
Depression is an acquired condition but there are genetic factors too, such as having a first degree relative with depression or another mental health condition. The causes are now known to be multifactorial and not simply a ‘serotonin deficiency.’ Depression is more like a final common pathway than a single same disease process.
The exact mix of factors is slightly different for different people and involve:
- Cognitive brain neural networking
- Hormone changes
- Inflammatory chemicals
- Neurotransmitter levels
- sleep wake cycle regulation.
- Lifestyle factors such as sleep patterns, exercise and diet
- Toxic chronic stress
- The Microbiome and Gut-Brain Axis
- Environmental influences including toxin exposures
- Trauma history
- Pain conditions or other chronic illness
- neurodiversity-adults and young people with ASD often get depressed especially if ASD goes unrecognized due to mental distress and overlap with ‘ASD burnout.’
Often as the lead up to the first time you become depressed, significant stressors are involved. These can trigger a complex web of interactions that results in depression in the brain. In recurrent or chronic depression, meaning depression that stays for years or that comes back after a period of recovery, your brain is more vulnerable to these stressor triggers, due to a brain-driven process called kindling.
Kindling in Chronic Depression
Kindling involves central nervous system dysfunction and decreased neuroplasticity (the ability of the brain to build new cells and adapt). That is why novel medicines like medical cannabis as well as ketamine therapy, both now available in the UK, which work on neuroplasticity networks can be more effective than traditional drugs and make a huge difference in the ability of the brain to recover.
With chronic or recurrent depression and the kindling effect, your brain also develops more sleep dysfunction patterns, such as decreased slow wave sleep and this can further contribute to brain dysregulation.
This is another symptom that can be addressed with a holistic integrative approach to restore healthier sleep to improve mood, which may include things like biofeedback, mindbody approaches and medical cannabis to aid sleep.
The Resilience Medicine Toolkit for Depression
The Resilience Medicine Holistic approach to treating depression incorporates cannabinoid (cannabis-based) medicines, mindbody approaches, diet and microbiome, prescribed combinations of supplements, nutraceuticals & medications, and creating a resilience environment. These things when stacked together result in a synergistic effect, where the overall result is bigger than the the sum of each part.
Often people have tried many things from meditation to medications and it has failed to help but it’s finding the right combination of interventions done at the right time that can lead to successful recovery even in difficult to treat depression.
In the clinic, we also use functional medicine tests and approaches to further personalise treatment based on biomarkers, gut markers and genomics in some cases. These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients.
It can be very overwhelming and confusing trying to navigate all of the pieces of a holistic treatment plan on your own. Having expert guidance and a system to measure your progress helps remove this overwhelm and makes sure you are on the best treatment path.
This is a new way of thinking about depression treatment that goes beyond a ‘disease management’ system but aims to enhance quality of life, energy, reduce anxiety and the total brain and body stress burden to stay well.
Medical Cannabis for Depression
Medical cannabis is a legal medicine in the UK, now available on private prescription from a specialist doctor. Medical cannabis are whole plant medicines which contain over 100 active cannabinoid compounds, which are thought to work together to deliver the medicinal effects although the main cannabinoids used for dosage currently are CBD and THC.
The different strains or chemovars, can produce different therapeutic effects on mood, making it a highly personalized medicine.
Often people have tried recreational high doses of THC and found that this worsened anxiety or caused a panic attack. That is because THC does opposite things in the brain at different dosages and with vs. without CBD. Medical cannabis for mood is very different to recreational cannabis.
For depression, specific strains and types of medical cannabis are chosen for day vs nighttime, so it is most effective for lifting the mood during the day and helping restore deeper sleep at nighttime.
Medical Cannabis works on our endocannabinoid system (ECS) dysregulation, our HPA axis stress response system as well as our serotonin system and inflammation pathways. All of these mechanisms are involved in anxiety according to the latest research.
Medical Cannabis can help patients who have failed other approaches, to get a quick win in terms of anxiety symptom relief and starting off a positive neurological ‘cascade’ leaving them more able to engage with other aspects of a holistic treatment plan. This is akin to the opposite of kindling in depression, because it encourages more neuroplasticity.
Most patients see a significant improvement within the first month of therapy across multiple symptom clusters.
Medical cannabis can be helpful in those who suffer from what is known as ‘treatment-resistant depression’ and related mood disorders where the standard medications and psychotherapy approaches have not been effective to help improve chronically low moods. Medical cannabis can also help with mental function, motivation, sleep disturbance and anxiety and pain, which often affect people suffering with depression and can be very difficult to treat using standard drug therapy.
Medical Cannabis works on all of these seemingly diverse symptoms because it works on a brain and body overarching balancing system called the Endocannabinoid system or ECS. Our ECS is involved with mood regulation, response to trauma and stress, sleep/wake cycles, eating behaviors, motivation, immune response and even gut health.
Medical cannabis works on endocannabinoid system (ECS) dysregulation as well as in the serotonin and other neurotransmitter systems, decreases inflammation pathways and acts via multiple second messenger systems. All of these mechanisms are involved in depression according to the latest research.
Hemp CBD oil wellness supplement products available over the counter at health shops are not the same as medical cannabis. Hemp CBD oil does not contain any measurable THC and are not made as medicines. Generally, they are not helpful in depression for most patients. Many full spectrum hemp CBD products are also very rich in myrcene, a terpene chemical that is very sedating and calming but may not be best suited if you have depression and are already feeling low or sluggish.
Dr Gordon is the most experienced cannabinoid medicine physician in the UK, has trained the first UK psychiatrist physicians in the prescribing of medical cannabis for mood disorders and has treated thousands of patients with medical cannabis first in Canada and in the past few years in the UK since it has become legal. She also uses a more holistic individualized approach to cannabinoid therapy due to her expertise in Integrative & botanical medicine in addition to her conventional medical qualifications.
Altered States and Psychedelics for Depression
Novel Medicines include non-standard medications and compounds often from plants that are being developed as new therapies in areas of medicine where the current standard drugs are not effective. Depression is one of these areas. These compounds are often collectively known as ‘therapeutic psychedelics’ or fast-acting novel psychotherapeutics.
Currently available as a legal medicine and treatment for treatment resistant depression in the UK privately, ketamine therapy can be very effective. It can often be combined with medical cannabis and other holistic approaches for shifting even the most difficult cases of long-standing severe depression.
Psilocybin, still in the research phase only in the UK, is showing very promising preliminary outcomes for treatment resistant depression and has recently been granted ‘breakthrough drug’ status in the USA. In some jurisdictions where it is legal, it is already being used as a clinical treatment for depression.
Long before their use in modern medicine, many of these compounds have been used in different cultures around the world since ancient times to help reduce suffering and to facilitate personal transformation and healing.
After a ban on studying these compounds for many years in many countries has been lifted, the research and body of evidence is catching up quickly. More of these compounds will likely be available as legal medicines in the not too distant future and hold promise for depression specifically.
Mindbody Medicine for Depression
Because many people with depression also suffer from anxiety, relaxation response techniques can help lower stress and anxiety levels which may also help depression indirectly. Other specific techniques such as mindfulness-based programs and compassion/loving-kindness meditation have been shown to have a direct antidepressant effect on the brain and can be combined with other treatments to suit you best.
CBT can be very helpful, especially for certain subtypes of depression known as the ‘cognitive affective’ type but does not work for everyone. Specific forms of exercise can also help too by stimulating endorphin release.
If trauma is playing a role, other types of psychotherapy are more helpful, since CBT is not generally effective for trauma. That is why seeing an expert who can assess all of the factors for your depression is so important to ensure the best of each approach is chosen for you specifically.
Bright light therapy can also be combined with brief morning exercises. To be most effective, the mindbody techniques should be tailored to each patient and combined with other treatments.
Diet and Microbiome for Depression
Specific types of diets may influence and improve depression symptoms according to the newest research, due likely to the mood effects of altering the microbiome as well as affecting neurotransmitter levels.
For example, a modified ketogenic diet, especially for those with certain biomarkers may improve symptoms of depression but can be difficult to stick to, especially without tailoring it to your specific lifestyle and needs.
Another diet tied to reduced risk of developing depression in the first place is a whole foods mediterranean diet. Processed foods and pro-inflammatory diets are also associated with worse depression symptoms and an anti-inflammatory diet has recently become recognized in having a role to play in the treatment of depression due to new research in this area.
However, if you already have depression, changing to a mediterranean diet alone is unlikely to put you into remission.
Different people may respond best to different therapeutic diets based on things like symptom cluster profile, depression type, gut and blood biomarkers and other factors which are assessed as part of a personalized medicine approach.
Medications for Depression
Depression is a complex mental health condition that often requires a multifaceted approach to treatment. While traditional medical treatments such as antidepressant medications, like selective serotonin reuptake inhibitors (SSRIs), SNRIs and tricyclic antidepressants (TCAs), are widely used to manage the symptoms of depression, there is growing recognition that not everyone with depression responds to conventional drug therapy and possibly nearly half of people do not respond fully or at all to these medicines.
Others have intolerable side effects from these medicines and have to stop them. Hence why novel medicines such as medical cannabis and therapeutic psychedelics including ketamine therapy are so promising for people with depression who have failed or can’t take these drugs.
Supplements for Depression
Supplements and Nutraceuticals from essential nutrients and single molecules and trace minerals to botanicals, medicinal fungi and adaptogens may all be helpful for different aspects of depression. It’s important to get the dosage and combination right and personalized to you in order to be effective. For example, most drug store supplements have ineffective dosages or single ingredients that lack the synergistic effect and are usually ineffective for clinical depression. Supplements on their own are usually not enough to put you into remission, but instead should be part of a holistic approach. Each person will likely have a slightly different ‘stack’ of supplements based on their specific case but may include:
- SAM-e (avoid in bipolar depression)
- Folic acid
- Vitamin D
- specific probiotics
- Cordyceps and Lionsmane Mushrooms
- Saffron standardized extract
- St. Johns Wort
- High EPA omega 3s
- Trace minerals including elemental ultra low dose lithium orotate
- mitochondrial support nutraceuticals such as NAD+ precursors in sluggish depression
Resilience Environment for Depression
Our environment also interacts with our genes to influence how we respond to our external environment. For example, if you have the genotype for certain enzymes not working as strongly as they could, you may be more sensitive to the effects of pollutants in the environment, which can influence a wide variety of health symptoms including impacting mood balance.
Even factors not normally considered as part of depression treatment, such as air quality and air pollution are now a recognized risk factor for developing depression. Improving indoor air quality through using a high quality air purifier in the bedroom as well as the main living room of the house if possible may be helpful, making sure it filters things like mold spores as well as small molecules from chemical ‘off gassing.’
Having plants which clean the indoor air and also have been shown to have positive mood benefits is another way to alter your environment at home, including plants such as snake plants, spider plants and ferns.
Infrared saunas and cold water immersion therapy may also be helpful to reduce depressive symptoms, but should be done gradually after discussing with a doctor or health practitioner to make sure it’s right for you.
Lastly, neuromodulation and biofeedback devices, used at home, may be prescribed and monitored by the doctor as part of the brain-based holistic approach to treating depression, since these devices have positive studies for efficacy in treating depression even when used as a sole treatment.
Functional Testing for Depression
There is no standard blood test to diagnose depression. In research studies, there are brain imaging patterns associated with depression but not used to diagnose it. Depression is a clinical diagnosis. However, there are some subtypes of depression with higher inflammatory biomarkers.
From stress tolerance and resilience testing to looking at the gut microbiome for mood related markers and looking at inflammatory biomarkers and circadian rhythm dysfunction and mitochondrial function markers, functional medicine testing can play a role in the holistic treatment of depression and in many cases, can help further personalize treatment based on underlying contributing causes of depression.
Depression Patient Case Study
Patient: Simon, 45 years old. First Diagnosed with depression 15 years ago
Goal: improve mood and motivation so he enjoys his young family more.
History: After failing multiple medications including SSRIs, SNRIs and forms of psychotherapy, Simon was frustrated and giving up hope of feeling happy.
The plan: after a thorough integrative assessment that looked not only at his depression but also his sleep, body pain and medical history, Simon was started on a cannabis based medicine to help with his mood, alongside a specific nutraceutical and dietary protocol including a keto-lite diet, brain-gut axis support and a short targeted mindbody practice to be done after taking his evening medical cannabis dose. He was given sleep and stress hormone support to reduce early morning waking and daytime fatigue and mood crashes.
Outcome: 4 months later, his mood was the best it had ever been ‘as far as I can remember’ and he was happier at home and at work & able to truly enjoy spending time with his young children and partner. His sleep improved and he felt more positive about his life and more confident as a parent.
Depression can be really difficult to navigate on your own but you can start feeling better and get well again even if you have tried many treatments that were not effective thus far.
Dr. Dani has helped thousands of patients with difficult to treat mental health conditions including depression over the past 15 years using this approach, first in North America where it is more developed and now in the UK.
Using a specific, personalized holistic approach to depression and related symptoms can dramatically improve your quality of life and help you get well.
To take the next step in your journey, book an initial consultation with our expert physicians.