Introduction to the Holistic Treatment of Depression
The Resilience Medicine Approach to the treatment of Depression with holistic, integrative and cannabinoid medicine.
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.
The Resilience Medicine Holistic approach to treating depression incorporates cannabinoid (cannabis-based) medicines, mindbody approaches, therapeutic diets, prescribed combinations of nutraceuticals & medications, increasing passion and connection and creating a resilience environment using evidence-based and evidence-informed interventions stacked together for to help you feel better faster.
In this article you are going to learn about each of these holistic approaches in detail, how to use them for your healing journey as well as the latest research evidence and review a depression case study using this approach to healing from depression.
Symptoms of Depression
Everyone has their own unique experience with depression but symptoms can include:
- Feeling down, depressed or hopeless
- Little interest or pleasure in doing things
- Fatigue or low energy
- Slowed down physically or the opposite-feeling irritated
- Trouble getting motivated
- Social withdrawal
- Negative thoughts
- Feelings of Overwhelm with decision making
- Appetite changes–eg craving carbs or the opposite–having no
- Sluggish thinking, poor concentration
- Feelings of excessive guilt or worthlessness
- Disrupted sleep-sleeping too much or waking up in the early morning
- Suicidal thoughts or acts
In addition to these symptoms, many patients also suffer from anxiety alongside depression, since anxiety and depression are not completely separate in the brain. In fact, most people with depression, especially with chronic depression also have an element of anxiety. These two things need to be treated together.
Chronic Illness & Depression
Other chronic illness conditions, especially chronic pain conditions and neurological conditions as well as connective tissue disorders, hypermobility syndromes like hEDS and also chronic fatigue and long covid can also cause depression and anxiety or worsen it. So treating these causes of depression holistically at the same time is more effective, 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 undertreated and this negatively affects overall quality of life.
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.’
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.’
Kindling in Chronic Depression
Often as the lead up to the first time you become depressed, significant stressors are involved, since 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 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 involves incorporating interventions from 6 main categories: Cannabinoids & Novel Medicines, Diet + Microbiome, Mindbody, supplements & botanicals, Passion and connection & creating a resilience environment.
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. We also, where needed, use medications, often with prescribed combinations of nutraceuticals.
These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients. Often it is when things from different categories are ‘stacked’ on top of each other to create a unique integrative plan or ‘stack’ that gives the most benefit in depression, since everyone’s illness is slightly different.
It’s also worth remembering that even if you have tried some of these things before on your own, it is often getting the right combination of things done at the right time that makes a big difference.
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 helps remove this confusion and overwhelm and makes sure you are on the best treatment path.
Novel Medicines & Cannabinoids 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 leading drugs are not very effective. These include cannabinoid medicines, from the cannabis sativa plant as well as other compounds collectively as ‘therapeutic psychedelics.’ These include ketamine therapy, which is currently available in the UK in a clinical setting as well as psilocybin, still in the research phase in the UK with ongoing studies showing preliminary positive outcomes for treatment resistant 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.
Medical cannabis is the most accessible novel medicine currently in the UK, where it is legal 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 for depression, making it a highly personalized medicine.
Medical Cannabis can often help patients those who have failed other approaches, to get a quick win in terms of symptom relief and starting of a positive neurological ‘cascade’ leaving them more able to engage with
other aspects of a holistic treatment plan.
Most patients see a significant improvement within the first month of therapy across multiple symptom clusters including mood, stress tolerance, pain, sleep and mental function.
Medical Cannabis for Depression
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 our endocannabinoid system (ECS) dysregulation as well as our serotonin system and also decreases inflammation pathways. All 3 of these mechanisms are involved in depression according to the latest research. To help with mood specific strains and types of medical cannabis are chosen, based on minor cannabinoid and terpene profiles and the mode of delivery into the body so it is most effective for depression symptoms.
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 depression 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 specialization in Integrative & botanical medicine from the US in addition to her conventional medical training as a physician.
Therapeutic Diets 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 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. Often more specific and individualized interventions are needed as part of a holistic approach.
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.
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 pyschotherapy 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.
Testing in 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.
Functional Medicine Tests for Depression
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 also play a role in the holistic treatment of depression, although not relied on to diagnose it. These tests are optional. In some cases, they can help further personalize treatment.
Supplements & Nutraceuticals for Depression
Supplements including nutraceuticals, botanical extracts, medicinal fungi, adaptogens and and minerals may all be helpful for different aspects of depression, depending on the person. Each person will likely have a slightly different ‘stack’ of supplements based on their specific case and will not need all of these but may include:
- Folic acid
- Vitamin D
- specific probiotics
- Cordyceps and Lionsmane Mushrooms
- Saffron standardized extract
- St. Johns Wort
- High EPA omega 3s
- mitochondrial support nutraceuticals such as NAD+ precursors in sluggish 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) 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 to these medicines.
Others have intolerable side effects from these medicines and have to stop them. Hence, novel medicines are so promising for people with depression who have failed these drugs.
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.
Factors such as air quality and air pollution is 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 also a good idea 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.
Passion & Connection
Social connection, bonding and having warm close relationships can have a positive impact on physical, immune system and brain health.
Social connectedness is a protective factor for depression. Even doing one small thing each day like phoning a friend or meeting up for coffee can be a mood booster and reduce isolation, which can improve depression symptoms.
Reconnecting with a passion project or hobby that brings you joy can also help boost mood, but scheduling it in to make sure it happens is key, since if you suffer with low moods the brain can find it harder to stick with it, even though you enjoy it once you get started.
Incorporating passion and connection into your care plan is part of the holistic treatment of depression and something that is often missed in standard medical care, despite the immense (and free) healing potential it can offer.
Case Study for Depression
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 was improved and he felt more positive about his life and more confident as a parent.
In summary, using a specific, evidence-based holistic approach to treating depression and related mood disorders can dramatically improve your mood and quality of life even if you have failed multiple treatments in the past. To take the next step in your journey, book an initial consultation with our expert physicians.