How Come They're Happy and I'm Not? (25 page)

Remember to ask your doctor to help you wean off the medications for a minimum of two months. The longer the tapering period, the better. For people who have been on medications for several years, it may take six to twelve months to taper properly. There's no hurry here. It's best to go as slow as possible. If your prescribing physician would like to go even slower, then that is just fine. Weaning off too quickly from the drug can never help—your body's own ability to make neurotransmitters needs time to start doing its job. The above supplement recommendations should help that process. Even when you do not need the medication anymore, weaning off too quickly will negatively affect your brain's ability to make you happy. Also, when you add a supplement, if something does not feel right or any symptoms get worse, you may want to avoid taking that particular supplement as part of the regimen. You can find these individual supplements in a quality health food store or online, or you may order the ones I use with my patients at
www.drpeterbongiorno.com
.

During the weaning process, I strongly recommend scheduling regular acupuncture once or twice a week to help your energy balance as the responsibility for your neurotransmitter production is claimed by your body. Acupuncture can be invaluable to help this process. Also, please be aware that as you move towards the lower doses of medication, it may be appropriate to increase one or more of the supplements by a dose. Remember, to continue to work with your doctor during this time, and if you have any unsafe, difficult, or unexpected feelings, please discuss this with your doctor. I have seen many people do very well with this process, but each individual may need slightly more individualized care or schedules for change.

When you employ 5-HTP, tryptophan, or Saint-John's-wort with antidepressant medications, or even with each other, some people are concerned about serotonin syndrome. This is a situation in
which combined SSRI drugs or a single SSRI drug paired with natural therapies might increase serotonin levels when used together. This syndrome can be characterized by severe agitation, nausea, confusion, hallucinations, fast heartbeat, feeling hot and flushing, coordination issues, hyper reflexes, or gastrointestinal tract symptoms like nausea, vomiting, and diarrhea. Severe cases can cause rapid fluctuation of temperature and blood pressure, mental status changes, and even coma.

Although research shows that giving too many pharmaceutical medications has caused cases of serotonin syndrome, there have been no reports of natural substances causing this syndrome to date, and I have not seen this in my practice using the doses described in this book. Of course, it's best to tell your prescribing physician that you are working with these supplements so you can both carefully monitor your progress and catch any unlikely side effects.

Well, I do not want you to stay on supplements forever either. Although they are probably safer than pharmaceuticals in the long term, a healthy body should be able to sustain itself with food, water, sleep, exercise, and a balanced spiritual life. So once you are off your medications, wait two more months and then start removing the supplements weekly, just as you added them in. Patients do not tend to experience withdrawal when they wean off the amino acids and herbs, but if you feel you do, you can stay on them as long as you need, for the side effects are minimal to none when used at these dosages.

Remember that diet, lifestyle, exercise, doing what makes you happy, meditating, keeping positive messages in your brain, and all the other positive changes you have brought into your life are what really keep you healthy in your mind, body, and spirit. These are core needs for your body that should never be weaned off.

If you start feeling some recurrence of mood symptoms at any point in the future, it's likely your body's way of saying something is not in balance. Please come back to this book, review the changes you made that worked, and get back on that plan. Once you are back on track with these, your body will respond. Please see the Individualized Recommendation List at the end of this book for a complete list of recommendations in this book. Take some time now to check off what you have been doing, what has been working well, and what you need to keep in mind for the future.

Here's a great chance to give you some applause. In psychiatry, most doctors are not well versed in using natural remedies to help drugs work their best, and they are even less versed in helping people get off medications. With this chapter, you have learned how to use natural medicine to allow your body to get the most out of your medications. Even further, you have learned how to support your body naturally in the challenging process of saying goodbye to the drugs. Bravo.

As far as I'm concerned, being any gender is a drag
.

—P
ATTI
S
MITH

Although both men and women are all still from the same planet at this point in human evolution, there are clear differences regarding why each gender can become depressed, how they experience depression, and what it takes to overcome it. My hope with this chapter is to help you refine your depression remedies by learning how your gender influences your depression.

Men and women clearly have different predispositions to psychiatric and emotional issues. Alcoholism, antisocial personality (which is defined as a pattern of disregard for the rights of others), and suicide are more common in men than in women. However, 50 percent more females get depression than males. Along with depression, anxiety, eating disorders, and attempted suicide are also more common in women.

Regarding gender and suicide, about four times as many men kill themselves as do women. So any man with depression needs to be especially monitored. However, it is equally important to remember that suicide attempts are more common in women. This could be because women are more likely to look for support earlier in
the depressive process and use a suicide attempt either consciously or subconsciously as a way to reach out. As a note to my fellow doctors out there, physician suicide rates are higher than people in other professions or the general population, and doctors show suicide rates equally divided between men and women. This is a reminder that no one is immune to the ravages of depression.

Remember, if you are considering taking your life, please immediately visit a hospital, psychiatrist, or other practitioner and explain what you are thinking. Medical professionals can and want to help you. This is where modern medicine and drugs can really help, so please take advantage of this care.

Overall, the stress hormone cortisol is higher in females. Poor blood sugar control, which can be worsened by cortisol, may affect women more than men. This suggests that women may need to pay more attention to blood sugar by checking it with a test (see
chapter 4
), eating frequent small meals, consuming plenty of protein (see
chapter 3
), and possibly adding natural remedies such as chromium and cinnamon, which are known to help the body balance blood sugar levels (
chapter 5
).

Although hormones are obvious factors in the differences between men and women, emotional and environmental factors, like marriage, can also make us react differently than the opposite sex. Stable, happy marriages tend to create healthy mood. Difficulty in marriage relationships is not only a risk factor for depression, but it has also been found to be a predictor of poor participation in and expectation of therapy. People in unhappy marriages do not tend to respond well to depression treatment, regardless of the type, and are more likely to relapse. Divorce raises the risk of depression by 40 percent. In fact, many women I have worked with to wean them off antidepressant medications started these while going through
divorce proceedings as a way to deal with the difficult situation. The problem is, the feelings and coping mechanisms that are covered up by the meds still need to be addressed when the medications are removed.

Ongoing household issues also contribute to mood problems, and vice versa, having a depressed spouse can contribute to marital dissatisfaction, separation, and divorce. Marital therapy attended by both partners, as either a primary or maintenance treatment, can be an important step toward healing. I highly recommend couples counseling if both partners are open to this. A good counselor doesn't necessarily set a goal of saving the marriage but instead helps each person by teaching communication tools so they can figure out what is really best for each person, treating each other kindly and respectfully in the process, no matter the outcome.

Animal studies that mimic human social predicaments have taught us much about what stresses men versus women. I have compiled the most valuable research and applied it to identify stressors in my patients and to offer changes when possible. Review the following list to see which stressors apply to you.

Crowded situations induce social stress in male rats, whereas females are not strongly affected by this condition. I see repeatedly that men can get very stressed when having to deal with crowds on a regular basis. What this means is that maybe a retail job in a busy department store may not be the best place for a man who is prone to depression.

One of my male patients was a manager at Macy's on 34th Street in New York, and as Christmastime neared, he started to get depressed. Although his psychiatrist told him he had seasonal affective disorder, by talking to him about his experience at work, I realized throngs of people were the reason. At first, I thought
maybe he was a bit agoraphobic, meaning he was simply afraid of crowds. But as we talked, it sounded more like depression—the crowding induced his low mood. We opened him up to the idea of taking a different job in the company. Once he took a position in office administration and didn't have to deal with the crowds, his depression didn't come back.

When one rat is pitted against another, defeated males become despondent, whereas female rats are not so affected by defeat. Studies regarding the economic crisis these past few years have seen an increase in male depression and suicide in Western nations. It's likely that this financial defeat weighs heavily on men. If you are a man with depression, ask yourself: Where in my life do I experience conflict and feel like I lose? These situations could be with a boss, a competitor, an in-law, a savings account that is dwindling, or many other forms of defeat.

How can you change this reaction? Write these situations down, and start to think of them as guides. For instance, if you were a boxer and were defeated after twelve rounds, you would want to look at the video to learn what your opponent did to win and what you could do better the next time. The old saying that “it's only a mistake if you have not learned from it” applies here. Each loss can be a winning situation when we take what we need from it and change our habits for the better.

Some studies regularly switched rats from cage to cage so that none of the rats were able to spend much time with each other or acclimate to their social environment. This was very stressful to the female rats, whereas male rats didn't care much.

If you are a woman in a work or home environment that is not stable, think about ways to change your situation to bring a sense of regularity. Sometimes there are other opportunities regarding
places to live or work that might be more in line with your emotional needs. Other studies in humans have also shown that changing sexual partners is generally more stressful for women, but not as much of a stress issue in men.

Animal studies showed that keeping an animal away from the rest of the group led to depressive behavior in females much more than in males. Applying this to people, it seems that living alone is quite taxing on women. If you are a woman who lives on your own, I recommend looking into community involvement, volunteering, and social activity as a way to balance the sense of isolation that can affect some women. In the long term, a roommate or housemate may help the situation.

Years ago, when I was a young research assistant at the National Institutes of Health, I asked my mentor why all our experiments were performed with male rats, not females. He said female hormones were very complicated and would confuse research results, so it was simpler not to use females. I learned later that this is also why most research in humans with conditions such as cardiovascular disease is done with men—at the expense of properly treating the disease in women. My hope with this section is to explain what these differences are, and how to use them to our advantage when treating depression.

Ten to 15 percent of women of reproductive age develop a major depressive disorder—which is slightly higher than the general population's 8 to 10 percent. If you are a woman using birth control pills (BCP), you should know that these little pills are notorious for depleting a woman's body of a number of vitamins and for
lowering brain serotonin and norepinephrine function as well. As a result, BCP can play a role in contributing to depression. As far as vitamins are concerned, one of the most notable casualties is vitamin B
₆
, which is needed as a cofactor to manufacture neurotransmitters. Zinc and iron levels are also known to drop, which may also play a role in depression. While not discussed in the literature, my guess is that extra hormonal processing through the liver due to the BCP leads to deficiency by using up valuable vitamins like B
₆
.

Speaking purely as a naturopathic physician, my preference for my patients would be not to use BCP, especially if they are having mood issues. In a few cases, discontinuation alone helped my patients' low mood. Of course, I also understand that each woman needs to decide what is best and most practical regarding her life. Consider talking to your doctor about other birth control options to see if another is right for you. You may learn about other choices that you could be interested in later even if they are not best for your life situation right now. The idea is to keep yourself educated about your choices and to keep the option of using something other than BCP open.