How Come They're Happy and I'm Not? (26 page)

If you decide to take or continue using BCP, then it's very important to take a high-potency multiple vitamin to avoid nutrient depletion. Equally important is to check your iron levels. If you choose to continue taking BCP, avoid Saint-John's-wort, which has been shown in several studies to lower the effectiveness of BCP.

Eating disorders are common among patients with depression. With bulimia, bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting. With anorexia, symptoms are similar, and a person does not eat enough to maintain a healthy weight.

About 95 percent of eating disorder sufferers are female. If you are currently dealing with an eating disorder, then it may be difficult for you to follow the dietary recommendations found earlier in
this book, for attempts to modify food may be a depressive trigger. My work and experience with eating disorder patients has taught me that even if patients have been recovered for years, a sudden food change can bring back old memories and tendencies. As a physician, I tread carefully in this territory.

Blood sugar balance is key when working with eating disorder issues. The steep blood sugar changes that accompany bulimia and anorexia spark depressive episodes—and these episodes continue a vicious cycle of poor eating patterns.

For blood sugar support in cases of anorexia and bulimia, I recommend the following actions in addition to the lifestyle and nutrient recommendations in this book:

• Eat a nutrient-dense breakfast to help balance blood sugar
  
• Eat small frequent meals, up to five small meals a day. Eating as soon as you feel hungry.
  
• Alternate gentle strength training and cardiovascular exercise six days a week.
  
• Take 400 mcg of supplemental chromium every day with food.
  

A few more supplements may be beneficial for alleviating both your mood and the eating disorder. Women with bulimia who were given tryptophan and vitamin B
₆
throughout the day reported improvement in eating behavior, feelings about eating, and mood. It has been observed that both zinc and folate deficiency contribute to depressive symptoms in bulimia, and zinc replacement has promoted increased food intake and weight gain in anorexia patients. About half of patients with eating disorders have evidence of these nutrient deficiencies. Please add to your regimen:

• L-tryptophan: 1,000 mg three times a day
  
• Vitamin B
  ₆
  (pyridoxine): 45 mg three times a day
  
• Zinc: 30 mg twice a day, with a meal
  
• Folate (methylfolate form): 1,000 mcg a day
  

For many women, there's a clear association between the menstrual cycle and depressed mood. Premenstrual syndrome (PMS) refers to a myriad of emotional and physical symptoms that show up five to eleven days before starting a monthly menstrual cycle. The most common physical symptoms include gas and bloating, tender breasts, clumsiness, headaches, constipation or diarrhea, and food cravings (anyone crave chocolate?). For the person with a tendency to be depressed, this time also brings on great fatigue, sad and hopeless feelings, anxiety, low libido, mood swings, trouble sleeping, and low self-esteem. Do these symptoms sound familiar?

Premenstrual dysphoric disorder (PMDD) is a similar condition, but a woman has much more severe depression symptoms, with irritability and tension before menstruation.

My short list below is very helpful in improving mood symptoms around PMS and PMDD. Please note that it's still important to read
chapters 2
through
6
and start working on the bigger picture factors that could be affecting your mood.

• Exercise. Running three miles three days a week can severely decrease symptoms.
  
• Remove sugary foods and other refined carbohydrates from your diet. Instead, eat whole grains. Avoid removing all grains, for sometimes that can create a temporary drop in serotonin, increasing mood symptoms. Add one or two cups of liver-supportive foods (like carrots, beets, dandelion, parsnips, and kale) to your diet every day to help your liver metabolize hormones. Also, add two tablespoons of flax meal every day, for fiber is also a key to helping your liver flush excess hormones.
  
• Have your thyroid checked. Some studies suggest low thyroid hormone plays an especially strong role in PMS and PMDD.
  
• Have your iron and ferritin checked. In many menstruating female patients with depression, serum iron is normal and ferritin is low. Supplement if needed.
  
• Supplement your diet with any of the following:
  
  • Magnesium glycinate: 250 mg a day
    
  • Vitamin B
    ₆
    : 50 mg a day
    
  • Evening primrose oil: 3 g a day
    
  • Crocus: 15 mg twice a day (This may be especially useful for patients with digestive symptoms [see
    chapter 5
    ].)
    
  • L-tryptophan: 2 g three times a day from ovulation to the third day of menstruation
    
  • Progesterone: If the above supplements do not help after three consecutive cycles, then consider a progesterone cream from ovulation until menstruation. Follow the directions on the label. stronger progesterone preparations are available as vaginal or rectal suppositories and through compounding pharmacists. The idea here is that in cases where there's too much circulating estrogen, progesterone can help balance it and alleviate symptoms. This seems to work well in my patients who have a strong anxiety component with PMS or PMDD, for progesterone can enhance gamma aminobutyric acid (GABA) in the brain, which is calming. In fact, some of my patients use it for relaxation before sleep. In a small percentage of patients, progesterone may increase low mood, so if you try it and your mood worsens, discontinue the progesterone.
    

There's a greatly expanding body of research showing the relationship between menopause and mood. One 2006 study found menopausal women were twice as likely to experience significant depressive symptoms as premenopausal women. The risk for depression onset was an astounding fourteen times higher for the twenty-four months surrounding a woman's final menses than for all the previous thirty-plus premenopausal years.

Perimenopause occurs in women between the ages of forty and fifty-five and is a time when hormones fluctuate and menstrual patterns become irregular. Menopause is the time after which the menstrual cycle completely stops.

While the risk for depression is greatest around perimenopause and menopause, the time after menopause is also a risk due to very low levels of estrogen. Currently, women can expect to live until their mid-eighties, suggesting that one-third of their lives will be spent in the postmenopausal state. As a result, we will be seeing more postmenopausal depression, too. Melatonin and Saint-John's-wort can both be beneficial for women experiencing depression during any of the three stages of menopause.

Melatonin is especially helpful with postmenopausal depression and anxiety. Many women in this situation have a delayed sleep onset and offset, meaning that their melatonin levels rise too late in the evening and then come down too late in the morning. In contrast, it has been shown that women who are morning types and like to get up soon after the sunrise tend to have more morning light exposure, which suppresses melatonin secretion during the day and results in less depressed mood. If you are peri- or postmenopausal and are having trouble getting to bed at night, and waking up in the morning, refer to the “Retraining Your Circadian Rhythm” section in
chapter 5
. Generally, I recommend 1 to 3 mg of melatonin thirty minutes before bedtime, with a bedtime between ten thirty and eleven p.m.

In addition to Saint-John's-wort's amazing efficacy for mild and moderate depression (see
chapter 5
), Saint-John's-wort may also be the therapy of choice for peri- and postmenopausal hot flashes. Women of an average age of fifty with menopausal symptoms found that after eight weeks taking Saint-John's-wort, their hot flashes decreased in duration and severity over women who took placebo. Another study showed that after three months taking Saint-John's-wort, women also reported significantly better quality of life and drastically fewer sleep problems. I like to use Saint-John's-wort with black cohosh, another herb known to help with
both menopausal symptoms and low mood. Saint-John's-wort is dosed at 0.25 mg of hypericin content and 1 mg of triterpene glycosides from black cohosh twice a day. This combination has been used by botanical herbalists for decades, and these doses are supported by large-scale research as well.

In this section, I will discuss hormonal therapies to support your system. You may be asking yourself: Are these hormones safe for me? Or maybe: How can I get a doctor to prescribe me some hormones as soon as possible? We will answer these questions. Although hormone therapy may seem like an easy fix, I strongly encourage you to first read
chapters 2
through
6
and implement the recommended diet, lifestyle, and nutrient changes as well as therapeutic modalities. It's definitely true that lowered estrogen can play a strong role in declining mood during peri- and postmenopause. However, it's important to keep in mind that many women do not have low estrogen and still experience low mood. Likewise, many women in lower estrogen states do not have low mood or depression during or after menopause.

This tells us there are a number of factors that alter the interplay between mood and hormones. I have found with my patients, the naturopathic changes recommended earlier in this book are often enough to help the body adjust to the new lower estrogen levels.

At least once a week, my office receives a call from a prospective patient who has just read one of Suzanne Somers's books and would like to start hormone replacement. Suzanne Somers is inspirational and her informative books have certainly increased awareness for many natural treatment modalities that women and men would otherwise not have heard about. I praise her for the courage to put out this information. My concern, however, is that you may read her book, or even the following hormone section, and think, I just need hormones, and then forget about everything else in this book.

Good holistic care does not simply give hormones, the same way I would not just hand you a bottle of drugs and wish you good luck. Good care looks at underlying causes and uses multiple, gentle ways to help the body heal itself. This is why all the other methods in this book need to be implemented first. In my experience, about eight out of ten women who are interested in bioidentical hormone replacement therapy end up not needing it because diet, lifestyle, stress reduction, and proper nutrients do the trick.

Okay, now that you've read my disclaimer, let's talk about hormones.

The balance of hormones affects not only the chances of getting depressed but also whether a treatment will help with peri-and postmenopausal symptoms. One research group looking at depression risk during this time of life showed an association between increased hormones for follicle stimulation (FSH) and luteinizing (LH) and jump in estrogen and FSH levels. FSH is typically low (under 20) and steady in younger, menstruating women. It rises as women enter menopause.

Rising FSH levels are not a negative event, just as menopause is not a disease state—despite what conventional medicine may have you think. This is a time when women start moving forward with creativity and newfound wisdom, and rising FSH may be responsible for it. I see many women take on painting or other arts and flourish during this time. Do you have a wise and intuitive senior female in your life? Have you sensed this intuition in yourself? If you have, do not discount it. It's very real. Of course, this can also be a time of mood swings, especially when a woman is not able or allowed to do the creative things her body and mind are naturally moving toward.

As you read this, you may want to consider the creative endeavors you have always wanted to do that you have not been able to up to this point. As Dr. Christiane Northrup reminds us in her book
Women's Bodies, Women's Wisdom
: “Now is the time when she grieves the loss of any unrealized dreams she may have had
when she was a young woman, and prepares the soil for the next stage of her life.”

With menopause and changing hormones, past psychological and spiritual issues need resolution as a new plan to fulfill dreams is created. It's understandable how all this can push previously happy people to be not so happy—especially if they feel like they cannot cultivate the soil.

During this time while you consider hormone replacement and the other steps in this book, please ask yourself:

• What past issues need resolution and healing? What needs to be let go? What is my plan to let go of these?
  
• What present issues need healing? What path do I see to work on these?
  
• What are my dreams and goals for the future, and what steps are needed to move toward these goals?
  

While emotional and spiritual issues are a major factor in menopausal mood changes, let's switch gears to talk more about the physical side of this subject. In the medical community, low estrogen is considered a major culprit in mood issues, hot flashes, osteoporosis (bone loss), and vaginal dryness. Estrogen is known to enhance serotonin and brain-derived neurotrophic factor (BDNF), which can help elevate mood and maintain brain pathways. A number of studies have shown the benefit of giving estrogen for mood. In some women being treated for depression, estrogen replacement therapy may actually improve the effects of conventional antidepressants as well.

Unfortunately, we have learned that hormone replacement therapy (HRT) is not all that safe. In 2002, the Women's Health Initiative revealed that while reducing risk of colorectal cancer and bone fractures (which is good), HRT unfortunately increases risk of heart attack, stroke, blood clots, and breast cancer. It seems the
risks of these synthetic hormones outweighs the benefits to the point that use of these commonly prescribed hormones was dramatically cut. After this study, most physicians stopped prescribing HRT, resulting in a drop in breast cancer cases estimated at fourteen thousand women per year. This was the first time breast cancer rates have ever dropped. A follow-up study in 2009 showed that ovarian cancer rates dropped 20 to 40 percent since the reduced use of HRT as well.