How Come They're Happy and I'm Not? (9 page)

A complete blood count (CBC) looks at the health of your red and white blood cells. Red blood cells carry your oxygen around your body to keep your tissues alive, your energy up, and your mood strong. White blood cells form the army that is your immune system. When there are not enough red blood cells carrying oxygen, depression can result.

Iron is also important, for it helps your blood cells carry oxygen. Even if your red blood cell count is fine, if your iron is low, you will still feel fatigued. If you are predisposed to depression, low iron could be enough to cause you to become clinically depressed.

• Low red blood cells
  
• Low hemoglobin (the molecule within red blood cells that carries oxygen)
  
• Low blood iron (serum iron) or storage (ferritin)
  

Anemia can be debilitating and has been shown to contribute to lost work, decreased physical and emotional well-being, and interference with the ability to think clearly. All of these can lead to anxiety and depression. Do any of these symptoms describe you?

One study looked at 134 very fatigued women, most of whom had low ferritin (iron storage). The researchers split these volunteers into two groups: one group received iron supplementation while the other received a placebo (which was an inert substance without iron) daily for four weeks. None of the women knew which supplement they were receiving. In the iron group, the level of fatigue after one month decreased 29 percent versus only 13 percent in the placebo group.

Although the iron group benefit was double over the control, 71 percent of the women in the iron group did not improve. There were likely other issues affecting those women—perhaps blood sugar was one other factor. We must remember that in most cases of fatigue and depression, more than one issue needs fixing. For 29 percent of the women, iron was likely the sole issue; for the other 71 percent, other things we talk about in this book probably needed work too. Still, achieving a nearly 30 percent improvement was pretty good given that only one recommendation was given. That is about the same rate of benefit as antidepressant medications.

When serum iron and ferritin are low, it's best to talk to your doctor about possible reasons for this. In men and nonmenstruating women, it's especially important. Sometimes, improper bleeding within in the body (from an ulcer, for example) can cause this and should be looked into. If the iron and iron storage are simply low due to poor intake or absorption of iron, then a supplement is appropriate.

I usually recommend a patient start with 25 mg of iron per day, taken with food. Then increase to 25 mg three times per day with food. Iron succinate or fumarate forms are generally gentler on the stomach than other forms. Also, take 500 mg of vitamin C with the iron for best absorption. Finally, in some cases, I recommend taking the herbs nettles and yellow dock for best iron support and absorption effects. Nettles and yellow dock can be purchased in pills, teas, or tinctures at a health food store; follow the doses on the product you buy. Food sources of iron include grass-fed beef, dark turkey meat, and dark, leafy greens. Cooking in an iron skillet can provide some iron too.

The thyroid test looks at how your thyroid functions. Besides its importance in mood, your thyroid is a key factor in your ability to burn food as energy, to have good bowel movements, and even to keep bad cholesterol (LDL) in check. Low thyroid function is very common. According to the American Association of Clinical Endocrinologists, one in ten Americans suffers from thyroid disease and almost half of these remain undiagnosed. Many experts suspect the heavy metal pollution and radioactive by-products from nuclear power plants may be increasing the incidence of thyroid disease. Low thyroid symptoms include weight gain, slowed thinking, memory problems, feeling cold, and constipation. Often, low thyroid can be an early or even first symptom of oncoming depression.

Figure 2
: The Hypothalamic-Pituitary-Adrenal Axis

The blood tests I recommend look at how the brain instructs the thyroid and how well the thyroid responds to those instructions. These are Thyroid Stimulating Hormone (TSH) and the thyroid hormones thyroxine (T4) and triiodothyronine (T3). TSH is made by the pituitary gland, in the base of the brain. TSH tells the thyroid how much thyroid hormone (mostly in the form of T4) should be produced. That T4 travels to nearly all cells of the body, and gets converted to T3, which is the active form of the hormone. T4 is identical to the molecule they use to make thyroid replacement hormone. The brain has an area called the hypothalamus, which keeps track of how much T4 and T3 is present in your body, and sends a signal to the pituitary in the form of thyroid releasing hormone (TRH). The TRH in turn tells
the pituitary how much TSH to make. This system is called a negative feedback loop.

In the blood stream, T4 and T3 can either actively create an effect (called the “free” form) or not (called the “bound” form). This is why it is a good idea to ask your doctor for both free and total measurements of T4 and T3 as well as something called Thyroid Binding Globulin (TBG). Sometimes your total amounts can be normal, but the active free form is low. The liver puts out this protein called TBG, which will bind up the thyroid hormones in your blood and not allow them to be active.

If your TSH is greater than 2.5, I usually recommend patients run what is called a thyroid antibody panel. This panel helps you determine if your thyroid is malfunctioning because your immune system is attacking it (a condition called Hashimoto's disease or thyroiditis). Some doctors say 2.5 is just fine for thyroid, but the American Association of Clinical Endocrinologists has been lowering the threshold of TSH. If yours is near the new 3.0 threshold, it should be checked.

If the results show an autoimmune thyroid condition, please refer to the following section in this chapter on digestive and antiinflammatory work.

If there's no autoimmune condition and

• TSH is above 2.2 and T4 is low but T3 is in normal range: Eat extra kelp and seaweed every day and take a thyroid glandular support, 200 mcg of selenium per day, and 300 mg of tyrosine per day.
  
• T3 and T4 are both low: Work with a naturopathic physician to start on a low dose of natural thyroid replacement like Armour Thyroid or Nature-Throid. These are made from dried pig thyroid. Most standard endocrinologists do not work with natural thyroid replacements because they are concerned that the amount of thyroid hormone is not identical in every batch.
  Experience tells me that it's relatively uniform and patients generally do quite well on it. A good low starting dose is 15 mg per day. Your doctor should check your pulse and symptoms before starting, and then recheck you once a week to see how you feel. She should also take blood tests every few weeks to recheck your thyroid levels.
  
• If natural thyroid replacement is not helping you feel better, you can try a more standard synthetic thyroid replacement such as thyroxine (which is T4). This synthetic replacement is an identical molecule to what your body uses, so the chances of side effects are minimal when used at the proper dosage. With any thyroid replacement, you and your doctor should watch for palpitations and heart racing, increased temperature, excessive sweating, or weight loss. I prefer using the natural thyroid or giving T3 because it has been shown to be more helpful in depression (see the next section and
  chapter 7
  for more on T3).
  
• If only T3 is low: Consider working with a doctor for a prescription of Cytomel, which is pure active T3. You can start with 5 mcg each morning and continue to increase by 5 mcg every three days until you feel well. Do not increase your dosage above 125 mcg. If you are over fifty-five years of age, cap your dosage at 60 mcg. Reasons to discontinue or lower your dosage would be if you feel a racing heart, excessive sweating, shakiness, anxiety, or fast-paced thought patterns.
  
• If your free T4 and T3 amounts are low, but your total amounts are normal and you have a high TBG, then you will want to consider using a detoxification plan (see
  chapter 4
  ), which should include plenty of foods to help clear the liver, such as extra fiber, beets, dandelion, artichoke, kale and taking liver supportive herbs like milk thistle.
  

Note: If you complete the above tests and therapies and still sense your thyroid is not balanced, you may want to ask your practitioner or endocrinologist for a TRH stimulation test. With this
test, a form of TRH is injected in the blood, directly stimulating the pituitary gland. If there is a problem with the pituitary, this test should be able to help identify it. Before the TSH test became more sensitive, this test was more commonly used by the medical community. This test may help you understand even better how to use various forms of thyroid support.

The parathyroid glands are four pea-sized organs inside the thyroid gland. Primary hyperparathyroidism (over-functioning thyroid gland) will show a high PTH number. This is frequently accompanied by high blood calcium and a low vitamin D status. The body tries to suppress intake of vitamin D in order to reduce the level of calcium in the blood, and low vitamin D alone can cause significant depression. Depressive disorders and low mood usually normalize after treatment of hyperparathyroidism. If your parathyroid and calcium are high, see an endocrinologist for best treatment options to lower parathyroid activity.

Related to testosterone, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEA-S) are molecules produced by the adrenal gland. Low DHEA-S levels are correlated with depression severity. Levels decrease with age and psychological stressors, and as DHEA goes south, mood can deteriorate. DHEA can protect against the adverse effects of stress, especially the ravages of the stress hormone cortisol. Like exercise, DHEA can increase the hippocampus nerve growth as it protects new nervous tissue from being destroyed by stress hormones.

There are two ways to measure DHEA—by looking at serum DHEA and also at DHEA-S. DHEA may be a more accurate assessment of proper hormone levels than DHEA-S, so I rely more on DHEA levels to suggest supplementation. DHEA is nonprescription over-the-counter hormonal therapy.

A number of studies report that DHEA supplementation benefits brain health and has direct antidepressant effects. DHEA can be especially effective for midlife-onset minor and major depression. A well-designed six-year study published in the
Archives of General Psychiatry
in 2005 looked at twenty-three men and twenty-three women aged forty-five to sixty-five years with midlife-onset major or minor depression. Some patients were given 90 mg of DHEA every day for the first three weeks, while other patients received a sugar pill. Those who took DHEA treatment had a 50 percent or greater reduction in depression. The treatment with DHEA was well tolerated and helped both men and women.

Though many studies have used 50 to 450 mg every day in divided doses, I recommend starting with lower doses of 5 to 15 mg every day, checking blood levels every two to three weeks. If mood does not improve or if the level of hormone does not increase, then you can increase your dosage in increments of 5 mg while monitoring with blood tests.