Just the other day I came across a news story about a woman who had committed suicide after a long-term battle with depression and an eating disorder. Helen Williams was only 38 years old.

Helen’s story is not uncommon. Many patients struggling with eating disorders often have depression. The statistics associated with both illnesses are shocking.

• 1 in 5 diagnosed with anorexia will die within 20 years after initial diagnosis
• Anorexia has the highest death rate of any disorder treated by psychiatrists
• Currently only 30-40% of individuals with anorexia fully recover
• Up to 88% of patients with anorexia have a diagnosis of depression
• Roughly 70% of individuals with depression will experience recurring episodes throughout their lifetime

Why is anorexia (and other eating disorders) so inexplicably linked to depression? Malnutrition.

Malnutrition exacerbates depression and eating disorder behaviors by depleting the brain and body of vital nutrients. These nutritional deficiencies can and do have profound effects on the brain. Several studies have shown that deficiencies of zinc, cholesterol, and B vitamins are found in patients with depression. People struggling with eating disorders may also have abnormal levels of zinc and other nutrients.

Treating the malnutrition is a key step to recovery from anorexia, other eating disorders, and depression.

In April and May, I will be addressing these issues of malnutrition in depression and eating disorders at various seminars and conferences. I welcome you all to join me as I concentrate on topics such as nutritional strategies in the treatment and prevention of depression and eating disorders, focusing specifically on zinc, cholesterol, essential fatty acids, and B vitamins.

Helen’s story is too common. It doesn’t have to be.

Everyone is pretty familiar with the emotional and mental symptoms of depression: feelings of helplessness and hopelessness, loss of interest in daily activities, feelings of worthlessness or guilt, and irritability or restlessness.

Many people, however, are unfamiliar with the physical symptoms of depression.

• Headaches
• Back pain
• Muscle aches and joint pain
• Chest pain
• Digestive problems

These physical symptoms are often overlooked as being caused by depression because they occur with many other conditions. To make matters worse, depression can not only cause pain, but can also worsen existing pain.

Recently, South Korean researchers and physicians have found that depression is associated with arthritic knee pain. In a study of 660 Korean men and women, aged 65 and older, researchers found that depression was associated with an increase in pain in patients with mild to moderate knee osteoarthritis. Although the X rays showed no significant joint damage, those with mild to moderate arthritis of the knee judged their severity of pain much worse if they were also diagnosed with depression.

Because pain and depression may be linked, sometimes easing pain may help with depression. The reverse may also be true; in some cases, treating depression will resolve physical symptoms.

The bottom line is that it’s important to consider all aspects of your health—emotional, mental, and physical—in treating any condition.

Based on a recent survey, an estimated 27 million Americans use antidepressants. And according to a FDA survey, more than 80% of survey respondents were exposed to pharmaceutical advertising with antidepressants being one of the most heavily advertised class of medications.

Yet, given the heavy use and promotion of antidepressants our knowledge of them is surprisingly poor.

A new study published in the American Journal of Psychiatry, raises concerns that antidepressants may lead to increased stroke risk. The researchers examined stroke risk based on previous reports that antidepressants — particularly selective serotonin reuptake inhibitors — may induce bleeding complications in arteries of the brain.

The study analyzed data from 24,214 patients enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007. Researchers compared rates of antidepressant use 7, 14, and 28 days before the onset of stroke.

Research Findings

• Antidepressant use in the 2 weeks before the stroke was associated with a 48% higher stroke risk.
• There was no association between stroke risk and the number of antidepressant prescriptions in the previous year.
• Patients who had more than 6 antidepressant prescriptions had a lower stroke risk and those who had 1 or 2 prescriptions had greater stroke risk.

Authors of the study concluded that the somewhat conflicting results indicated that short-term use of antidepressants increased the risk of stroke, but long-term use had beneficial effects on stroke risk.

Many physicians and researchers, however, agree with me that these contradictory results are confusing and require further studies.

But what is clear, is that

If you or your doctor is considering the use of antidepressants or if you are currently on antidepressants, please be aware of the more serious potential side effects. And make sure to follow up with your doctor about any side effects you may be experiencing, no matter how minor you may think it is.

As you recall from my earlier blog post, Fight Depression with Exercise, exercise has many great physical and mental benefits. One of the most important of those benefits is exercise’s ability to lift depressed moods.

Now a new study published in 2011 suggests that exercising outdoors may lead to greater mental and emotional benefits than indoor exercise. After examining 11 studies with 833 participating adults, the author’s concluded that when compared to indoor exercise, outdoor exercise led to

• Greater improvement in mental well-being
• Greater feelings of revitalization
• Increased energy and positive engagement
• Greater decreases in tension, confusion, anger and depression

Those who exercised outside also stated that when compared to working out indoors, they found greater enjoyment and satisfaction with outdoor activity and were more likely to continue with their outdoor workouts.

To get the most anti-depressive effects out of exercise:

• Engage in any form of exercise (mild activity is fine if you don’t want to over-exert yourself)
• Exercise in your spare time
• Exercise with someone or in a group
• Exercise outdoors!!

As the weather gets warmer, be sure to grab a friend and exercise outdoors!

Selecting medications for psychiatric disorders is typically a hit-or-miss process.

Over the years I’ve seen many patients come in who have tried one medication or combination of medications after another over months or even years with little success.

Unlike many other diseases, psychiatric disorders such as depression are vague collections of symptoms. And there are no objective medical tests to reveal their presence nor clearly defined physical signs of their resolution. This leaves many psychiatrists with only a trial-and-error approach to selecting medication.

If only there was a test to help psychiatrists predict more accurately which drug is likely to help their patients. The good news: THERE IS!

The referenced electroencephalogram, or rEEG, is a revolutionary test that helps guide medication selection. An EEG records the brain’s electrical activity. A patient’s brainwave patterns are then “referenced,” or compared, to a database of more than 20,000 medication trials. This information guides the physician in selecting medications that are more likely to work for you.

The EEG is painless, harmless, and noninvasive. The procedure involves placing about 20 small patches, or electrodes, on the scalp. A machine then records the brain’s electrical activity for 30 minutes to 1 hour.

Then, the patient’s EEG is entered into a database where it is matched with other similar brainwave patterns. The database produces a readout of medications which have helped patients with similar brainwave patterns.

Although the rEEG helps more accurately select medications, the rEEG can NOT diagnose particular illnesses; particular brainwave patterns do not correspond with specific diagnoses. The rEEG only indicates which drugs are likely to help a particular patient.

This revolutionary, yet simple, brain test enables psychiatrists to improve the traditional trial-and-error approach to medication selection.

Lately, exercise has been at the forefront of every conversation about health. No doubt due to increasing concerns over obesity and sedentary lifestyles. And it’s true that exercise can improve our health by reducing high blood pressure, high cholesterol, and the risk of developing diabetes, but exercise also has amazing positive psychological effects.

Besides the obvious physical health benefits, exercise can also:

• Lift depressed moods
• Reduce stress
• Enhance self-esteem and body image
• Produce feelings of euphoria

This is not a new idea: studies dating back to 1970 have shown that exercise can help improve mood. Now research is helping us determine the intensity level and timing of exercise that’s most beneficial.

According to a recent 2010 article in the British Journal of Psychiatry, people who engaged in regular physical activity—even mild activity in which they never broke into a sweat—were less likely to be depressed than their sedentary counterparts. The intensity of the physical activity didn’t make a difference. A brisk walk and a long run had the same effect.

Surprisingly, the researchers found that exercise only helped relieve depression when it was carried out in people’s spare time. People who do heavy lifting or extensive walking at work were as likely to be depressed as those with desk jobs.

Researchers concluded that the most important factor in lifting depression was the social benefits of exercise—having a walking partner or a tai chi group, for example.

Based on this study, to get the most anti-depressive effects out of exercise:

• Engage in any form of exercise (mild activity is fine if you don’t want to over-exert yourself)
• Exercise in your spare time
• Exercise with someone or in a group

The bottom line is find an exercise you enjoy, choose a pace that feels comfortable, and do it regularly. You will improve your health and feel better!

Negative thinking has a way of quickly turning a good mood into a bad one.

Every person suffers from the occasional negative thought. There are days we don’t feel that we’re at our best, days where it’s easy to say “I’m not good at this. I want to give up.”

But for some people these negative thoughts may have a snowball effect. One negative thought easily leads to another and yet another until all that pent up negative thinking gives way to anxiety and depression. For these people it’s easy to transition from “I don’t think I can finish this in time” to “I’m not good at my job. I must be a failure.” no matter how untrue these thoughts may actually be.

Whether you have the occasional negative thought or habitual negative thinking, here are some tips to help you overcome negative thinking.

• Become aware of negative thoughts. The negative thinking that characterizes depression is usually automatic: these thoughts form a mental soundtrack that we don’t question. Try to become aware of negative thoughts. Once you recognize them, it will be easier for you to identify and avoid or eliminate triggers to your negative thinking.
• When you catch yourself dwelling on the negative. . . .do something different! When you recognize the same old soundtrack, try to turn it off by switching to something completely different. Switching your behavior will help shift your focus. Take your dog for a walk, call a friend, or watch a suspenseful movie.
• Question your assumptions. Fear of being rejected can sometimes make us assume other people’s behavior is a reflection of their attitudes toward us. Usually, another person’s bad mood is the result of something else entirely. Stop worrying about what you did wrong unless you have proof.
• Avoid using absolutes. If you think or tell a partner, “You always let me down!” or “You’re never there for me,” you can convince yourself that the situation is worse and more global than it is. Try to stay in the moment and deal with the particular disappointment at hand.

Any other helpful hints that you use for overcoming negative thinking? Feel free to add to the list in the comment section.

One of the major controversies in psychiatry today is the question of whether antidepressant medications are effective in helping people recover from depression.

Undoubtedly, many who have suffered from depression have been helped by these drugs. But to a large extent antidepressants are not as successful as pharmaceutical companies claim. In The Breakthrough Depression Solution I discuss facts that are usually ignored when pharmaceutical companies boast about the success of antidepressant drugs:

• Many clinical trials for antidepressants are conducted by pharmaceutical companies with a financial interest in selling medications.
• Studies show that only about a third of patients who take antidepressant medications remain symptom free in the long-run.
• Antidepressant medications can trigger a host of unpleasant side effects, ranging from unwanted sexual side effects to weight gain.

A recent study published in the Journal of Clinical Psychiatry compared the effectiveness of antidepressant medications and complementary and alternative medicine (CAM) in treating depression. CAM treatments are health practices and products, such as nutrients and herbs, that aren’t considered part of conventional medicine. The study found that the CAM remedies were just as effective as standard antidepressant drugs. In addition, the study found that patients receiving CAM remedies were less likely than those taking conventional drugs to experience a placebo effect—an improvement based on belief in the drug’s power to restore health rather than an actual drug response. Moreover, people taking antidepressants were more apt to stop treatment because of side effects than those using CAM remedies.

I encourage anyone who is depressed to take charge of their own recovery. Explore the many alternatives to standard antidepressant treatment. Be sure to consider other factors, including nutritional deficiencies, which may be contributing to your depression. Depending upon your unique biochemistry, complementary and alternative medicine may offer the best approach to feeling healthy again!

Symptoms of low thyroid hormones often include depression and fatigue; however, very few people with depression have their thyroid hormones checked.

The thyroid, a major part of the body’s endocrine system, mainly regulates the heart and respiratory rates by sending out messenger hormones. Located around the voice box and windpipe (larynx and trachea, respectively), the thyroid produces the hormones T4 (thyroxine) and T3 (triiodothyronine). Every cell in the body depends upon adequate levels of these hormones. Too little of these messenger hormones result in hypothyroidism. When too much is produced, the result is hyperthyroidism.

Hypothyroidism is linked to depression and fatigue among other symptoms. It’s important to note that even a small thyroid hormone imbalance can set the stage for depression. But luckily, patients often emerge from depression and regain their energy when hypothyroidism is treated.

Lesser Known Symptoms of Hypothyroidism

• Depression
• Anxiety
• Memory and concentration problems
• Low libido
• Fatigue

Because symptoms of hypothyroidism can seem vague and unrelated, as many as 50% of people who have this condition are never diagnosed. In addition, the test most commonly used to diagnose thyroid imbalances—the TSH, or thyroid-stimulating hormone test is often inaccurate.

In The Breakthrough Depression Solution, I explain why tests measuring T3 and T4 levels in the blood provide much greater accuracy than the TSH test in diagnosing hypothyroidism.

I recommend that anyone who suffers from depression have their T3 and T4 levels checked and corrected, if necessary. If your thyroid hormones are too low, you WILL feel renewed energy, better mental focus, and perhaps relief from depression once it is treated!

Undiagnosed celiac disease could be getting in the way of your recovery from depression.

Celiac disease is a common problem which affects about one of every 130 Americans or 2.25 million people. This may be an underestimate because celiac disease has varied and often confusing symptoms (such as anemia, fatigue, and depression), which makes it difficult to diagnose.

Celiac disease occurs when the body’s immune system mistakenly attacks a protein called gluten, which is found in wheat, rye, and barley. In its attack on gluten, the immune system damages the small intestine, producing intestinal symptoms such as abdominal cramps and swelling, pain, gas, vomiting, diarrhea, and constipation. Once damaged the small intestine may not absorb essential vitamins, minerals, and proteins as well as it should. The health consequences of celiac disease, however, extend beyond gastrointestinal issues and may affect every organ system, including the brain.

Other consequences of celiac disease include:

• Anemia
• Anorexia
• Arthritis
• Behavioral changes
• Depression
• Fatigue
• Infertility
• Joint pain and inflammation
• Migraine headaches
• Missed menstrual periods
• Numbness and tingling of the hands and feet
• Osteoporosis
• Seizures and other neurological problems
• Skin lesions
• Tooth decay and discoloration
• Weakness
• Weightloss

Researchers have long observed an overlap between patients with celiac disease and patients who are depressed. Adolescents with celiac disease have a 31% risk of major depressive disorder, while only 7% of healthy adolescents face this risk.

But what does a disease that directly affects the small intestine have to do with a lingering sadness or listless mood? The answer is plenty. The intestinal damage wrought by celiac disease prevents absorption of essential nutrients that keep the brain healthy, especially zinc, tryptophan, and the B vitamins.

Diagnosing celiac disease is difficult, which is why the disease is underreported and often misdiagnosed. People with celiac disease are often misdiagnosed with disorders with similar symptoms such as anorexia nervosa, chronic fatigue syndrome, IBS (irritable bowel syndrome), or Crohn’s disease.

A blood test for the antibodies to gluten—anti-gliadin, anti-endomysial, and anti-tissue transglutaminase—can be used to diagnosis celiac disease. High antibody levels indicate the presence of celiac disease. However, the only way to make a definitive diagnosis is to perform an endoscopy of the intestinal lining.

Once diagnosed, how do you treat celiac disease? The tragic news is that no treatment will cure celiac disease. But the disease can be managed with a gluten-free diet. By avoiding foods containing gluten, the symptoms of celiac disease will resolve and the body can heal some if not all of the intestinal damage. Most people who begin a gluten-free diet feel better almost immediately.

I encourage every patient with depression to be tested for celiac disease!