While typical antidepressant medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) have their place in depression treatment and psychiatry, they are just one tool we have to offer. With less than optimal response rates and a realization that depression is a complex condition, likely with different subtypes, it makes sense that we have other tools to specifically target and address contributing factors.
Here is what is taken into consideration with an integrative medicine approach:
The Immune System/Inflammatory Connection
Inflammatory/Immune Subtype of Depression
When do we consider the immune system/inflammatory subtype? This subtype is considered and addressed if someone has digestive symptoms, chronic fatigue, rashes, brain fog, obesity, or known food sensitivities or conditions such as multiple sclerosis, fibromyalgia, PCOS, irritable bowel disease, chronic pain, diabetes, obesity, long COVID, obstructive sleep apnea, dementia, mold toxicity, or chronic tickborne diseases.
As I shared in my latest post about mitochondrial function and its relationship with depression, even mitochondria issues can contribute to inflammation in the body.
Laboratory testing is an objective way to assess for non-specific inflammation (homocysteine, hsCRP), omega 3 and 6 acid levels, and mitochondrial function status. Lab testing can also be utilized to assess for gut health, infections, thyroid issues, and mold toxicity if warranted.
Integrative Medicine Depression treatments for this subtype:
An elimination diet (with reintroduction) to assess if certain food antigens are causing symptoms and also contributing to inflammation.
Immune modulating treatments such as low dose naltrexone
Anti-inflammatory treatments such as omega 3 fatty acids, L-methylfolate
Optimization of Vitamin D, iron, and B vitamins
Photobiomodulation such as red light therapy
Treatment of underlying infections, environmental causes, and medical causes - if possible which may include herbal or pharmaceutical antibiotics or antifungals, binders, improving detoxification in the body.
Treatment of mitochondrial dysfunction which may include targeted supplements, photobiomodulation, diet changes
Improve gut function depending on specific issues through diet, targeted supplementation, vagus nerve balancing.
Stressors in Life
Trauma/Psychological Stressors Subtype of Depression
It's no surprise that stressors - big or small, recent or during childhood - can contribute to depression. Emotional, physical, and sexual trauma actually changes the brain's structure, how it works and specifically, how it responds to threats. We can carry core wounds such as "I'm a failure" or "I'm not good at anything" learned from a young age. Automatic thought patterns and "stuck" thinking can contribute to depression by impacting how we act and how we feel - both physically and emotionally.
Additionally, depression can arise after stressors in the form of life changes such as getting divorced, losing a loved one, or retiring from a job.
Laboratory testing is not helpful for this subtype of depression; rather, understanding someone's childhood upbringing and their life story is much more important.
Integrative Medicine Depression treatments for this subtype:
Structured therapy to increase flexiblity in thinking such as cognitive behavioral therapy (CBT) to help someone identify automatic unhelpful thoughts and reframe them.
Therapy to increase compassion and awareness of one's own patterns and layers such as internal family systems or ketamine assisted therapy.
Therapy that includes movement or somatic-based practices.
Vagus nerve and limbic system regulation practices.
Circadian Rhythm/Sleep Connection
Circadian Subtype of Depression
Individuals with depression are more likely to have troubles with both falling and staying asleep - and those with sleep issues are more likely to have depression. The circadian rhythm in our bodies is responsible for producing melatonin, which is a hormone that is responsible for helping us feel tired and fall asleep. Issues with melatonin production or suppression can contribute to sleep issues and therefore, depression. Circadian rhythm issues may contribute to seasonal depression in winter as well.
In regards to laboratory testing, if someone with depression has particular issues with feeling wired and tired, during the day and/or at bedtime - or an individual wakes up feeling panicked or anxious overnight or first thing in the morning, it may be helpful to measure cortisol levels, as hypercortisolism can contribute to sleep issues as well as depression. Cortisol is our body's main stress hormone. If an individual with depression has symptoms concerning for sleep apnea, a sleep study (at home or overnight in a sleep clinic) may be warranted.
It's important for a history to include asking about underlying causes of sleep issues such as the environment (screen time), caffeine consumption, too little exercise during the day, or catastrophic thoughts or anxiety specifically about sleep.
Integrative Medicine Depression treatments for this subtype:
Treating underlying causes of insomnia - cognitive behavioral therapy for canxiety around sleeping, CPAP or a dental device for obstructive sleep apnea, eliminate afternoon caffeine consumption, increase daytime movement, cortisol regulating treatments
Chronotherapy such as light box therapy
Photobiomodulation
Of course, these three subtypes are deeply connected. For example, if someone has an underlying sleep disorder, that can increase inflammation and therefore, negatively affect immune system function. Research also shows that emotional trauma causes changes in the immune system by increasing inflammatory markers. Understanding the significance of and the interplay of these subtypes of depression help with effectively addressing and treating individuals who present with depressive symptoms.
Interested in working with Dr. Burger and using an integrative treatment approach for depression beyond antidepressants? Learn more about becoming a patient here.
A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.