January Newsletter
New Year, New Decade…..Have you thought about where you want to be on the health continuum? We are all on a health continuum either moving in the direction of disease or the direction of optimal health. Usually there is one or two things we can do to start moving in the direction of health. Start by setting a SMART goal for the new year. Think about where you are now, where you want to be and what is the once small change you can make toward health?
Depression? It is not uncommon to experience depressive symptoms this time of year, perhaps from changes in daylight, dietary changes or situational factors. In the functional medicine model, we think about the health of the gut and hormonal imbalances and micronutrients that can contribute to imbalances and symptoms of depression. We also consider depression an inflammatory state of the brain so our efforts are concentrated on reducing inflammation as well.
Antidepressants called SSRIs (Selective Serotonin Reuptake Inhibitors) are the most widely prescribed medication for depression. Data from the National Health and Nutrition Examination Survey (NHANES) published in 2017 showed that 1 in 8 people over the age of 12 in the United States had taken antidepressants during the previous month. I always try integrative and lifestyle treatments first when clinically appropriate. In my clinical experience, I have found that sometimes these medications are helpful for symptom relief while we are working on lifestyle factors and root cause functional medicine analysis of why the symptom of depressed mood is present. When I need to prescribe them, I often use genetic testing to see which medications are more likely to be effective in that person rather than trial and error.
An interesting article published in BMJ Evidence-Based Medicine questioning the efficacy of antidepressants long term showed that compared to placebo (using the pooled data from multiple studies), there may be minimal effect on depressive symptoms! They found that most of the studies had pharmaceutical industry bias and that few looked at using the medications long term (most were for 4-6 weeks). They also found the risk of side effects and difficulties withdrawal may outweigh the small benefit. I think that for some people these medications can be “helpful enough” to gain the traction needed to do the work of getting health and life back on track (placebo or not). It is interesting though that frequency of prescription is disproportionate to the efficacy research. I also wonder if the mixed results could be related to biochemical individuality. Like everything, the decision to use medications should be personalized.
Reference
Jakobsen JC, Gluud C, Kirsch I. Should antidepressants be used for major depressive disorder. BMJ Evid Based Med. 2019.
Hot Salad
This time of year I often don’t feel like eating cold salads so I make what I call “Hot Salad”. It is simple, I take greens and saute them in a little olive oil with the lid on the pot so they wilt. I often add garlic or other spices. I add other veggies too- shredded carrots or onions, sweet potato. You can add pretty much whatever you have on hand. Sometimes I put a scoop of hummus on top or chickpeas, sometimes I add a little chicken, or walnuts for my protein on top. Keep in mind that you can wilt down and eat 3 cups of greens (one serving = one cup RAW) and you can add 3 veggie servings to your tally for the day!
