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Depression Breakthrough by Greenblatt

Publication date: 18 September 2012

I recenty read 'The Breakthrough Depression Solution' by James Greenblatt, MD. Greenblatt is an integrative psychiatrist and his approach to depression is very different from that of mainstream psychiatry. I personally found his argument very convincing. For nutrition and nutritional therapy aficionados there's much here to learn from. This post is about why I think this kind of approach represents the future of medicine.

The book's sub-title is 'A Personalized 9-step Method for Beating the Physical Causes of Your Depression'. I think this succinctly draws out most of the major themes of integrative medicine:

  • Integrative medicine targets causes, not symptoms. The most common treatment for depression is drug therapy (antidepressants) which simply aims to suppress symptoms. When (and if) people stop taking the drug, depression is likely to return.
  • Depression like other common modern day illnesses has multiple causes. Examples are low thyroid function (hypothyroidism) and nutrient deficiency. There are different levels of causation, from biochemical and nutritional to physiological to psychological and social. Dr Greenblatt's book mainly discusses physical causes but he acknowledges others.
  • All individuals are not the same. Depression is not the same in all individuals. In any case of depression there will be a sub-set of the possible causes that are relevant. Not all depression cases involve a low thyroid but some do. Even at the biochemical level we are unique - small genetic differences mean that for example one person may need a lot more of some specific nutrient than the next person.
  • Therapy must target the individual's relevant causal factors. This is the meaning of "personalized medicine" (widely haled as the future of medicine).
  • Therapy must target as many of the relevant causes as possible, not just one. Therapy needs to be holistic.

Dr Greenblatt draws out the full implications of this integrative approach to treating depression, offering concrete and practical steps for sufferers and practitioners.

Nutritional Therapy

Dr Greenblatt lists many different nutritional deficiencies that can cause depression. Clearly part of the solution is to supply those nutrients needed - and this usually means in supplement form since it can be difficult to get all that is necessary even from a healthy diet. For example zinc and magnesium can easily be lacking - and both are vital to mental health. (Another element in the philosophy of integrative medicine is, give the body what it needs, and take away what is harmful, and then the body will do the rest.)

Dr Greenblatt lists numerous research studies attesting to the relevance of nutrition and supplementation for depression and mental health generally. Ironically in the UK the Advertising Standards Authority prohibits nutritional therapists (and other "alternative" practitioners) from claiming to be able to help pretty much any illness, ostensibly on the grounds of absence of evidence.

The Need for Objective Testing

Clearly, if we are going to address individual causes we need a way of finding out what those causes are in any case. Mainstream medicine conspicuously doesn't do this (in mental health cases). The typical approach is, try one anti-depressant, and if it doesn't work try another, and so on. (Incidently, Dr Greenblatt uses a method called referenced EEG to match his patients to particular medications based on measuring their brain state. Surely that is a step forward.)

Dr Greenblatt advocates laboratory testing to determine causes. For example many nutrient deficiencies can be uncovered by lab testing - not necessarily by measuring the level of the nutrient itself but perhaps indirectly, by assessing the body's need for that nutrient. This is the basis of functional lab testing. Vitamin D status can be determined by measuring the level in the blood, but magnesium may be better assessed not by the blood levels but by indirect functional methods. (By the way vitamin D deficiency has been linked to depression too.)

Brain Health Depends on Body Health

Traditional psychiatry does not really look beyond the brain. Dr Greenblatt sees the limitations of this. For example gut health is extremely relevant to brain health. A compromised gut will struggle to absorb all the nutrients needed by the brain, and furthermore can subject the brain to toxic exposure. As an example Dr Greenblatt tells us how gliadorphin and casomorphin, which result from the incomplete digestion of milk and wheat, may function as opioids, affecting the brain like morphine.

Strengthening the gut is very often a vital component of therapy for depression.

In future blog posts I plan to write about specific therapeutic steps that Dr Greenblatt discusses as part of therapy for depression.

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