Courtney Snyder, MD
Psychiatric medications are a good thing ...for a lot of people....at least at this time in the history of medicine. They save lives and alleviate suffering and pain.
The current understanding is that such meds increase or decrease the activity of neurotransmitters - chemicals produced in nerve cells which allow cells to communicate with one another. Some of the big players are serotonin, dopamine, norepinephrine, GABA, glutamate, and acetylcholine. Think of them as the words spoken between nerves. Some are excitatory (you know the type) - they tell the next nerve to fire, "GO! GO!" Others are inhibitory, telling the next nerve cell, "Whoa, slow down." Some do both, depending on who they're talking to.
Let's look at a couple examples of medications and how their impacts can be farther reaching than intended. Ritalin, like many meds for ADHD, increases dopamine activity between the cells. This can help improve attention and decrease hyperactivity for many. Some people, however, have too much dopamine activity already. Increasing it further can cause psychosis, ie. paranoia or hallucinations. Traditional treatments for psychosis, such as Thorazine, worked by lowering dopamine activity. But if lowered too much, a person could develop Parkinson's like symptoms. Parkinson's is due to insufficient levels of dopamine in certain parts of the brain. There's a fine balance and different parts of the brain need different amounts of these neurotransmitters.
Another example would be the commonly prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), such as Sertraline/Zoloft, Fluoxetine/Prozac, Paroxetine/Paxil, etc. They increase serotonin activity with the intent of improving mood or decreasing anxiety. Yet again, there are some people with depression who have too much serotonin activity and can get dramatically worse on such medication. We're not all the same. The blanket increasing and decreasing of neurotransmitters can have some unintended consequences aside from annoying side effects. But until fairly recently, it's been the only option.
The greatest limitation of medications, however, is that they don't address the deeper problem. Why exactly are those neurotransmitters out of balance in the first place? Symptoms are our bodies way of telling us, "something's not right." The ADHD child who goes on as an adult to have depression and then many years later perhaps even dementia, didn't just have bad luck, they had a biochemical problem that affected them differently at different times in their life. Though likely helpful, none of the medications addressed their individual biochemical imbalance.
So what do I mean by a biochemical imbalance? Neurotransmitters aren't autonomous. Just as words require letters to exist, neurotransmitters are made of nutrients and require nutrients to communicate with the next cell. For a variety of genetic and environmental reasons, we may be deficient or even overloaded in certain nutrients - amino acids, vitamins, minerals, and other natural biochemicals.
Here's what they do in the brain:
(1) Nutrients play a role in the synthesis of neurotransmitters:
Take a look at B6 which is needed to make serotonin, dopamine and GABA.
L-Amino Acid Decarboxylase
5-Hydroxytyrptophan ----------------------------------------------------> SEROTONIN
L-Amino Acid Decarboxylase
L-DOPA -------------------------------------------------------------------> DOPA
L-Amino Acid Decarboxylase
GLUTAMIC ACID -----------------------------------------------------------> GABA
While you could tweak these neurotransmitters with multiple psychiatric medications, you could also take a simpler and more refined approach to normalize nutrient deficiencies or overloads.
Copper Overload can cause too much dopamine to turn into norepinephrine, resulting in low dopamine activity [think ADHD] and increased norepinephrine activity [think high anxiety].
DOPAMINE ------------------------------------------------------------> NOREPINEPHRINE
Copper, Vitamin C, O2
It's not uncommon for people to be on a stimulant (ADHD medication) and an SSRI antidepressant (for anxiety). Instead, the problem could be addressed by normalizing their copper levels.
(2) Nutrients are involved in the neurotransmitter reuptake process at the synapse - the space between the nerve cells. (more reuptake, means less activity)
- Methionine and SAMe (serotonin reuptake inhibitors) = more serotonin activity.
- Folate = reduced serotonin, dopamine and norepinephrine activity.
Not less important, but too large for this post to hold:
(3) Certain nutrients are antioxidants that protect the brain from damage.
(4) Nutrients amazingly play a role in genetic expression - ie. whether certain mutations are expressed or not.
And though crucial, when it comes to the brain, there aren't a lot of nutrients to think about.
From Dr. William Walsh, PhD (whose work I am referring to throughout this post):
"..only about six or seven (out of the more than 1000 important nutrients in the body) ...seem to have a dramatic impact on mental health. I used to be bothered by the fact that the same chemical imbalances kept turning up in different conditions.... It turns out that each of these nutrient factors is directly involved in either the synthesis or the epigenetic regulation of a neurotransmitter in the brain. That was really good news. If we had to study over 200 possible chemical imbalances and correct whatever we found, designing treatments would be very difficult. Fortunately, we can focus on six or seven nutrients, and by balancing them, we can help most people with mental disorders."
When it comes to the brain:
Deficiencies in Zinc, Methionine, Folic Acid, B6, B12, Se, Glutathione, Vitamins C and E can be a problem.
Excesses/overloads of Copper, Folic Acid, Iron, Methionine, SAMe, and toxic metals (lead, mercury, cadmium) can be a problem.
Yes, that's right - one person can have depression due to folate deficiency (too much serotonin, dopamine and norepinephrine activity) while another person can have depression due to excessive folate (not enough of these neurotransmitters). This is again, why people respond differently to certain medications - some get better, some no response and some get worse - sometimes dramatically so (think school shooters recently put on an SSRI antidepressant who may have been folate deficient with too much neurotransmitter activity already). Similarly, multivitamins are good for some people and not good for others, especially when it comes to brain related disorders.
Many factors, both genetic and environmental, can produce nutrient imbalances. Addressing nutrient levels through biochemical or nutrient therapies isn't just about checking levels and then normalizing them, though that's an important part. It's also about addressing the genetic expression (more on methylation in a later post) that may be contributing, addressing gut health (and the absorption of nutrients), diet and environmental exposures (which can run the gamut from toxic chemicals to toxic relationships). None of this negates the benefits of psychiatric medications. Nutrient therapies do allow some individuals to not need medication, some to eventually come off medication and others to be on fewer medications at lower doses with less side effects.
I'm not a spokesperson for the Walsh Research Institute, but I do feel strongly that the work of Dr. Walsh and his colleagues, Dr. Albert Mensah and Dr. Judy Bowman will dramatically shift the way mental illness is understood and treated. There are too few of us in the US who are trained in these specific treatments, which need to become more accessible. I highly recommend the Physicians Training program to any physicians treating brain related disorders (CME credit is approved by the American Medical Association). To find a physician in your area, visit the Walsh Research Institute Resource List.
I'm a conventionally trained child, adolescent and adult psychiatrist. My current approach to health is both holistic (pertaining to the whole person) and functional (addressing the root causes of illness). I write this blog to share what I've learned.