Bottom Line/HEALTH: Here’s a frightening statistic—one in four women in their 40s or 50s are on antidepressants. And here’s another frightening statistic—in a 2013 study, six out of seven people over 65 were found to be on antidepressants but did not qualify as having been depressed. What is going on, and what should you do about it?
I’m Sarah Hiner, president of Bottom Line Inc., and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.
Today I’m talking to Dr. Holly Lucille, a leading naturopathic physician and expert in integrative medicine. Dr. Lucille was listed in Time magazine’s ALT list as one of the “Top 100 Most Influential People” and is the author of Creating and Maintaining Balance: A Woman’s Guide to Safe Natural Hormone Health. You can learn more about Dr. Holly Lucille at DrHollyLucille.com.
Welcome, Dr. Holly.
Holly Lucille, ND, RN: Thank you.
Bottom Line: All right, there’s this major epidemic of misdiagnosis of depression out there. What’s going on? Besides the fact that we’re a culture that loves giving pills to solve some problem immediately.
Dr. Lucille: Right, misdiagnosis, overdiagnosis, it is out of control. The mechanism of “Here, take this” just is not working. I think when it comes to depression, we’ve got to be able to understand if somebody is truly depressed. Because clinically that could be a dire situation, and that’s extremely important to be able to assess.
But a lot of times, hey, is it sickness or depression? One of the things that I like to do with folks is ask them, “Do you have a desire to do the things that you used to find joy in?” If the answer is “Yeah, I have the desire, I’m just frustrated with my lack of energy” or their moodiness, then I kind of know that perhaps we need to look deeper. Is there a sickness going on?
Now, if somebody says they’ve lost hope, they don’t have any desire to do things that used to bring them joy, and then we can make more of a discernible idea of a depression spectrum going on.
Bottom Line: Are there other things, like prescription drugs—there are a number of factors that can actually create symptoms that might masquerade as depression, and then in their haste the doctor might diagnose it. So, for example, what about side effects of prescription medications?
Dr. Lucille: That’s a great point, Sarah, because one of the things that I have learned to do astutely in my practice is make sure that I know each and every medication that a person is on. Because I need to look for all contributing factors, and as you said, sometimes side effects of especially cardiovascular meds—or I would say they’re not side effects, they’re actually direct effects—of these medications can be causing the clinical presentation of depression.
So we get into a really gnarly situation if all of a sudden, you go to your primary care doctor—not only are you on a couple different medications perhaps for your blood pressure or what have you, and then those medications are causing you to feel melancholy. You present like that, and guess what? You’re on another medication.
Depression is not a Prozac deficiency. It’s not. It’s not a medication deficiency, and it might not be depression. I think that’s what we’re trying to get to. Many times in our modern day, boy oh boy, our chronic stressors that we string together create an adrenal disregulation. It just really creates almost a fatigue-type thing over time that feels like you got bit by a tsetse fly.
That actually could be what really needs to be supported. There are other things also that could be contributing to these signs of depression, but it’s not a clinical depression diagnosis, and you do not need a medication.
Bottom Line: I think that’s really important for people to realize, that there are all these stressors, and that it’s easy—again, we think we’re broken because we don’t feel great all the time, but we’re wearing ourselves down.
So let’s talk about what are some of the major categories of medications that people are taking that have side effects or effects that show as symptoms of depression.
Dr. Lucille: Yeah, the big ones, I’ve got to tell you, it’s exogenous—that’s outside of our body—sources of estrogen. So either birth control pill or hormone therapies. Here’s the number one reason—this is going to decrease the function of the thyroid. Thyroid at the end of the day, in every single cell in your body, fuels your aerobic and anaerobic metabolism.
And it could be what we call sub-laboratory. If you start under-functioning from a thyroid perspective and it’s not picked up by these thyroid function tests—that, by the way, are outdated by 30, 40 years, and you can find that in the endocrinology books—then you’re going to start feeling signs of hypometabolism. Certainly, depression and fatigue are some of them.
So exogenous sources of estrogen and also estrogen-dominant situations undoubtedly decrease thyroid function, which can contribute to you presenting depressed symptoms.
Bottom Line: If somebody starts having some of these symptoms—fatigue, difficulty sleeping, lack of enthusiasm over a period of time, those are some of the classic symptoms of depression—is there a physiological test they can take that will demonstrate either a thyroid issue or perhaps a side effect of a drug or something else before they go and get on an antidepressant, that can rule out some of these other issues before they start thinking about medication for depression or serious depression?
Dr. Lucille: Sure. One of the best ways I feel like medicine should be practiced is you take good clinical acumen from the history taken and getting that patient’s story. Then especially in the naturopathic medicine world, there are so many functional medicine tests that we can use and also regular reference range laboratory tests to understand and confirm clinical suspicions that you get from the person’s story and how they’re presenting.
Also, there’s something called differential diagnosis. So hey, is it depression, or guess what? Is it anemia? There are many things that will create this fatigued, melancholic situation. We want to be able to rule in or rule out all of them. Candida complexes actually can do that.
So you want to be able to run these laboratory tests that confirm your clinical suspicion so you know exactly what’s going on with that patient and so we can treat appropriately. Identify and then treat the cause.
Bottom Line: Thank you, Dr. Holly Lucille. The bottom line on depression? There is an epidemic of overdiagnosis of depression, or I should at least say an overdiagnosis of prescribing antidepressants. Be aware. Even if you’re moody, even if you’re having some fatigue, we’re in a very high-stress life. You might need to address some lifestyle things and look at your life and see that you have other issues that have to be dealt with, but it’s not going to be solved by a pill. That’s not going to be the answer.
Also, be sure if you start having fatigue or insomnia or the other classic symptoms of depression, be sure to work with your doctor to rule out if there’s any other physiological reasons that might be affecting your mood. It might be anemia, it might be thyroid, and it might be a Candida infection. It might be a side effect of another medication you’re on. Therefore, rule out all those things before you accept yet another drug. This is Sarah Hiner with Bottom Line.
