Depression is a common mental health disorder that particularly affects older adults in the US, at an estimated 15-20% of those over the age of 65.1 Yet despite these numbers, a major study published in 2018 found that
only about a third of patients diagnosed with depression actually start treatment.2
For those who adhere to antidepressant therapies, treatment of the acute phase of major depressive disorder (MDD) leads to a greater number of adverse events in patients 65 and over, according to a 2019 systematic review.1 Antidepressants included in the study were selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, and vortioxetine; specifically, the reports found that SSRIs and SNRIs led to a greater number of study withdrawals due to adverse events, and duloxetine increased the risk of falls.1
Non-adherence to antidepressants is also common.3 A 2017 study found that 68% of the females surveyed were non-adherent to their prescribed antidepressant therapy.3 Forgetfulness was the main reason for missing doses. Another study showed that antidepressant non-adherence is common among veterans, with ineffectiveness and avoidance of side effects frequently reported as reasons.4
With the general ineffectiveness of prescriptions and the additional tendency of patients to not adhere to the prescribed treatment, if prescriptions are all you can offer, the clinical encounter can seem as hopeless as the patient feels. Depression is a multi-factorial condition with a large number of potential antecedents and triggers. How can you get to the root cause for an individual patient, and what adjunct therapeutic interventions might improve outcomes?
The Path Forward: Complementary Therapies
The Functional Medicine model emphasizes a multi-pronged approach to health and wellness, engaging patients in a therapeutic partnership that recognizes that the current conventional paradigm does not optimally address the needs of patients with depressive symptoms. In the following video, IFM educator Patrick Hanaway, MD, IFMCP, talks about how a clinician might unravel the root cause of depression by looking at several factors, including levels of vitamin D and other vitamins, amino acids, and minerals—as well as the gut microbiome.
Clearly, variable reports on the efficacy of antidepressants,5,6 combined with the high prevalence of depression,7,8 have left many clinicians challenged about how to help patients. According to one report, 42% of doctors had a hard time differentiating between unhappiness and clinical depression.9 What’s more, clinicians differ greatly in how they diagnose depression—from using checklists to using “gut sense.”10 Perhaps due to lack of time or the inherent difficulties of diagnosis, some clinicians are not inquiring much or at all about depression.11 But there is a wealth of medical research on the topic, and studies continue to point to the effectiveness of non-pharmacological therapies for depression.
For patients who have tried several different antidepressants to no avail, other therapeutic interventions such as diet may yield better results. Although epidemiological studies do not establish causality, some have suggested an association between diet and mental health.12 A 2019 study found that long-term adherence to a healthy diet may offer protection against recurrent depressive symptoms.13 Analyses were conducted on a sample of 4,949 men and women, and diet scores were calculated using data collected from food frequency questionnaires repeated over 11 years of exposure. Higher scores on the Alternative Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension, and transformed Mediterranean diet were associated with a lower risk of recurrent depressive symptoms.13
Evidence suggests that dietary or supplemented intake of other nutrients, such as those listed below, can be protective against depression or reduce depressive symptoms:
- Vitamin K14
- Fatty acids15-17
- Zinc (postpartum depression)18
Exercise and movement are also not to be overlooked. Research suggests that physical activity alone can treat mild to moderate depression symptoms.21-23 A 2015 cross-sectional national data study found that higher physical activity levels were associated with fewer self-reported days of poor mental health.24 Another large cohort study found that regular leisure-time exercise is associated with reduced incidence of future depression; it was predicted that 12% of future cases of depression could have been prevented if all participants had engaged in at least one hour of physical activity each week.25 Accumulating evidence also suggests that tai chi can significantly regulate emotion and relieve the symptoms of depressive disorders.26
Depression is a common and complex mood disorder that can severely affect a patient’s quality of life and even their family dynamic. The source can be biological, psychological, and/or social, and in the Functional Medicine model, it is incumbent upon the clinician to unravel the root cause of depression in order to address it effectively. Functional Medicine tools like the timeline, as well as other resources, can help the patient cope, manage, and navigate a path to recovery.
Gain new tools to more effectively evaluate and personalize treatments for depression and other disorders at the Energy Advanced Practice Module.
Read more about the Functional Medicine approach to treating depression and improving health outcomes in the following IFM-authored articles:
Click here to see all references
In the latest Ground Rounds lecture, Wayne Jonas, MD, executive director of Samueli Integrative Health Programs, discusses the determinants of patient healing within the context of today’s healthcare system. He explores a patient’s journey to wellness through an integrative healthcare approach.Read More
Understanding potential nutrition-hormone relationships, including hormone signaling sensitivity, is a key part of the Functional Medicine approach to hormonal dysfunction. Are tissues and cells more resistant or more sensitive to hormones based on specific nutrients, dietary patterns, or overall nutrition?Read More
While it’s fairly common knowledge that a major aspect of good health is diet, how can clinicians help their patients embrace dietary changes and maintain them for the long-term? Many Functional Medicine clinicians are transitioning to team-based care with the integration of health coaches to help patients with sustainable lifestyle change.Read More