One Clinician’s Take on Factors That Contribute to Depression Symptoms

Depression can affect a person’s physical health. During a clinical visit, practitioner-patient collaboration can help identify patterns or underlying issues that influence a patient’s depression-related symptoms. In this video, IFM educator Kristi Hughes, ND, IFMCP, talks about the approach she takes, as well as the initial questions she asks her patients who present with symptoms related to depression. She also shares the reasons why she typically starts treatment with a nutrition intervention.


I see quite a few patients who present with symptoms related to depression. Some of them may have physical depression—they may be feeling slow and fatigued, they may have lack of motivation and lack of energy. And for some of them, it’s mental depression. And honestly, for some of them, it’s an emotional depression.

Initial Questions and What to Explore

First of all, I want to explore with them their motivation, the things that make them happy:

  • Are there things that do spark true joy in their lives, and what are those things?
  • I want to know if they have play, the element of play in their lives, and what makes them happy.

When I’m working with depression patients, I’m asking a lot of questions about the mental, emotional, spiritual components that may influence and impact their physical state of being.

I also want to make sure that I know:

  • What is their social network?
  • Who is there to support them?

I want to look very carefully in that 360 direction:

  • I want to explore their foods, what they’re eating.
  • What they’re doing.
  • What they’re thinking.
  • Who they’re spending their time with.
Nutrition Intervention

Now, where do I usually begin in my therapeutic interventions? I, personally, typically start with diet because food and nutrition have such a powerful impact on the brain and our moods and how we express them.

I want to see a diet diary. I want to see where some of the deficiencies are.

I certainly see common themes in patients who are experiencing depression:

  • Some of them may have methylation defects.
  • They may have challenges with processing their B vitamins—getting them on the right formulas may make a difference.
  • For other patients with depression, it could be because they don’t have enough protein in their diet or inadequate levels of essential fatty acids.

There are just such key critical nutrients that fuel the brain and support these pathways that I want to start with food first. Sometimes, it’s not adding things to their program, it’s actually looking for what is a part of their lifestyle that isn’t helpful.

Sometimes it’s looking for and finding the things that could contribute to their depression that we need to take away:

  • I want to look for processed foods.
  • I want to look for what I call sort of the cardboard foods, where there’s no nutrient value that’s there.
  • I want them eating live, real food.
  • I want them bringing this level of vitality back into their bodies through healthy choices.
  • I want to look for sugars.
  • I want to look for imbalance in the glycemic impact, things that can drive that sugar and insulin level up and then land them crashing on the other side, which lends to that feeling of depression and lack of motivation.
  • I want to look for stability.

I want to see that the diet, and the nutrition, feed their brain in an appropriate way so that we get this nice, gentle consistency.

Other Considerations & Foundations

For me, personally, I may end up using various nutraceuticals. I might be opting for botanical medicines and options before using prescription items.

But the first thing I’m going to do is I’m going to dig into their root causes.

I’m going to look at the foundations of the lifestyle factors and make sure that they have the right healing and helpful, supportive relationships that are critical for all of us to feel joy.

Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

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