Depression and anxiety are the world’s leading disabilities; recent studies show that one in six people are prescribed psychiatric drugs, and SSRI’s are the second-most common medication taken worldwide. Naturopathic physicians are in the perfect position to offer alternative support to this population of patients, mainly because they spend more than 8-10 minutes per visit with their patients, and thus can help identify underlying causes, and avoid Band-Aid solutions. What follows are some tips and recommendations to help you optimise your patients’ mental health.

Sanesco Neurotransmitter Testing: Sanesco and Neurolab have provided a large cohort (over 20,000 patients) study of data collected over the past 10 years, to validate the clinical application of urinary neurotransmitter testing, as well as non-drug interventions, to effectively support patients. (Sample report from Sanesco). You may want to consider this testing for your difficult patients who seriously want to get off their medications. Two retests are recommended within 8 months to help you navigate through the three phases of treatment, and achieve optimal HPA axis function.

Sanesco Tranquilent ($24.15 for 30 tabs): this chewable inositol 1000 mg, L-theanine 25 mg and 5-HTP 20 mg combination is effective for pediatrics (not more than 2 per day: see dosing recommendations) and adults (up to 8 per day). It is effective in the treatment of anxiety and obsessive thoughts, and supports serotonin and GABA production in the body. I encourage patients to keep these in their purse or desk and take as needed throughout the day and especially in the evening to help with sleep.

Sanesco Prolent ($56.95 for 60 caps): studies have shown that it is effective in crossing blood-brain barrier to promote melatonin and serotonin production, and help with blood sugar regulation. It contains NSB, a proprietary blend of plant-based fermenting enzymes, and has been shown to reduce toxins and enzyme inhibitors, making them more effective. Bioperine® in NSB™ formulas is another way Sanesco® aims to ensure optimal absorption and efficacy of its nutraceuticals. Not only has piperine been shown to improve digestion, but it also enhances neurological function. Piperine has shown anti-depressant-like activity by increasing the synthesis of 5-HT (serotonin) from 5-HTP (an ingredient in Prolent™)[xviii]. Studies have found that MPTP (associated with Parkinson’s disease) is inhibited by piperine, making it neuroprotective against Parkinson’s disease [xix]. Piperine is also thought to be neuroprotective to the hippocampus, a part of the brain essential for cognition and memory.
Prolent contains B6 20 mg, L-theanine 75 mg and 5-HTP 50 mg. Patients need to be monitored carefully when combining with SSRI’s. Dosed at two caps, taken in the evening or before lunch or dinner for cravings.

Other areas to support when treating anxiety and depression:

1. Basic support for any anxiety and depression case: the treatment plan should include a B complex; Nordic Naturals Ultimate Omega fish oils or Vital Nutrients Ultra Pure Fish oil: 3000 mg per day; magnesium (Jigsaw Mag SRT), especially taken at bedtime for restless and poor quality sleep; and a multi vitamin and mineral complex (Vital Nutrients: Minimal and Essential). It has amazed me over the years how the above can help in a matter of weeks! Most people who live off the SAD (Standard American Diet) are terribly deficient. Many females are low in iron with serum ferritin less than 60. Once this is treated they feel so much better. (Vital Nutrients: Iron plus C)
2. Adrenal fatigue: measure level of adrenal fatigue and burnout using salivary testing. Cortisol and DHEA levels can be measured as in the Sanesco testing. MediHerb Combinations to consider: AdrenoCo and Withania Complex (if no blood pressure issues) and Rhodiola & Ginseng.
3. Thyroid support: many female patients do not have ideal levels of TSH, T3 and T4. Check for autoimmune disease with TPO. See recent blog on thyroid support.
4. Brain support: for brain fatigue consider: Bacopa Complex and Ginkgo. Kerry Bone has told us he takes up to 9 per day of ginkgo when he is travelling and lecturing. Anyone over the age of 50 might want to take ginkgo to prevent strokes and MCD (mild cognitive decline).  Lions Mane, according to recent research, increases BDNF (brain-derived neuro-factors) in the brain and enhances memory.
5. Anxiety and Insomnia: Kava Forte, Valerian Complex, St. John’s Wort (be careful of light sensitivity in summer months and is great for SAD: Seasonal Affective Disorder), Nevaton Forte or Mag SRT. The goal is 8 hours of restful sleep per night.
6. Hormone support: women in peri-menopause and menopause need added support in addition to the above. Consider FemCo, Chaste Tree, Tribulus Forte, Wild Yam Complex and Withania Complex. Consider Vital Nutrients: Menopause Support or Mediherb Wild Yam Complex for hot flushes.
7. Blood sugar regulation: Gymnema helps with cravings and blood sugar regulation. Dream Protein mixed with Greens First can be used as a morning smoothie for those too stressed or rushed to eat breakfast. It will maintain blood sugar until lunchtime. Even some children will take this combination especially before playing sports. A diet high in protein helps with blood sugar regulation and sugar cravings.
8. Depression; Mediherb St. John’s Wort provides high levels of “flavonoid glycosides” which increase the bioavailabilty of hypericin, the main active ingredient in St. John’s Wort, to help with depression. Liquid St. John’s Wort does NOT contain any hyperforin.
9. Food sensitivities: some foods can cause fatigue, anxiety and depression. A gluten-free diet, according to Dr. Mark Hyman in his “Broken Brain” docuseries, is the best diet for depression and anxiety.
10. Parasympathetic balancing: unplugging from devices, exercise, yoga, meditation, and the Arts are all great for lowering cortisol. When patients are prescribed “The Arts”, visits to MD’s and hospitals are reduced by up to 40%! (Read my 30 Day Intentions handout!).

Until next month!