PSYCHOTHERAPY • Therapy is individualized• CBT• Interpersonal psychotherapy• Problem solving• Usually combined with anti-depressants to

give higher efficacy• Caregivers who develop depressive

symptoms can benefit from that

PSYCHIATRY DISODERS• Complex Patterns: requires systems review• Multi-faceted cause• Power of Mind and Spirit• Relational Foundation• Self correctional Power• Mental/Emotional/Spiritual Homeostasis

MECHANISTIC ASSUMPTIONS IN PSYCHIATRY

• Complex triggers often ignored• Narrow measures of efficacy and success• Mind has no effect on Brain• Treatment is often narrowly focused• Ignores self correction capacity• Ignores epigenetics

CHALLENGED BELIEFS• Psychiatry illnesses represents fundamental

imbalances of brain biochemistry• Our current psychiatric diagnostic is valid

and reliable• Over the long term psychiatric medications

are safe and effective treatments• Psychiatric treatments other than

psychopharmacology represents second tier approaches

VALIDITY ISSUES• Thomas Insel MD Chief of NIMH announced

that DSM Criteria will no longer be used for research: rely on superficial phenomenology only

• We have not mapped the core pathophysiology for one psychiatric illness

• The biochemical imbalance concept is dated and all of the money targeting psychiatry in venture capitalism and big $$$$$. Research is moving to circuits

THE MYTH OF CHEMICAL IMBALANCE• No serious science to support it.• Given wide reach of SSRI

SSRE• Tianeptine ( Stablon )• Selective Serotonin Reuptake ENHANCER• Clinical Trials: better than placebo• SSRE: 63% responded• SSRI: 62% responded• TCA: 65%

• Wagstaff AJ CNS Drugs, 2001• Kaper, S CNS Drugs

STAR D STUDY OF MAJOR DEPRESSION• Largest US Study of Major Depression• 3,671 patients over 1 yr• No medication better than the other.• 37% remission after 1 trial• 67% after 4• Massive drop out rates upto 42%• More than 1 med more likely to relapse• The 67% rate is certainly an overestimate of

what happens in the real world

LESSONS LEARNED• Research not sponsored by pharmaceutical

industry• Looks at long term results• Designed to mimic clinical practice in real

world• Offers pessimistic views of current day psych

meds

MITOCHONDRIAL MODULATION: NEW APPROACH• Mitochondrial disorders are implicated in

wide range of psychiatric disorders• Known Modulators• 1. N-Acetyl Cysteine ( NAC )• 2. Acetyl-L-Carnitine• 3. S-Adenosyl Methionine ( SAM-e)• 4. CoQ10• 5. Alpha Lipoic Acid• 6. Creatine Monohydrate• 7. Melatonin

• Aust NZ J of Psychiatry

NEUROPROTECTIVE AGENTS• Chronic Psychiatric disease combination of

inflammation, oxidative stress, HPA axis dysregulation

• Lithium, Mg, Minocycline, Statins, NAC, ASA, Leptin, Melatonin

• These agents may slow the progression of severe psychiatric illness.

DEPRESSION AS A MODELExerciseEFAsSt. Johns WortAcupunctureECTLight therapySAMeFolate

ECOLOGY OF THE PERSON

• Environment• Physical• Mental• Emotional• Social• Spiritual

ASSESSMENT: PHYSICAL• Exercise• Energy/Vitality/Sexuality• Appetite/Diet/Food allergy• Weight• Sleep rule out sleep apnea• Physical illness/symptoms

ASSESSMENT: LAB• Thyroid• Adrenal : DHEA-s & Salivary cortisol• CBC/Ferritin• GI/Dysbiosis• Vit D• Homocysteine• Hs CRP• MHTFR

ASSESSMENT: MENTAL• Mood/affect• Recreation/Relaxation• Work• Hobbies• Addiction• Creative outlets• Sexuality• Relationships

ASSESSMENT: SOCIAL• Family time• Family relationships• Friends-type• Community connection• Neighbors

ASSESSMENT: SPIRITUALITY• Worship• Prayer• Centering • Love

DEPRESSION TREATMENTS HOLISTIC APPROACH• Exercise• Nutrition• Herbs and supplements• Energy medicine• Acupuncture• Somatic• Pharmacology• Hormonal

EXERCISE AND DEPRESSION• Aerobic exercise increases BDNF• 15 to 20 min• 4 times per wk• SMILE study: 10 months later 70% response

vs 48%. Relapse 8% vs 38%

• Babyak, D psychosomatic Medicine 2000

NUTITION AND DEPRESSION• High protein• Food allergy• Caffeine free• Low sugar• Vit C protein metabolism• Omega 3 oils

TO AVOID• No Caffeine and low Sugar• Consider Gluten free trial• Complex Carbs• Food allergies• Avoid additives and sweeteners

VIT C AND DEPRESSION• RCT of depressed patients• Vit C : 500 mg po BID for 8 days• 71% reduction in mood disturbance• 51% reduction in distress• 2/3 deficient in Vit C, 20% in scurvy levels

HERBS AND SUPPLEMENTS• St. Johns Wort-450 mg BID• 5-HTP- 50-400 mg/day• Gingko Biloba 80-120 mg BID stimulating• Tonics ( Ginseng/Ginger)• Vit B6-B12 ( Vit B Complex)• Folic Acid or Methyl folate

ENERGY MEDICINE• Light- 10,000 lux, 30 min in AM, Dawn

simulator also helpful• Negative ions• Cranial electrical stimulation• Electro-stimulation• Acupuncture

HORMONAL AUGMENTATION• Desiccated thyroid• Cytomel• DHEA• Estrogen/Testosterone

• Arch Gen Psych 2005

SOMATIC• Massage• Qi Gong• Cranial manipulation• Reiki

MENTAL• Psychotherapy• Recreation• Social/Relationships• Work• Hobbies• Education• Cognitive-Behavorial• DBT (Dialectical Behavorial Therapy)• Meridian Therapy• Group Therapy

SPIRITUAL• Retreat• Spiritual Counselling• Dream Work• Service• Existential Exploration• Prayer• Love, Joy, Hope

DECREASING INFLAMMATION• Diet- Mediterranean diet, Dean Ornish• Exercise• Meditation- Mind /Body therapies• Supplements: Omega 3, Ashwagandha,

NAC,VitD• Medications Statins, Lovaza

PROTOCOLS• Vit C• Vit B complex• EPA• SAMe or SJW• Inositol• High Protein diet• Exercise• Psychotherapy• Sunlight, Vit D

SUMMARY• Modern day Psychiatry has taken an increasingly

narrow and commercially driven path• The level of evidence for diagnostic reliability

and treatment efficacy is more limited than we expect

• The chemical imbalance theory remains poor science

• Consider multi-modal approach• Patients are unique and multi-dimensional• Education, support and motivation are valuable

tools• Avoid simple solutions and unidimensional

thinking• Strive for balance and harmony• Embrace the complexity and potential in each

person

REFERENCES • Bupropion sustained release versus paroxetine for the treatment

of depression in the elderly. Weihs KL, Settle EC Jr, Batey SR, Houser TL, Donahue RM, Ascher JA Department of Psychiatry, George Washington University, Washington, DC 20037, USA. The Journal of Clinical Psychiatry [2000, 61(3):196-202]

• Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study K. Jongenelisa, b, , , A.M. Pota, b, A.M.H. Eissesc, A.T.F. Beekmana, b, H. Kluiterc, M.W. Ribbea, b

• Screening for Depression in Elderly Primary Care PatientsA Comparison of the Center for Epidemiologic Studies—Depression Scale and the Geriatric Depression Scale.Jeffrey M. Lyness, MD; Tamson Kelly Noel, MS; Christopher Cox, PhD; Deborah A. King, PhD; Yeates Conwell, MD; Eric D. Caine, MD

Arch Intern Med. 1997;157(4):449-454. • Risk Factors for Depression Among Elderly Community Subjects:

A Systematic Review and Meta-Analysis. Martin G. Cole, M.D., F.R.C.P.(C.); Nandini Dendukuri, Ph.D.

Am J Psychiatry 2003;160:1147-1156. doi:10.1176/appi.ajp.160.6.1147