Metabolism Relevance: SSRIs and Depression

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Metabolic irregularities frequently interfere with the effectiveness of SSRIs, indeed any psych meds or supplements.

Two points bear attention:

  1. Eat right: If you don't bring in the right nutritional components, you simply will not get better. SSRIs are “serotonin reuptake inhibitors.” They rearrange neurotransmitters that are already in your body. If your steam engine is chugging up the hill, using SSRIs is like poking the coals. Using the right neurotransmitter building blocks [e.g. by adding protein] is like throwing real wood on the fire. More about the Power Breakfast in a later post. See this previous post.
  2. Correct Chronic Bowel and GI problems: If your GI tract from your stomach down is not working properly, little nutrients will come across for your use. Your bowel is the size of a singles tennis court. If your court has chunks of asphalt or weeds growing in the clay, good tennis will turn to bad. Balls will bounce out of bounds.

Problems:

Proper metabolism, proper nutrition will help prevent these frequent downstream effects.

  1. Medications don't work: Depression becomes worse with no wood on the fire.
  2. Medications make you feel worse: They build up quickly as the system is already challenged
  3. Medications make your brain feel toxic: they accumulate based on metabolic issues
  4. Depression increases as med failures bring a sense of futility, shame, and embarrassment, and you don't want to tell your doc as you know they are well intentioned.

More next post on the art of medicine, a comment by Francis Ford Coppala, movies, poetry and that first office visit.

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8 Comments

  1. Chuck Parker says:
    January 14, 2007 at 8:41 AM

    CP-
    No tension over here on directing others to your content at http://clinpsyc.blogspot.com – always good to add another voice.

    Completely agree with the research from my office experience:

    See comments in the post at CorePsychBlog after this next post,
    Thanks,
    Chuck

  2. CL Psy says:
    January 11, 2007 at 9:24 PM

    A recent study suggested metabolic problems linked to SSRIs. I posted on it over at my blog. http://clinpsyc.blogspot.com — pardon the self-promotion.

    CP

  3. Chuck Parker says:
    January 5, 2007 at 11:59 AM

    Michael-
    Thanks so much for your thoughts. The future of medicine will be determined through evolved team work with deep, thoughtful players like yourself.

    Interesting how Chinese medicine’s understanding of “bowel relevance” connects with the challenging chronic psych problems.

    Thanks for your comment!
    Chuck

  4. Michael Max says:
    January 5, 2007 at 11:45 AM

    As a practitioner of Chinese medicine, we always ask the state of the bowels. It is one of the clear indicators of the internal environment. Our ability to live in this world is directly dependent on our digestive system. We have this idea in Chinese medicine that digestion is the “central pivot”. Everything else pretty much revolves around it. if it is not working properly, you will usually find problems in other places as well.

  5. Chuck Parker says:
    January 5, 2007 at 10:07 AM

    Lisa-
    Without further information, your suggestion regarding metabolic irregularities would be my very first set of questions.

    Just talked to a delightful young adult woman who has been “refractory” for years with meds, and she confessed in the first interview: bowel movements once every 1-2 weeks, with an emphasis on the 2! With this person meds worked for 1-4 weeks then quit, and going up on meds blows her out the top of the window creating more moods, depression and impulsivity.

    You got it Lisa, when meds quit working and we have to push beyond recommended guidelines, we have to put our core hat on, and ask all the metabolic questions.

    Final note: metabolic testing will seal the deal. With testing speculation diminishes and accuracy increases-
    Thanks
    Chuck

  6. Lisa says:
    January 4, 2007 at 8:57 PM

    Dr. Parker,

    What is your thought about the patient who initially responds very well to a stimulant but after 6 months or so complains that they are not getting the same response, even after increasing the dose.

    For example:
    started Adderall XR 10mg and over time increased to 60mg but effectiveness is still minimal

    Is this a metabolic problem? Do you continue to increase the dose? Until when? Has the patient become resistant/depended? Do you try a different stimulant? Are they really ADD?

    Thanks,
    Lisa

  7. Chuck Parker says:
    January 2, 2007 at 8:29 PM

    Hey Lyle:
    Often the emphasis with some folks is “swell” and forget the analogy!

    Just saw a young woman today, first visit, both the north and south end of the GI tract cramp completely out of control, and the liver, downstream, has been bullet proof to all kinds of psych meds. Let me see, what could this mean?

    Amazing how frequently this presentation appears.

    Thanks and better bouncing,
    Chuck

  8. Lyle Lachmuth - The Unsticking Coach says:
    January 2, 2007 at 4:11 PM

    Chuck, I’ve never had my innards likened to a tennis court…

    but it is a swell analogy.

    Some days my guts do feel like a bunch a tennis balls bouncing around.

    LL