Depression — Part 2

Part 2 of 2
David Arneson, ND

Many vitamins and minerals serve as cofactors and coenzymes for the production of neurotransmitters from amino acids. Our mainstay for treating depression and other mental health issues has always been intravenous (IV) nutrition and focused amino acid therapy. The IV treatments are almost always standard nutritional IV therapy. The following two case studies describe two such positive outcomes.

E.W. is a 52-year-old Native American man who first came to see us in March 2004. At that time, he had been in recovery from alcoholism for 17 years. The year before, he had suffered the loss of his grandmother (his spiritual teacher), 2 of his favorite aunts, and his father. The personal relationship with his girlfriend had also ended. His depression was “off the charts,” and the staff at the local college where he teaches urged him to seek help. E.W. not only practiced his Native ceremonies but also attended church regularly and considered himself to be a strong Christian: “I’ve tried counseling, but nothing seems to work.” At the time of the interview, I asked E.W. if he had taken time to grieve his losses. He responded by saying, “No, I have to be strong for my family.” We talked extensively on the need to grieve. Those who stuff their grief will always be depressed. As a physician, I have this talk with many patients. To grieve is not an abnormal human experience. It is a necessary human experience. To grieve is to heal. His laboratory test results were all in the normal range. We started him on basic IV nutritional therapy and the amino acid protocol, with instructions to find his “sacred space” and allow himself to feel his losses. We revisited 2 weeks later, and his comments at the time were “I feel wonderful” and “I feel like I am back into life.” We continued seeing him weekly to biweekly for the next few months. It took him about 4 months to finally come to peace with the loss of his relationship, and we continued to treat him over that time. He continues to be a patient for general health issues. It is not uncommon for us to meet and just talk about “life.” He continues to do well. This is a common case of perceptual or situational depression.

L.L. is a 47-year-old woman who first came to see me in September 2012 with diagnoses of fatigue, fibromyalgia, brain fog, insomnia, and depression. She had experienced depression over her lifetime due to growing up with her “angry and bitter grandmother.” She still had a deep-seated anger at her grandmother, who had passed away years ago. The patient grew up poor in rural Mexico. She is married and has a “wonderful relationship” with a caring and loving husband. I had a long discussion with her and her husband about nutritional treatment and about the need to resolve her anger. Her vital signs were in the normal ranges, and the results of her chemistry panel and complete blood cell count were normal. The patient was currently on duloxetine hydrochloride (40 mg/d) (a serotonin-norepinephrine reuptake inhibitor), pregabalin (100 mg/d), and zolpidem (10 mg) for sleep. The patient and her husband were going on vacation and would be gone about 2 to 3 weeks. She wished to get off all drugs. When we see drug regimens such as these, we address one drug at a time. Antidepressants are always a step-down regimen over time. We started the patient on the amino acid protocol with the Mucuna (because duloxetine and drugs in its class have strong actions on norepinephrine), with instruction to reduce her duloxetine by quarter-dosing every 10 days. We revisited 1 month later after the family got back from vacation. We started her on weekly nutritional IV treatments and continued the amino acid protocol. One week after starting more focused treatment, she reported a “huge increase” in energy and actually played soccer with her children. At this point, she was taking 5 mg of duloxetine per day. She started taking 5 mg of duloxetine every other day, and 1 week later suspended dosing the drug. Over the holidays, she had some depression “creep” in due to memories of more difficult times, yet she continued therapy and has rebounded. Overall, her fibromyalgia pain has reduced by 90%, and the patient feels more grounded emotionally. She continues treatment on a biweekly basis and has made contact with counselors who are helping her work through her anger issues.

What About Serotonin Syndrome?

One of the first questions usually asked by physicians wanting to prescribe amino acid protocols to treat patients with depression is “What about serotonin syndrome?” Serotonin syndrome is caused by an overabundance of serotonin in the central and peripheral nervous systems and has a constellation of symptoms that may include the following: cognitive effects (headache, agitation, hypomania, mental confusion, hallucinations, and coma), autonomic effects (shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, and diarrhea), and somatic effects (myoclonus [muscle twitching], hyperreflexia [manifested by clonus], and tremor). There is no laboratory test for serotonin syndrome; therefore, diagnosis is by symptom observation and investigation of the patient’s history.¹⁹

Over the last 12-plus years, we have treated many patients with the issues pointed out in these case studies, including detoxing them from unnecessary antidepressants. The most common cause of serotonin syndrome is an intentional overdose of antidepressants.²⁰ In using combination amino acids and treating both the serotonin and dopamine sides, we have never seen serotonin syndrome. Our protocols mirror those of Marty Hinz, MD, of NeuroResearch, Inc,²¹ who is undoubtedly one of the leading experts in the country on amino acid treatment. Serotonin syndrome is a possibility if one treats just the serotonin side, especially if the patient is on a selective serotonin reuptake inhibitor at the same time. We have never seen this using combination amino acid treatment. However, if you suspect serotonin syndrome in your patient, have him or her seek immediate emergency treatment. Benzodiazepines and serotonin receptor blocking drugs are the common treatment.

Primum non nocere

In conclusion, nutritional therapy can be a complex issue. Using the “shotgun approach” is often worse than the single-nutrient approach. Clinicians who wish to pursue this level of treatment for their patients must understand extensive information on metabolism and genetic function. Without understanding what the intricacies of molecular functions are and how they are activated and manipulated through nutritional treatment, the clinician is more likely to create more harm than good. Even if harm is not caused to the client, treatment often fails to produce the desired result. Just taking one particular vitamin, or amino acid, to address mental health issues is much akin to supplying the client with just fluoxetine to “cure” his or her depression.

Majid Ali, MD (unpublished manuscript, 1994) says it best: “…[N]o molecule exists in biology alone, functionally or structurally. This is self evident. And yet we physicians insist in diagnosing ‘a nutrient deficiency’
to understand ‘a disease’ which we can
then treat with ‘a nutrient therapy’…. The central issue here is: Mono-nutrient therapy has no place in the clinical practice of molecular medicine.”

David Arneson, NMD received his doctorate in naturopathic medicine in August 2000 from Southwest College of Naturopathic Medicine. Since 1988, Dr Arneson has worked in both the volunteer and employee capacity in the field of addiction, as well as with the seriously mentally ill, working extensively with both adult and adolescent populations. From October 2000 to July 2002, he served in the capacity of Clinical/Medical Director at the Naturopathic Detox Program, a non-profit 14-28 day residential naturopathic drug and alcohol detoxification facility. From February 2003 to March 2007, he held the position of Medical Director of The River Source Naturopathic Detoxification and Treatment Program (a 30-day program) in Mesa, Arizona, where he still works part time. From November 2007 to June 2009, Dr Arneson was medical director of the World Addiction and Health Institute (WAHI) in Phoenix, Arizona. He is an adjunct clinical instructor (since 2001) of naturopathic medicine at the Southwest College of Naturopathic Medicine and Health Sciences where he supervises and trains student doctors in clinical settings.  He also maintains a private practice, focusing on treatment of alcoholism, drug dependency, and chronic disease.

References

1. Wikipedia. Serotonin syndrome. http://en.wikipedia.org/wiki/Serotonin_syndrome. Accessed January 18, 2013.
2. Mayo Clinic. Serotonin syndrome. http://www.mayoclinic.com/health/serotonin-syndrome/DS00860. Accessed January 24, 2013.
3. Hinz M. NeuroResearch Clinics, Inc. Sunrise, FL.