What Your Doctor May Not Tell You About Depression

What Your Doctor May Not Tell You About Depression: The Breakthrough Integrative Approach for Effective Treatment
by Michael B. Schacter, M.D., with Deborah Mitchell
Published by Warner Wellness; November 2006.

Beware of books that advertise themselves as “the breakthrough treatment” for anything.

This is a book I really would like to recommend. There is a lot of good information in the book that would probably be useful for anyone suffering from or vulnerable to depression. But ultimately the book suffers from a thinly disguised anti-psychiatry bias and frequently weak or misleading evidence for alternative therapies. On the one hand, the author warns against the “debilitating side-effects” of conventional antidepressant medications; on the other, he recommends dubious procedures such as chelation to cure depression by ridding the body of “dangerous toxins” – but fails to mention that procedures such as chelation have their own risks and side-effects and are based on weak or no evidence to support their efficacy.

As just one example of what I found annoying about this book, in Chapter 3, Discover Your Biochemical Profile, Schacter presents a case study (which, by the way, he seems to prefer to systematic controlled efficacy studies as “evidence” for his recommendations) for one patient, Patricia. Dr. Schacter has this to say about his case study:

The table above [see book] shows the neurotransmitter test results of one patient, Patricia, who was treated with amino acid therapy for depression and fatigue. As you can see, all of her neurotransmitter levels were out of optimal range when she first came to be tested. After four months of amino acid therapy, all of her neurotransmitter levels had changed significantly and moved toward optimal levels. More important, she was feeling 100 percent better and, for the first time in five years, had the energy and motivation to initiate a career change.

Now let’s look at this for a moment. First, we are not told whether Patricia had been treated previously using conventional medications and/or psychotherapies. Could it be that the reason she felt better “for the first time in five years” was that this was the first time she had followed through on treatment recommendations at all? Note that there is no “Patricia control group” for comparison. Second, while he concludes that “all of her neurotransmitter levels had moved toward optimal levels”, he fails to point out that three of the five are still outside the optimal range, or that the two that made it into the optimal range after four months were not very far out of range to begin with. And, third, we have no way of knowing how this patient would have responded to four months of treatment with an SSRI, especially if combined with psychotherapy, (e.g., cognitive behavior therapy).

To be fair, there is a lot of excellent information on nutrition and lifestyle issues in this book. I wish they had been presented as adjuncts to conventional treatment rather than implying that it is one or the other.

Excerpt from the book:

Basics of a Healthful, Antidepression Diet
By Michael B. Schachter, MD, & Deborah Mitchell
What Your Doctor May Not Tell You About Depression

For some people, the phrase healthful diet is enough to send their mood tumbling. “Guess I’ll have to give up everything I enjoy, like chocolate and hamburgers and french fries,” sighed one patient. “That’s enough to make me even more depressed!” But healthful need not be equated with unappetizing or boring. Different, perhaps, and for some people a change to a more healthful diet requires big adjustments — in the foods they buy, where they eat out, and how they prepare their choices. The rewards, however, are many, including improved mood, more energy, enhanced immune system, better concentration, and invigorated sex drive, to name but a few. I’ve found that laying down a few basic but critical guidelines for a healthful diet, and then tweaking them for individual patients, works much better than expecting people to follow a complicated program that involves counting grams of carbohydrates or protein, weighing foods, referring to charts, or combining certain items in complicated ratios. That being said, here are my lists of Positive Foods and Foods to Avoid.

Positive Foods

  • Sweets. In moderation, natural sugars such as rice syrup, date sugar, pure Vermont syrup, unsulfured blackstrap molasses, and unfiltered honey are all acceptable. An herbal sweetener — that has nearly no calories — is stevia, which can be found in health food stores and increasingly in mainstream grocery stores.

  • Fats. Some fats are healthy and instrumental in maintaining mental health, especially omega-3 fatty acids. When you choose oil for cooking, your best choice is probably cold-pressed olive oil. Butter and other saturated fats (like coconut oil, but not margarine that contains transfatty acids) may be used in moderate amounts. I suggest you avoid fried foods (especially deep-fried).

  • Whole fruits and vegetables. Whenever possible, choose fresh, organic fruits and vegetables and eat at least five to seven servings daily. To derive the most benefit from these rich sources of vitamins, minerals, fiber, and carbohydrates, eat them in as pure a state as possible, preferably raw or lightly steamed. (Sorry, deep-fried potatoes and onion rings don’t count as servings of whole vegetables.) Fruit and vegetable juices are good as well, and if you have a juicer, please learn how to make your own fresh juices, remembering to drink the pulp as well!

  • Whole grains and cereals. Whole grains and cereals (organic if possible) are excellent sources of complex carbohydrates. These foods include whole grains, brown rice, and unprocessed cereals. Complex carbohydrates break down gradually and provide a more steady supply of glucose – brain fuel – thus helping maintain an even or calmer mood. Simple carbohydrates, however, such as those found in sugary foods or those made with white flour, metabolize rapidly, contributing to and causing mood swings and energy highs and lows. Also, be aware that some grains and even other whole-food starches may be problematic for some people.

  • Beans, legumes, nuts, and seeds. Choose organic foods in this important category as well. Foods in this group are excellent sources of protein, especially for people who want to reduce or eliminate animal protein. Beans, legumes, nuts, and seeds are also high in fiber and many nutrients. Also in this category are tofu and other forms of fermented soybeans (miso, tempeh) and flaxseed.

  • Eggs and dairy. Eggs and dairy foods — milk, cheese, butter, cream, and yogurt — are good sources of protein, calcium, and other important nutrients. They are also rich sources of saturated fat, which may be fine for many people. The major concern I have about eggs and dairy relates to whether hormones were used in raising the animals; whether or not they were given foods containing pesticides, antibiotics, toxic minerals, or other chemicals; and whether the animals were confined to inhumane cages. Soft-boiled eggs are best because heat is applied without exposure to oxygen, thus reducing free radical damage. I recommend organic eggs and dairy products and prefer nonhomogenized milk. Although pasteurization of milk products is the norm today in order to eliminate harmful bacteria, certified raw milk is preferred in areas where it is available, provided the cows are clean and hygienic principles are used in caring for them. If you are lactose-intolerant because of a deficiency of the enzyme lactase, or you choose not to consume dairy items, nondairy foods may be used. These include products made from soy, rice, or nuts, such as soy milk, rice milk, and almond milk; cheese made from these “milks”; and nondairy desserts. These “dairy” foods are also good sources of protein.

  • Organic meats and poultry. Despite a push for people to eat more fish, meat and poultry continue to be major sources of animal protein for many people. For patients who eat meat, I recommend organically raised products, which are virtually free of hormones, pesticides, antibiotics, and other unnatural additives, all of which can have a detrimental effect on mood and general health. Such meat and poultry choices are slowly becoming more accessible and typically are available in natural and whole-food stores. Meats and poultry are sources of methionine, which is critical for methylation; this amino acid is difficult to get from plant-based sources.

  • Fish and shellfish. Fish and shellfish can be excellent sources of protein and omega-3 fatty acids, if you make judicious choices. I’m calling for “judicious choices” because of the persistent and very real problem of mercury, pesticides, PCBs, and other contamination of the fish supply. Fish that I tend to recommend that are high in omega-3 fatty acids, but relatively low in mercury, are wild Alaskan salmon and sardines. I am wary about farm-raised fish because some studies indicate that they are high in PCBs and other contaminants. The smaller the fish (say, sardines), the less likely they are to accumulate mercury. But if you eat fish fairly frequently, I recommend that you have your blood mercury levels checked, because there is no way to guarantee the fish you eat regularly is not contaminated. Everyone whom I have checked for mercury who eats sushi more than once a week is quite high in it. Swordfish, king mackerel, shark, and most tuna tend to be quite high in mercury.

I would like you to consider two factors when choosing foods from this list. One, do you have any reactions to these foods that may be contributing to or causing your depression? Two, do you have any specific food preferences based on religious, ethical, and/or moral beliefs? If you are a vegetarian, for example, you will not select meat, poultry, or fish, so you will need to choose other protein-rich foods such as soy products, legumes, beans, seeds, and, depending on the type of vegetarian diet you follow, eggs and/or dairy.

Foods to Avoid

Most of the foods included in this list should come as no surprise to you. In most cases, foods on the Avoid list have been highly refined and processed. Fortunately, for every food you should avoid, there is a healthy alternative on the Positive Foods list. You may find that the Avoid list reads like your current grocery list; or you may discover that only one or two categories apply to you. Next time you’re in the grocery store, here are the items you want to skip:

  • Sugar. Avoid all foods that contain added sugar, such as soda, candy, cakes, ketchup, some breakfast cereals, and so on. Become a label reader. If sugar (or one of its companions, such as corn syrup) is one of the first few ingredients, put the item back on the shelf! Sugar can give you a burst of energy, but in the long run it can leave you depressed and tired.

  • White-flour products. Just say no to white bread, white pasta, and other products that use white flour, including many crackers, rolls and bagels, refrigerator biscuits, pizza dough, and baked goods. Also avoid white rice. These overly processed food products have been stripped of their nutritional value, and then they are “enriched” with some nutrients, along with synthetic additives.

  • Alcohol. This includes beer, wine, and liquor. People often forget that alcohol is a depressant, even though it provides an initial kick. Drinking alcohol can also disturb your sleep, which is a problem with many people who are depressed.

  • Caffeine. Avoid coffee, tea, colas, and chocolate. (Okay, you can have a limited amount of organic dark chocolate on occasion.) If you must have coffee, choose an organic coffee, since most coffees are high in pesticides. Decaffeinated coffee is fine for most people, provided that it is organic and does not use toxic chemicals in processing.

  • Hydrogenated fats. Hydrogenated fats are oils to which hydrogen atoms have been added in the factory in order to harden them and improve shelf life. These hydrogenated oils or fats contain high concentrations of trans-fatty acids, which have recently been clearly shown to disrupt fatty acid metabolism in the body and cause serious disease. Hydrogenated fats are found primarily in margarines, snack foods (potato chips, corn chips), crackers and cookies, baked products, and fast foods. When you read ingredient labels, look for the words hydrogenated, partially hydrogenated, margarine, or shortening, which indicate the presence of trans-fatty acids, or look at the nutritional panel for the percentage of trans-fat in the product. Beginning January 2006, food manufacturers were required to list trans-fat content on labels.

  • Chemical food additives. To avoid artificial preservatives, flavorings, colors, and sweeteners, you need to read labels. Not all labels list all the chemicals in the food item, but the general rule is: If the product has been processed, it probably contains chemicals. For example, artificial preservatives such as BHA, BHT, nitrites, monosodium glutamate, and nitrates are often seen in cereals, breads, frozen dinners, boxed meals, and crackers. All foods containing artificial colors (such as red dye 40) or artificial flavorings should be avoided. Artificial additives can cause various adverse reactions, including mood swings, depression, fatigue, headache, rash, aggression, irritability, and attention difficulties, among others. I believe all artificial sweeteners, including saccharine, aspartame, and sucralose, should be avoided. In particular, avoid diet sodas containing aspartame.

  • Fluoride. Do not drink fluoridated water or tap water (unless filtered) or use fluoridated toothpaste. Despite the popularity of fluoride dental treatments for both adults and children, I strongly recommend you not get them. Also, avoid fluoridated vitamins for children. There are a number of excellent books and websites that clearly document the lack of efficacy and dangers of fluoride ingestion and fluoride use. If you live in an area where the tap water is fluoridated and you want to drink the tap water but not the fluoride, you need to use a water filter with a reverse osmosis component; carbon filters will not remove fluoride.

  • Chloride. Do not drink chlorinated water (unless the chlorine has been filtered out), as chlorine is toxic. A simple carbon filter will remove chlorine from tap water. 

In the end, I would like to recommend this book for the useful information it contains. I cannot recommend it globally because of the overly-prejudicial way that information is presented. Had the author aimed more at a balanced view of conventional and alternative treatments, this could have been a much better resource. It is, I think, a worthwhile read for the practitioner with a critical eye, but not recommended for most patients.

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3 Comments

  1. David,
    Excellent post and well done blog! Coming from the psychiatric perspective, having worked for years with the unfortunate polarization present in contemporary medicine, I completely agree with your observation that we must open our minds to all possibilities. So many of the “functional types” think that traditional meds are not only valueless, but wrong – and on the other hand so many “traditional folk” decry the functional med practitioners as quacks.

    In my own postings I spend considerable time on this important point, as the evolution of medicine, as noted in the Structure of Scientific Revolution by Thomas Kuhn, is characterized by a slow and often adversarial process, while the patients continue to suffer. Let me see… does cigarette smoking cause lung cancer? Can you prove it?

    So much of what we do in practice every day must include all the varieties of information. Having completed training in psychoanalysis years ago, I can testify that my practice over nearly 40 years has changed dramatically for the better. I now ask hormone and bowel questions in great detail and find an abundance of undiscovered medical issues with so many folks identified as refractory psych cases.

    In fact, that’s why I came to study SPECT brain imaging and worked with Amen for almost 4 years. “If you don’t look you can’t see!”

    I am personally very interested in this Schacter book and your review regarding amino acid neurotransmitter precursors, as there are many people who prove refractory to simply modifying the neurotransmitters at the synaptic level.

    From one “simple intervention” point he is making a good argument for protein breakfasts [amino acids start the day] – and I will have to read the book to connect all of those dots. My own view is that everyone on any psych meds should have a protein breakfast everyday, period.

    Further, I do notice that interventions that include the whole person, from nutrition to metabolic challenges, will support initial interventions with psych meds. Without the body view the brain meds often don’t work, especially on the long haul.

    Thanks again for this excellent posting,
    Chuck

  2. The article is comprehensive and to the point. Can depression be linked with dual diagnosis?
    ………………………………………….

    jim dunn

    Dual Diagnosis

  3. Jim-
    While I am not hosting this blog, I can tell you without reservation, a very big yes!

    Having said yes, on what I suspect is the underlying question, let me ask one other key point… what is the “dual” on the diagnosis?

    I see so many in my office who are dual on several issues and have discussed depression associated with chemical dependency since the 80’s. With progressively greater *depression insights* with the multiple new technologies [one of my favorite topics] we see many “duals” walking with our clients down the diagnosis trail.

    Hope I hit the right dual on this question!
    cp

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