I am not a doctor, but I have been to many, so I am going to write out here the information that I have collected over the few years. The first step, if you are feeling depressed, would be going to a doctor. In Canada you can visit your family doctor if you have one, or you can go to ER. In October 2015 I was waiting for a subway train in the station and I thought of jumping under it. The thought was not spontaneous, I have been getting more and more depressed over a period of time. I told my boyfriend about my thoughts of jumping and he convinced me to go to the ER. I was terrified when the doctor who examined me said that I would be involuntarily hospitalized in the psychiatric unit. The first thing that came to mind was probably a scene from One Flew Over the Cuckoo’s Nest. Given that I was in a psychotic state, I imagined that my boyfriend and the doctors conspired to lock me up for an indefinite amount of time. Well, none of this happened. The law is that you can be involuntarily hospitalized for three days, and then your case has to be reviewed. Two opinions of physicians are required to maintain the detention.
Actually I should say I got lucky that when I went to the ER I got seen by several psychiatrists and got to be examined for three days. At the moment there are not enough beds and not enough psychiatrists in Ontario, often people needing help are placed on six to nine months wait lists. Going to ER is therefore a good option because it’s more likely that there will be a psychiatrist available right away (yes, you might sit in the waiting room for five hours, but that’s not six months). Also blood tests would be performed to determine whether any health conditions could be causing your psychiatric symptoms. Tests performed could include the following:
- TSH level to check for hypo/hyperthyroidism
- Blood glucose level to check for diabetes
- Iron/ferritin levels to check for anemia
- Renal function (for chronic kidney disease)
In my experience doctors did not check for autoimmune diseases as part of the lab work, but if you are experiencing physical symptoms as well, you could ask your doctor to check this. Autoimmune testing:
- Thyroid antibody levels (Anti-Tg and Anti-TPO antibodies) – high levels can indicate Hashimoto’s thyroiditis, also Hashimoto’s Encephalopathy (but this is quite rare)
- C-reactive protein – marker of inflammation
- Antinuclear antibodies (ANA) – checking for lupus
- Rheumatoid factor – associated with rheumatoid arthritis
- Anti-NMDAR antibodies – anti-NMDA receptor encephalitis (rare occurrence)
- Celiac disease testing (it is also an autoimmune disorder)
Gastrointestinal disorders are also associated with depression. Individuals with gastritis are more likely to suffer from anxiety, panic attacks and depression. Depression and anxiety is also more often present in people with irritable bowel syndrome. If you experience any gastrointestinal/abdominal pains and discomfort, it’s important to visit a gastroenterologist. You can be tested for celiac disease. New research also indicates that many people who considered themselves having a gluten sensitivity actually had issues with high FODMAP foods. These are fermentable oligo di mono-saccharides and polyols, short chain carbohydrates and sugar alcohols. Personally I was diagnosed with chronic gastritis a few years ago, even before I got to the psychiatrist. The gastroenterologist who diagnosed me did not have any suggestions for me. A year ago I visited a different gastroenterologist, and she advised me to try a low FODMAP diet. I have been following it for a while, even after I stopped the AIP diet, and it definitely reduced my abdominal pains. Hopefully it is affecting my mood positively as well.
Once you talk to your family doctor or your psychiatrist about depression, if you do get diagnosed with depression, usually anti-depressants are prescribed. If you experience psychosis, anti-psychotics can be prescribed (on their own or along with anti-depressants). I am not a doctor, so it’s not for me to tell you which medication to take, but I just want to bring to your attention recent research on the link between depression and inflammation. I think no matter whether you do or don’t take psychiatric medication, it might be worthwhile to analyze your lifestyle and to think whether there are unhealthy aspects of it that you could change.
I know this may sound pointless – it may seem that no medication or lifestyle changes can help because it is life itself that is so meaningless, so emotionally painful, and how is that going to get changed? I used to get angry at suggestions by psychiatrists to attend therapy or my mom telling me to take fish oil. What does fish oil have to do with my life? How will it make me less lonely, how would it make life less dull and meaningless? The thought that helps me to try a suggestion is “what do I have to lose?” If I am already at the point where I no longer want to live, what will I lose by trying fish oil? Yes, it means I will agree to still be alive and try taking these stupid capsules, but I don’t have to be alive forever, it’s not possible anyways. I am not agreeing to suffer forever, I am just agreeing to stay alive for now, and to try.
Back to inflammation discussion – so for example you say “ok, fine, maybe I will try to stay alive, but so what? What is the suggestion?” Well my suggestion is in addition to discussing with your psychiatrist medication/therapy options, look into your daily diet and activities. From the article above, it is stated that the Journal of Clinical Psychiatry published a study with results indicating that increased inflammation in the body may be linked with depression. Inflammation is when there is a response from the immune system. Many different immune cells can be activated during inflammation and they produce different substances, such as antibodies (there are different types).
We need the immune system to be active to fight viruses and bacteria, but what the authors of the paper are saying, is that chronic inflammation does not help us and is damaging instead, reducing chronic inflammation may reduce depressive symptoms. PsychologyToday author in the article recommends avoiding fried foods, soda, white bread and pastries, margarine, lard, and red meat. In general highly processed foods and refined carbohydrates are considered to be linked with inflammation. White bread, white rice, pizza pops, hot dogs, salami, cookies, etc. In general a lot of doctors advise to follow a Mediterranean diet, which means reducing red meat, processed foods, refined carbohydrates and sweets. It includes eating the following:
- whole grains/pseudograins (quinoa, brown rice, millet, oats, buckwheat, etc.); it is suggested to eat them whole and not in form of grain flour
- poultry – turkey and chicken
- fish, especially fatty fish like salmon
- eggs (I suggest trying quail eggs!)
- olive oil instead of vegetable and seed oils
- legumes (checked whether you have issues with high FODMAP foods)
- nuts and seeds (try finding those that weren’t roasted in vegetable/seed oils, you can eat raw nuts)
- dairy – if you have issues with cow milk, there is goat milk; there is also goat yougurt and you can make goat kefir
- some fruits
I think no matter what you were diagnosed – depression, schizophrenia, bi-polar, etc., a healthy diet is very important. It’s very important for anyone. Our brain is just an organ like all other organs and it needs proper nutrients and can also get damaged, like other organs, by chronic inflammation. At first I was very skeptical about the correlation between diet and my thoughts, but then as I started experimenting with changes in what I eat, I noticed that it does affect what I think. Sometimes I am really tempted to buy ice-cream or something like that, but I just remind myself that for me it’s not worth it, it can take me to a very dark place. I just have to accept that as someone with diabetes has to watch their carb intake, I also have to watch what I eat because of my chronic autoimmune condition. This is just how it is, I have to accept that it’s chronic, and that I can’t just go to the food court and buy whatever I want. I mostly bring food from home or I buy from places that list all of their ingredients, so that I can make sure it doesn’t have gluten, cow’s dairy, a lot of sugar, high FODMAP items, etc.
Yes, it’s not pleasant having to worry about the ingredients each time you eat, but the benefit for me was a change in my thought process, and I find that the most valuable. Our thoughts and emotions are what matters because that is our experience of life, so that is the number one thing that I want to change myself, I want to have a positive life experience.