HDC Therapy for autoimmune disorders

HDC, hymenolepis diminuta cysticercoids, is a larvae stage of a nice and friendly rat tapeworm, an adult of this species can be 20-60cm long. You might have a thought now “what am I reading and why?”, but hold on. Humans are not the usual host of hymenolepis diminuta, rats are, and in humans this helminth does not develop into an adult. There have been very few cases documented of humans being infected with adult HD. For this reason the HD larvae, HDC, is one of the species chosen for helminthic therapy as it does not reproduce inside humans, stays in the gut, does not reach adult size, and yet modulates the immune system as it tries to survive.

HDC survive in humans only for about two weeks, therefore for continuous therapy, HDC would need to be ingested at these intervals. HDC will live in the small intestine and attach to the intestine wall. There are no reports in the scientific literature of H. diminuta mis-migrating to other organs in humans. In a scientific review of helminthic therapy from 2016, HDC was listed as one of the more popular helminths:

Five physicians monitoring more than 700 self-treating patients were interviewed. The results strongly support previous indications that helminth therapy can effectively treat a wide range of allergies, autoimmune conditions and neuropsychiatric disorders, such as major depression and anxiety disorders. Approximately 57% of the self-treating patients observed by physicians in the study had autism. Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis. However, approximately 1% of paediatric patients experienced severe gastrointestinal pains with the use of H. diminuta, although the symptoms were resolved with an anti-helminthic drug. Further, exposure to helminths apparently did not affect the impaired comprehension of social situations that is the hallmark of autism. These observations point toward potential starting points for clinical trials, and provide further support for the importance of such trials and for concerted efforts aimed at probing the potential of helminths, and perhaps other biologicals, for therapeutic use.

Practices and outcomes of self-treatment with helminths based on physicians’ observations

Here is another paper from 2017 reviewing HDC use by self-treating individuals. Unfortunately there are not many clinical trials with treatment and control groups, therefore we have to rely on information on experiences from people like me who are obtaining helminths and treating themselves. ” In this study, we describe the production and use of HDCs in a manner that is based on reports from individuals self-treating with helminths, individuals producing helminths for self-treatment, and physicians monitoring patients that are self-treating.” The authors from Duke University are quite optimistic about helminthic therapy: “Helminthic therapy, the use of helminths to treat disease, offers the best hope of decreasing inflammation via immunomodulation rather than immunosuppression, and probably also improves mucosal barrier function.”

Production and Use of Hymenolepis diminuta Cysticercoids as Anti-Inflammatory Therapeutics

I was glad to read that I already have access to the most hopeful treatment for inflammation. I have to say that I tried a lot of supposedly anti-inflammatory treatments  and was quite disappointed with most. Turmeric lattes, green tea extract, probiotic capsules, licorice root tincture…  Personally, I don’t really want to buy any more supplements, except basic ones such as vitamin D, since I live in cold and dark Canada, and occasionally I take fish oil on days that I don’t eat seafood.

The idea behind helminthic therapy, on the other hand, is quite logical to me. It’s not a promotion of another one magical super inflammatory ingredient. The logic is that humans and certain helminths have evolved to co-exist in a symbiotic relationship and therefore our immune system has also evolved  to be modulated by molecules that helminths produce. Recent eradication of helminths in humans in developed countries could be resulting in a destruction of a beneficial symbiotic relationship and increase in rate of autoimmune diseases.

“Graph the data points, and the trend is unmistakable. Since the 1950s, rates of multiple sclerosis, Crohn’s disease, type 1 diabetes, and asthma have soared by 300% or more (1). Similar graphs depict concurrent spikes in hay fever and food allergies (2).”

“Prevalence of food allergy in preschool children is now as high as 10% in Western countries, but remains just 2% in areas like mainland China (). The number of new cases of type 1 diabetes (T1D) in Finland per year is 62.3 per every 100,000 children, compared with just 6.2 in Mexico and 0.5 in Pakistan (). Ulcerative colitis, a form of inflammatory bowel disease (IBD), is twofold higher in Western Europe than in Eastern Europe—6.5 per 100,000 people versus 3.1 per 100,000 ().”

In each of these disorders, either the immune system is overreacting to a trigger, such as pollen, peanuts, or pollution, or it’s attacking tissues it shouldn’t, such as beta cells in the pancreas in the case of T1D and in the intestines in IBD.”

News Feature: Cleaning up the hygiene hypothesis

 

Celiac disease, vitamin and mineral deficiencies, and a beef patty

I’ve done something today that I probably haven’t done for at least a year or more. I bought a beef patty. I felt very guilty because I don’t want to eat large mammals. Ideally I wouldn’t eat any birds or animals, but we have to make practical choices. From my experience, having celiac disease, I don’t absorb vitamins and minerals well. A chicken leg of 100 grams has approximately 6% daily value of cobalamin, 6% DV magnesium, 7% DV potassium, and 25% DV B-6. Without eating meat or fish, you could try to get vitamin B-6 from beans, also fortified cereals contain B-6. Here is the issue – with celiac you cannot eat most fortified cereals and breads since they are not gluten-free, also eating too many beans causes digestive problems. So I had to make a choice and about a year ago  I chose to eat seafood and poultry, but not mammals. My reasoning is that compared to chickens and turkeys, large mammals such as pigs and cows have more complex brains and nervous systems and therefore have more complex emotions and might suffer more during their short life in a cage at a factory farm. I have no proof of that, but I had to make a choice.

Unfortunately recently I had to make another choice to start eating red meat again. I was experiencing lethargy and noticed white bands on my nails. Some sources stated that white spots on nails could be a sign of zinc deficiency, while others indicated that there was no correlation. This did lead me to wondering whether I was getting enough zinc, selenium, and B vitamins from chicken and salmon. 100 grams of beef on average contain 43% DV (daily value) of B12, 20% DV of B6. Dietitians of Canada also list beef as top sources of zinc, 75 grams of beef containing 4.0 – 8.6 mg of the mineral (women need 8 mg per day).  Chicken is much lower in zinc, 1.3 – 2.2 mg per 75 grams. Salmon was not listed as it is not a good source of zinc, it contains about 0.64 mg per 100 grams. Some studies indicate that it’s harder to absorb zinc from a plant based diet, in addition to that my absorption may be worse due to gut inflammation caused by autoimmune disease.

With reduced intake of meat and increased intake of phytate-containing legumes and whole grains, movement toward plant-based diets reduces dietary iron and zinc absorption.

Moving Toward a Plant‐based Diet: Are Iron and Zinc at Risk?

zinc1

Why do we need zinc and what happens if there is a zinc deficiency? Zinc is found in cells throughout the body and is needed to make proteins and DNA. Zinc plays a role in cell division, cell growth, wound healing, and the breakdown of carbohydrates. It is important for the function of the immune system and also the senses of smell and taste.

zinc2

Zinc deficiency can cause appetite loss, poor immune system function, diarrhea, eye and skin lesions, feeling lethargic, strange taste sensations, hair loss, weight loss, poor wound healing. Individuals with chronic conditions and poor absorption are more likely to be zinc deficient.

Zinc performs its biochemical functions as a divalent cation (positively charged ion) primarily when bound to enzymes and other proteins. Zinc is essential as a catalytic, structural, and regulatory ion and is involved in homeostasis (the tendency to maintain a stable, relatively constant internal environment), immune responses, oxidative stress, apoptosis (the death of cells which occurs as a normal and controlled part of an organism’s growth or development), and aging. Zinc is recognized as being important for stabilizing DNA and appears to reside in the nucleus longer than any other cell compartment. Therefore, it is possible that as intracellular levels of zinc increase, more iron will be displaced from nucleoproteins and less OH-driven DNA damage will occur.

Biological consequences of zinc deficiency in the pathomechanisms of selected diseases

A study on zinc deficiency in relation to psychiatry:

“Zinc participation is essential for all physiological systems, including neural functioning, where it participates in a myriad of cellular processes. Converging clinical, molecular, and genetic discoveries illuminate key roles for zinc homeostasis in association with clinical depression and psychosis which are not yet well appreciated at the clinical interface. Intracellular deficiency may arise from low circulating zinc levels due to dietary insufficiency, or impaired absorption from aging or medical conditions, including alcoholism. A host of medications commonly administered to psychiatric patients, including anticonvulsants, oral medications for diabetes, hormones, antacids, anti-inflammatories and others also impact zinc absorption. Furthermore, inefficient genetic variants in zinc transporter molecules that transport the ion across cellular membranes impede its action even when circulating zinc concentrations is in the normal range. Well powered clinical studies have shown beneficial effects of supplemental zinc in depression and it important to pursue research using zinc as a potential therapeutic option for psychosis as well. Meta-analyses support the adjunctive use of zinc in major depression and a single study now supports zinc for psychotic symptoms.”

The Emerging Role for Zinc in Depression and Psychosis

From my own experiment with N=1, I did feel better after eating a beef patty. This could be a coincidence, a placebo effect, or an actual effect of the minerals/vitamins in beef on my mood. I also thought of a substitute for beef that is not a mammal – mussels and clams. A 3-ounce serving of cooked mussels contains about 15% of daily value of zinc. The same amount of moist-cooked clams also provides 15% of the daily value for zinc. Clams and mussels contain high amounts of vitamin B12, selenium, and iron, as well as omega-3 fats. I think therefore it’s possible for me to continue avoiding beef if I include chicken, fish, mussels, and clams.

Depression and TSH levels

I continue to track my thyroid hormone levels and thyroid antibody levels. As my endocrinologist predicted, after a thyroid inflammation event (as indicated by ultrasound test results), and a state of hyperthyroidism, my thyroid hormone levels went the opposite way and now I am hypothyroid. I will say that for me personally the hyperthyroid state did not feel as bad as the current hypothyroid state, though I am hopeful that hypothyroidism can be treated with levothyroxine, which was recently prescribed to me. My antibody levels continue to be high and my endocrinologist stated that with Hashimoto’s autoimmune disease in general antibody levels stay chronically elevated. I might be receiving IVIG treatment soon, in April, and hopefully that will reduce the inflammation of the thyroid.

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In terms of emotions, during hyperthyroidism, I did feel jittery and very hungry, but I also experienced a roller coaster of more positive emotions such as more interest in men, infatuation, desire for adventure. I can’t say that my depression went away, but I do remember having moments of making plans to travel to Guatemala to attend a Spanish course, thinking of having an affair, wanting to perform in a band with my violin. Recently with hypothyroidism, as I described in a previous post, what I had been feeling is complete disinterest and grief. As if your life is somehow passing by, the world keeps going without you. There is a feeling of slowness in your movements and speech, a sense of painful emotional weight, inability to fully engage in an activity. Well if you have experienced hypothyroidism, you might know what I’m talking about. It’s feeling lonely and yet having no energy to call someone to make plans. Thinking that in theory I do enjoy playing violin, but today doing that would be just too difficult. Exercising definitely was becoming impossible, my legs have been feeling very heavy, and my whole body in general.

Today I started levothyroxine 0.025mg and I am hopeful that this will lower my TSH and therefore relieve all the symptoms that I am experiencing, at least I am very hopeful that levothyroxine in combination with IVIG will really help. I found an interesting study in which the authors seek a TSH threshold for depression. Two thirds of the study participants were female, as expected. There were 174 hypothyroid patients who were receiving levothyroxine treatment and were considered euthyroid. “Individuals who had developed euthyroid state under treatment with levothyroxine with TSH levels of 0.5–5 MIU/L with no need for dosage change were included in the study. After comprehensive history taking, laboratory tests including TSH, T4 and T3 were performed. Beck depression questionnaire was completed for all patients by trained interviewers. TSH cut-off values based on depression was determined by Roc Curve analysis.” Basically, as I understand, the researchers wanted to find out whether there is correlation between TSH levels and depression for patients who were diagnosed with hypothyroidism and are receiving levothyroxine.

Results were the following: “According to Roc curve analysis, the optimal cut- off value of TSH was 2.5 MIU/L with 89.66% sensitivity. The optimal TSH cut- off based on severe depression was 4 MIU/L. The present study suggests that a clinically helpful TSH cut-off value for hypothyroidism should be based on associated symptoms, not just in population studies. Based on the assessment of depression, our study concludes that a TSH cutofff value of 2.5 MIU/L is optimal.” I think what they are trying to say here is that based on large population studies there was a range for normal TSH levels determined, for example on my lab tests that range is stated as 0.32 – 4.00. Their study shows though that even though my individual TSH could be within this range, it doesn’t mean that I won’t be having any hypothyroidism symptoms, such as depression. Maybe for me personally TSH of 3.80 would be too high and my mood would be influenced and I would be better off at a level of levothyroxine that would bring my TSH below 2.5. Therefore it’s important to consider the symptoms of a specific patient and not just the determined ‘normal’ range.

TSH cut off point based on depression in hypothyroid patients

Also different countries and labs don’t state the same ‘normal’ ranges. In the study the TSH range is indicated as 0.5 – 5 MIU/L, while my lab states 0.32 – 4. So if I went to a doctor in another country, he could have said that my thyroid hormone levels are normal, but based on my lab’s range, my endocrinologist said that I might be becoming hypothyroid, since TSH is out of range, and therefore prescribed me levothyroxine. Also he did take into account the symptoms that I was experiencing, which is what the authors suggest – don’t just look at the TSH, how does the patient feel?

 

Doing something while depression is on

On Sunday I woke up not very late and made pancakes, brewed a thermos with green tea and drove on a highway to a park to build a snow woman. Yes, it was specifically a very shapy lady, not a snowman. Today after I got home from work I felt that I couldn’t move. I couldn’t move because of overwhelming emotional pain – it was a sense of grief, a feeling that my personal world has collapsed, that there is nothing to look forward to. I am not going to say that on Sunday I was extremely happy, but it was clearly a more normal and stable day. What has occurred to make today different? I’m sure the answer lies in biochemistry, but at this point we don’t have the tools or knowledge to know what exactly should be measured and when. My last period started on February 15th. (I suggest to record start dates in order to understand whether the cycle affects your mood – at least in the case that you usually feel worse in the first few days before/during your period – you can remind yourself that this is not permanent and it will pass as it did before).

Today it is March 14th, could my serotonin levels be dropping? WebMD suggests that “as many as 90% of women experience unpleasant symptoms before their periods“, it has now been almost a month since my period, therefore today is supposed to be close to the “before period” time.

Estrogen and Women’s Emotions

My thyroid antibodies also continue to be high, Anti-TPO at 250 and Anti-Tg at > 4000. TSH is abnormally high as well. My CT scan also indicated “partially imaged polypoid mucosal thickening in the right maxillary sinus”. What does that mean, does that have anything to do with depression? It seems to mean chronic sinusitis. I don’t know whether this ever has any effect on your mood.

lifelabs_15032019

The information above leads to some guesses about why I started to feel more severe emotions, but I can’t say that I actually know. I believe I have already made the changes to my lifestyle that I could – cutting out gluten and cow dairy because of celiac disease, avoiding processed foods, eating a lot of whole grains, fruits, and vegetables. I drink a lot of green and black tea, never drink or smoke, I go to sleep a bit before 12am and sleep for 8 hours. I walk to the subway instead of taking the streetcar, on a grey day I use my daylight lamp in the morning. I got an unlimited pass to a yoga studio and go there during lunch. No caffeine after 6pm. I call my mom and my grandmother. I try to avoid scrolling through Facebook. Therefore I would say – I’ve really done it all, what I could.

So what if you feel you’ve been as healthy as you can, you see your psychiatrist regularly, but the depression still sets in? Currently I am waiting for the IVIG procedure which is supposed to be done in April. You might be waiting for your next appointment to talk about switching medications, or you just started an antidepressant and the psychiatrist said that the positive results may take effect only after four to six weeks. I think the only strategy in such a situation is to think of activities to pass the time. Doing something even though feeling depressed. Even if your brain is dissuading you from it, it’s telling you to sit still, to not move, that any action you take will make it worse.

In DBT therapy there is an idea of opposite action and I believe this is a useful technique. “In DBT, the opposite action skill is a deliberate attempt to act OPPOSITE of your emotion urge. If your emotions are doing more harm than good, try acting opposite.” My thoughts are telling me that I am in too much emotional pain to do anything, but doing nothing will prolong the sense of time and I will just suffer more while waiting. For example last Thursday while sitting at work, I felt that I feel too depressed and lethargic to do anything expect stay seated during lunch and that trying to do any activity would make me feel worse. In this case my emotions and thoughts were only harming me because continuing sitting, after already three hours of sitting, would definitely not make me better off. I would be wrapped in my thoughts, prolonged sitting is not good for blood flow and chronic pain, time would also go very slowly. I had to use opposite action and I forced myself to go downstairs, change, and attend a yoga class. The 45 minute class passed quicker than 45 minutes of sitting would be and because the classroom was hot and I had to keep focusing on switching poses, my negative thoughts were less persistent. I am not saying that I went to yoga and felt delighted and blissful for the 45 minutes, I am saying that I was better off by going there instead of following my emotions and doing nothing.

Another example where following my emotions would make me worse off is often when I start feeling lonely I get wrapped in thoughts that I don’t have any close people and not many people to spend time with. Next, I start to think that I am the only one with no plans for the evening/weekend, and therefore it is pointless to ask anyone whether they want to meet. Clearly in this case acting as my thoughts and emotions tell me to would only harm me as I would end up not reaching out to anyone and of course then I will have no plans with certainty. Here opposite action would be texting/calling someone and proposing to make plans. Preferably be specific with an activity, place, and time. Refer to Sheldon’s friendship algorithm for instructions.

Sheldon’s Friendship Algorithm

Suggestions for passing time with depression are listed below. What works for me are simple activities, not trying to follow some life changing goals or saving the world. Depression is a real illness, and if all I was able to do during a bad day is coming out to convenience store to buy plantains, I will say – good for me.

  • See an old friend, talk about your feelings, or talk about nothing in particular – remember a dumb high-school story, laugh about it
  • Talk on the phone to someone you think is a good person, call them even if your brain is telling you that you are better off not speaking to anyone
  • Cook/bake something that you know how to make and enjoy eating, I make crepes because the recipe is simple and this activity passes time as I have to fry each crepe separately
  • Walk to a store nearby to buy something small – tea, eggs, apples, etc.
  • Jump with a skipping rope at home, or on a porch, or outside. Aerobic exercise is healthy
  • Get the lyrics to a song that you know and sign the full song, even if initially you really don’t feel like it. It will help pass the time and singing will not hurt you
  • Walk around the block while listening to a podcast
  • Watch CollegeHumor or Big Bang Theory

 

Planks, gut health, and mental health

I’ve had many conflicts with my father, but one thing I’ve always agreed with him on is that there is no mental health without physical exercise. Especially for those with emotional instability like me, I find that exercise is a necessity. It’s definitely not easy to do it with an autoimmune disease since sometimes after I get home from work – I feel lethargic, or I feel arm pain, or I feel isolated and a need to go on Facebook and see that people are alive. Well this is where logical thinking comes in – in the end choosing to exercise has the best payoff even though it’s not immediate. Lying down on the sofa and turning on Netflix has an immediate pay off, but if this is what I will do daily after work, after a while I will be worse off.

Currently I am trying to exercise two to three times a day. I do about 10-12 minutes before leaving for work in the morning, I include stretching, planks, downward dog, inversion poses, etc. Recently there have been some articles about positive impact of even very short intervals of exercise. I would like to believe that these statements are true as I am not able to force myself to wake up another twenty minutes earlier and engage in a 30 minute work out before work or breakfast. I do believe that some exercise is better than no exercise. I work in a boring office, so my hours are pretty standard. During lunch I walk around listening to a podcast and currently I signed up at a yoga studio located in the office building downstairs, which offers lunch classes. In the evening I try to do another 20-30 minutes of exercise. Is this exercise plan difficult? Yes, but once you do it several days in a row, I feel that there is some kind of adjustment and you get used to the schedule. Also I find it easier when I know that my exercise interval is only 12 or 20 minutes, I am not trying to push myself into an hour jog. In fact I don’t jog at all. I mentioned this before – one psychiatrist with whom I had a consultation stated that the best way to combat inflammation is exercise and that I should only do the type of exercise that I like, otherwise I will not stick with the routine for long. Therefore no jogging for me, I am doing planks and yoga poses.

The latest research shows that a single 10-minute bout of very light (30% of VO2 Max) physical activity can increase the connectivity between brain regions linked to memory formation and storage.

This potentially groundbreaking study on the cognitive benefits of short periods of mild exertion activity (such as gentle yoga, tai chi, slow dancing, or playing bocce) was conducted by researchers at the University of California, Irvine (UCI) and the University of Tsukuba in Japan.

Ten minutes of mild exercise may improve brain connectivity and enhance memory

From the abstract of the actual paper: ” A single 10-min bout of very light-intensity exercise (30%V˙O2peak) results in rapid enhancement in pattern separation and an increase in functional connectivity between hippocampal DG/CA3 and cortical regions (i.e., parahippocampal, angular, and fusiform gyri). Importantly, the magnitude of the enhanced functional connectivity predicted the extent of memory improvement at an individual subject level. These results suggest that brief, very light exercise rapidly enhances hippocampal memory function, possibly by increasing DG/CA3−neocortical functional connectivity.

Rapid stimulation of human dentate gyrus function with acute mild exercise

I now have some evidence to support my belief that my 10 minute work-outs are useful. Sometimes at work I do yoga poses in the staircase, or run up ten flights of stairs. There are many ways to exercise for free, it’s not necessary to purchase a monthly gym membership or pay $20 for a yoga class.

Some studies also indicate that exercise positively modifies gut bacteria. This change in turn can reduce inflammation and depression.

Recent studies suggest that exercise can enhance the number of beneficial microbial species, enrich the microflora diversity, and improve the development of commensal bacteria.

Collectively, the available data strongly support that, in addition to other well-known internal and external factors, exercise appears to be an environmental factor that can determine changes in the qualitative and quantitative gut microbial composition with possible benefits for the host. In fact, stable and enriched microflora diversity is indispensable to the homeostasis and normal gut physiology contributing also to suitable signaling along the brain-gut axis and to the healthy status of the individual. Exercise is able to enrich the microflora diversity; to improve the Bacteroidetes-Firmicutes ratio which could potentially contribute to reducing weight, obesity-associated pathologies, and gastrointestinal disorders; to stimulate the proliferation of bacteria which can modulate mucosal immunity and improve barrier functions, resulting in reduction in the incidence of obesity and metabolic diseases; and to stimulate bacteria capable of producing substances that protect against gastrointestinal disorders and colon cancer (such as, SCFAs).

Exercise Modifies the Gut Microbiota with Positive Health Effects

From ScienceDaily – “Two studies — one in mice and the other in human subjects — offer the first definitive evidence that exercise alone can change the composition of microbes in the gut. The studies were designed to isolate exercise-induced changes from other factors — such as diet or antibiotic use — that might alter the intestinal microbiota.”

Exercise changes gut microbial composition independent of diet, team reports

I think it’s very crucial to our mental health to exercise daily in any way – on a yoga mat at house, running up the stairs at work, going out for a jog, dancing, playing ping-pong, jogging with your dog, anything really that replaces sitting.

CAMH ER Waiting Room

The room is in the building at College and Spadina. The room doesn’t have any windows,  but it does have a clock, so you can know what time of day it is. What you can’t know is when you will be let out (but to be fair, involuntarily hospitalization can be a maximum of 72 hours). There are armchairs along the perimeter of the area and in the middle. There are about six of us at the moment. Some will be released soon and new ones will arrive. None of us want to be waiting here, twisting on the pale green chairs. Also most don’t agree that they should be here. A young black woman is banging on the locked door of the staff room, a nurse comes out. The woman is nearly dressed with a designer purse and fur boots. She starts pacing back and forth. “If I knew what this place is like, – she yells at the nurse, – I would have never come here. Look at me, I don’t need to be here. I don’t cut myself and shit.” The nurse talks to her calmly, she tells her what she tells everyone – you have to wait to speak with the psychiatrist. The woman continues to yell that she is not like the rest of us. She complained to her family doctor about stress at work and the doctor referred her to this address,  told her that she could get a note for stress leave. She just wants a note,  she assures that she doesn’t cut herself.

As of that is what we all do. If only it was that simple – you either cut yourself and are insane, or you don’t,  and are not. I’ve never cut myself and yet I voluntarily checked myself into the CAMH ER. I also didn’t think that I needed to be in there, but there was no other way. I wanted to be set free from my inflamed brain, from the malfunctioning neuronal synapses. I wanted to be free to get lost in writings of other people’s ideas, to play Bach’s Gavotte, to be attracted and be attractive. I wanted to be released from the dark well inside my own mind. I wanted to suppress the hell, to get the intravenous immunoglobulin treatment. But how to convince them, how to make them understand that is what I needed?

After sometime the black woman was released. I was still waiting. There was renewed yelling,  coming from a different patient. Similar to the woman who just left,  she was yelling at the nurse that she didn’t need to be here. She was also getting extremely agitated,  I think if she had something to throw,  she would. The whole room now was aware that she was old enough to have ten children and that she didn’t want this visit on her record. Her sister couldn’t take care of her own kids and who would then be doing it if not her? But with a CAMH visit on the papers, maybe she wouldn’t be allowed to take the children in. The nurse tried to explain that visiting CAMH was not same as police record, but the woman already went into rage, reasoning does not work at that point.

So why do we all scream in fear – I shouldn’t be here, I am not like the rest of them? We must have evolved to have this fear of being declared insane. Insane means being banned from the tribe, starving alone in the savannah. It’s hard to let go of that basic fear of being abandoned by our tribe. Even in the isolated room at CAMH, where only the doctors and about five other strangers could hear you, we still don’t want to admit that something could be wrong. We could admit cancer, meningitis, infertility, but not that we are not mentally well. Most diseases are just affecting our body, but it is our mind that makes us who we are. And if there is something wrong with that, then what are we? Of course this is not what I think, this is an assumption of what goes on through people’s minds in this state of fear. There is no separation from mind and body, both are a combination of cells, proteins, amino acids. Signalling to each other, reproducing. And any part of the whole mechanism can malfunction.

I would say – learn to accept. You didn’t choose this body, you just sort of woke up in it. I would have chosen another model, if I could, but no choices were given. Well here I am, at CAMH ER, because some signals are malfunctioning, and it’s not my fault. This is the situation though, and I have to accept.

List of medications and supplements for depression and obsessive thoughts

Here I will list different medications, supplements, and  procedures that are used to treat depression, anxiety, and obsessive/suicidal thoughts. I am not suggesting that you go out and buy a bunch of antidepressants and try them one by one, I just want you to be aware of what exists out there so that you can discuss this with your doctor. Some things, such as a daylight lamp, or omega 3s, don’t require prescription. Since I have been dealing with autoimmune encephalitis for more than three years already,  I have tried most of these treatments in attempts to reduce my depressive symptoms, psychosis, and intrusive thoughts.

Many people do get better with antidepressants. I have to note though, that in my case, the most useful treatment was high-dose intravenous steroids (IV Solu-Medrol) for five days. I did have severe psychotic depression with suicidal tendencies, my neurologist and psychiatrist propose that this was due to autoimmune encephalitis (Hashimoto’s encephalitis) – brain inflammation. Many people have milder depression and do well after antidepressant treatment. My state has improved but it is not without moments of intrusive thoughts and for this reason I continue trying different methods.

Medication

Antidepressants

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How does your psychiatrist determine which antidepressant to try? It seems that in general this is not based on any specific medical tests, but is based on the discussion with you about your symptoms. I did get a genetic test done on my saliva. This was part of CAMH Impact Study in Toronto, the provided report is called GeneSight Psychotropic Test. The company states that their test “analyzes how your genes affect your response to psychotropic medications commonly prescribed to treat depression, anxiety, bipolar disorder, posttraumatic stress disorder (PTSD), obsessive compulsive disorder, schizophrenia and other behavioral health conditions. There are dozens of medications used to treat depression and other mental illnesses and selecting the right antidepressant medication or other medication can be a challenging and frustrating process. GeneSight Psychotropic’s genetic testing enables your clinician to identify and avoid depression, anxiety and/or other medications that are unlikely to work or may cause side effects.” This test was provided to me for free by CAMH in Toronto.

GeneSight Psychotropic Test link

New antidepressants: 

There are three new antidepressants that have become recently available in US and Canada – vortioxetine, levomilnacipran extended-release (ER), and vilazodone. Vortioxetine – may enhance serotogenic activity via reuptake inhibition of serotonin receptors. Levomilnacipran is a a serotonin norepinephrine reuptake inhibitor. Vilazodone is a serotonin reuptake inhibitor and partial serotonergic 5-HT1A receptor agonist.

The role of new antidepressants in clinical practice in Canada: a brief review of vortioxetine, levomilnacipran ER, and vilazodone

Antipsychotics

Sometimes antipsychotics are added to antidepressants during treatment. Usually antipsychotics are used to treat schizophrenia, why are they given to depressed patients? I think the reason is that many patients don’t achieve remission with antidepressants, so other medications/methods must be tried. In the large National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, only about 30% of patients achieved remission (virtual absence of depressive symptoms) after up to 12 weeks of first-line treatment with citalopram. Evidence of the usefulness of atypical antipsychotics in treating MDD goes back more than 7 years (statement from 2009). A controlled trial found that the combination of olanzapine and fluoxetine was more helpful in treating patients with MDD (without psychosis) than fluoxetine or olanzapine alone.2 The group that received combination therapy did significantly better than the others. In November 2007, the FDA approved aripiprazole as the first atypical antipsychotic to treat MDD. It is specifically for adjunctive treatment, along with an antidepressant, for the treatment of refractory MDD.

Atypical Antipsychotics for Treating Major Depression

Aripiprazole (Abilify) – was approved by FDA for major depressive disorder in 2007, for patients who had inadequate response to antidepressants. Aripiprazole is a partial agonist at dopamine D(2) and D(3) and serotonin 5-HT1A receptors, and is an antagonist at 5-HT(2A) receptors.

Ripseridone – risperidone has actions at several 5-HT (serotonin) receptor subtypes. A study showed that depression symptoms improved modestly but significantly more in the risperidone group compared with the placebo group, as measured by clinician-rated symptom response and patient-rated self-assessment. The 17-item Hamilton Rating Scale for Depression score improved more in the risperidone group versus the placebo group.

Quetiapine (Seroquel) – quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with some anticholinergic properties. Quetiapine binds strongly to serotonin receptors; the drug acts as partial agonist at 5-HT1A receptors. One study involved more than 700 people who had suffered from depression for at least one month but less than one year. Patients were randomly assigned to take one of three doses of Seroquel or a placebo once a day for six weeks. Those taking Seroquel showed greater improvement in depression symptoms than those on placebo.

Supplements

St. John’s Wort  – hypericum perforatum, it is a flowering plant. Sold in health stores/drug stores/online. A 2008 review of 29 international studies suggested that St. John’s wort may be better than a placebo and as effective as different standard prescription antidepressants for major depression of mild to moderate severity. A 2015 meta-analysis review concluded that it has superior efficacy to placebo in treating depression, is as effective as standard antidepressant pharmaceuticals for treating depression, and has fewer adverse effects than other antidepressants.[23] The authors concluded that it is difficult to assign a place for St. John’s wort in the treatment of depression owing to limitations in the available evidence base, including large variations in efficacy seen in trials performed in German-speaking relative to other countries. In Germany, St. John’s wort may be prescribed for mild to moderate depression, especially in children and adolescents.

Omega – 3 – omega-3 fatty acids are found in oily fish such as salmon. You can also purchase fish oil supplements in health stores/online. In general eating oily fish is considered to be a healthy choice. There is some evidence that omega-3s might help with depression, but this evidence is not very strong. From Cochrane review: “At present, we do not have enough high quality evidence to determine the effects of n-3PUFAs as a treatment for MDD. We found a small-to-modest positive effect of n-3PUFAs compared to placebo, but the size of this effect is unlikely to be meaningful to people with depression, and we considered the evidence to be of low or very low quality, with many differences between studies.

SAMe – S-adenosyl-L-methionine (SAMe) is a compound found naturally in the body. SAMe helps produce and regulate hormones and maintain cell membranes. A synthetic version of SAMe is available as a dietary supplement in the U.S. In Europe, SAMe is a prescription drug.  From Cochrane review: “We included eight studies involving 934 people in this review. There was no strong evidence of a difference in effectiveness between SAMe and imipramine or escitalopram when used alone. It was superior to placebo when used in combination with selective serotonin reuptake inhibitor antidepressants, but this evidence was of low quality. There was no significant difference in terms of effectiveness between SAMe and placebo alone, but again this evidence was of very low quality.

Folic acid – also known as vitamin B9. Foods that are naturally high in folate include leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice.

“The evidence for a link between depression and folate levels comes from various sources. Along with vitamins B6 and B12, folate helps break down the amino acid homocysteine. High blood levels of homocysteine are associated with Alzheimer’s disease and depression, although a cause-and-effect relationship hasn’t been proven. The breakdown of homocysteine generates SAMe, a major constituent of brain cells and, some think, a possible treatment for depression. Low levels of SAMe might explain any connection between folate and depression.”

Folate for depression

Probiotics – there is one combination of two bacterial strains that has shown some promise in treating mental health issues. Bifdobacterium longum R0175 and L. helveticus R0052 have been found to reduce symptoms of stress and anxiety. In Canada there are two brands with these strains – CalmBiotic and Jamieson Probiotic Sticks.

Clinical Guide to Probiotic Products Available in Canada

Other things to consider

  • Getting tested for hypo/hyperthyroidism – potential need for thyroid hormones

Treating an underactive thyroid gland may improve mood

  • Getting tested for anemia

Sometimes the first symptoms of iron deficiency are neurologic

  • Getting tested for coeliac disease – possible benefit from excluding gluten from diet

The Link between Celiac Disease and Depression

  • Autoimmune disease testing – includes coeliac disease, hashimoto’s thyroiditis, autoimmune encephalitis, lupus, type 1 diabetes, etc.

Infection, autoimmune disease linked to depression

  • Don’t forget to exercise and eat healthy! I really mean it, you just really need to do it, there is no other way…

Depression and anxiety: Exercise eases symptoms

Mediterranean diet tied to lower risk of depression