Reclaim Your Brain: How to Avoid or Get Off Meds & Optimize Brain Function Hyla Cass MD www.cassmd.com
Biography: Hyla Cass, M.D Integrative medicine and psychiatry: clinical practice, writings, lectures, and media Former Assistant Clinical Professor of Psychiatry at UCLA School of Medicine Medical Advisory Board, Health Sciences Institute and Taste for Life Magazine; Associate Editor, Total Health Magazine Board Member American College for Advancement in Medicine (acam.org); California Citizens for Health Author of Natural Highs, 8 Weeks to Vibrant Health, Supplement Your Prescription, The Addicted Brain and How to Break Free, and others Website: www.cassmd.com
How did I get here? Goals Antidepressants and anti-anxiety agents Getting hooked - and unhooked - from meds How to utilize diet and natural therapies The gut-brain connection Mental health maintenance
Dietary Link to Depression: Is Food Making You Depressed? 3,486 individuals aged 35-55 (none initially depressed); 5- year follow-up Evaluated two dietary patterns 1. Whole Food (heavily loaded with vegetables, fruits & fish) 2. Processed Food (higher sweets, fried foods, processed meat, refined grains & high-fat dairy products)
Results: People consuming Processed Food diets were much more likely to develop depression. Adbaraly TN, Dietary pattern and depressive symptoms in middle age. British Journal of Psychiatry 2009 Nov;195(5): pp 408-413
Depression: Latest Statistics from the CDC 26.2% (1 in 4) Americans 18 and older suffer from diagnosable mental disorder in a given year Mental disorders are now leading cause of disability in US & Canada according to The World Health Report (WHO/2004) About 11% of Americans 12 and older are taking antidepressant medications (over 30 million) Antidepressant use increased almost 400% (1988-94 to 2005-2008) 23% women (ages 40-59) take antidepressant (highest of any group)
Antidepressant & Anti-anxiety Drugs Drugs are toxic Detoxification requires/utilizes many nutrients Over time, this causes nutrient depletions Reuptake inhibitors actually accelerate depletion of neurotransmitters The meds change the structure of the brain: cause a down regulation of neurotransmitter receptors fewer by 40-60 These drugs are highly addictive; difficult to discontinue Wamsley JK, et al., Receptor alterations associated with serotonergic agents: an autoradiographic analysis, J Clin Psychiatry. 1987 Mar;48 Suppl:19-25
SSRIs: Changing The Brain Bartholoma, P et al., Neuronal cell death induced by antidepressants. Biochemical Pharmacology April 15, 2002; Vol. 63 (8): 1507-1516. Andrews PW, et al., Primum non nocere: An evolutionary analysis of whether antidepressants do more harm than good. Frontiers in Psychology, April 24, 2012
Controversies In Psychiatry Depression: most episodes usually last only 3-6 months Are we turning short-term suffering into long-term disability? Antidepressant drugs are causing both biochemical & structural/anatomical changes in the brain Long-term follow-up studies: very poor outcomes for people treated with antidepressants in hospitals and outpatient settings Overall prevalence of depression is rising dramatically despite increased use of antidepressants
Controversies In Psychiatry Antidepressants only slightly better than placebos; antidepressants fail in active placebo trials Magic bullet theory questioned: belief that psychotherapy could be replaced by simply taking a pill. (Psychotherapy = Pill)? Fournier J. C., DeRubeis R. J., et al. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 303, 47 53. doi: 10.1001/jama.2009.1943 Kirsch I., Moore T. J., et al. (2002). The emperor s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention and Treatment, 5, 23 doi: 10.1037/1522-3736.5.1.523a
SSRI Side Effects GI disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, sexual dysfunction, birth defects in fetus, and paresthesias (tingling or heightened sensitivity). Akathisia (motor restlessness) Violence, homicide, suicide Many occur during withdrawal
Getting Off Meds Stacking of meds can make it worse SNRIs even more difficult than SSRIs Understanding the underlying issues: e.g. genetics, nutrient deficiencies both pre-existing and secondary to meds Go off slowly vs (commonly)abrupt -> discontinuation syndrome including brain zaps Amount varies case to case can try larger decreases eg Sertraline 100-50- 25-12.5 mg every 7-14 days OR if needed: 10% lower every 7-14 days (may need compounded liquid), even 5% or 2%
Getting Off Meds Multiple meds: general rules but not in stone: last one first; benzo first so others can cover the symptoms; otherwise rotate the dose/med Work with nature to repair the damage, restore balance Provide ingredients to produce neurotransmitters Caution: 5 HTP at least 2 hrs away from meds Methylation issues
Nutrient Precursors / Cofactors Required for Neurotransmitter Synthesis Iron Calcium Folic Acid Vitamin C Vitamin B6 Tryptophan 5-HTP Serotonin Magnesium Vitamin B6 Zinc Magnesium TYROSINE Folic Acid Iron Vitamin B6 Vitamin B6 Magnesium Vitamin C Copper L-Dopa Dopamine Noradenaline
Natural Therapies For Depression, Anxiety, Withdrawal Nutrients/neurotransmitter synthesis: 5-HTP, vitamin B6, tyrosine, B12, B3 SAMe (S-adenosylmethionine) Folate & vitamin B12 (methylation issues) Omega-3 fish oils Magnesium, Mn, Cr-
Natural Therapies For Depression, Anxiety, Withdrawal Vitamin D, Vitamin C Herbal products Lifestyle Factors: exercise, sleep, diet Light therapy, Acupuncture, Neurofeedback Probiotics Combination products
The Gut Brain Connection 90% of the cells in the body are bacteria Estimated 90-99% of the DNA in our body is bacterial The vagus nerve directly connects the gut to the brain We have 2 nervous systems w/ common embryonic source 1. Central Nervous System: brain & spinal cord 2. Enteric (autonomic)nervous System (The Second Brain): Gut/GI tract
Revolutionary Psychiatry The Psychobiotic Revolution How gut bacteria control/influence your emotions & state of mind Lead article in Psychology Today/April 2014 : Can Yogurt Cure depression? The Psychobiotic Revolution Various strains of probiotics produce neurotransmitters that counter anxiety(gaba), depression (SE) and stress (affects cortisol)
What About Gluten? Gluten sensitivity can be primarily and at times exclusively be a neurological disease affecting not only the brain and nervous system directly, but also causing cognitive and psychiatric illness Neurology (vol 56/No.3 2/13/05)
Summary & Points to Ponder Depression is not a Prozac deficiency Anxiety is not a benzo deficiency Live, eat, & supplement well, feed your microbiome, & balance your brain Aging is not optional: brain aging can be
Thank you! Hyla Cass MD Visit www.cassmd.com for a free E-Report: Reclaim Your Brain