A whole-person approach to treating depression
We talked with Dr. Peter Bongiorno, ND, LAc, a naturopathic physician who specializes in treating patients with mental health conditions. Dr. Bongiorno graduated from Bastyr University and completed five years of training in naturopathic medicine and acupuncture. Before medical school, he researched as a pre-doctoral fellow at the National Institutes of Health in Bethesda, Maryland and at Yale University in New Haven, Connecticut, and he co-authored numerous medical journal articles in the field of neuroendocrinology.
Dr. Bongiorno is the author of four books on the subject of mental health. Two of these are professional textbooks: “Healing Depression: Integrated Naturopathic and Conventional Treatments,” the first comprehensive textbook designed to teach physicians how to use the science and art of natural medicine to heal depression, and “Norton’s Holistic Solutions for Anxiety and Depression.” He has also penned two books for the public, “How Come They’re Happy and I’m Not?”—a book about healing depression naturally and “Put Anxiety Behind You.” He is an educator and helped create the first elective natural and integrative medicine class at the Mt. Sinai School of Medicine. Dr. Bongiorno regularly guest lectures to medical students about natural medicine and acupuncture and travels all over teaching functional physicians and other naturopathic doctors about employing his brand of mental health care.
PinnacleCare (PC): Data gathered by the CDC found that 2.8% of American adults experienced severe depression symptoms and an additional 15.7% had mild to moderate depression symptoms. And that data was gathered before the pandemic, which has caused a marked increase in the number of people living with depression and anxiety. A large percentage of those people receive a prescription for antidepressant medications and many take those drugs for years. But a recent study published in the journal PLOS ONE raised some questions about the effectiveness of long-term antidepressant use for people with mild to moderate depression. What do we know about the effectiveness of antidepressants for people with mild to moderate depression?
Dr. Peter Bongiorno (PB): Some older studies suggested that not all the studies about antidepressants and their efficacy for depression had been counted in a number of meta-analyses that people were using to show the benefits of antidepressants. Jay Fournier, PhD then published a study showing that when you include all the studies that were not previously included, in mild to moderate depression, you weren’t getting any advanced benefit of using antidepressants versus placebo, although the benefit for people with severe depression was significant. When a patient is a suicidal risk or at risk for hurting somebody else, medications can be lifesaving. Of course, further research is needed, but we’re not seeing phenomenal benefits of long-term antidepressant use in people with mild to moderate depression.
That’s because when we’re using medications to change the levels of serotonin or other neurotransmitters, we remain distracted from understanding why those neurotransmitters are low or imbalanced in the first place. Mental health issues are typically the result of a number of underlying issues—poor sleep, lack of exercise, not eating healthy foods, inflammation in the body, imbalances in digestion, imbalances in hormones, low nutrient status. When you address these underlying issues in a more synergistic and holistic fashion, then you can help people with their mood.
If we look at long-term studies on antidepressant medications, we see a drop off from the initial benefit that might occur within six months. That’s because the body has multiple pathways to work around medications, which results in tolerization. If you comprehensively address the underlying factors and work on all of those together, we’re helping the body move in the direction it really wants to versus telling it what to do with medications.
PC: What’s the process for working on the root causes of depression symptoms?
PB: The key is to sit down with the patient, and first of all, make sure that they’re not in a dangerous situation either to themselves or somebody else. Then once we’ve ascertained that the patient is in a relatively safe place, we start the work of looking into the reasons they’re feeling the way they’re feeling. That will include a thorough interview and getting to know them: are they sleeping enough? Are they exercising? What are their stressors? What are they eating? What are the plans to work on those things?
Then we start to create a plan to work on ongoing issues, which may include laboratory tests that go beyond basic labs, to get more detail regarding what’s going on with their underlying physiology. For example, some of the factors we can study include vitamin D, iron levels, inflammation in their body, magnesium levels, thyroid, hormonal levels, estrogen and progesterone balance, and testosterone. All of these things are very important for mood. We need to look at each person’s physiology to understand what’s contributing to their depression symptoms. I will also typically run urine tests that look at a patient’s stress hormones throughout the day. And then once we have that information, we create a plan to work on lifestyle issues to address imbalances that we find in the lab tests.
Lifestyle changes might include doing things to help their sleep improve, food changes to make sure they’re balancing and stabilizing blood sugar, choosing an anti-inflammatory diet, and moving their bowels every day because good digestive health is important for neurotransmitters in the brain. It could include making sure a person gets in touch with nature once a day, which in and of itself can have very good ramifications on mood. I may also recommend yoga or meditation for stress management.
A second part of the plan is to use the right supplementation to help bring the body back in balance as naturally as we can. There are specific supplements that are very useful for mood. Depending on the patient and what their lab tests show, we might include supplements that should help them feel better while we’re also working on the underlying issues. These supplements might be vitamins to replace low levels (such as iron and vitamin D), or possibly herbs and amino acids to help balance mood directly, such as St. John’s wort and cannabidiol (CBD), as examples.
PC: What would be some of the key things people should look for in an integrative medicine practitioner if they’re looking for help with mood?
PB: Find someone who’s an accredited naturopathic doctor or certified functional medicine doctor. If possible, work with someone who has experience in mood issues and makes that a center for the work they do. Take the time to look for the right practitioner for you and know that sometimes it might take working with a couple of people to find that person. I know with mental health, it feels overwhelming. But know there are answers out there and people who can help you. It’s always worth striving to feel better. The body does want to heal itself.