Medically Speaking

When I started this blog, one thing I intended to write about is the medical aspect of my depression. I’ve hesitated a bit to share this, because frankly, I’m not a doctor. I have no medical experience or training. In fact, most medical procedures make me a bit light-headed. When my mom injured her collarbone in a skiing accident, I was in the hospital room when the doctor tried to shove it back into place. I was just standing there watching, not bothered at all, and then suddenly I realized I was kind of woozy and that I might faint – not my finest moment. 😊 I can tell myself all about mind over matter, but at some point my body and my mind separate and I just can’t handle some things. Clearly, the medical world is not the best place for me.

The other reason I’m hesitant to share is that I don’t want to give false hope. Depression comes in many forms and for many reasons. Just because I found answers in the route I took, doesn’t mean that is the route for everyone. I still maintain that healthy coping skills, learned through a trained counselor, can have the biggest impact in your ability to survive depression. A healthy community of friends and family who support you is equally important. And I promise you a deep relationship and dependency on Jesus is what got me through this more than anything.

However, despite my reservations and caveats, I do feel compelled to share a bit of my story, in hopes that it might help someone else who may have a similar source of their depression. I may not be anything close to a medical expert, but I have lived in my body for 41 years, and I had a front-row seat to everything that had an effect on my battle with depression. I studied my symptoms and every attempt at a cure very closely. I balanced the insights and input from multiple doctors with my own careful observations. I am NOT an expert on your situation, but I can definitely tell you what I learned about mine. I hope in some small way that it helps.

Several years ago, when I finally realized that I was truly struggling with depression, my husband gave me some very wise advice. He suggested that I start to keep track of how I was feeling on a day-to-day basis. In a small notebook, I started recording daily how I was feeling. I created a number scale that helped – “1” meant I was extremely happy, “3” meant I felt good and pretty normal, and “10” meant I was suicidal. Between “3” and “10” was a broad range of varying levels of depression. Eventually I also added a similar scale for anxiety, as that became more and more pronounced. Along with the date, I also included the day of my menstrual cycle. This really helped me track and confirm the fact that the severity of my depression had a very direct correlation to the cycle my hormones were undergoing every month. Over the course of time, I had gone from having a few days of PMS-like symptoms each month, to three solid weeks of hard-core depression each month. I had suspected hormonal issues all along, but to see hard evidence was simultaneously daunting and empowering.

Armed with that information, I spent months (and beyond) pursuing a solution. I met with my therapist as well as trusted friends and mentors. I read books and took a personal retreat to Colorado for a time of reflection and rest. Eventually I took a leave of absence from my job, and then quit my job when it was clear that would be best for my mental health. But alongside the spiritual, mental, and emotional healing I sought, I knew there were physical issues that needed to be addressed.

Over these months and years, I saw/spoke to several doctors, received guidance from nurses, tried multiple medications and supplements in varying dosages with all their side effects, had one trip to the ER, and underwent a lot of testing to help determine my underlying issues. None of it was easy. I had to balance advice from multiple doctors, friends who had tried supplements and oils that worked for them, and well-meaning people who advised that if I simply exercised more I’d feel better. There was one day where I saw both my functional medicine doctor and my primary care doctor within an hour of each other – both who are individuals I highly respect – and I had to weigh their separate advice and make the decision for myself what was the next best step forward.

I could detail all of this for you – and to be honest I started to, and then deleted it all – but seriously it’s really long. So here’s something of a (still too long) summary and advice that hopefully will help you understand the physical aspects that may be involved with an individual’s depression.

The first bit of advice is to be persistent and patient when pursing the medication that’s right for you, as it could take awhile to find the right one. I have several friends who had success on a low dose of the first medication they tried. I was not so lucky, but it’s good to know that it can happen. I tried three (maybe four?) different medications at varying dosages over the course of several months. Each had awful side effects for me – the main side effect being extreme tension and anxiety. I was jittery a lot, my legs would shake anytime I was sitting still, and stress sent me into a tailspin. Thankfully, my primary care doctor and his nurse were amazing at helping me walk this road. Eventually I took a DNA test that helped determine the best medication for me. That medication still had those side effects, but I learned to live with them and adjust dosages when the side effects became too pronounced. I am still on that medication now, and it truly does help me to be more stable and to get through the worst days. If you do get on a medication, be sure to read the side effects closely. Some will go away in time, but others are dangerous – serotonin syndrome is a real and scary thing. You have to be the one who cares for yourself and is aware of what you’re feeling… and voices your concerns over and over again to doctors as needed.

The other thing I would say is to look carefully at underlying issues that may not even seem connected to depression. When I hit a point where my medication was working, but I still wanted to figure out what was going on, I decided to see a functional medicine doctor based on the advice of several friends. He used a heavily-scientific approach, testing various systems of the body to see how symptoms might be connected. I really appreciated the scientific approach he had – I was afraid he was just going to tell me to stop eating gluten and call it good (which would be sad, because I really love bread!). Unfortunately, this was an expensive process, but we had health account money that had to be used by the end of the year, so we did it. I’m not saying you have to do this – I certainly don’t have it in the budget anymore, so I know that it’s not realistic for most – but it is wise to look beyond medication as the only physical cure.

Because I had kept track of my depression and my cycle alongside it, I was 99.9% sure that my depression was based on my hormones. More than that, though, testing revealed that it was really gut issues that were the root cause of my hormonal imbalance and my resulting depression. For most of my adult life I had dealt with acid reflux, and had been on acid reflux medication for at least five years just to keep me from a constant upset stomach. I had also taken a stool softener for years on the advice of a nurse practitioner because I had intestinal pain from an over-abundance of gas. That, combined with a diagnosis of SIBO (Small-Intestinal Bacterial Overgrowth) – an intestinal infection – meant that my digestive system was seriously struggling. On top of that, the tests showed that my iron levels were too high, my cortisol levels were tanked (that’s from years of living a ridiculously stress-filled life for too many years), and my liver was inflamed.  All of those things explained many weird and annoying issues I’d had over the years – things that my doctor could never quite figure out.

Interestingly, it was the intestinal infection that proved to be at the root of most of my problems. Research and my experience with medications showed that depression often happens when our body doesn’t produce enough of the hormone serotonin. What I hadn’t realized is that serotonin is primarily created in the gut. And because my gut wasn’t healthy, my brain couldn’t be healthy. Years of antibiotics for various reasons, along with band-aid medications for reflux and gas, had created a very unhealthy balance of bacteria in my digestive system. I had far too much bad bacteria, and not nearly enough good bacteria. In addition to that, reproductive hormones are closely tied with gut health, which may have contributed to my years-long struggles with PCOS, PCBS, PMDD, infertility, heavy periods, and inconsistent menstrual cycles.

So my functional medicine doctor helped me fight my gut infection with supplements, though I imagine my primary care doctor could have done the same thing if he’d realized that he needed to look deeper at my digestive issues and their ties to my depression. I took supplements that fought the infection, while also taking probiotics to replace the bad bacteria with good. I stopped taking my acid reflex meds and stool softener. And then, over the course of the next few months, some remarkable changes happened… that landed me in the ER. I know, I know, that doesn’t sound good, but really, when we sat back and figured it all out, it was actually a sign that my body was healing.

You see, once my digestive system started healing, my body began to create its own serotonin again. Which was amazing! However, the only way we figured that out was when I started having some strange situations where I started passing out/nearly passing out. I got incredibly dizzy, disoriented, couldn’t sit up straight, and it usually happened right after I ate. When it happened pretty severely one time, we decided to go to the ER. Unfortunately, all they did was run a bunch of tests, say I was fine, and look at me like I was crazy for taking supplements.  But when I saw my primary care doctor the next day, he was quickly able to see that the issue was serotonin syndrome—an excess of serotonin in the body. He immediately lowered my very high dosage of anti-depressant. I had been on 225 mg, and I went down to 75 mg within a few days. And suddenly I was back to normal. As we reflected on what happened, and conferred with my functional medicine doctor, it became clear that my body had finally started developing its own serotonin, so it no longer needed such a high boost from my anti-depressant. The combination of my own serotonin, plus the excess from the anti-depressant had flooded my body with too much serotonin, hence the passing out and other weird symptoms.

Over the coming months our money for health expenses ran out, so I stopped seeing my functional medicine doctor. It was a hard decision, but we just couldn’t afford to keep going when insurance didn’t cover any part of it. But I have been able to maintain my gut health through probiotics. It’s actually interesting too the other ways my body changed during this time. I used to be cold ALL THE TIME – now I actually get hot. I also gained ten pounds – not my favorite change, but I think my low weight before hadn’t been healthy in some ways. I also developed seasonal allergies, oddly enough. So my body clearly went through some not-so-great changes, and unfortunately I never was able to ask my functional medicine doctor where all that came from. However, my depression has been manageable, and I even reduced my anti-depressant dosage again. I’ll take ten pounds and some seasonal allergies if it means that my depression is under control.

I have noticed that when I’m on a lower-quality probiotic my depression gets worse, so I have to be careful to buy something that has the right ingredients (note: high quality doesn’t necessarily mean more expensive, but you do need to look for the right things – ask me if you need some help finding something).

In addition to this, on the advice of his therapist, we started to give our son who had struggled with depression a probiotic designed for kids. That small change made a big difference for him too. In hindsight, he had been on antibiotics several times one year because he had recurring sinus infections, and the probiotic helped him build up the good bacteria in his system again. As a result, he became a much happier kid and didn’t have the down moments he’d had for so long.

Trust me when I say, I’m not selling something here. I don’t have a link for a probiotic or supplements that would benefit me or a friend. I buy my probiotics on Amazon, because I like my free two-day shipping. 😊 I just want you to know that although anti-depressants, therapy, Jesus, friends, and family are all VERY important parts of the healing process, there may be some underlying medical issues that are worth looking into. Our culture is not exactly known for healthy eating, and our medical world is very quick to throw a prescription at any symptom that may pop up. In fact, there’s even more to my story than what I’ve already shared, including anti-anxiety meds, a not-so-great neurologist, CT scans, a brain scan, and a recommendation of anti-seizure meds despite inconclusive results. Navigating the medical world was no easy task for me, even when I had a primary care doctor who I respected very much. Despite all that, I’ve learned that the systems of our body are interconnected, and there is wisdom at looking at the whole picture of your health when trying to get to the bottom of mental health issues.

All this being said, I know I still have a lot to learn. I still struggle with PMS and its accompanying depression some months, though usually just for a few days instead of three weeks. I’m still on a low-dose of my anti-depressant, and plan to be on it for the foreseeable future. I’ve had to try out various probiotics and ways of eating when things have seemed a little off. And realistically, I’m a 41-year-old woman. I have years of fluctuating hormones ahead of me and I honestly don’t know what to expect with that. I know I will have to adjust and adapt and keep learning about the systems of my body and how I can keep myself healthy both mentally and physically.

But I’m thankful I have a way forward. And when depression hits hard I have coping skills that I’ve learned to help me fight it. I have Truth I can rely on when the voices of self-hatred start. I have people I can confide in who willingly walk this road with me.

I pray the same for you.

As always, if I can help in any way, or if you want more information, please feel free to contact me. The worst thing you can do is keep quiet when you need help. There is no freedom in silence.