Yoga & Integrative Medicine for Mood
Written by Sara Gottfried.
Antidepressants Make You Fat and Cancerous? Um, Other Options? Secrets of a Harvard Gynecologist on How to Deal with Mood Problems.
Recently, Harvard published a study* demonstrating an 11% increased risk of breast and ovarian cancer associated with taking certain anti-depressants - Selective Serotonin Reuptake Inhibitors (SSRIs). Turns out that many SSRIs cause a problem with an enzyme related to estrogen metabolism, and that Paxil may be one of the worst offenders.
Oh, dear. Eleven percent of U.S. population is on an antidepressant. Do Canadians take them as often as those in the U.S.? Probably not!
Makes me wonder... are people TOLD by their doctors about the risk? Is informed consent truly happening when patients, alone in an exam room with their clinician, are handed a prescription for the antidepressant du jour?
Weight gain is a common side effect. Did you get warned about that? Or increased risk of stroke?
As a board-certified physician pondering this dilemma about mood and how to go about correcting it without causing cancer, stroke and weight gain, it makes me don my yoga teacher hat.
Let's see, yoga has been helping folks find their way through moodiness, depression and anxiety for 5000 years. That's a decent track record. I, along with millions of other Americans, race from my stressful job to the yoga mat in an ongoing attempt to shift from a Type A doctor by day to a Type B teacher/student by night. Oh, and did I mention my two young kids and travelling husband? You get the picture, and I bet your list is similarly long. Oy.
One important point before we launch into alternatives to SSRIs: anti-depressants are a good idea when you have moderate to severe depression. I'm not suggesting that everyone stop their anti-depressants; rather, I recommend having a candid discussion with your own doctor about other ways to augment or approach your current ways of managing mood.
If SSRIs are risky, what are my other choices? It's all about choice, my friends. I've been studying the alternatives for 20+ years with the skepticism of a Harvard- trained physician scientist, and the protectiveness of a mother cub, and here's what I've learned.
What Yoga Offers
Yoga will get you connected to your True Self and deeper purpose. I don't mean that in a woo woo, saccharine New Agey way, but rather in a deeply psychoanalytic,
attuned Dr. Winnicott way. Dr. Winnicott was a pediatrician and psychoanalyst who had me at 'good-enough' mother. He describes True Self as follows (from my
favorite journal, Wikipedia):
True Self is the instinctive core of the personality, the infant's capacity to recognize and enact its spontaneous needs for self-expression. A True self that has a sense of integrity, of connected wholeness. This spontaneous self and this experience of aliveness is the heart of authenticity.
In the yoga parlance, lack of True Self results in low vitality, or low life force, known as prana.
Ok, fine. Cut the theoretical crap and tell me what yoga can really do for my irritability, disconnect, rage, PMS and feeling like I suck first thing every morning?
Well, I only get a few paragraphs here but the best demonstration of what yoga can do for you is in master teacher Ana Forrest's new book, Fierce Medicine:
Breakthrough Practices to Heal the Body and Ignite the Spirit (HarperOne, 2011). If you asked Ana to help you with depression, she would respond as she does on p
Our bodies tell our stories, and they always tell the truth when we listen. I want to help you hear your body's story and then teach it to speak its truth. In other words, your mood is a teacher. Listen deeply. What's the fear? Can you shift from prey to predator? What's it going to take to stop numbing out? At some point your Spirit got knocked out of your body and is on a leash following you around in your life - how can we invite Spirit back in?
Most yoga teachers, myself included, recommend boosting prana with sun salutations and back bends, under the careful watch of a qualified teacher, when you're down.
Getting back to my skeptic roots, Ana and Amy sound good and all, but where's the beef? Pardon me, where's the tempeh? Got some proof? Yes, indeed. Several 3- and 6-month studies show that regular yoga practice increase serotonin, the main neurotransmitter governing mood, sleep and appetite in that pretty brain of yours. Yoga also has been shown to lower high cortisol levels, which is the best objective measure we have of stress and how you surf stress. Functional MRIs of meditators show enhanced activity of the pre-frontal cortex, which is associated with happiness and is considered evidence of the neuroplastic effects of yoga and meditation.
Still unconvinced? I excerpted Dr. Timothy McCall, MD's references of how yoga benefits anxiety, depression, insomnia and Post-Traumatic Stress Disorder below (with permission of the author).
Those who know me understand that I completely agree with Hippocrates: Let food be thy medicine, and medicine thy food (he said this around 460 B.C.). When it comes to mood problems, what are some of the nutrient deficiencies that could be at work?
- Not enough Omega 3s. You know fish oil is a good idea - they have been shown to increase favorable eiconsansoid hormones in the body and prevent mood problems. You can measure your level or aim take a daily dose of a mercury-free supplement.
- Are you getting sufficient protein? Those of you with adrenal problems - that is, too much time stuck in 'fight or flight,' would benefit from sufficient protein. If you know your body fat, you then know your lean body mass, and I recommend 0.75 grams of protein per pound of lean body mass.
- B vitamins. Stress burns through your B vitamins, which are essential for production of certain neurotransmitters such as serotonin and hormones such as melatonin, which helps you sleep deeply and restoratively - and is essential for mood. B vitamins are also depleted by alcohol. Many don't realize that their nightly ritual of a glass of wine or beer can actually act as a depressant, or cause increased anxiety the next day. Try stopping alcohol for one month as a test. If you have difficulty, you may have a sticky relationship with alcohol.
Root Cause Analysis
When a patient comes to see me with moodiness, I offer a questionnaire to get at the root cause. I'm not a fan of masking symptoms: I find getting to the origin of the problem and working there leads to more sustained benefit and, frankly, transformation.
Common conditions that I see for mood problems include adrenal dysregulation, estrogen dominance, borderline or overt thyroid problems, low androgens and general burn out.
There are other excellent ways to assess mood, reported in the literature, such as PHQ -9, which is a great tool used in Primary Care to assess folks for Major Depression.
In summary, I question the orthodox approach to mood problems. While I was taught at Harvard Medical School to hand a depressed patient a prescription for an anti-depressant, I also was taught to review critically the conventional treatment at every turn - I now believe SSRIs may do more harm than good in mild-to-moderate depression, and a more integrative approach is preferred.
*The Harvard Study looked at 61 trials in a mode of analysis called a meta- analysis, so to be precise scientifically, the link between SSRIs and breast cancer is provocative but only an association and does not prove causation. Only randomized trials (say, randomizing women with depression to Paxil or Placebo, and then tracking breast cancer) show causation. However, another interesting gem came out of the study: researchers with ties to pharmaceutical companies seem to underreport cancer risk compared with those with 'clean' resumes. Here's the citation. Cosgrove L, Shi L, Creasey DE, Anaya-McKivergan M, Myers JA, et al. (2011) Antidepressants and Breast and Ovarian Cancer Risk: A Review of the Literature and Researchers' Financial Associations with Industry. PLoS ONE 6(4): e18210. doi:10.1371/journal.pone.0018210.
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