I’ve had the great pleasure, over the last couple of weeks, of giving some lectures on the Functional Medicine approach to depression and anxiety. I honestly did not anticipate such a big response.

One of the biggest problems that we seem to face in medicine is the cookie cutter, “one-size-fits-all” approach. People of varying complication, gender, age, background, stress levels, etc come into the office, and one thing that seems to be common across the board is – what types of medications they’re on. I see, predominantly, that most people are on either an SNRI (serotonin and norepinephrine reuptake inhibitor) or an SSRI (selective serotonin reuptake inhibitor). So, my first question to my patient is: “How did they know that you had a serotonin and/or norepinephrine deficiency?” Usually I’m met with a blank stare.

Serotonin and Norepinephrine are just 2 of the neurotransmitters that can be involved in Depression and/or Anxiety. Just 2 – of MANY. Some of the other big players are Dopamine, Epinephrine (Adrenaline), Cortisol, GABA, Glutamate – and there are more. What typically happens with the current mode of medical practice, is that it’s assumed (not tested) that one of those two neurotransmitters is the issue. But chances are, based on how those 2 interact with the others, and with the body, that they’re not.

So, how do we find out? Well, there are blood, saliva, and urine tests that can track neurotransmitters, hormones (cortisol is a hormone), and metabolites of neurotransmitters  to see where there might be a disconnect.. IF even the neurotransmitters are the problem.

Looking at the adrenals, which produce epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol (hormone) – we know that epinephrine and norepinephrine are fight or flight stress neurotransmitters. If a saber toothed tiger is chasing you, these neurotransmitters are going to kick into overdrive to help you keep from being eaten. But once the immediate threat has left, and you’re left with – say a nagging boss, a 2 hour commute, or bills stacking up – then cortisol takes over to manage the long term stress. After weeks, months, even years of constant long term stress – which is what most of us are dealing with, the adrenals tire (heard of adrenal fatigue/burnout?) and this leads to serious imbalance in neurotransmitters and the inability to cope with stress altogether.

So, this is just one facet of the depression/anxiety issue. There are so many other players. Is there a genetic issue (COMT or MTHFR) which prevents people from producing or metabolizing neurotransmitters properly? Is there an issue with the microbiome (the microbiome can produce MOST of the neurotransmitters with the proper nutrients)? Or absorption (can’t absorb the proper nutrients, or are absorbing toxins that interfere with production)? Or just a poor diet/inadequate nutrient intake (low vitamin D, low methylated B vitamins)?

Of course, we can test for all of these things. We can test for genetic factors. We can test for gut integrity. And, as previously mentioned, we can test for neurotransmitters/metabolites. We can even test for vitamin levels or if there are any other organs interfering with production/break-down of nutrients, hormones, and neurotransmitters.


So, I often ask myself… Why don’t we do it? Why don’t we actually find out why people are anxious or depressed? It’s really a rather simple process. Why isn’t it done?

The answer is that it’s because each person is different, and each person requires a different approach and different therapies to get better. It’s not done because, if it is – then we can’t just prescribe 2 different families of drugs for everyone that walks into the door.

Once we find out that information, there are a ton of things that we can do. But every person and every protocol is different. We can rebalance the neurotransmitters, give proper nutrients, repair the gut, rebuild the microbiome, lower stress levels, exercise more, reduce inflammation, etc etc, all as part of the recovery process. We can re-evaluate often to see how progress is being made. It can take time, but I assure you – things do improve.

In 2001, I blew out my adrenals. I didn’t just fatigue them – I blew them out. I had been from doctor to doctor trying to figure out why I was.. well, horrifically depressed one second, and nearly psychotic the next. They all wanted to give me meds… And then I had my neurotransmitters checked.

This was in 2001. We’ve known about this testing and treatment since 2001! My adrenals were so fatigued that I wasn’t producing any epinephrine, norepinephrine, OR cortisol. I was about to be hospitalized for intensive adrenal therapy and they suspected Addison’s disease. I started working with an amazing practitioner who told me that if I didn’t comply, I’d go to the hospital (way to get someone to behave, doc) and so I spent about 2 years in intensive neurotransmitter therapy to rebuild my adrenals.

We know more now. We know more things to test. We know more things to treat. It’s likely that I would’ve recovered much more quickly if we knew to test Vitamin D levels, or gut dysbiosis, or even liver function. Chances are I would’ve recovered much more quickly. That was 16 years ago.

There is hope – a lot of it. We know what to do. We know how to do it. If this is something that you’re struggling with, PLEASE see a practitioner and get evaluated with some functional testing. And if you’re struggling with depression or thoughts of suicide, whether you get testing done or not, please seek out help.

Suicide Prevention Hot Line: 1-800-273-8255

Until next time,
Dr. Andrea

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