Neurometabolic disorders and treatment-refractory depression

[anciendaze]

This paper published in a mainstream psychiatric journal was accompanied by an editorial. Among the authors you will see Robert K. Naviaux. You may recognize others.

About 15% of cases of clinical depression are categorized as "treatment-resistant" or "treatment-refractory". Depression is called the "common cold" of psychiatry, so this is not particularly rare. Patients included in this study had attempted suicide. Among long-term "treatment-refractory" cases actual completed suicide may reach 50%. Many others are permanently disabled.

These authors found a surprising percentage of metabolic disorders in the research cohort, and a number of patients responded well to metabolic interventions based on the particular abnormality discovered. None of the healthy controls showed such abnormalities. This is a small study, but the striking nature of the results, in cases where other approaches had been exhausted, suggests reconsideration of diagnostic techniques used in psychiatry.

The implication is that significant numbers of patients diagnosed with a life-threatening psychiatric condition actually have treatable primary metabolic problems.

 

[Sea]

This is the direction I believe I need for my daughter, but how difficult it is to get a doctor to listen.

 

[wastwater]

That's the trouble they will most likely say cbt and routine is the answer

 

[anciendaze]

This is the direction I believe I need for my daughter, but how difficult it is to get a doctor to listen.

When nothing is working it is hard to get a doctor to run sophisticated tests, but they may be open to running treatment experiments on the patient. (After all, that is what every ineffective attempt at treatment really is, an uncontrolled experiment.) One option is adjunctive L-methyl folate (deplin is one trade name). Other reasonably-safe supplements are vitamin D and/or C. Even if laboratory tests show adequate levels of some biochemicals there may be autoantibodies affecting parts of the biochemical cascade that have not been tested.

One caution: it may be necessary to start folate supplements quite a bit lower than normal to avoid side effects. Always make one change at a time, so you know what is causing problems, and increase doses slowly.

This is not a cure-all, but it is something you can do without spending a great deal of money on medical doctors. In some cases it helps.

Added: one more thing that a patient can do without depending on the doctor, morning sunlight. Every person I've know with severe depression has had disturbed sleep, often with sleep phase lag (sleep late mornings, stay up late nights). It's like constant jet-lag. From experience in crossing oceans, I learned that 1/2 hour to an hour of sunlight in the morning tends to reset my body clocks to stay connected to sunlight. This doesn't require much exercise or activity, but if it improves the quality of sleep later at night it can be a life-saver. This is part of a coping strategy while you wait for M.D.s to get their act together.