Pulse
A Different View of Depression
Some physicians are taking a holistic approach to treating depression that involves nutrition, exercise, and changing the way patients look at the world.
In his 2006 book, The Chemistry of Joy, psychiatrist Henry Emmons, M.D., presented a new model for treating depression that addresses patients’ physical, emotional, and spiritual needs. It’s an approach that Emmons says is “advanced common sense.” His straightforward, two-sentence rationale for it is this: “Depression is a holistic illness that affects every aspect of who we are as human beings. It only makes sense to address it from every available angle, both with regard to our bodies and brain chemistry and vis-à-vis our psyches and spirits.”
Shortly after the publication of his book, Emmons and his colleagues at Abbott Northwestern Hospital’s Penny George Institute for Health and Healing shaped its principles into an eight-week program called resilience training.
Patients who take part in resilience training start by meeting with Emmons for a 90-minute assessment, during which he conducts a thorough medical history; learns what treatment approaches or medications the patient has tried thus far for their depression; recommends nutritional supplements when necessary (particularly vitamins B6, B12, or D and folic acid, as low levels of these components have been associated with depression and other cognitive dysfunction); and looks for any other physical conditions such as insulin resistance or hyperthyroidism that may exacerbate depression or mimic its symptoms.
Following this evaluation, the patient meets with nutritionist Carolyn Denton, M.A., L.N., to address issues such as food sensitivities, nutritional deficiencies, and blood sugar dysregulation, which can trigger inflammation. Inflammatory hormones such as C-reactive protein are often elevated in people with depression. “Inflammation affects the brain just as it does any other part of the body,” she says.
Exercise physiologist Sue Masemer, M.S., then assesses how the patient can improve his or her fitness level in conjunction with psychiatric and nutritional approaches. Exercise not only releases endorphins but also has been shown to regulate and even decrease levels of the stress hormone cortisol. The final component of the program is an eight-week group session during which 15 to 20 patients learn mindfulness meditation and discover ways to manage negative emotions that, if left unchecked, can spiral into a new depressive episode. “For someone who has been through bad depression or anxiety, there is always this fear that experiencing a negative emotion will lead them right back to where they were,” Emmons explains. “We try to teach them to experience those negative emotions but not dwell on them—and to create more positive emotions in their place.”
Emmons says most of the patients he sees have been treated with various medications. “Very often, by the time the patient and I meet, he or she has been on numerous antidepressants for many years, sometimes decades. The usual scenario is that the medications worked well for a while, but their effectiveness waned over time, and so clearly they are looking for a different approach.” He says resilience training can benefit nearly any patient other than those with psychoses or who are in an acute, severe state of depression.
Evidence of Efficacy
Emmons has been informally evaluating the efficacy of resilience training since 2007. More than 250 patients have gone through the program thus far, and Emmons says they have been reporting a 30 percent to 50 percent improvement in symptoms after eight weeks. In many cases, patients have been able to reduce their use of antidepressants or stop taking them altogether.
In 2008, to more formally evaluate the program’s effectiveness, Emmons and his team asked employees of Allina Hospitals and Clinics, which owns Abbott Northwestern, if they would be interested in enrolling in a study of resilience training. “We had 450 phone calls,” Emmons says.
The study was limited to 40 individuals with moderate to moderately severe depression. Team members obtained blood samples to determine levels of vitamin B6, B12, and D, as well as levels of cortisol, thyroid-stimulating hormone, and blood glucose.
Participants were divided into two groups of 20. The first group completed the training this past winter. The second finished in March. Preliminary findings from the first group indicate that their PDQ-9 (depression screening) scores dropped from an average of 13 to 5—indicating a significant improvement in self-reported symptoms.
In addition, members of the first group said their sleep improved by an average of two hours per night. “When people are sleep-deprived, their cortisol levels are high and they gain weight, which affects their insulin metabolism,” Emmons says. Insulin resistance can cause symptoms that resemble those of depression—namely, fatigue and lack of energy. “So just by improving sleep, we are improving a lot of these symptoms.”
Spreading the Word
Emmons hopes to use the results of the Allina employee study to get funding for more comprehensive research on resilience training. In the meantime, he and his colleagues have put together a curriculum for teaching other providers to use the program. So far, Emmons says he’s heard from “several dozen” who are interested in learning how to do resilience training. The first educational session is scheduled to start in June.
“Judging by the response so far, I think it will be an easy sell to both providers and patients. People—whether from the vantage of the clinician or the patient—are looking for different ways to address these chronic problems,” Emmons says. “When you approach depression or anxiety from a whole-person perspective, you give people hope—hope that they can do something for themselves that will make them feel better.”—Jeanne Mettner