Get to know more about what you should eat to increase your brain health and improve mental wellness. Dr. Drew Ramsey talks about the latest research on nutrition and the brain in his new book Eat to Beat Depression and Anxiety. Read the excerpt below.
DEFINING DEPRESSION AND ANXIETY
Terms like “depression” and “anxiety” are used in a variety of ways in everyday conversations. You hear them talked about in books, movies, and your favorite television shows. With both terms used so widely, it’s not surprising that they often mean different things to different people. That said, it’s important to note that both depression and anxiety are clinical mental health disorders. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the reference book used by healthcare professionals to help them diagnose mental health conditions, provides a list of symptoms for each that we look to when we assess our patients and determine if they have one of these brain illnesses. But as you start to think about ways you might eat to beat depression or anxiety, it’s important to understand what these terms really mean.
We tend to talk about depression as the experience of consistently feeling sad or hopeless. In psychiatry and medicine, doctors try to differentiate whether those feelings are due to some kind of situation happening in your life, like a traumatic breakup or the death of a family member, or some sort of biological issue that would lead to a diagnosis of a major depressive episode. The DSM-5 defines depression as a person having multiple symptoms, which may include a depressed mood, loss of energy, diminished ability to concentrate, changes in appetite, and decreased interest or pleasure in normally enjoyable activities, for more than a two-week period. It also states that depression is disruptive, meaning that a person’s decreased mood is interfering with their ability to comfortably live their lives. A person with depression may have a lot of trouble getting out of bed in the morning, finishing basic tasks, or connecting with friends and family. One of my patients once described depression to me as what happens when life loses its color—and I think that’s a very illuminating description.
Anxiety, on the other hand, is often characterized as a sort of extreme bout of worry. That description is not too far off the mark, but people experience anxiety to varying degrees. The DSM-5 defines generalized anxiety disorder, the most common anxiety disorder, as “excessive anxiety or worry,” with symptoms that may include feeling “keyed up,” irritability, fatigue, and sleep troubles. To be diagnosed with anxiety, you would be experiencing some of those symptoms more days than not over a six-month period. Like with depression, psychiatrists try to differentiate a situational anxiety, perhaps due to a chaotic time at work or a challenging life transition, to a cause that may be rooted in neurobiology.
Let me further explain: the human brain has evolved to have an essential “alarm system” that helps us survive. Think about the most fundamental survival reaction, the so-called fight-or-flight response. In response to a stressful situation, the brain will ramp up stress hormones, including one called cortisol, to help better prepare you to deal with the situation at hand. So, a little anxiety can be a good thing. It can help us up our cognitive game, preparing us to perform well before a big test, a sporting event, or just a drive home on an icy road at night. But when that alarm system steadily misfires, flooding the brain with stress hormones in situations that don’t require that sort of vigilant response, clinical anxiety issues sometimes start to take root. That’s when you’ll see the worry really start to ramp up and, with it, sleep problems, gastrointestinal issues, and even, sometimes, physical pain. Like depression, anxiety really becomes a problem when it starts to intrude upon your day-to-day life, interfering with your work and your relationships.
Treating these conditions isn’t as easy as you might think. Despite the development of many effective antidepressant and anti-anxiety medications, not everyone responds to them in the same way. More than ten years ago, the National Institute of Mental Health (NIMH) published a landmark study, the Sequenced Treatment Alternatives to Relieve Depression This study looked at the efficacy of several common antidepressant treatments like selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft and cognitive behavioral therapy (CBT). They found a whopping two-thirds of the study participants didn’t find relief after being prescribed a single antidepressant medication. Most had to try several different medications before they saw a significant drop in their symptoms—but their doctors had to go through a mostly trial-and-error process to get there. And, even after all that, 62 percent of patients either dropped out of the study or didn’t feel better with treatment.
We see a similar pattern in medications to treat anxiety disorders. Medications, too often, offer “incomplete” remission from symptoms. As a practitioner who works hard to help my patients feel better, that’s alarming. While we know that psychiatric medications help millions of people, they aren’t the be-all-end-all in treatment.
These studies, taken together, show us that we need to do more than write a prescription for a medicine to help people striving to beat depression and anxiety. We need to take a more complementary approach, including many forms of psychotherapy—better known as talk therapy—as well as careful inventory of lifestyle factors, like diet and exercise, to help design a more thorough approach to symptom management.
A note about anxiety: As you continue on with the following chapters, you may notice many of the studies described within these pages look at how different nutrients or food interventions affect depression—and only depression. If you picked up this book because of concerns about anxiety, I can understand that may be frustrating. Generalized anxiety disorder is the most commonly diagnosed mental health disorder in the United States. As a mental health practitioner, I, too, am dismayed that the link between food and anxiety by itself hasn’t been more thoroughly investigated. Luckily, that is changing. But, that said, I would add that depression and anxiety often travel hand in hand. Many people are diagnosed with both conditions. They share some of the same symptoms. And when you look closely at the factors that can both cause and exacerbate these two mental health conditions, the overlaps are hard to miss. Those who work in the nutritional psychiatry field, like me, have learned firsthand that the kind of dietary changes that can prevent or better manage depression can do the same for anxiety disorders. And as you read on, and learn more about how inflammation and the microbiome affect the brain, I hope you’ll better understand why that is.