Depression or Depletion?
By Gary Ruelas, D.O., Ph.D.
Ericksonian Integrative Medical Institute of Orange County Orange, California
Estimated Reading Time: 3 minutes, 36 seconds
We are often presented with a patient who complains of what appears to be mild depression or general fatigue. Both of these terms have significant overlap, and in reality they may be difficult to distinguish. Fatigue may actually lead to depression or vice versa. About 25% of the general population will experience a symptom profile consistent with fatigue and/or depression. The symptoms can be insidious. They gradually build into what feels like concrete blocks, impeding health, or compromising resilience. After a while, these symptoms may become familiar to patients, and a level of resignation may appear: “Maybe this is just who I am.”
We, as healers, use our tools to intervene…be it CBT, hypnosis, or other forms of psychotherapy. But try as we may, with a specific patient, we may reach a ceiling (and sometimes not a good foundation) with our treatment. We have all had such a patient for whom our typical interventions do not appear adequate. We discuss patients’ motivations, tap into their environmental and social systems, or refer them for medication consultation. And yet, it still feels like an uphill battle.
There may be a good reason that our best psychotherapy may not be sufficient with these patients. Fatigue and depression can result from many biological processes, including other illnesses such as diabetes mellitus, hypertension, or even cancer. They may also result from medication or drug interaction. These factors should all be addressed by the patient’s physician. But what about the patient who has visited their doctor and been told, “All is fine.”? The patient’s response is, “But doctor, if all is fine, then why do I feel so bad?”
One of the curious aspects of this problem may (and I underline may) include a simple remedy. In the Ericksonian light, simplicity is our first goal. The majority of nutrients enter the body and brain through our intestinal system. Many individuals have problems with the intestinal absorption of nutrients. The experience of being depressed and fatigued can be signs of this nutritional depletion. For many individuals, this is a primary problem. Others, though not yet symptomatic, may not be experiencing the optimal level of nutrient absorption.
For example, I had a 43-year-old patient who was a mother of three. She was referred for consultation due to a three-year history of depression, general fatigue, and feeling run down. She had two adolescents (reason enough to be run down) and a husband who was an executive and had been promoted three years earlier. Since then she had become increasingly depressed and experienced general fatigue. Her primary care physician found nothing physically wrong other than some symptoms of perimenopause. As a result of reviewing her activity and evaluating her nutritional status, I started her on digestive enzymes while awaiting the results of the other studies. Within two weeks, she reported that her depression was lifting and that she had an increase in overall energy, better sleep, and less irritability. The patient went on to make other changes with her biochemistry, including hormonal balancing, but a significant effect was found just with the addition of digestive enzymes with each meal.
Please be reminded that we are not discussing an actual disease, but only a compromised digestive process. Our body normally uses enzymes to assist us with the digestion of essential amino acids and elements. An enzyme is not a laxative or fiber, but a catalyst for change in the system. At times, our body may warrant additional enzymes to assist in the absorption rate of these essential elements. Essential elements, such as the B vitamins that support the nervous system or essential amino acids that are used by the brain to generate neurotransmitters or neurohormones, can be diminished or depleted by a compromised system.
Therefore, when you find a patient for whom your normally effective therapies are not as efficient as you might expect, it might be time to refer to a practitioner who can test for nutritional absorption, related nutritional depletion, and biological imbalances. While the presenting symptom may be feelings of being overwhelmed, depression, or fatigue, the underlying problem may be physical depletion.
This excerpt has been extracted from Volume 26, Issue No. 3 of The Milton H. Erickson Foundation Newsletter.
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