The Nutritional Complexity of Anxiety and Depression

There is nothing I love more about my job, than getting a set of test results back for a patient confirming my suspicion and suddenly everything makes so much sense about why they are feeling the way they are! It excites me to be able to dig to the deepest cellular biochemical pathway to truly understand the causes and contributing factors of my patients’ symptoms. This is never more true than when exploring the links between nutrition and mental health and helping a patient identify what might be the root cause of their anxiety and depression.  

By Caryn Levick ND

With over 15 years of clinical experience, using nutritional medicine to correct, support and enhance these pathways is my passion. 

Let me give you an example of the depth I will go, to understand your individual biochemistry.

One in five Australian adults is diagnosed with anxiety and depression annually. A very commonly prescribed medication for this is an antidepressant that belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRI). This drug works by inhibiting the re-uptake of serotonin, not by increasing serotonin production. They work very successfully for many patients, but a common concern I hear is “I don’t want to be on this forever, I would prefer not to be taking this drug, I just keep being prescribed a higher and higher dose”. Some patients have found some relief, but still “don’t feel quite right”, “I just feel numb or flat”. So my digging begins… if working on the serotonin pathway is somewhat helping to relieve your symptoms, why is the pathway not functioning optimally, naturally? Like it’s designed to do?

The way serotonin is produced in the body is shown in the diagram below:

Nutrition and Mental Health: What Are The Links?

The necessary ‘building blocks’ for serotonin production include:

• L-Tryptophan (an amino acid derived from protein. Are you eating enough protein? Are you breaking it down and absorbing it? The liver can use tryptophan to produce vitamin B3, so if you are B3 deficient – guess where your tryptophan is going to be used… not to make Serotonin)
• Vitamin B3 (are you vitamin B3 deficient, or is your demand for vitamin B3 higher than what you are consuming? Vitamin B3 is essential for energy metabolism and DNA production)
• Iron (are you iron deficient? This is a very common presentation I see in clinic. If you are already supplementing with iron, how well are you absorbing it, and is it causing any common tummy irritation/constipation?)
• Folic acid (this is a big kettle of fish…you might be getting enough folate from your diet, and many processed foods are fortified with folic acid… however, there is a gene (MTHFR) that is responsible for producing an enzyme that allows the conversion of folic acid to its active form (5-MTHF), which is the primary form of folate used in the body. Perhaps you need a MTHFR gene test?
• Vitamin B6 (if you are low in vitamin B6 – I want to know why? Do you have a condition called polyuria? are you over producing cortisol (stress hormone), which takes up a lot of vitamin B6 stores.
• Zinc (are you not consuming enough zinc foods? Zinc is required for production of stomach acid and maintaining integrity of the gut lining, therefore a deficiency in zinc can affect digestion and nutrient absorption.)
• Magnesium (involved in over 300 enzyme processes, this super important nutrient is the ‘fuel’ for your nervous system)

Without sufficient amounts of each and every one of these nutrients, you simply won’t have enough raw materials for your body to produce adequate serotonin.

For me, its not as simple as supplementing with these co-factors alone, I want to understand why you may be deficient in the first place – are your zinc levels low because you have copper toxicity, is your demand for vitamin B6 high because you have pyrrole disorder, or perhaps you have been under a lot of stress for a period of time, are you low in iron because you have an undiagnosed gastro-intestinal parasite? 

Over and above the core ‘building blocks’ necessary for the production of serotonin, there are other factors that play a very big role too – long term stress can affect serotonin production, a large amount of serotonin is produced in the gastro-intestinal tract (is yours healthy? Not only do good bacteria play an important role in the production of serotonin in the gut, but the gut microbiota can regulate neurotransmitter (brain chemical messenger) synthesis by modulating neurotransmitter-related metabolism pathways.) Perhaps you are producing enough serotonin, but it is not being effectively transported around the nervous system. A Neurotransmitter test can assess levels of 6 neurotransmitters or ‘Brain Chemicals’: serotonin, GABA, dopamine, noradrenaline, adrenaline, and glutamate.

Maybe it’s not only serotonin that you are deficient in? I frequently see patients who respond very well to us supporting the Dopamine pathway (Dopamine deficiency can cause symptoms such as muscle tightness, stress and mental exhaustion, general fatigue and exhaustion, decreased memory function, depression, low libido, decreased basal metabolic rate, lack of motivation).

Research has shown that the cause of depression and anxiety can often extend beyond a disturbance in neurotransmitters (brain chemicals). Dysfunction within several biological pathways, including Hypothalamic-Pituitary-adrenal (HPA) axis activity, neuroplasticity, neuroinflammation and mitochondrial function have been identified as contributing and perpetuating factors. 

The human body is so complex. For any diagnosed condition, or presenting symptoms, a thorough case taking consultation helps me to start connecting the dots of what the possible causative pathways may include in your presenting symptoms. From there, I may recommend some general or functional pathology to confirm and use as a baseline as we launch into a treatment plan to identify and treat the cause!

I work closely with other health care professionals; I refer when necessary and I welcome an interprofessional collaboration to provide you with the best possible care. Make an appointment with me and let me help you get to the bottom of your symptoms and understand if there is a link between your nutrition and mental health symptoms.

Other blog posts you may be interested in:

Coping With Anxiety: Diet & Lifestyle Changes That Can Help

Understanding ADHD and the role of the Naturopath