Mental Health and Thinking Beyond the Brain

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If you or a loved one has suffered with a mental illness, you know it’s a whole-body illness. Not only does mood drop, but also, basic daily activities like sleep and regular meals become an obstacle. Weight fluctuates, interests fall off, and relationships take a hit. People with mental health concerns suffer in many ways for an often unnecessarily long time.

While the field of psychiatry has helped many people, much of the focus throughout history has been narrowed in on the “neurotransmitter hypotheses” to explain and treat mental health conditions. These hypotheses describe mental illness and mood disorders as being the results of specific neurotransmitter imbalances in the brain. Neurotransmitters are chemical messengers responsible for several different activities in the brain and body. The major neurotransmitters include serotonin, dopamine, norepinephrine, epinephrine, and gamma-aminobutyric acid (GABA). Unfortunately, there are no reliable ways to measure these neurotransmitters. Unlike in other areas of medicine, where you are able to measure blood values and adjust treatments accordingly, in psychiatry, the way medications are adjusted is based on the way the person responds. It is more “subjective” than “objective.” Simply put, objective medicine relies on scientific values, but subjective medicine relies on the clinician’s impression, experience, and the way the patient is able to explain their symptoms. This is an undeniable challenge of mental health medicine.

Psychiatrists are trained in the medical model. They must first graduate from an accredited medical program just like any other physician. Given the medical and biochemical training psychiatrists receive, it is no surprise they would have an affinity for biological explanations for mental illness. The concern is that, to this day, many of the commonly accepted “causes” of mental illness remain to be proven. Journalists like Robert Whitaker, author of Anatomy of an Epidemic, have also raised important questions to consider about our current approach to mental health and psychiatric patients. His book reviews the history of psychiatry, the rise of mental illness, and the effects and outcomes of psychiatric medications, demonstrates some serious issues with the current approach. In 1987 for example, 1 in every 184 Americans were disabled as a result of a mental illness. By 2007, it was 1 in 76. He notes the dramatic rise in prescription medications said to “treat” these illnesses during this same time period.[1] If these medications were effective, he questions, should we not see less disability, less chronic mental illness, and less suffering? His conclusion was that each class of medications appears to worsen long-term psychiatric outcomes. He advocates for more responsible use of psychiatric medications given their strong side effects, negative long-term outcomes, and evidence of success in alternative models of treatment (where medications are used temporarily or as a last resort).[1] While controversy surrounds Whitaker’s findings, he raises important questions and shines a light on the imperfections of the neurotransmitter hypotheses that have ruled decades of psychiatry.

Considering these issues and the alarming number of people impacted by mental illness, it is worth thinking outside the box. Looking at the whole person, seeking underlying causes in a more diligent way, and looking beyond the “brain” have become a big area of importance. Holistic psychiatrists and functional medicine doctors are growing in numbers, and alternative practitioners treating mental health are gaining more traction and support. While neurotransmitter imbalances may be part of the story, for most, there is much more to it. Dr. Kelly Brogan, a leading holistic psychiatrist, describes this beautifully: “The best way to heal our mind is to heal the body in which we reside.”[2] In order to heal mental health concerns, we need to look beyond the brain. We cannot separate the whole from the part.

Inflammation 

Did you know that most chronic illnesses—heart disease, asthma, colitis, Crohn’s disease, endometriosis, autoimmune disease, and so forth—are inflammatory in nature? Research has demonstrated that many mental health concerns are inflammatory in nature too. Depression, bipolar disorder, and Alzheimer’s disease have all been shown to have inflammatory components to the course of disease. People suffering with depression, for example, tend to have higher levels of inflammatory cytokines.[3] This means the immune bodies which promote inflammation are higher in those with depression. Think back to a time where you were fighting a virus, for instance. The symptoms you developed were signs of malaise, which describes that general unwell feeling, the low energy, low mood, low motivation, and so forth. This, in part, is because the immune system is in overdrive. Inflammation created by fighting an infection can literally create symptoms of depression. This has been tested in a clinical setting as well. Researchers injected cytokines, which produce inflammation in the body, and 50% of people experienced depressive symptoms. This is described as “sickness behaviour.”[3] It has been found that both external and internal stressors can trigger this inflammation in the body, leading to depression. This means that certain events or traumas can trigger this pathway, just as much as certain diseases or mechanisms inside the body begin this inflammatory cascade. This is a great demonstration of the importance of considering the whole picture, inside and out.

Blood Sugar

Clinicians and researchers know that, if someone has a cardiovascular disease like congestive heart failure, or a metabolic disease like diabetes, their risk for depression may increase. Studies are now starting to demonstrate that this link may be even closer than we once thought. A stable blood sugar means that we are eating things that are releasing sugar slowly into the bloodstream, and this means that insulin can also be released slowly. Stable blood sugar helps to stabilize energy, supply fuel to our cells, and prevent insulin from becoming less sensitive over time, which is part of the chain of events which leads to diabetes. Eating high amounts of simple sugars and carbohydrates—such as white-flour products and refined sugar—causes high surges of glucose in our blood. This forces our bodies to produce high amounts of the hormone insulin (this hormone helps remove glucose from the blood and into our cells). High spikes of insulin eventually lead to a dip in blood sugar way below what it normally should be and cause us to feel like we’ve “crashed.” At these times, we often crave more sugar (bread, pasta, pastries, muffins sweets, etc.) or caffeine (which stimulates the release of sugar into the blood).

Additionally, when our blood sugar dips too low, our adrenal glands produce certain stress hormones, like cortisol and adrenaline, to help bring the blood sugar back up. The release of adrenaline can bring about symptoms of anxiety, irritability, nervousness, agitation, nausea, and unease. At times, it can even feel like a panic attack. Cortisol, apart from its effects in releasing blood sugar, also affects certain neurotransmitters like serotonin. Prolonged release of cortisol has been shown to blunt the serotonin receptors and cause symptoms of depression.[4] A large study also looked at the relationship between depression and diabetes in over 72,000 female nurses. The researchers found that depressive symptoms were associated with a “modest” increase in the development of type 2 diabetes.[5] This connection likely has many factors. Lower mood, higher cortisol, poor dietary choices, and changes in metabolism can all occur as part of the depression picture, and all are related to the development of diabetes. Fortunately, there are many easy, affordable ways to promote healthy blood sugar balance—in fact, one of the more difficult parts of this is just learning to effectively listen to our bodies.

• Avoid refined carbohydrates and sugars as well as processed food as much as possible, and increase consumption of complex carbohydrates and whole foods. Whole foods have more fibre, and this helps stabilize blood sugar.
• Eat protein with every meal. Eating proteins—such as chicken, fish, beef, nuts, seeds, eggs, and lentils—with every meal ensures a steady and slow release of sugar into the bloodstream.
• Eat good fats with every meal. Foods with good fats include coconut oil, avocado, olive oil, nuts and seeds, and oily fish such as salmon. These good fats, again, help to slow down the absorption of sugar into the bloodstream.
• Avoid stimulants such as caffeine, for reasons already mentioned and because caffeine stresses your adrenal glands without providing them any nourishment.
• Get good sleep. Studies have shown that even poor sleep and insomnia can increase cravings for sugar and simple carbohydrates.

Thyroid

Either high or low levels of thyroid hormone can impact our other hormones as well as our mood, stress, coping skills, and nervous-system reactions. There is a strong association between anti TPO levels (which are associated with autoimmune thyroid dysfunction) and depressive symptoms.[6] It is important to have a full work-up, mentally and physically, when you see your doctor about a mental health concern. Common symptoms to show up when the thyroid is dysregulated include unexplained changes in weight, dry or oily skin, hair loss or change in texture, nail changes, temperature regulation issues, low mood, and digestion problems like constipation or diarrhea. As you can probably tell, there is an overlap between thyroid problems and many mental health issues. This is where bloodwork becomes valuable. It’s also important to note that while thyroid levels may not technically be “out of range,” they may not be “optimal”. This means that you may be experiencing low thyroid symptoms, without it showing up in your bloodwork. If this is the case, medication is often not prescribed, but there are many things you can do through diet, lifestyle, and supplements that can support thyroid health, and thus mood and anxiety.

The list goes on and on. Gut dysbiosis, vitamin depletions (B6, B12), hormone imbalances, nutritional dependencies (higher need of certain nutrients), high histamine, and medication side effects are other potential contributors. This does not even take into account family dynamics, socioeconomic status, traumas, education, and other social/psychological factors that are intertwined with mental wellness. Together, this really demonstrates the importance of a whole-person, holistic model for mental health, and that these concerns span further than the brain. Become a health advocate for yourself, and seek to dig deeper to improve your mental health and mood! Happiness, recovery, and resiliency are within reach!