How Come They're Happy and I'm Not? (24 page)

If you are on medications that are not working well, ask your doctor to check your thyroid levels. If they are okay, but on the lower to normal side, you may want to ask for a small dose of T3 (called Cytomel) or a natural glandular thyroid like Armour Thyroid, and to have your levels rechecked regularly. Your doctor may insist on using T4 (also known as thyroxine). You can refer to this book to guide a discussion with your doctor.

The discussion about thyroid hormone in
chapter 4
also talks about nonhormonal ways to support thyroid if you would like to use those first. When taking thyroid hormone, always look for signs of too much hormone. These can show up as a fast heart rate, sweating, and greasy skin and hair as well as in anxiety symptoms.

In some post menopausal women being treated for depression, estrogen replacement therapy has been shown to improve the effects of conventional antidepressants. If you are a post menopausal woman who is struggling with medications that do not work for you, please read the hormone discussion in
chapter 8
.

This wonderful herb will be discussed further in
chapter 8
for its benefits in the senior population. In this chapter, I want to discuss ginkgo specifically in relationship to helping common side effects of antidepressants: loss of sexual drive and low libido, which occur in 43 percent of men and women taking SSRIS.

Patients are known to experience sexual dysfunction with antidepressant medications. In an open trial, ginkgo extract was found to be 84 percent effective in treating antidepressant-induced sexual dysfunction. In this study, women were found to be more responsive to the sexually enhancing effects of ginkgo than men, although both enjoyed its benefit, with success rates of 91 percent and 76 percent, respectively. Ginkgo biloba generally had a positive effect on all four phases of the sexual response cycle: desire, excitement
(including erection and lubrication), orgasm, and resolution (the afterglow or good feeling immediately following orgasm).

I recommend starting ginkgo at 40 mg of the extract (standardized to 24 percent ginkgo flavonglycosides) three times a day. If no change is noticeable in two weeks, increase dosage to 80 mg three times a day. The standardization means that about 24 percent of the total amount of ginkgo should be made up of the flavon-glycoside component. A good quality company usually lists this information on the label. Although the level of flavonglycosides is important, also remember to use an extract that includes the whole ginkgo leaf, for we do not know exactly what parts of the ginkgo actually help with mood and sexual side effects.

Ginkgo biloba leaf extract is quite low in toxicity, but this supplement should be avoided if you are taking diabetes medications, anticlotting medications, or antiepileptic drugs. Find a full description of ginkgo in
chapter 8
.

From the coffee plant family,
Pausinystalia yohimbe
contains an alkaloid named yohimbine, which is well known for the treatment of erectile problems and impotence.

Medical research is starting to look into this herb for depression. In fact, my former employer, the National Institute of Mental Health, currently has a trial on the effect of yohimbe as an antidepressant underway. This study will assess the efficacy of a single dose of intravenous yohimbine compared with placebo in improving overall depression symptoms when administered during sleep. I am very interested to see how it turns out and whether oral forms will work too.

Yohimbe also seems to possess the ability to help medicated patients respond more quickly and better to SSRI medications. One randomized, controlled trial of fifty patients with a diagnosis
of major depressive disorder showed that subjects who took Prozac plus a titrated dose of yohimbine responded more rapidly than those who took Prozac alone. Titration means the dose was slowly increased while monitoring patients for blood pressure changes. You should know that one real concern about yohimbine and the yohimbe plant is that its powerful effect on the nervous system can not only improve mood and sexual feeling, but it can also raise blood pressure. Dosage needs to be watched carefully. Right now, we do not know what demographic is more inclined to experience high blood pressure as a side effect, so each person taking yohimbe needs to be careful.

Yohimbe is known for helping with the sexual side effects of antidepressant medications due to its ability to block receptors called presynaptic alpha-2 adrenergic receptors. When these are blocked, our adrenergic tone (healthy nervous response) is enhanced, allowing for a robust sexual response.

One study of five patients with either obsessive compulsive disorder, trichotillomania (obsessive hair pulling), anxiety, or affective disorders like depression who suffered sexual side effects after treatment with SSRIs were given yohimbine on an as-needed basis. All five patients experienced improved sexual functioning after taking yohimbine. In the largest known study, seventeen of twenty-one patients showed improvement of sexual side effects when treated with yohimbine at an average dose of 16.2 mg. That is a pretty significant response.

Yohimbe does not have any depression research completed at this point, so I do not directly recommend it as an antidepressant therapy. But it may help medications work better and alleviate sexual side effects including low libido.

Yohimbine studies have dosed anywhere from 2.7 mg to 16.2 mg daily, usually divided into three daily doses. Another choice is using an herbal tincture with a concentration of 1:5 giving a range
of 5 to 20 drops three times a day. The amounts of yohimbine in these liquid preparations may vary, so it is best to start at a low dose and work up as needed.

Please note: If you are experiencing sexual side effects, I strongly recommend trying ginkgo before using yohimbe. If you use ginkgo for two months and still do not see a benefit, then consider a low yohimbe dose. If you decide to take yohimbe, you should work with a naturopathic physician, qualified herbalist, or other practitioner experienced with this herb—and let your prescribing medical doctor know you are using it as well. As described, it's best to start at low doses and titrate to a therapeutic dose to avoid side effects and then keep monitoring your blood pressure daily. Possible side effects of yohimbe included higher blood pressure, excessive sweating, increased anxiety, and a wound-up feeling. This is not an herb to use lightly—be respectful of this one.

After reading this book, you may think, Okay, I am ready to stop my medications. That is a wonderful goal to move toward—but it's important to remember that until you bring in the recommendations in this book and make the necessary changes in your body and spirit, simply stopping your medications may not help you feel any better, especially if you are in the 30 percent of patients who benefit from using antidepressants. Also, if you're experiencing severe depression, it's important to remember that it may be best to take medication for the longer term while working with natural supplements.

Getting off antidepressants is like getting off any drug—there's a withdrawal that has its own set of symptoms. These can include confusion, irritability, dizziness, lack of coordination, sleeping problems, crying spells, and blurry vision. I have seen patients who have unfortunately stopped their own medications cold turkey or could not get ahold of a refill in time. Believe me when I tell you, they were not happy people. While the drug companies and
medical community call these withdrawal symptoms “discontinuation syndrome,” we should call it what it is: drug withdrawal.

Antidepressant withdrawal evokes a major behavioral stress response and can cause neurological damage. Improper withdrawal of medications causes greater neurological damage, which can even decrease benefits of future treatments. Getting off medications requires a plan. Please read on with me to learn about that plan.

One thing I have learned through my research and clinical practice is that conventional doctors and psychiatrists are well trained and very good at placing people on medications but are not at all trained or focused on helping people get off their medications. Oftentimes, patients with depression may be left with no choice but to stay on medication. As I have said before, I am not antidrug, for in certain severe circumstances, medications may be an appropriate life-saving choice. However, even in these cases, a post-crisis exit strategy should be discussed from the start.

You should also know that, as with any addictive medicine, people who start antidepressants—whether they have a mood disorder or not—have a very, very challenging time getting off these drugs. Our brains and bodies become dependent on them and withdrawing without negative experience is nearly impossible.

If you have thought about, or even tried, getting off medications but could not due to side effects or a return of the original symptoms, do not fear—I have a plan for you.

Do not try to get off medications without first speaking to your prescribing doctor. I am glad you are reading this book, but I do not know your personal story. As such, I want you to work with someone who knows your situation to make sure your symptoms are within a realm of safety to get off the drug. Some people with severe depression need to stay on medications longer than they sometimes think. And some patients with complicated medical conditions like schizophrenia, bipolar, or other medical issues may
not be able to stop taking them at this time. so please, check with your prescribing doctor to make sure you are ready.

When my patients and I talk about this, a number of them say, “But I can't talk to my doctor.” If you do not feel like you have a good relationship with your particular doctor, then start looking for another one with whom you're comfortable speaking. Remember, your health is on the line, and you deserve someone whom you can spend time with and speak honestly to. There are many gentle, caring psychiatrists out there too. You may need to interview a few, but you will find one that is right for you.

Follow the quick guide to the naturopathic path in
chapter 2
and then start the naturopathic recommendations that apply to you as laid out in the other chapters (learn which in
chapter 1
). You will start to change foods, lifestyle, stress responses, sleep, nutrients, botanicals, and more. If you do not make changes to prepare your body for stopping antidepressants, you cannot expect your body to be able to wean off medications.

As a general rule, follow your regimen for at least four months. What I find is typically, after two months, my patients who are still on medications start to talk to me about the idea of not needing their medications anymore. That means there has been some shift in their body and consciousness, and we can get started on the road to safely weaning off the medications. This shift is not always tangible, but when it happens, you will know. I usually recommend once you have added the recommended naturopathic remedies and feel that shift, wait at least another month or two to make sure that shift holds and is a real change.

This is the step in which we add a few things to help your body get up to neurotransmitter speed. The general idea is to consider which
medications you are taking and then to gently support your body by giving it the precursors to the neurotransmitters that the drugs already support.

I strongly recommend you do this only after starting the other naturopathic therapies discussed in this book. Once you feel your body and mind are in a significantly healthier place, you can then begin the following supplement and drug-weaning schedule. Please work with the knowledge and support of your prescribing doctor. Have your doctor help create the best schedule for slowly tapering any medications.

The following chart lists medications and the related naturopathic support to help your body create its own neurotransmitters. These supplements are like little stairs that help you go down a steep decline so you can avoid the icy ramp. These amino acids and herbs put out little steps for your nervous and hormonal system to brace themselves as they move down the path to a medication-free life.

Natural Supports for Weaning Off Medication