The Future of Depression Treatment [Interview][Transcript]

Dr_James_Greenblatt_Integrative_PsychiatryGuest: Dr. James Greenblatt
Presenter: Neal Howard
Guest Bio: James M. Greenblatt, MD, is a pioneer in the field of integrative medicine and one of the founders of Integrative Medicine for Mental Health (IMMH). He currently serves as the chief medical officer and vice president of medical services at Walden Behavioral Care in Waltham, Massachusetts. Dr. Greenblatt is also an assistant clinical professor in the Department of Psychiatry at Tufts University School of Medicine in Boston.

Segment overview: Dr. James Greenblatt, MD, author of “Breakthrough Depression Solution: Mastering Your Mood with Nutrition, Diet & Supplementation”, talks about the treatment of depression in the future and how it is not a one-size-fits-all prescription.

Transcription
Health Professional Radio – Future of Depression Treatment

Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Our guest in studio is returning to speak with us Dr. James Greenblatt, Psychiatrist and Pioneer in Integrative Medicine who says that contributing factors to a very disturbing trend in suicide among our young folks in particular our young girls can be found in malnutrition, antidepressant use and many other factors. He’s the Author of the brand new book, Breakthrough Depression Solution: Mastering Your Mood with Nutrition, Diet and Supplementation. Also the Developer of a brand new depression treatment called The ZEEBRA treatment, he’s here in studio today to talk with us about the future of depression treatment as it relates to nutritional intake and also how the current prescription based psychiatric care is not a one size fits all. Hello and welcome to the program Dr. Greenblatt.

Dr. James Greenblatt: Thank you very much, it’s good to be part of your show.

N: Thank you. When we’re talking about depression, the black box warning has been on all our antidepressants that are prescribed for adolescents and even younger, is there a rise in antidepressant use, is there a fall or?

G: Well I think when the black box warning first came out in 2004, there was a decrease in prescribing as most of antidepressants are prescribed by non-psychiatrists. So there was a somewhat of a fear but that has now kind of been taken back and the prescription rates are increasing and I think psychiatrists and primary care doctors who are prescribing these medicines often forget about this black box warning and it is really important because most of the suicidal ideation and I’ve seen it a lot accrues the first couple of weeks of an antidepressant being prescribed. So it’s really important that we monitor particularly our young adolescents in the first 2 to 4 weeks. Often times patients get prescriptions and they say “Come back in three months” and the intense suicidal thoughts that could occur are simply they ignored or missed.

N: I see ad after ad on all of these mini antidepressants. They seem to come out every week, there’s some new tongue twister. Aren’t these drugs being developed after studies? Don’t you have a study and then a trial and then the drugs developed? Why the continued use of new and I guess improved medications that don’t seem to be improved at all?

G: Well it’s a great question. Again for severe depression there does seem to be evidence that the medications can be part of the solution and can help but they don’t help everyone. And what we’re finding is that some of the studies that were done that showed the medications were helpful, so this was one study that was done, that medication called…approved for adolescent depression. When a scientist took the same data and reanalyzed it last year, they found that it actually was not helpful and there was increased suicidal ideation in the study that was not reported. It was some in a British Journal of Psychiatry and looking at a study 12 years later, the same data it was very frightening. It showed the medicine not only wasn’t helpful for adolescent depression but it increases suicidal ideation. So we have to be really cautious on prescribing these medications in our adolescents.

N: Why in your opinion do you think that that one piece of huge, hugely important information was kept from the public or from the clinicians who are trying to help the public?

G: To me that’s quite amazing. I mean it did get some press, it was it was called the reanalysis, the study 529 but it certainly is kind of been pushed under the rug and we’re talking about it anymore. Depression is such a serious illness with suicide risks and suicide rates increasing that our physicians and our therapists are desperately trying to help our patients and medicine is one tool that we have but there are many other tools and we’ve actually found that the suicidal ideation is decreased when we add some of these nutritional supplements.

N: Now you’ve written the book, Breakthrough Depression Solution: Mastering Your Mood with Nutrition, Diet and Supplementation. Does the title suggests where you would like to see us go in the future of treating depression?

G: I think the real goal of treatment for depression that we’ve been talking about but has not been the reality that I would hope for is this concept of really personalized medicine. As you said in the intro it’s not a one size fits all. Not everyone can take the same medication, not everyone needs the same vitamin but as we look at a more comprehensive genetic analysis, nutritional analysis, family history analysis, I believe we do have the science and the tools to start developing personalized treatment plans that can be much more effective for the treatment of depression.

N: Personalized treatment plans, are these plans personalized after a branching off point from your standard questions that you ask on your standard diagnosis from everyone that comes to see you? Or are you talking about asking new questions in order to personalize it from the beginning of the visit?

G: Well it’s a great question because the questions we’re asking, we’re asking about a list of symptoms. So we all know what’s the list of symptoms of depression are so we’re sad, we’re tearful, we feel guilty, we might have physical symptoms of fatigue, we might be hopeless, helpless and think of suicide but it does no representation of what might be contributing to those symptoms, it could be an infection, it could be celiac disease, a disorder an autoimmune disorder of malabsorption, it could be B12 deficiency, there could be 20 different causes. So the questions help us elicit the symptoms of depression but for too long psychiatry has just been this symptom based treatment model and what we’re talking about is a root based analysis of what’s causing the symptoms and then treating those underlying causes.

N: I’ve been on social media, it’s depressing especially when it comes to what some of the young people are doing and saying and using social media for. How much does social media play in addition to malnutrition?

G: I think social media is a huge factor in above from romanticizing mental illness from a depression to eating disorders to even suicide. So our young kids can get on these chatrooms and these other social media platforms where they get supported for not eating, gets supported for cutting themselves, gets supported for thinking about suicide and you can find websites with the cocktail of what to do, what to take and are vulnerable to depressed kids get sucked into this very inappropriate support network.

N: Have you seen a one part of the country or one part of your area that seems to be hardest hit by adolescent depression?

G: I travel a lot and I give lectures and I really think that the adolescent depression and the suicidal and self-injurious behavior is rampant in this country and abroad and I do not think it’s any one part of the country. I think certain packets are hit harder with the substance abuse and the opiate epidemic but I think depression is now epidemic and we need better tools to treat these kids.

N: If I’m understanding correctly your book, Breakthrough Depression Solution, it doesn’t champion just a single treatment to end depression instead offering a very wide range of tools and vantage points to create their desired results, first you need to understand the problem, nourish the brain as well as the mind and as you said in another segment, those who have a strong faith in something not necessarily a religious based faith but something seem to do a little bit better when combating depression when nutrition is one of the main sources of treatment?

G: Absolutely. I think that the mind if you will is influenced by so many factors that every single, from mindfulness to meditation, it’s been shown to be helpful. A new study came out with looking at preventing relapse of depression because depression is a chronic relapsing illness and mindfulness meditations had a very significant effect on preventing relapse.

N: And where can our listeners get a copy of your book?

G: Our website jamesgreenblattmd.com, Amazon.com as well.

N: Thank you. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. And we’ve been in studio talking with Dr. James Greenblatt, currently serving as the Chief Medical Officer and Vice-President of Medical Services at Walden Behavioral Care in Waltham, Massachusetts. It’s been great having you here with us today Dr. Greenblatt.

G: Thank you Neal, I appreciate the opportunity.

N: Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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