Depression: A Functional Root Cause Approach

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Greetings and welcome to the Wellness
Connection MD Podcast.
I'm your host, Dr.
McMinn.
October was Depression AwarenessMonth, so in this episode, we
are going to take a deep diveinto a root cause approach to
depression.
Depression is a complexcondition that can profoundly
affect the lives of millions ofpeople, and I'm sorry to say
that it's getting worse.
Medications and talk therapyhave been the cornerstones of

(00:20):
therapy for many years for suchconcerns.
And to be clear, these therapiesare valuable tools in our
toolbox.
However, in many instances,depression is actually a
manifestation of an underlyingroot cause condition.
A functional medicine approachcan uncover the root cause,
which is often treatable,sometimes resulting in great
improvement or even a completecure.
In this episode, we present themost evidence-based, complete

(00:42):
list of the causes of depressionthat you will find anywhere.
So listen to the end, it may belife-changing.
Find this at McMinMD.com andsubscribe to Wellness Connection
MD Podcast for the latestinformation about functional
integrative lifestyle andwellness medicine.
Enjoy the show.

SPEAKER_01 (00:57):
Welcome to the Wellness Connection MD Podcast
with Dr.
McMinn and Coach Lindsay, wherewe bring you the latest
up-to-date evidence-basedinformation on a wide variety of
health and wellness topics,along with practical take-home
solutions.
Dr.
McMinn is an integratedfunctional MD.
Lindsay Matthews is a registerednurse and IIN Certified Health

(01:18):
Coach.
Together, our goal is to helpyou optimize your health and
wellness in mind, body, andspirit.
To see a list of all of ourpodcasts, stay up to date on the
latest topics.
Be sure to subscribe to ourpodcast by your favorite podcast
player, which you'll be notifiedwhen future episodes come out.
Discussions continue thispodcast for educational purposes

(01:40):
only.
And diagnose your three diseasedo not apply any of this
information without approvalfrom your personal doctor.
And now, on to the show with Dr.
McMahon and Coach Lindsay.

SPEAKER_00 (01:54):
Hello and welcome to the Wellness Connection MD
Podcast.
Thank you so much for joining ustoday.
I'm Dr.
Jim McMinn, and I'm here withour very own Coach Lindsay
Matthews.
Together we bring you theevidence-based podcast with
honest, commercial-free,unbiased, up-to-date information
about functional, integrativelifestyle and wellness medicine.
Our goal is to empower you withpractical solutions, to overcome

(02:16):
your health care challenges, tooptimize your wellness, and to
help you become a captain ofyour ship when it comes to your
health.
So let's get going.
Good morning, coach.

SPEAKER_02 (02:25):
Morning, Dr.
Mack.
It's great to be back on theshow.
Excited to approach anotherimportant topic.

SPEAKER_00 (02:31):
Well, coach, it occurred to me that October was
National Depression AwarenessMonth.
So it's high time we shine alight on this dark and important
corner of healthcare.
Sometimes in modern medicine, itseems we focus almost entirely
on our physical concerns and wesweep mental health under the
rug.

SPEAKER_02 (02:47):
But if you or a loved one have ever been
affected with depression, thenyou know it can be a very
serious disease, which can havea profound impact on a person's
life and can even be fatal forsome people.
Depression is one of the mostmisunderstood conditions in
healthcare.
You can't see it on an x-ray orfind it in lab work.

(03:07):
So sometimes it's hard to wrapour heads around it.
And a lot of times depression isnot just depression, it's a
manifestation of some underlyingproblems.
So we're going to unpack ittoday by taking a deep dive into
a functional root cause,integrative and lifestyle
approach to depression.

SPEAKER_00 (03:26):
You know, coach, I think some of the other things
like chronic fatigue syndrome,fibromyalgia, and dysautonomia,
anything that once again youcan't see on an X-ray and
doesn't show up on the labs,then we we just can't really
understand it.
And sometimes we think thepatient is anxious or stressed
out or malingering or whatever.
And so um we're we're happy tokind of shine some light on this

(03:47):
today.
Over the years, doing thepodcast, we've talked about what
I call the symptom pill ordiagnosis pill approach to
medicine.
The doctor hears certainsymptoms or makes a particular
diagnosis, and the next thingthat he or she does is to get
out the prescription pad.
Well, unfortunately, it's theway doctors are trained to
think.
But the functional medicinemovement is trying to move the

(04:07):
needle towards a more root-causeapproach to healthcare.

SPEAKER_02 (04:10):
Just as many doctors are quick to, at like, as you
said, Dr.
McMahon, get out that scriptpad.
But patients also have come toexpect that approach as well
when they go to the doctors.
And the pharmaceutical companiesare there in the background, and
they're, you know, they're theones in the main benefit of
this.
So I'm sure that you've seen theAsk the Doctor commercials on TV

(04:32):
where half the commercial istaken up with a list of possible
side effects and dot dot dotdeath at the very end, right?

SPEAKER_00 (04:38):
Aaron Powell Coach, I remember back in the ER days,
uh people would come in with asniffle, and I actually kept
some literature from the CDCwhich showed that you don't need
antibiotics for that sniffle.
And so I wouldn't write them.
And next thing you know, you'regetting a complaint letter that
I I waited for two hours in thewaiting room and I came to the
ER and the doctor didn't evengive me antibiotics.
So, you know, people have beenprogrammed that they have to

(05:01):
have antibiotics when most ofthe time they don't.
And so anyway, it it's it's astruggle.
But try sitting in the waitingroom of your doctor sometime and
see the parade of drug reps thatcome in who who often serve
lunch to the entire staff.
I'm just saying, coach, followthe money.

SPEAKER_02 (05:17):
The traditional approach to depression is just
another example of thisdrug-focused type practice.
When a patient sees their doctorwith symptoms of depression, the
doctor makes the diagnosis andthen writes for Prozac, for
example.
But we feel that we owe it tothe patient to look under the
hood a bit to do a thoroughworkup to see if there's some

(05:38):
other treatable cause ofdepression so that we don't have
to get the patient on what turnsout to be maybe a lifetime of
meds.
And those meds, by the way, alsocould have untoward side
effects, not to mention the costof the to the patient and the
healthcare system at large.
So it's worth noting that onceyou get on those drugs, it can

(05:59):
be hard to also get off of themdue to something called
antidepressant withdrawalsyndrome.

SPEAKER_00 (06:05):
And coach, uh from an integrated medicine point of
view, we also feel that we needto expand our therapeutic
toolbox to include other provenevidence-based therapies besides
drugs and talk therapy.

SPEAKER_02 (06:15):
And before we go further, though, I know Dr.
McMahon, we both share that wewant to be perfectly clear that
we're not anti-drug.
We understand that there'sdefinitely a time and place for
such meds.
These have helped many people,and we're fully supportive of
that.
But the Wellness Connection MDpodcast is also a no-judgment
zone.
And we feel that it's importantthat a patient deserves a

(06:38):
thorough eval to look for theroot cause of the problem and
consider other treatmentmodalities, expand that toolbox
besides just drugs and talktherapy.

SPEAKER_00 (06:47):
Coach, you know, I think a lot of people really
don't appreciate the impact ofdepression on our society.
So let's uh set the stage just abit by describing the scope of
the problem.
Here in the United States, about37% of women have been diagnosed
with depression, and about 25%of American women actually take
antidepressants.
Oh my gosh, coach, what's goingon in this world that we live in
that that results in over athird of our women uh being

(07:10):
depressed?
And I would also contend thatmany others have depression but
have not been diagnosed forvarious reasons, including lack
of access to care.

SPEAKER_02 (07:19):
Yes, agreed.
And depression, by the way, isanother, I would say, sexist
disease, Dr.
Mack.
It appears to be more common inwomen than in men.
And it's hard to say why.
Maybe women are just in more intouch with our feelings or men
have this denial mode.
But, you know, I think theremight be a couple, lots of
possible reasons for thisconglomerating to yield this

(07:41):
higher incidence of depressionin women.
And maybe some examples might bethat estrogen affects serotonin
production differently, and howthis can also, estrogen can also
affect the activity in theamygdala.
The HPA axis in the brain isdifferent for women as far as
how cortisol is regulated.
There's a lot of differentmechanisms that could be it.
So I just think that's alsointeresting to think about.

(08:03):
I found that there was a studyby the American Journal of
Psychiatry and LancetPsychiatries between 2022 and
2024 that showed the perceivedrole, even for women, this
overload that we have, socialcomparison that also can really
be predictive for depressionsymptoms in women.
So I think there could be likephysiological things, but also

(08:24):
just our role in society ingeneral plays a plays a part of
this picture.

SPEAKER_00 (08:29):
Yeah, coach, I do think that women are just
inherently more complicatedhormonally than men are uh for
good and bad.
So but the data is particularlyworrisome for young females,
Lindsay.
And as of 2025, the CDC and theWorld Health Organization
indicate that 57% of girls inAmerica report symptoms of

(08:49):
depression.
Wow, coach, that's let me repeatthat.
And even scarier is the datafrom recent survey that showed
that 30% of high school agegirls said they seriously
considered attempting suicide inthe past year.
Oh my gosh, coach, it justbreaks my heart when I read the
stats like that.
And I'm sure as a mom of twoyoung precious kids, one of whom

(09:09):
is a girl, I'm sure this trendmust be pretty concerning for
you.

SPEAKER_02 (09:12):
This topic is extremely personal to me.
And just recognizing the sheernumbers, like you said, having a
daughter myself, but then alsohonestly, having experienced
depression myself.
I'm one of those numbers.

SPEAKER_00 (09:25):
You know, Coach, uh, let me be clear that men and
boys can also suffer depression.
Us men just tend to withdrawinto our igloos.
We're often reluctant to seekhelp.
It's just not a manly thing todo.
And let's face it, there aresocial stigmas for a man to
admit he has depression.
I remember, Coachie rememberedthis.
There was a guy um years ago, Iforg I forget his name.
He was actually a vicepresidential candidate.

(09:48):
They found out he got depressionand they had to withdraw him
from the ticket.
Now he had a broken arm, no,they wouldn't have drawn him,
but he had depression, so theyhad to withdraw him from the
presidential ticket.
So uh yeah, there's a stigmawith us guys.
Um and you know, we're supposedto be strong like bull.
Studies have shown that in men,depression is vastly
underdiagnosed andunderreported.
My beloved father-in-law Gordon,who was a true, don't fence me

(10:10):
in Western cowboy who reallyused to ride the range and rope
stray doggies, he had thisillustrative uh saying that went

like this (10:16):
cowboy up or suffer in silence.
So that's exactly what us menfolk tend to do.

SPEAKER_02 (10:22):
Unfortunately, the trend is moving in the wrong
direction.
Overall rates of depression inAmerica are getting worse and
now at an all-time high.
In fact, depression rates havenearly doubled in less than 10
years, with the steepestincrease, to your point, Dr.
Mack, in young adults and womenparticularly, and those also
with lower incomes.

(10:43):
The reason for this increase isdefinitely multifactoral.
Certainly, there's somelingering effects of the whole
COVID epidemic.
But also the science is clearthat high levels of political
rancor and division in ourcountry significantly
contributes to these risingrates of depression, anxiety,
and other forms of psychologicaldistress.

(11:03):
And of course, the ever-presentand ever-growing kind of baby
tiger of social media and thestress and negativity related
there, think about it.
It's when when was the last timeyou heard a happier uplifting
news story there on your feed?
It's been probably quite awhile.
So all of those things, Dr.
Mack, they're all part of this.

SPEAKER_00 (11:24):
Mm-hmm.
From time to time, many of ushave the blues.
Stuff happens in life, but as aphysician who is taking care of
patients who were hospitalizedwith incapacitating depression,
and as an old ER doc who's beenon the receiving end of many
suicide attempts, uh, somesuccessful and some not.
I've seen the face of depressionfirsthand, and it's not a pretty
psychoach.
So this issue is kind ofpersonal to me, and so I'm glad

(11:46):
that we're finally bringingabout some awareness to this
topic and also bringing to theaudience a functional approach
to depression, because as we'vesaid many times, awareness is
the first step to change.

SPEAKER_02 (11:57):
So, Dr.
Mack, as always, let's look atthe scientific evidence.
Break it down for our listenersout there as far as the root
causes.
And as we proceed, I'd like toalso just say this for us to
keep in mind it's a profoundsaying, or also it comes from
the what's known as the serenityprayer.
Grant me the serenity to acceptthe things I cannot change, and

(12:19):
courage to change the things Ican, wisdom to know the
difference.

SPEAKER_00 (12:24):
Well, thanks for sharing that, coach.
And it is very applicable to ourtopic today.
For instance, uh, this sciencetells us that there is a strong
link between genetics anddepression.
So we can't change our genesthat we were born with.
So we have to learn to acceptthat.

SPEAKER_02 (12:38):
Here's the good news the vast majority of things that
cause depression are manageableto a great degree.
So that's what we're reallygoing to focus on today.

SPEAKER_00 (12:47):
You know, coach, I think we're going to present to
the audience probably the mostcomprehensive list of the causes
of depression today, ever in thehistory of the world.
And I counted them up.
I think it's about a hundred ofthem, coach.
And guess what?
Most of them are manageable.
Isn't that interesting?
You know, control the things wecan control.
So most of these things you cancontrol.
And let's start with a veryinteresting true uh case

(13:09):
history.
Years ago, I saw this uh35-year-old woman who presented
to me in the office with majordepression.
And in the functional medicinespace, we always try to take a
thorough history, including atimeline of events.
And so I asked her, when did thedepression start?
And sadly, she told me shecouldn't ever remember not being
depressed.
From her very first memories oflife, she had always been sad.

(13:32):
She had never known joy.
And at numerous points in herlife, she had often struggled
with uh suicidal thoughts.

SPEAKER_02 (13:38):
That's heartbreaking, Dr.
Mack.
Wow.

SPEAKER_00 (13:41):
Yeah.
Coach, it really was.
It made me sad to hear it.
Uh and she had been to manypsychiatrists and had tried just
about every medication in thebook, but nothing really worked.
She had also been topsychologists and counselors,
had years of talk therapy andanalysis, but again, sadly, no
relief.

SPEAKER_02 (13:57):
And I'm sure that only compounded things.
Um, so she'd basically triedeverything the traditional
system had to offer, and she wasfeeling desperate on top of
feeling depressed enough thatshe wanted to try something out
of the box.
And that's the way it oftenhappens in a functional medicine
practice.
When the people fall through thecracks of traditional medicine

(14:18):
and nothing's working, andthat's when they really show up
on the doorstep, miserable,desperate, really just hoping
for a miracle cure.
And the good news is that moreoften than not, the that miracle
cure can be found for them bygetting back to the basics and
treating the root cause.
As you always say, Dr.
Mack, why?

(14:39):
Why are we here?
Why the depression?
Why?

SPEAKER_00 (14:42):
Now, Coach, you you worked with me for years in the
clinic, and didn't you witnessthat?
I mean, these people would comein and and I say the vast
majority of them, we got them alot better.
Would you agree?
Agreed.
Yeah, yeah.
Okay, good.
Agreed.
I was often the last stop forthese patients, and they would
tell me so right off the bat.
But no pressure, right, coach?
Uh so anyway, I patientlylistened to her story, and as we

(15:03):
talked about it, I vividlyremember telling her there's no
point in me reinventing thewheel and doing everything the
other doctors already done,which had failed miserably.
I'm not going to just get you onanother antidepressant if none
of them have ever worked before.
And I suggested we take afunctional root cause approach
and see if we could outsmart herdepression.
So she put her trust in me andagreed to give it a try.

SPEAKER_02 (15:24):
I love that.
Outsmart the depression.
So now we're on the edges of ourseats.
So what did you find?

SPEAKER_00 (15:31):
Well, coach, I put on my detective cap while still
wearing my white coat, and I rana comprehensive panel of tests.
And when I got the results back,here's what really stood out to
me the most.
Her vitamin D level wasextremely low.
I mean rock bottom, coach.
And it was the lowest I'd reallyever seen.
And now the list of uh lowvitamin D causes goes on and on,
and we don't have time to gointo that today.

(15:51):
That's a topic for another wholepodcast.
However, it is important topoint out that that is the next
step to figure out why hervitamin D is low.

SPEAKER_02 (15:59):
And so that was it.
V low vitamin D was truly theculprit for her.

SPEAKER_00 (16:04):
Well, coach, uh the proof's always in the pudding,
isn't it?
So here's what we did.
We got her on proper vitamin Dsupplementation, and within a
few months, her depression wascompletely resolved.
I mean, coach, 100% gone.
When I saw her back in theoffice at her next visit, I
could hardly recognize her.
She was like an entirely newperson.
I was blown away.

(16:24):
And needless to say, she wasthrilled with the outcome.
And for the first time in herlife, she knew the real meaning
of the word joy.
And guess what, coach?
I treated her for years and thedepression never came back.

SPEAKER_02 (16:36):
That's profound.

SPEAKER_00 (16:38):
It really isn't it.

SPEAKER_02 (16:40):
Every time I hear stories like that, I get so
inspired and encouraged.
And I remember, like to yourpoint, we uh had I had the
privilege of working with youfor many years.
And it's a gift to think back onthose stories and those faces
and to think about the familiesthat are impacted just by the
health of the patients.

(17:01):
So a functional medicine rootcause approach enabled us to
help so many people that regularmedicine had limited or no
answers for.
And this isn't just a one-offantidote about vitamin D.
There's real science behindvitamin D and depression, that
connection there.
A major systematic review in theBritish Journal of Psychiatry

(17:21):
found that people withdepression had significantly
lower vitamin D levels comparedto the controls.
And here's the striking partabout this people with lower
levels of vitamin D were 60%more likely to have depression
than those with higher levels.
60%.

SPEAKER_00 (17:38):
Yeah, coach, there's really definitely a connection
here.
And you know, many people withdepression never get their
vitamin D checked, right?
Right.
I'd been sure to say few tonone, unless you happen to have
a functional medicine doctor.
Most providers just uh do thesame old knee-jerk reaction of
getting out the prescription padand writing a prescription for
an antidepressant.
If you've got depression,there's your Prozac, often for

(18:00):
life, along with all the sideeffects and the cost of the
drug.
It's really sad to me, coach,that we're missing the root
cause of depression with so manyof these patients.
And let me be clear, as I'vesaid many times, my purpose here
is not to bash doctors.
These are kind, caring,compassionate, hardworking folks
who go to work every day to helppeople.

(18:20):
Yes.
And the symptom pill approach tomedicine is what these doctors
have been taught.
My goal is to enlighten patientsand hopefully providers to the
fact that there is a differentand sometimes more effective way
of caring for these patients.

SPEAKER_02 (18:33):
One might be tempted, if you're listening, to
think that this was just a rarefinding about the vitamin D.
But according to ClevelandClinic's report in 2025,
approximately 35% of US adultsare vitamin D deficient.
And multiple sources cite afigure closer to about 42% for
vitamin D deficiency amongAmericans.

(18:54):
Certain subgroups are at evenhigher risk for deficiency.
For example, the rate of vitaminD deficiency is about 70% in
kids from the ages 6 to 11,69.2% in Hispanic individuals,
and up to 82.1% in AfricanAmericans.

SPEAKER_00 (19:12):
So Lindsay, you got kids.
No, I'm just saying 70% in kids.

SPEAKER_02 (19:21):
Yeah.

SPEAKER_00 (19:21):
Oh well.
Might might want to think aboutit.
Yeah.
But uh wow, coach, uh that's alot of deficiency, isn't it?
And uh so there could be a lotof depression hiding in there
among those groups with the lowvitamin D, as well as other
healthcare concerns caused bylow vitamin D.
Uh, vitamin D is not justdepression, osteoporosis,
whatever, I mean you you nameit.
And uh quite frankly, coach, Ichecked vitamin D levels on just

(19:42):
about every patient who came tosee me.
It's just such a big deal.
I think that this vitamin D uhsituation is really
underappreciated, not only fordepression, but also for the
other healthcare concerns.
I want you all out in theaudience there to think about
it.
When was the last time yourdoctor ever checked your vitamin
D?
I'm just saying.

SPEAKER_02 (19:58):
Aaron Ross Powell I also think it's important at
this point to say perhaps yourdoctor does check your vitamin
D, but what are the levelsthey're trying to achieve?
You know.
Would you care to comment onthat, Dr.

SPEAKER_00 (20:08):
McMahon, what the appropriate levels are?
Aaron Powell Well th this seguesinto a whole nother conversation
about uh normal levels versusoptimal levels.
Right.
You know, you you have tounderstand where they get those
normal ranges.
It's basically what we call a95% confidence interval.
In other words, if you took thegeneral population and and
checked the vitamin D, 95% willfall between here and here.
But that's 95% of people, mostof whom are deficient.

(20:30):
Right.

SPEAKER_02 (20:30):
Right.

SPEAKER_00 (20:31):
So you have to uh look at you know what's the
optimal range, and the optimalrange is different.
And it should be I always liketo keep it around, say, 50 to
100.
And I think if you uh check outuh, for instance, I looked at uh
the recommendations from HarvardMedical School, and they were
also in about that range.
They I think they said aroundmaybe 40 to 80, but uh I'd like
to keep it about fifty to onehundred.
And my patient with the severedepression, her level is five.

unknown (20:54):
Yeah.

SPEAKER_00 (20:54):
Wow.
Yeah, wow.
And that's gonna cause her a lotof problems, not just depression
down the road, but a lot, a lot,a lot of problems.

SPEAKER_02 (21:01):
Yes.
So to top off this discussion ofvitamin D and depression,
meta-analysis of randomizedcontrolled trials showed that
vitamin D supplementation leadsto a statistically significant
reduction in depressive symptomsfor all comers with depression
compared to placebo or controlswith greater benefits for those

(21:21):
with baseline deficiency.
And this came from the Journalof Frontiers in Psychiatry, Hot
Off the Press, 2025.

SPEAKER_00 (21:28):
And coach, that's really important.
Let me emphasize that becauseit's it's one thing to say
vitamin D can uh contributes todepression, but it's a whole
nother thing to say doestreating with vitamin D improve
depression?
And the answer is yes, right, asuh shown in that hot off the
press study.
Back to the concept ofcontrolling the things we can
control, optimizing vitamin Dlevels is highly controllable

(21:50):
and easy peasy.
We just have to think about it,coach, and then test for it and
then treat it.
It's a piece of cake.
And so why aren't we doing it,coach?
That's that's the big deal.
Why aren't we doing it?

SPEAKER_02 (22:01):
I guess the analogy would be it's like you're
driving along and your checkengine light bing comes on.
You could cover that light upwith some duct tape and ignore
the problem and probably end upwith a blown engine down the
road, or you can do theappropriate diagnostic test,
figure out what's wrong with theengine, fix it at that root
level cause before it gets bad,and ultimately save yourself a

(22:22):
lot of trouble later on.
And the beautiful thing is whenyou address and find the root
cause, you're not just maskingsymptoms, you're actually
solving the problem.

SPEAKER_00 (22:32):
But coach, vitamin D-related depression is just one
example of a treatable cause ofdepression.
You know, uh, we're this wholepodcast today is not just about
vitamin D.
We're gonna list a whole ton ofthem for you.
So uh put your seatbelt on.
Um and uh so we're going to takea deep dive into a
comprehensive, evidence-basedlist of potential root causes
for depression that most people,including many healthcare

(22:54):
providers, never consider.
We think that we are going topresent to you the most
comprehensive list ever in thehistory of uh of the world.
And so I have painstakingly putthis together over many years of
practicing functional medicine.
I do apologize, this podcast isa bit longer than I would like,
uh, but we always err on theside of being thorough.
So bear with us.
If you need to break this upinto chunks, then feel free to.

(23:15):
But our hope is that by bringingawareness to these treatable
causes, we can save some folksfrom a lifetime of depression.

SPEAKER_02 (23:22):
Now, certainly, people can have what we would
call situational depression.
You get fired from your job,you're on your way home, your
car breaks down, you get home,your house is burned down, and
your wife has left you, yourdog's died.
Then you have the right to bedepressed.
That is very real depression.
And unfortunately, it's all toocommon in the world these days.

(23:42):
Sometimes life just doesn't goyour way.
And a lot of people arestruggling out there.
This is situationally relateddepression, and it's very real,
and it needs to be treated assuch.

SPEAKER_00 (23:52):
Genetics can also play a role in depression.
And as we said uh earlier, wecan't change our genes, but we
can sometimes affect what wecall epigenetic expression,
mainly through the power oflifestyle medicine and some
other things as well.
But the the main thing islifestyle medicine.
An example of this is when twotwin sisters have the exact same
genetic risk of getting breastcancer, yet one gets it and one
doesn't.

(24:13):
And this is often results ofcertain lifestyle factors that
affect those uh genes.
Uh for instance, maybe one ofthe sisters smoked or had a
terrible diet and the otherdidn't.

SPEAKER_02 (24:22):
So maybe to make an analogy, your your genetics can
certainly load the gun fordepression, but epigenetics is
what's going to pull thetriggers.

SPEAKER_00 (24:30):
Oh, great, great analogy.
Yeah, thanks.

SPEAKER_02 (24:32):
So, Dr.
Mack, let's move on to examiningsome other nutritional and
biochemical factors that affectdepression, starting with the B
vitamin family.
These are like the spark plugsof your brain's engine.
B12 deficiency, for instance,can cause symptoms that look
identical to depression.
And B12 deficiency is way morecommon than people think.

(24:54):
Certain populations are more atrisk.
Vegetarians, vegans, people over50, people on certain
medications like metformin orproton pump inhibitors like
prilosec or the purple pillnaxium.
Many digestive issues likeceliac disease can also cause B
vitamins to be low.

SPEAKER_00 (25:15):
But here's what's crazy, coach.
It could take years for vitaminB deficiencies to show up on
standard blood tests.
Standard vitamin B12 testsmeasure what's in your blood,
but that doesn't necessarilyreflect accurately what's going
on inside your cells where the Bis needed.
So someone could have a quotenormal end quote B12 basic blood
test, but still be functionallydeficient.

(25:36):
That's why we often looked attests like methylmalonic acid
and homocysteine levels, sincethese tend to be much more
sensitive markers for B vitaminsat the tissue level.

SPEAKER_02 (25:45):
Same thing happens with folate and other B
vitamins.
And here's where it getsinteresting.
Some people have geneticvariations like MTHFR mutations
that affect how they processthese nutrients.
It has been estimated that about60% of people with depression
have an MTHFR mutation, muchhigher than the general

(26:08):
population.

SPEAKER_00 (26:09):
Now, MTHFR stands for methylene tetrahydrofolate
reductase.
That's a mouthful, isn't it,Coach?

SPEAKER_02 (26:15):
Right.

SPEAKER_00 (26:16):
But basically, it's an enzyme that helps your body
process fully in vitamin B12 viaa process called methylation.
If you have certain geneticvariations in this enzyme, you
might not be able to use thesevitamins efficiently, even if
you're getting plenty in yourdiet.
This can affect neurotransmitterproduction like serotonin,
dopamine, and norepinephrine,all the brain chemicals that
regulate mood.

(26:36):
So the end result of this ispotentially depression.

SPEAKER_02 (26:53):
Also, multiple high-quality studies published
in major medical journals haveshown that patients with
depression and certain MTHFRmutations experience significant
improvement in depressivesymptoms with appropriate
treatment.

SPEAKER_00 (27:08):
Now, coach, there are many ways we can treat a
MTHFR mutation, but importantly,again, it starts with lifestyle
medicine.
I can't get into a completetreatment protocol here due to
the length of the podcast, butcertainly a good starting point
beyond healthy lifestyle wouldbe a supplementation with
L-methylfolate.
And by the way, if you want tolearn more about uh lifestyle
medicine, which I call the mostpowerful medicine on earth, then

(27:28):
please check out our entirepodcast that we did devoted to
this subject back in 2023.
And I guess another thing,Coach, is if you have an MTHFR
mutation, it would be reallyhelpful to see a good functional
medicine doctor.
I think your average doctor'snot going to know much about
this.

SPEAKER_02 (27:43):
So again, proof is in the pudding.
What do the studies show?
Clinical trials and systematicreviews show that
supplementation with B12, folicacid, B6, or complex of B
vitamins can improve mood andlower depressive symptom scores,
especially in patients withmeasured deficiencies.
And this is described in theOpen Neurology Journal.

(28:06):
So once again, we have anothertreatable root cause of
depression if we just look forit.

SPEAKER_00 (28:12):
And the next nutrient that we'll mention is
the omega-3 fatty acids, aka,also known as fish oils.
Omega-3s, particularly EPA andDHA, are crucial for brain
health.
They help reduce inflammation,support neurotransmitter
function, and maintain healthybrain cell membranes.
Many studies have shown thatomega-3 fatty acid levels
contribute to depression, andlikewise, multiple studies have

(28:34):
shown that omega-3supplementation can
significantly reduce depressivesymptoms.

SPEAKER_02 (28:39):
Most people are not getting near enough, not even
close.
So unless you're eating fattyfish several times a week or
supplementing, then you probablyare deficient.
And I will say, Dr.
Mack, this is our main jam atour house as far as
supplementation goes.
Everyone in our house takes andhas been taking an omega-3
supplement.
Our kids since birth.
Well, actually, let me correctthat prenatally, since basically

(29:03):
conception, since I supplementedmy entire pregnancy.
I think this is a superimportant nutrient.

SPEAKER_00 (29:08):
And that's why they're so brilliant, right?

SPEAKER_02 (29:10):
Yes, of course.
Exceptionally so.

SPEAKER_00 (29:14):
Yeah, the research from the British Medical Journal
revealed that about 68% ofadults and over 95% of children
in the United States have lowlevels of omega-3 fatty acids.
Wow, coach, 95% of children.
That's just kind of scary, isn'tit?
Meaning they do not consumeenough to meet the current
nutritional guidelines, makingthem susceptible to many
healthcare problems, includingdepression.

SPEAKER_02 (29:36):
And another important factor is the ratio of
omega-6 to omega-3 fatty acids.
Meta-analysis have shown thattoo much of those omega-6s from
processed foods can promoteinflammation, and that can
directly contribute todepression.

SPEAKER_00 (30:00):
Analyses of randomized controlled trials
report statistically significantimprovements in depressive
symptoms with omega-3supplementation.
So, once again, coach, here wehave another correctable cause
of depression.

SPEAKER_02 (30:11):
Amazing.
And other key nutrients thatcause depression, also let's
list some.
Magnesium.
Deficiency with magnesium canimpair neurotransmitter function
and our stress responsecontributing to depressive
symptoms.
Zinc as well.
Zinc influences neurotransmittermetabolism and neuroplasticity.

(30:34):
Low levels of zinc are stronglyassociated with depression.

SPEAKER_00 (30:38):
Iron is required for oxygenation and neurotransmitter
production.
Low levels may trigger fatigueand depression, and selenium is
involved in antioxidative andanti-inflammatory responses that
protect neural tissues.
Studies have shown that lowlevels of selenium are linked
with depression.

SPEAKER_02 (30:53):
Calcium is important for neuronal signaling, and low
levels may contribute to moodchanges.
And amino acids from protein areneeded for neurotransmitter
synthesis, including serotonin,dopamine, and norepinephrine.
Deficiency of certain aminoacids can cause depression by
limiting the production of thesecrucial neurotransmitters.

SPEAKER_00 (31:14):
Persistent deficiency in vitamin C has also
been associated with chronicdepression and fatigue, and
studies have shown that lowlevels of vitamin A, manganese,
inositol, chromium, iodine, andpotassium can also contribute to
depression.
So the bottom line is that wehave many nutrients that are
important for mood regulation.
And when deficient, a lack ofthese nutrients can directly

(31:35):
contribute to depression.
The good news is that all ofthese are testable and treatable
if we just take the time to lookfor the underlying root cause.

SPEAKER_02 (31:43):
So let's segue our conversation into talking about
inflammation, since in somecases it can be related to
nutrition.
And this seems to be another bigpiece of the depression puzzle.
We're learning that depressionisn't just a chemical or
neurotransmitter imbalance.
It's often linked toneuroinflammation, which diverts

(32:04):
resources away from making ourmood-regulating
neurotransmitters.
We did an entire podcast oninflammation back in 2023.
So you might want to check thatout if you want to learn more
about this important topic.

SPEAKER_00 (32:16):
Okay, coach.
With the inflammation, though,presents another opportunity to
talk about the power offunctional medicine.
Let's say the patient presentsto the doctor with depression.
First question should again notbe what drug can I put her on,
but it should be why does thepatient have depression?
Right.
And then there are numerous labtests that the doctor can do to
look for inflammation and othercauses.
And if the doctor concludes thatinflammation is a factor, then

(32:37):
the next question is, why doesthe patient have inflammation?
So, of course, you just keeppeeling back the layers of onion
with that question, why?
I have put together an extensivelist of all of the causes of
inflammation, which you can findand download at McMinMD.com
under the documents section.
The cause of inflammation shouldbe investigated and the patient
should be put on an aggressiveprogram to reduce inflammation,

(32:59):
which may then result inimproved mood.

SPEAKER_02 (33:02):
One major cause of inflammation that we'll briefly
mention is food sensitivities.
And gluten is a great examplehere.
Double-blind trials have shownthat people with celiac disease,
a gluten-induced autoimmunedisease, and also people with
non-celiac gluten sensitivityexperience statistically
significant increase indepression scores when exposed

(33:26):
to gluten compared togluten-free diets.

SPEAKER_00 (33:29):
And also, again, does uh change the diet help?
Well, here's what the studiesshow.
Removing gluten from the diet ofa depressed patient with celiac
disease usually leads tosubstantial improvement in mood.
Also, meta-analyses and systemicreviews show that gluten-free
diet significantly improvesdepression in people with
non-celiac gluten sensitivity.
So here's another great exampleof a correctable cause of

(33:51):
depression just by changing thediet.

SPEAKER_02 (33:53):
Yes.
And I love that second part ofthat statistic that it's not
just if you are diagnosed withceliac disease, but you could
have that, you could not havethat as well and see
improvement.
When it comes to other foodsensitivities besides gluten,
these also can affectinflammation and
neuroinflammation and thusdepression.
Food sensitivity testing can bevery helpful here, although it's

(34:16):
not perfect.
Such testing can have falsepositives and false negatives.
So sometimes we do eliminationdiets to actually figure out
trigger foods for patients.
See the McMinnMD.com for anexplanation about how to do an
elimination diet properly.
But the key point here is thatwhat you eat can directly affect

(34:39):
your mood.
And of course, this is anothereasy correctable issue that can
improve your depression withoutpills and without counseling.

SPEAKER_00 (34:46):
So, coach, let's move on to blood sugar.
Blood sugar roller coasters canlook a lot like mood disorders.
When your sugar crashes, it cantrigger anxiety, irritability,
fatigue, and yes, depression.
And insulin resistance, which isway more common than people
realize, can cause braininflammation and depression.

SPEAKER_02 (35:02):
Numerous studies have shown this, including a
Stanford-led study published inthe American Journal of
Psychiatry, which found thatinsulin resistance doubled the
risk of developing majordepressive disorder, even in
people who had never experienceddepression before.
So here we have anothercorrectable cause of depression.

(35:22):
These people don't need Prozac,they just need to stabilize
their blood sugar.

SPEAKER_00 (35:27):
So to wrap up the nutrition portion of this
discussion, the bottom line isthat solid science shows us that
improving your diet and avoidingnutrient deficiencies can make a
big difference in your mood.
Your doctor can check for all ofthese nutrient deficiencies,
like I did with my patient witha low vitamin D, and the
deficiencies can be corrected,which in some cases can be very
helpful for these patients.

SPEAKER_02 (35:47):
And while we highly recommend testing to find out
what nutrients you might bedeficient in, in the absence of
testing, the Mediterranean dietis most strongly associated with
improved mood and reduced riskof depression.
Multiple randomized controlledtrials show that following
Mediterranean diet, which isrich in fruits, vegetables,
whole grains, beans, nuts, fish,and olive oil with minimal

(36:11):
processed foods, leads tosignificant reduction in
depressive symptoms compared totypical diets.
So check out McMinMD.com formore info on the Mediterranean
diet.

SPEAKER_00 (36:23):
And let me just interject here that I think the
diet has to be personalized foreach patient.
If you look at the uh the data,uh uh there is more data to
support the Mediterranean dietfor this purpose than any other
diet.
However, that's not true forevery patient.
And uh Lindsay's husband, forinstance, Tyler, who has
dysautonomia, the best diet forhim was not the Mediterranean
diet.
The best for him was thecarnivore diet, which uh

(36:45):
improved him greatly in manyareas, including mood.
Am I right there, Clay?

SPEAKER_02 (36:49):
Yes.
Yes, sir.

SPEAKER_00 (36:50):
Right.
So it really has to beindividualized for every
patient.
So let's move on to talk aboutthe effects of hormones on
depression.
I know from many years ofexperience that this is a huge
factor, especially for women.
I've witnessed it firsthand.
We'll begin with the thyroid.
Studies have shown that bothhypo and hyperthyroid conditions
are linked with higherdepressive scores.
And studies confirmed thatcorrecting these conditions

(37:11):
significantly improves mood anddepressive symptoms.
So here we have anothercorrectable cause.
So let's think about it andcheck for it when appropriate.

SPEAKER_02 (37:20):
So we recommend a thorough thyroid workup and then
thyroid optimization.
Again, we did an entire podcaston hypothyroidism back in 2019.
So we won't go into great detailhere at this point.
However, if you're interested intaking a deeper dive into that,
then we highly recommend you goback and listen to that.

SPEAKER_00 (37:40):
Cortisol is another hormone associated with
depression.
Cortisol is our stress hormone,and it's kind of like Goldilocks
in that too little can be badfor you, and too much can also
be bad for you when it comes todepression.
It needs to be just right.
An article from the journalEndocronology discusses how low
cortisol may indicate HPA axisexhaustion, and it's observed

(38:01):
with patients with persistentstress or trauma history,
leading to a depleted stressresponse system.
Along with this low cortisol,you can often see certain
subtypes of depression, such aschronic atypical depression,
PTSD-related depression, andlater life depression.
Again, this is easilycorrectable if you just take the
time to look for it.
And by the way, we did an entirepodcast on this subject called

(38:21):
adrenal fatigue, which isavailable for your listening
pleasure.

SPEAKER_02 (38:25):
And next on our hit list is a hormone called
pregnenolone, which isconsidered to be the mother of
all hormones.
It is the first hormone madefrom cholesterol.
Pregnenolone then goes on tomake all of the other sex
hormones.
A randomized controlled trialfrom the journal
Neuroendocrinology in 2021 foundthat patients with depression

(38:47):
had lower pregnenolone levels,and pregnenolone supplementation
was associated with significantimprovement in depressive
symptoms, especially in patientswith bipolar depression,
particularly.

SPEAKER_00 (39:00):
Well, coach, next up is DHEA.
And again, we find that multiplehigh-quality studies show that
patients with major depressionoften have lower DHEA levels
compared to healthy controls.
And DHEA supplementation canreduce depressive symptoms in
some patients.

SPEAKER_02 (39:15):
Moving on to estrogen, clinical studies
consistently show that naturallyoccurring periods of low
estrogen, such as thepremenstrual phase of the cycle,
late perimenopause, and thenaftermenopause, are linked to
greater vulnerability todepression.
Estrogen modulates serotonin andother neurotransmitters, exerts

(39:35):
anti-inflammatory effects, andsupports neural circuits
involved in mood regulation.
So it's very important.

SPEAKER_00 (39:41):
And research demonstrates that estrogen
withdrawal or low levels candisrupt the stress response, can
result in emotional reactivity,and can affect cognitive
processes and can contribute tothe onset of worsening
depression.
Furthermore, estrogenreplacement therapy has been
found to improve mood in manylow estrogen women with
depressive symptoms.

SPEAKER_02 (40:01):
Of all the hormones, estrogen therapy stands out as
the hormone consistently shownto help depression in women.
Randomized controlled trials andreviews indicate that
transdermal bioidenticalestrogen is significantly more
effective than placebo intreating depressive disorders.
And if done correctly, it's safeand effective for the vast

(40:23):
majority of women.
But you need to make sure thatyou do have a provider who knows
what he or she is doing.
And just to be crystal clear, wedo not recommend oral estrogen
or non-bioidential estrogen dueto the potentially dangerous
side effects.

SPEAKER_00 (40:39):
Pegesterone is another potential culprit when
it comes to depression,particularly in women during
times of hormonal fluctuationlike the luteal phase of the
cycle, perimenopause, menopause,and postpartum periods.
Clinical studies find that lowprogesterone is associated with
increased risk of anxiety,irritability, fatigue, insomnia,
and severe depression invulnerable individuals.

(40:59):
Low progesterone is alsoassociated with premenstrual
syndrome, premenstrual dysphoricdisorder, and postpartum
depression.
And again, this is easilydiagnosed and treated.

SPEAKER_02 (41:10):
Unlike estrogen, oral progesterone is recommended
for these women.
The oral form seems to have agreater effect on the central
nervous system than thetransdermal form does.
What we often recommended was atransdermal cream in the morning
so it doesn't cause drowsiness,and then the oral capsule at
night, and this can help withsleep, but also help with mood.

(41:33):
And again, you want to makeabsolutely sure that the
progesterone that you're takingis bioidentical.
It really matters in this case.
The artificial or syntheticprogesterone drugs, which we
call progestins, can actuallymake things worse since we find
that large epidemiologicalstudies have actually linked
common synthetic progestins withan increased depression.

(41:56):
So we'd have the oppositeeffect.

SPEAKER_00 (42:02):
When I transitioned into the integrative functional
mode of my medical practice, Ihad many learning curves ahead
of me, which included thingslike better understanding of
nutrition, detoxification,lifestyle medicine, and hormone
replacement therapy, among manyothers.
All those things that you neverlearn in medical school and
residency, which are soimportant.
But ultimately, after seeingthousands of patients for
hormone replacement therapy, Ifound the HRT to be one of the

(42:25):
most powerful tools in mytherapeutic toolbox.
For so many women, they it wasreally life-altering for them.
They came in feeling absolutelymiserable and they came back
feeling great.
And when they came back feelinggreat, like everything was
better.
It was just almost too good tobe true, coach.
I at first I couldn't believeit, but when I saw it over and
over and over again, you realizehow powerful optimal hormones

(42:47):
can be for many of these womendealing with issues including
depression.

SPEAKER_02 (42:51):
Unfortunately, the sad truth is that primary care
doctors get almost nosignificant training in hormone
replacement therapy for women.
And then you look at your OBGYNdoctors, who are often
considered the hormone doctors,and less than 20% of them get
significant training in hormonereplacement therapy.
And when they do, it's oftenwith the non-bioidentical

(43:12):
hormones due to the influence ofdrug companies, which, as we
said at the very beginning, canactually make things matters
worse.

SPEAKER_00 (43:19):
Multiple studies have shown that a properly
designed hormone replacementtherapy regimen is considered
highly beneficial for most womenwhen evaluating the full
spectrum of menopause-relatedhealth concerns.
And yet most women are notgetting this message and are not
being offered proper HRTtherapy.
So, bottom line to me, coach, itseems kind of simple.
We as a medical community arereally letting these women down.

(43:43):
We do not seem to value women'shealth.
And I guarantee you, if some ofthese same symptoms were
happening in men, we would beall over it.
We would probably pass laws andmake sure that all the men were
treated properly.
But instead, we tend to letthese women suffer needlessly.

SPEAKER_02 (43:57):
I love when you get passionate about that, Dr.
Mack.
You're one of the few, few men,doctor, met male doctors out
there, I think you would whowould take up women's cases the
way that you have.
Grateful for that.

SPEAKER_00 (44:09):
Well, coach, you know, I have a wife I care
deeply about, uh, you Dr.
Cheryl, and uh two amazingdaughters.
And I have been backed into acorner, Coach, and have been
forced to become a closetfeminist.
Now, please don't tell my guyfriends.
I think that women's livesmatter, and we all need to be
advocates for every man, woman,and child to get the care that
they deserve and need.

(44:30):
For instance, it's crazy thatsome insurance companies will
cover Viagra, but they won'tcover birth control pills.
Are you kidding me, coach?
That just screams sexism.

SPEAKER_02 (44:39):
And we'll move on here and take a look at
testosterone.
It's not just a guy thing,right, Doc?
Women have testosterone too, andit can help them in many ways.
A large meta-analysis in 2021showed a significant association
between serum testosteronelevels and depression in women.
Along with low mood, many ofthese women also had low energy,

(45:02):
poor motivation, brain fog, andlow libido.
Furthermore, some studies havefound that testosterone
augmentation improved mood anddecreased depressive symptoms in
women, particularly among thosewith treatment-resistant major
depressive disorder.

SPEAKER_00 (45:18):
I clearly saw it in my practice, coach.
I recall a particular woman whohad major depression for years,
was being treated with drugs andtalk therapy, but nothing was
helping.
It was clearly impacting herlife and her marriage.
I checked her labs and her tealevel was quite low, tea being
testosterone.
So I optimized her tea, and thedepression magically went away,
coach.

(45:38):
I mean, completely.
Her energy was much improved.
She felt great, and she wasblown away and extremely
grateful.
And it brought great joy to meto witness that amazing
transition in her due to hormoneoptimization, especially with
testosterone.
Again, another simple treatablecause.

SPEAKER_02 (45:54):
And let's not forget the men here.
Multiple large cross-sectionaland prospective studies confirm
that men with lower testosteronelevels are more likely to report
Testosterone influences brainneurotransmitters like dopamine
and serotonin, and low levelsmay reduce neuroplasticity and

(46:15):
increase the vulnerability todepression.
And again, yes, testosteronereplacement therapy for men with
low T has been shown in multipleclinical trials and systematic
reviews to significantly improvedepressive symptoms.
The proof is in the pudding.
So here we have yet anothertreatable cause for depression.

SPEAKER_00 (46:33):
The last hormone that we'll look at in the
context of depression ismelatonin.
A 2024 analysis of randomizedcontrol trials published in the
Journal Archives of Women'sMental Health found that
melatonin intake significantlyreduced depression in
postmenopausal women.

SPEAKER_02 (46:48):
The bottom line on hormones is that many of them
have a direct and powerfuleffect on brain health and mood
in particular.
At our clinic, we always embracethe concept of the symphony of
hormones.
The hormones don't actindependently, they all work
together, just like anorchestral symphony.
And when they are balanced andoptimized, they can make

(47:09):
beautiful music together,including an improvement in
mood.
We did an entire podcast onhormones back in 2019.
So you might want to go back andcheck that out to learn more
about hormones.
We also did podcasts ontestosterone in men and
testosterone in women in 2023,and you might want to listen to
those as well.

SPEAKER_00 (47:28):
You know, coach, let me uh try to give credit where
credit is due.
The first time I came acrossthat uh phrase, the symphony of
hormones, was Dr.
Pamela Smith at an A4Mconference years ago.
And I don't know if she's theone who originally came up with
it, but she's the one I learnedit from.
So I again I have to give hercredit.
She was a professor at the, Ithink, the University of South
Florida, and and uh so reallysharp lady.

(47:48):
I really like her work.
But uh now let's move on fromhormones and talk about
infections.
How can infections causedepression?
Well, uh chronic low-gradeinfections contribute ongoing
inflammation, includingneuroinflammation, that affects
brain function.
Lyme disease is a classicexample.
People with this can havedepression and many other
symptoms for many years withoutanyone connecting the dots to a

(48:09):
tick-borne infection that thepatient may have picked up years
earlier.

SPEAKER_02 (48:14):
Another quite common infection is a viral infection
by the Epstein-bar virus.
Most adults have been exposed toit, but in some people it can
reactivate and cause ongoingsymptoms, including depression.
We also see increased depressionwith other viruses like
cytomegalavirus, HIV, hepatitisC, and even chronic reactivation

(48:36):
of chickenpox virus.
Unfortunately, the treatment ofthese viruses can be difficult
and controversial.
Most docs really don't have ananswer.
My favorite podcast on EpsteinBarr virus is by Dr.
Aviva Romm, MD, on her podcaston health.
It's the podcast number 47called Epstein Barr virus, a

(48:56):
stealth infection.
I find Dr.
Rom to be quite experienced,informative, and credible.
So if you're interested in aprotocol for EBV, then you might
want to check that one out.

SPEAKER_00 (49:07):
And now we're hearing so much about depression
associated with long COVID.
Estimates suggest that up to 30%of people with long COVID
experience depression.
There are clinics who claim tohave protocols for prolonged
COVID, but unfortunately,there's no standard agreed upon
protocol at this point, which Ican share with you.
It's an evolving andcontroversial issue.

SPEAKER_02 (49:25):
And the next thing on our list of infections is
chronic sinusitis.
Multiple large studies andreviews demonstrate that people
with chronic sinusitis aresignificantly more likely to
develop depression compared tothose without the condition,
with more than a 50% increasedrisk.
And there is substantialevidence that a successful

(49:46):
treatment of chronic sinusitiscan improve depressive symptoms
in affected patients.
So check out episode 49 ofWellness Connection MD podcast
for an in-depth look on naturalmicrobiome-based treatment
protocol for sinusitis.
And also you might be interestedin Dr.
McMinn's book, McMinn'sSinusitis Microbiome Protocol,

(50:07):
available on Amazon.
Yeah, you can't.
I have my own copy.

SPEAKER_00 (50:11):
I've had some pretty good uh feedback from some of
the patients who've uh tried theprotocol from the book, and uh,
so that's really rewarding forme to hear that.
Uh a lot of these are patientswho have failed uh traditional
therapies with antibiotics andsurgery.
But anyway, uh likewise withurinary tract infections, uh
chronic or recurrent urinarytract infections are
significantly associated withincreased risk of depression.
Multiple clinical studies havefound that people, especially

(50:33):
women who experience frequentUTIs, report much higher rates
of depression, anxiety, andreduce quality of life compared
to those without recurrentinfections.

SPEAKER_02 (50:42):
In one study, 61.9% of patients with recurrent UTIs
exhibited some degree ofdepression at baseline.
And again, we find thatsuccessful treatment or
prevention of these recurrenturinary tract infections can
significantly improve depressivesymptoms and overall mental
health.

SPEAKER_00 (51:02):
Another treatable cause.
And another infection that isfrequently associated with
depression is viral myocarditis.
Recent studies have shown thatnearly half of myocarditis
survivors experience clinicaldepression, sometimes persisting
for years after their initialdiagnosis and recovery.
And furthermore, there seems tobe a heart-brain connection.

(51:22):
You've heard us talk about thegut brain connection, the the
gut-skin connection, but here'sa heart-brain connection, since
about 40% of people havesignificant depression after a
heart attack, much higher thanthe general population.
This type of depression shouldbe identified, addressed, and is
considered treatable to agreater extent.

SPEAKER_02 (51:40):
And the next infection that we'll mention is
parasitic infections, which aremore common than many people
realize, even in developedcountries like the United
States.
Meta-analysis found that theprevalence of mental illness,
including depression, wasfourfold higher among
individuals with parasiticinfection.
Several studies specificallyhighlight Toxoplasma gondi, a

(52:03):
common protozoa, often found incat feces and undercooked meat,
was strongly associated withdepression, suicidality, and
other severe adverse cognitiveand psychiatric outcomes.
Late-stage syphilis alsofrequently caused depression,
and syphilis is making acomeback globally, including in
the U.S.

SPEAKER_00 (52:23):
Moving on now to the gut brain connection, there are
numerous documented mechanismsby which the gut-brain
connection can influencedepression, starting with
dysbiosis, which is an alteredgut microbiome, which creates
neuroinflammation via manydifferent mechanisms.
And there is also a directeffect on vagus nerve signaling,
contributing to low mood.

SPEAKER_02 (52:43):
Gut microbes also influence the production of key
neurotransmitters likeserotonin, dopamine, and GABA,
as well as metabolites likebutyrate, which have direct
effects on brain function andbehavior.
Interestingly, fecal microbiotatransplants from depressed
individuals into germ-freeanimals induced depressive-like

(53:06):
behaviors, demonstrating acausal link.

SPEAKER_00 (53:09):
Isn't that interesting, Coach?
So you basically you're puttingfecal material from depressed
humans into, for instance, amouse, and then you get a
depressed mouse.
Fascinating.
I I think they've actually doneit the other way as well.
They they take uh fecal materialfrom normal individuals and put
them into depressed people andthey they feel better.

(53:29):
It improves them.
Yeah, yeah.
So again, we have good news,Coach.
Clinical studies show thatintervisions aimed at restoring
a healthy gut microbiome, suchas probiotics, dietary changes,
and fecal microbialtransplantation can improve

SPEAKER_02 (53:44):
You know, I remember many days just looking at
Tyler's eyes, dealing with hisdysautonomia stuff, which was
also ended up being very gutrelated.
But I remember looking at hiseyes and just seeing the
hopelessness there and the deepdepression and just telling him,
I'm gonna have the faith for youthat you're gonna get better.
But those were heavy days, andcertainly his gut health and

(54:06):
infection in his gut was a hugepart of his picture.
And we really saw with treatinghis small intestinal bacterial
overgrowth, his cyboinfectionthere, huge improvement in his
mood and his brain symptoms.
And I would definitely say brainfog was a huge component for him
that we saw improve, but alsojust his, you know, will to live

(54:28):
and keep going.

SPEAKER_00 (54:30):
You know, I think that would be just another
interesting point, Coach.
I I think that people who arediagnosed with or suffer with a
chronic illness, especially whenthere's a sense of hopelessness,
that in to oneself causesdepression.
I'm really kind of fascinatedand love to do a podcast
sometimes on the emotional andpsychological effects of chronic

(54:51):
illness.
Yes.
But I think that's uh it'sanother one on our list today
here.
But one variation of dysbiosisthat we'll single out today is
chronic yeast overgrowth.
Now, this is a subject that'sonce again controversial, but we
did a whole podcast on it, and Ithink we've made a pretty strong
case for it.
You may want to go back and uhcheck that out.
Anyway, candida, which is yeast,can produce toxic metabolites

(55:12):
that affect brain function.
And while there's not a wholelot of research on this subject,
since it's not really on thebelief system of the mainstream
medical doctors and researchers,some observations in small
studies report that people withsignificant candidate overgrowth
can experience mood disorders,including depression, as well as
fatigue, anxiety, brain fog, andirritability.
So again, our experience withthis is that yeast treatment

(55:34):
protocol can significantlyimprove these symptoms.
We have seen it time and timeagain with our own eyes.

SPEAKER_02 (55:40):
Now let's take a look at some lifestyle factors
that may contribute todepression.
And the main lifestyle factorsare as follows eating a healthy
diet, which we've discussed,maintaining an ideal body
weight, no smoking, exercise,stress reduction, restorative
sleep, adequate hydration,limited alcohol, socialization,

(56:03):
and having a strong sense ofcommunity, loving relationships,
spending time with friends andfamily, taking time for fun and
pleasure and remaining sexuallyactive if that works in your
life, maintaining good hygiene,like your dental hygiene,
connecting with nature, gettingdirect sunlight, and having a
sense of purpose and life andliving mindfully.

SPEAKER_00 (56:24):
And coach, you know, I'd love to have the time to go
into each of these individually,but I I promise you I did my
homework and feel free to goback and fact-check me if you
want to.

But here's the bottom line: every single lifestyle factor on (56:32):
undefined
this list is associated with ameasurable risk of depression.
That's according to currentresearch.
And as I've said before,lifestyle medicine is the most
powerful medicine on earth whenit comes to many issues that we
have, but including depression.

SPEAKER_02 (56:50):
And I'd like to just take a moment to shine a
spotlight on one of those, andthat is exercise.
Exercise is like a naturalantidepressant, it increases
endorphins, BDNF, orbrain-derived neurotrophic
factor, and helps reduceinflammation.
But here's the key it doesn'thave to be intense.

(57:12):
Even regular, consistent walkingcan make a significant
difference.
Even better, walk in nature andin the sunlight.

SPEAKER_00 (57:20):
You know, coach, I remember one time I read this
really interesting article aboutjust hearing birds chirp
improves depression and lessensanxiety.
So if you get out there and walkdown a nice trail, you know, you
get the sunlight, you hear thebirds chirp.
There's somehow that connectionwith nature is so powerful.
And yeah, the coach, the thisthe science is overwhelming
supporting exercise for improvedmood, including a review

(57:43):
encompassing 97 meta-analysis,which found exercise to be one
and a half times more effectivethan medication or counseling
for managing mild to moderatedepression.

SPEAKER_02 (57:54):
I love that.
You know, I've been doing a lotof walking up where we live now,
but I have noticed that of allthe walkers, I would say 75% of
them have their ear pods in orthey're looking down at their
phones even while they'rewalking.
So I just want to encourage you,listeners, leave the phone in
the car.

SPEAKER_00 (58:12):
Yeah, yeah, yeah.
You know, and okay, here'sanother thing.
Lindsay lives on a lake.
And and I I don't know thatthere are any studies, I'd have
to look it up.
Are there any studies showingthat that looking out at the
water reduces the pressure?
I bet there is.
To me, it just has such acalming effect to look at the
water.
I just love it.
So I'm I'm very jealous that youlive on the lake, Lindsay.

SPEAKER_02 (58:33):
It's a it's a good life.

SPEAKER_00 (58:34):
Good for your mental health.

SPEAKER_02 (58:35):
Lake life is good life.

SPEAKER_00 (58:37):
Yes.

SPEAKER_02 (58:37):
So next on our list is toxins.
There are three main types oftoxins that we like to look at:
heavy metals like lead andmercury, organic toxins like
PFAS, the forever chemicals, andmycotoxins from mold.
And these toxins are much morecommon than most folks realize.

(58:59):
Again, evidence is clear thatincreased exposure to any of
these may be associated withdepression.
But the first step to deal withthis is avoidance.
And then there are also specificdetox protocols for these
substances.
We did an entire podcast ontoxins back in 2021 that you
might find interesting.

(59:20):
But the bottom line is thatremoving toxins can result in an
improvement in depressed mood.

SPEAKER_00 (59:26):
And our next cause of depression is mitochondrial
dysfunction.
Mitochondria are the littleenergy factories in all of your
cells, and your brain cells areparticularly high energy cells,
so they need mitochondria to berunning on all cylinders.
Mitochondria play a significantrole in the pathophysiology of
depression by impairing brainenergy metabolism,
neurotransmitter regulation,cellular resilience, and

(59:48):
neuroplasticity.

SPEAKER_02 (59:50):
Studies clearly show that patients with mitochondrial
diseases or mitochondrial DNAmutations have a much higher
prevalence of depression.
Symptoms compared to the generalpopulation.

SPEAKER_00 (01:00:02):
Again, the good news is poor mitochondrial function
can often be improved through acombination of lifestyle
interventions, dietaryadjustments, targeted
supplements, and individualizedmedical therapies.
And as mitochondrial functionimproves, so does depression.

SPEAKER_02 (01:00:15):
Now, here is another treatable cause of depression
that may be surprising for somefolks.
Low cholesterol is associatedwith an increased risk of
depression, with numerousstudies supporting this
connection across differentpopulations and age groups.
Several studies, includingresearch in both men and women,

(01:00:36):
report that individuals in thelowest cholesterol percentile
have significantly moredepressive symptoms than those
with higher cholesterol levels.
This is particularly noticeablewith low LDL and is likely due
to effects on brainneurotransmitter systems and
cell membrane function.
Interestingly, one of the listedpotential side effects of

(01:00:58):
statins is depression.
Go figure.

SPEAKER_00 (01:01:01):
Yeah, that's right.
You know, coach, we often thinkwith uh cholesterols, especially
with LDL, the lower the better,but that's not quite the case.
I think uh it gets too low, itcan have an effect on brain
health, including depression.
Many other prescriptions andover-the-counter medications
list depression as a potentialside effect.
Some of the more common ones arebeta blockers, clonidine, ACE
inhibitors, tamoxifen, oralcontraceptives, benzodiazepines

(01:01:24):
like Valium, antieleptics,antiparkins meds, opioids, NSAID
drugs, steroids, proton pumpinhibitors, H2 blockers,
antibiotics, especially thefluoroquinolones, antivirals,
antihistamines, digitalis,cyclobenzaprine, a muscle
relaxer, and some of the GLP1drugs like ozimbic and wigovi.
So the cause of your depressionmay be right there in your

(01:01:45):
medicine cabinet.
Again, another correctablecause, but never stop meds
without the approval of yourdoctor.

SPEAKER_02 (01:01:52):
Another treatable cause of depression is seasonal
affective disorder.
Therapy for this may includelight therapy, psychotherapy,
medications, vitamin Dsupplementation, exercise,
healthy diet, managing stress,and increased daily natural
light exposure.
Such treatment usually helps andthe mood does improve.

SPEAKER_00 (01:02:12):
And coaches a new kid on the block when it comes
to the causes of depression.
That is the issue of screentime.
Studies show that increasedscreen time is strongly
associated with higher risk ofdepression across all age
groups, but especially inchildren, adolescents, and young
adults.

SPEAKER_02 (01:02:27):
There is a subset of screen time that is particularly
worrisome, and that is excessivesocial media use, especially
passive scrolling.
The average American teen spendsfive hours per day on social
media.

SPEAKER_00 (01:02:42):
Say that again, coach.

SPEAKER_02 (01:02:43):
Five hours per the average American teen on their
phones.

SPEAKER_00 (01:02:48):
Where do they find five hours to do that?
Is it take is it taken away fromtheir sleep or from their
homework or whatever?
That's incredible, coach.
Five hours a day.

SPEAKER_02 (01:02:56):
It's startling.
And this can actually, notunsurprisingly, increase
depression and anxiety.
And that's where we kind of havethis word doom scrolling.

SPEAKER_00 (01:03:07):
No wonder they call it doom scrolling, huh?

SPEAKER_02 (01:03:08):
Mm-hmm.

SPEAKER_00 (01:03:09):
So, okay, folks, we're about to wrap this up, but
bear with us just a bit longer.
Before we close out, I wouldjust uh briefly like to mention
an interesting concept calledmetabolic imprinting in infancy,
also known as micrometabolicimprinting.
It has to do with epigeneticmodifications induced by early
influences during infancy thatcan result in stable,
long-lasting alterations in geneexpression via epigenetics

(01:03:32):
relevant to brain function,emotional regulation, including
depression.
For instance, people who werebottle fed as infants appear to
have a higher risk ofexperiencing depression as
adults compared to those whowere breastfed, according to
multiple studies.
Again, in many instances, thisis preventable.
We should be stronglyencouraging breastfeeding when
possible.
And we get it that not all womencan breastfeed, and that's fine,

(01:03:54):
no judgment here, but I'm justsaying that when possible,
breastfeeding is a good thing.

SPEAKER_02 (01:03:58):
A huge advocate of that.
And I currently work with momsand babies, and breastfeeding is
hard.
Yeah, right.
It is so hard.
And I'm very passionate aboutpeople having education about it
during pregnancy andpre-pregnancy, so that in those
early postpartum times, theyknow and they have the strength
to keep going.

(01:04:20):
Like, why am I doing this?
Why am I trying to breastfeed?
Um, I turned out okay, but theydon't recognize what are some of
the long-term effects of bottlefeeding or or not getting that
good breastfeeding in.

SPEAKER_00 (01:04:32):
Well, coach, they say that I turned out okay, but
but the problem is we neverconnect the dots.
Like let's say they move on inlife and and and they're 40
years old and they getdepression.
They don't realize that bottlefeeding made them more
susceptible to that.

SPEAKER_02 (01:04:45):
Yes.

SPEAKER_00 (01:04:45):
Right?
It's all about connecting thedots.

SPEAKER_02 (01:04:48):
I agree.
I think connecting the dots isso important and just really
educating people on facts.
So we've got longitudinalstudies that show that exposure
to antibiotics during infancyand early childhood, especially
the first two to three years oflife, is associated with a 10 to
50% increased risk for mooddisorders later in life.

(01:05:09):
And that's definitely notsomething you hear in the moment
when you're when you're givingthis to your child.
And certainly there are timeswhen antibiotics are needed and
we're 100% supportive of that.
And the modern medicine is isvery good for many situations.
However, all of the expertsagree that antibiotics are
vastly overused.

(01:05:30):
As patients, we become expectantof a script for antibiotics for
every sniffle.
While we don't fully take intoaccount the long-term connecting
those dots, the long-termconsequences, for example, like
changes in our microbiome, andthen long-term consequences like
mood alteration and depression.

SPEAKER_00 (01:05:50):
Yeah, there are some other direct causes of
depression that we'll mentionhere, but due to time
constraints, we won't go into ingreat detail because we're
trying to wrap this up for you.
But I've done my homework onthis, and the science is very
solid.
Every one of these factors isrelated to increased risk of
depression.
And the factors are trauma inearly childhood events, brain
injury, even many years prior tothe onset of depression,

(01:06:10):
systemic autoimmune conditions,cultural factors and stigmas,
especially for minority groups,substance abuse, including
alcohol and drugs, chronic pain,obesity, neurodivergent
conditions such as ADHD, andautism spectrum disorder,
sensory loss, including hearingand vision loss, PCOS, which is

(01:06:31):
polycystic ovary syndrome,prenatal mood disorders, anemia,
neurologic diseases such asParkinson's and MS, the epidemic
of loneliness, air pollution,histamine intolerance, and mast
cell activation syndrome.
Well, that's a mouthful, coach.
Yes.

SPEAKER_02 (01:06:46):
And we've covered a lot of ground here.
And the health coach in me isrecognizing that this might feel
overwhelming to someone who'slistening or struggling with
depression.
So where do we start, Dr.
Mack?

SPEAKER_00 (01:06:58):
Well, coach, it starts by taking a why approach.
You know, why does the patienthave depression?
Or why do you have depression?
And then I I I'm a big believerin taking a thorough history.
So you look at the timeline, youfocus on the antecedents.
Uh, was there anything going onor right around the time
depression started or justbefore?
And the potential triggers.
Um, and if needed, start diggingwith a good medical workup like

(01:07:19):
I did with that patient withvitamin D.
And start with the potentialcauses that are most likely
based on the history andphysical.
Coach, this should all be in thewheelhouse of a good functional
medicine doctor.
In order to find a goodfunctional medicine doctor, you
may you may want to check outIFM.org for someone in your
area.
And let me be clear, coach, anydoctor can become a functional

(01:07:40):
medicine doctor.
It's not a privateinvitation-only fraternity.
It's all about changing yourmindset as a provider from a
knee-jerk symptom pill approachto a why approach.
Why does the patient have theproblem?
And then putting in the work toovercome your learning curves,
like topics such as hormonereplacement therapy, nutrition,
toxins, lifestyle medicine, justto name a few that you were

(01:08:02):
never taught in medical school.

SPEAKER_02 (01:08:04):
The next thing you'll want to do is pay close
attention to lifestyle factorsagain.
The most powerful medicine onearth.
It takes some time anddedication, but start today to
move your major lifestylefactors in the right direction.

SPEAKER_00 (01:08:18):
On the nutrition part, Coach, consider working
with someone like our friendRachel Olson, who has been on
the show a couple times.
It may be difficult for you tofind your own personalized diet
to help you overcome yourhealthcare challenges, including
depression.
So Rachel can definitely helpyou make that transition.
You can find her contactinformation and her bio at
bigmenmd.com, or you can findanother similar nutritionist and

(01:08:40):
health coaches at ifm.org.

SPEAKER_02 (01:08:43):
So listen up, listeners.
This is super important.
Never stop psychiatricmedications, including
antidepressants, without workingclosely with your prescribing
doctor.
And at the end of the day, youmay just need to take those
medicines, and that's perfectlyokay.
No judgment and no guilt.
Do whatever you need to do toget better.
And if you ever find yourself ina crisis, here's a great

(01:09:06):
resource.
Call or text 988 or contact988lifeline.org.
You're not alone.

SPEAKER_00 (01:09:15):
And remember, this is a journey.
It's never a quick fix when itcomes to things like depression.
And if you can successfullytreat your depression at the
root cause level, then it can belife-altering for you.
So keep plugging away.
Leave no stone unturned.
Keep in mind that it may not beone big thing, but it might be a
lot of little things here thatyou have to fix.
So fix those small things, andyou may be able to achieve an

(01:09:36):
optimal outcome.

SPEAKER_02 (01:09:38):
The body and the brain have an amazing capacity
to heal when we give it what itneeds and remove what it's
what's harming it.
And that's really whatfunctional medicine is all

about (01:09:48):
working with your body's natural healing capacity rather
than working against it orcovering up symptoms with drugs.
This podcast is basically aboutrealistic hope and empowerment.
For many people, you don't haveto accept that depression is
just something you have to livewith for the rest of your life.
By addressing the above causes,you can often outsmart it.

SPEAKER_00 (01:10:10):
So, due to the length of this podcast, which
focuses on a functional approachto depression, we're unable to
really delve into theintegrative therapeutic options
for depression, but we'll make apoint of circling back around to
that and doing a separatepodcast on this subject.
So don't forget to subscribe tothe show and so you won't miss
our episode on integrativetherapies for depression.

SPEAKER_02 (01:10:29):
Well, that about does it for this edition of
Wellness Connection MD.
Thank you so much for listening,and we hope that we were able to
share something with you todaythat informed and inspired you.

SPEAKER_00 (01:10:40):
And if you like the show, please help us by taking a
moment to rate us on iTunes.
These reviews really do make adifference for us.
Also, if you like the podcast,then take a moment today to let
a friend know about it and helpus spread the word about
evidence-based, holistic,functional lifestyle and
integrative medicine.
We're trying to build a tribe ofpeople who are passionate about
holistic optimal health, and wehope that you'll join the tribe.

SPEAKER_02 (01:11:03):
If you'd like to reach out to us to comment on
the show or to makerecommendations for future
topics, then you may do so atdrmcmin at yahoo.com.

SPEAKER_00 (01:11:13):
And if you'd like to have a complete transcript of
the show, then go on over toMcMinn M D.buzzsprout.com.
That's B-U-Z-Z-S-P-R-O-U-T.com.
And now, coach, can you leave uswith another of your wonderful
Coach Lindsay Pearls of Wisdom?

SPEAKER_02 (01:11:29):
Thanks, Dr.
McMahon.
You know, we've discussed todayhow we've examined nutritional,
genetic, environmental,inflammatory reasons for
depression.
And I hope that this has reallypainted the picture that
depression is not just simply amental health disorder, but it's
a brain disorder.
There's very physical reasonsthat can be behind it.
And I say this not to minimizethe lingo of mental health,

(01:11:49):
which is critical, but tochallenge our entire concept of
how we're thinking about this.
Our brains are precious.
I tell my kids that all thetime.
I'm always like, you only haveone brain.
And this pertains to themwearing helmets when they're
bike riding.
It pertains to when we're eatingfood at the table and or we're
out socially and they're wantingsomething else.

(01:12:10):
They say, Well, we're takingcare of our brains.
We need to treasure our brainsand take care of them when they
are malnourished, inflamed, ortoxic, toxin overloaded, as well
as trauma overloaded.
So just want to encourage us tolearn to love our brains and
then they'll love our bodiesback too.

SPEAKER_00 (01:12:26):
You know, your Pearl of Wisdom reminds me of a
wonderful old uh James Taylorsong.
Now, you're too young toremember a guy named James
Taylor.

SPEAKER_02 (01:12:32):
I love JT.
My dad made sure I grew upknowing James Taylor.

SPEAKER_00 (01:12:36):
That was my generation.
Uh but uh he did a wonderfulsong called The Secret of Life
is Enjoying the Passage of Time.
Um love that song.
And I think there's some truthto it.
However, it's hard to enjoy thepassage of time when you're
depressed, right?
And so this is a seriousdisease.
And we're we're trying toempower you, and hopefully it's
with providers.
We're trying to empowerproviders to take it seriously

(01:12:57):
and do whatever is needed,whether it be drugs or treating
one of these treatable rootcauses to help people live a
life where they can enjoy thepassage of time.

SPEAKER_02 (01:13:07):
Yes.

SPEAKER_00 (01:13:07):
Okay.
Well, coach, that should do it.
Until next time, stay curious,stay informed, keep it real, and
remember small actions can leadto big change.
Take that first step towardsbetter health.

SPEAKER_02 (01:13:18):
This is Coach Lindsey signing out.

SPEAKER_00 (01:13:21):
And this is Dr.
McMinn.
Take care and be well.

All Episodes

Episode Transcript

Popular Podcasts

Stuff You Should Know

CrimeLess: Hillbilly Heist

Dateline NBC

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Depression: A Functional Root Cause Approach

Episode Transcript

Popular Podcasts

.css-r6mb8g{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:1;overflow:hidden;}Stuff You Should Know

CrimeLess: Hillbilly Heist

Dateline NBC

All Episodes

Depression: A Functional Root Cause Approach

Stuff You Should Know