One of the greatest conundrums in the diagnosis and treatment of Mental Health struggles is the glaring lack of specific biomarkers for a disease process.
- Example: with Blood pressure- test the level with blood pressure cuff, and if it’s above 130/90 = high blood pressure aka hypertension.
- Example: Throat is on fire, tonsils swollen, go to the doctor, Strep test is positive = strep throat.
However with many mental health diagnoses it is often based on symptom clusters, which often overlap with one another.
- Example: I’m tired a lot, I can’t focus, I don’t want to hang out with friends, I don’t really care about my work any more, I don’t get good sleep = depression. Once you name the disease you can pair it with the FDA approved drug – Depression = SSRI or Wellbturin, etc.
Mental health is complex. Really complex. It is a complex interplay between physiological, psychological and social factors.
At STAT we recognize that there may be many other reasons your mood may be suffering outside of a hard break up, the loss of a job, high stress, or the global uncertainties we face.
From a physiological perspective we can test for a wide range of factors that may be contributing to mood struggles.
We always say, “DON’T GUESS WHEN YOU CAN TEST!”
Having some concrete numbers to work on is often really nice when you feel like everything is unraveling inside your head.
- Vitamin D – the “Sunshine Vitamin” – this vitamin actually acts almost like a hormone in the body and one thing we know is that it is critical for healthy brain and mood function. Vitamin D modulates things like serotonin and dopamine, improves the immune system in the brain, and enhances how your cells talk to one another (1). Range is 30-100. Optimal over 60.
- Omega 3’s – healthy fats from your salmon, cod, tuna, algae and krill have potent effects on the brain. Research shows Omega3’s can: decrease brain inflammation, calm the adrenal stress system (HPA axis), improve neuroplasticity, and improve neurotransmitter function (2). Goal optimal lab level for “OmegaCheck”l > 5.5
- Magnesium(RBC). Magnesium is well known to be a critical nutrient for brain neuron health and function. Low magnesium has been correlated with both anxiety and depression in numerous clinical studies. Similarly several studies showed magnesium supplementation helped improve mental health symptoms. Most people have a very low magnesium diet. Magnesium also helps calcium and Vitamin D absorption(3). Goal RBC Magnesium >5.5
- B-Vitamins – B9(folate) B12(cobalamin) – B12 and Folate are critical nutrients for cellular energy production in your mitochondria and impact a chemical process in the body known as Methylation. Research shows B vitamins help support dopamine and serotonin regulation and hence supplementation has been shown to improve the stress response in the body, anxiety and depression symptoms(4). Goal B12 > 500 and Folate > 15 (bonus if you measure Homocysteine levels – a functional marker of how well that B12/folate are actually working. High homocysteine levels may cause heart and brain inflammation).
- Thyroid- TSH, freeT3, freeT4 -Thyroid hormones are also critical for brain nueron function, energy, and mood regulation. Hypothyroid symptoms include sadness, fatigue, distress and cognitive impairment. Hyperthyroid symptoms may include agitation, anxiety, panic, palpitations, and even psychosis(5). Optimal levels: TSH 1-2, freeT4>1.0, free T3>3.0.
- Cortisol and DHEA – I think we’ve all heard of cortisol- the stress hormone- now without cortisol we would all die- it is critical for energy, electrolyte balance, and responding to stress. Both very high and low cortisol is associated with worsening anxiety and depression. These 2 adrenal hormones often balance eachother out. DHEA is involved with emotional regulation and is also an androgen (like testosterone) which impacts energy and mood(6). DHEA is even FDA approved for depression treatment(7). For both hormones we suggest levels balanced mid-range. Check cortisol 1-2 hours after waking for most accuracy.
- Testosterone- did you know women actually have more testosterone per mL of blood than Estrogen and Progesterone?! Low Testosterone in men and women is associated with depression, fatigue, increased stress, and lower libido. High testosterone can cause irritability and anxiety (8). Optimal Range is to shoot for upper third of the reference range- ex Labcorp male range is 250-950, so shoot for >600. Women’s range is 10-50, so shoot for 35.
- Estrogen/Progesterone – Estrogen helps regulate levels of serotonin, dopamine, and norepinephrine in the brain supporting healthy mood and focus.. Progesterone helps calm the brain by binding to GABA receptors. Estrogen “dominance” (can be high estrogen or low manifests as increased irritability, insomnia, depression, poor focus, and PMS symptoms with mood swings. When estrogen and progesterone are low In menopause we often see brain fog, memory and cognition issues, anxiety, depression, insomnia and low libido (9). Assess the balance of estrogen and progesterone in mid-luteal phase. Suggest working with your practitioner to determine optimal levels as this is a very nuanced assessment.
- C-Reactive Protein – this is a non-specific marker of inflammation (non-specific meaning it doesn’t tell us what is causing the inflammation- although common causes are insulin resistance, stress, gut inflammation, auto-immune conditions, infections, environmental toxins and nutrient deficiencies -think Vit D, Omega’s, Vit C). Inflammation of the nervous system aka “neuro-inflammation” is rapidly being consider one of the most critical root causes of mental health inflammation causing disruption in healthy brain cell communication, increased adrenal stress response, decreasing focus and concentration and triggering hyperactivity and emotional outburst (10). Optimal level <1.
- Fasting Glucose/Insulin – Glucose is critical for life and for most people is the most abundant energy source in their body. In fact the brain cannot function without some glucose. However, when it runs unchecked at higher levels in the bloodstream it triggers inflammation, oxidative stress, and insulin resistance. Insulin resistance causes the brain cells to feel like they are starving and this can make you feel anxious, fatigued, sad, overwhelmed, and much harder to manage stress(11). Optimal levels: fasting glucose 70-85; fasting insulin <10
This is a great starting point to dig in deeper to factors you can take action on that influence your mental health. There are certainly quite a few more things we think about here at STAT Wellness from a Functional Medicine point of view. If you would like to learn more about what we take a look at feel free to schedule a Free 15-minute consult with one of our providers or jump right in and book a new patient visit!
Also, join me (Kyle Compaan, FNP-C, CIPP) for a Functional Medicine for Mental Health Masterclass where you can learn, discern, and implement which Functional Medicine principles are most crucial for your mental health journey. This 8 week session will include a weekly webinar with Q&A and in depth nutritional testing via Metabolomix+. The sessions start 1/18/24 and you can book here!
- Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. Indian J Psychol Med. 2020 Jan 6;42(1):11-21. doi: 10.4103/IJPSYM.IJPSYM_160_19. PMID: 31997861; PMCID: PMC6970300.
- 2. Zhou L, Xiong JY, Chai YQ, Huang L, Tang ZY, Zhang XF, Liu B, Zhang JT. Possible antidepressant mechanisms of omega-3 polyunsaturated fatty acids acting on the central nervous system. Front Psychiatry. 2022 Aug 31;13:933704. doi: 10.3389/fpsyt.2022.933704. PMID: 36117650; PMCID: PMC9473681.
- Botturi A, Ciappolino V, Delvecchio G, Boscutti A, Viscardi B, Brambilla P. The Role and the Effect of Magnesium in Mental Disorders: A Systematic Review. Nutrients. 2020 Jun 3;12(6):1661. doi: 10.3390/nu12061661. PMID: 32503201; PMCID: PMC7352515.
- Young LM, Pipingas A, White DJ, Gauci S, Scholey A. A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients. 2019 Sep 16;11(9):2232. doi: 10.3390/nu11092232. PMID: 31527485; PMCID: PMC6770181.
- Lekurwale V, Acharya S, Shukla S, Kumar S. Neuropsychiatric Manifestations of Thyroid Diseases. Cureus. 2023 Jan 20;15(1):e33987. doi: 10.7759/cureus.33987. PMID: 36811059; PMCID: PMC9938951.
- Sripada RK, Marx CE, King AP, Rajaram N, Garfinkel SN, Abelson JL, Liberzon I. DHEA enhances emotion regulation neurocircuits and modulates memory for emotional stimuli. Neuropsychopharmacology. 2013 Aug;38(9):1798-807. doi: 10.1038/npp.2013.79. Epub 2013 Apr 3. PMID: 23552182; PMCID: PMC3717538.
- Peixoto C, Grande AJ, Mallmann MB, Nardi AE, Cardoso A, Veras AB. Dehydroepiandrosterone (DHEA) for Depression: A Systematic Review and Meta-Analysis. CNS Neurol Disord Drug Targets. 2018;17(9):706-711. doi: 10.2174/1871527317666180817153914. PMID: 30124161.
- Justin M. Johnson, Lisa B. Nachtigall, Theodore A. Stern, The Effect of Testosterone Levels on Mood in Men: A Review, Psychosomatics, Volume 54, Issue 6, 2013, Pages 509-514,
- McCarthy MM. Estradiol and the developing brain. Physiol Rev. 2008 Jan;88(1):91-124. doi: 10.1152/physrev.00010.2007. PMID: 18195084; PMCID: PMC2754262.
- Firth J, Veronese N, Cotter J, Shivappa N, Hebert JR, Ee C, Smith L, Stubbs B, Jackson SE, Sarris J. What Is the Role of Dietary Inflammation in Severe Mental Illness? A Review of Observational and Experimental Findings. Front Psychiatry. 2019 May 15;10:350. doi: 10.3389/fpsyt.2019.00350. PMID: 31156486; PMCID: PMC6529779.
- Kleinridders A, Cai W, Cappellucci L, Ghazarian A, Collins WR, Vienberg SG, Pothos EN, Kahn CR. Insulin resistance in brain alters dopamine turnover and causes behavioral disorders. Proc Natl Acad Sci U S A. 2015 Mar 17;112(11):3463-8. doi: 10.1073/pnas.1500877112. Epub 2015 Mar 2. PMID: 25733901; PMCID: PMC4371978.