In October, we observe National Mental Health Awareness Month. Although it's important to raise awareness about issues like anxiety, depression and suicide, it's equally critical to understand that no one wants to be labeled as defective or abnormal. By labeling these issues as "mental health" or "psychiatric," people suffer in silence because of the shame they feel.

If we do not erase-or at least lower-the stigma for these issues, many more people will unnecessarily suffer, and some will die, without getting the help they need. We must do better because according to a large epidemiological study in Archives of General Psychiatry, 51 percent of the U.S. population will struggle with a mental health issue at some point in their lives.¹ Let that soak in for a moment-more than half of Americans will experience a psychiatric problem, meaning it's more common to have one than not.

Anxiety disorders and depression are the most common conditions, according to the National Alliance of Mental Illness,² and they are increasingly affecting young people. An estimated 36 percent of girls will experience clinical depression during their teenage years and so will 13 percent of teenage boys.³ Both numbers are unacceptable.

Even more disheartening is the fact that suicide rates are on the rise. Since 1999, suicide has increased 33 percent, decreasing overall life expectancy, while during the same period of time cancer has decreased 27 percent.⁴

We're heading in the wrong direction.

Discarding an Outdated Paradigm
Reimagining mental health as brain health changes everything. People begin to see their problems as medical, not moral. It decreases shame and guilt and increases forgiveness and compassion from their families. Reframing the discussion to brain health is also more accurate and elevates hope, increases the desire to get help, and increases compliance to make the necessary lifestyle changes. Once people understand that the brain controls everything they do and everything they are, they want a better brain so they can have a better life.

But psychiatry remains the only medical field that rarely looks at the organ it treats. If you have crushing chest pain, a cardiologist will do an imaging study of your heart. But if you have crushing depression, chances are no one will ever look at your brain.

This needs to change as a growing body of neuroimaging studies-including our own brain imaging work that includes over 160,000 brain SPECT scans related to behavior-clearly show that mental health is related to the physical functioning of the brain. We see it in people with depression, anxiety, and suicidal behavior.

Depression is associated with excessive activity in the brain's emotional center, which is known as the limbic system. When this brain network is less active, there is generally a positive, hopeful state of mind. When it is overactive, negativity and sadness can take hold.

Anxiety is linked to too much activity in the basal ganglia, a part of the brain that sets your emotional tone. When there is overactivity in this area, people are more likely to experience anxious thoughts, tension, heightened fear and increased awareness.

Suicidal thoughts and behaviors are complex and often tied to untreated conditions, such as depression or anxiety. We have scanned more than 300 people who have attempted suicide and many more who have contemplated taking their own life. We have found that a number of brain issues are often at work in people who are suicidal, including:

• Traumatic brain injuries. Head injuries, including so-called mild concussions where you don't even pass out, are commonly seen.
• Temporal lobe abnormalities. In an Amen Clinics study, we saw left temporal lobe problems in 62 percent of our patients who had serious suicidal thoughts or behaviors.⁵
• Low activity in the prefrontal cortex. When this area, which is involved in planning and judgment, is underactive, it increases impulsivity.
• Overactivity in the anterior cingulate gyrus. Too much activity in this area causes people to get stuck on negative thoughts.

Ending Mental Illness Through Optimized Brain Health

The most exciting thing about reframing the discussion about mental health as brain health is that an increasing number of studies have found that improving the physical functioning of the brain improves the mind.⁶ You are not stuck with the brain you have. You can make it better.

This doesn't necessarily mean medication. Be aware that some psychiatric medications intended to improve your mental state are actually harmful to your physical brain. For example, anti-anxiety drugs, such as benzodiazepines, are associated with unhealthy, toxic-looking scans. In addition, most people are never informed that it can be hard to stop taking certain psychiatric medications, such as anti-anxiety pills or antidepressants. Be careful about starting something that may be hard to stop.

Lifestyle changes can have a powerful influence on the moment-by-moment functioning of your brain. Adopting brain healthy habits can be one of the keys to minimizing symptoms of anxiety and depression and can improve the functioning of the troubled brain areas seen in people with suicidal tendencies.

For example, research has shown that physical exercise has been found to improve mood, anxiety, and even cognitive health in patients with depression.7 Increasing evidence suggests that nutritional treatment may help prevent, treat, or improve depression, anxiety and many other disorders.8 This means that fueling the brain with high-quality food can minimize symptoms.

Other impactful strategies to retrain the brain include learning how to kill the ANTs, the automatic negative thoughts that infest your mind and steal your happiness. Negative thoughts cause the brain to release chemicals that instantly make you feel bad, but by simply challenging or talking back to these thoughts, you can shut down or slow the production of these nasty chemicals so you can feel better fast.

A growing body of evidence also supports the use of natural supplements for mental health, or rather brain health, issues. A number of websites are dedicated to the extensive science of nutraceuticals for health, including brain health, such as MedlinePlus from the National Library of Medicine and Natural Medicines. They often grade nutraceuticals from the clinical science evidence similarly to how they rate pharmaceuticals, with A-level status reserved for those that have robust research conducted with more than two placebo-controlled, double-blind clinical trials.

Several nutraceuticals have A-level evidence for symptoms seen in common mental health, or brain health, conditions. For anxiety and stress, these include ashwagandha,⁹ theanine,¹⁰ and omega-3 fatty acids (EPA+DHA).¹¹ Nutraceuticals that support mood include EPA omega-3 fatty acids,¹² St. John's wort,¹³ saffron,¹⁴ and SAMe.¹⁵ I often recommend these, along with a core nutraceutical program that includes a broad-spectrum multiple vitamin-supplement and vitamin D, for our anxious and depressed patients.

Ultimately, to enhance brain health and manage or overcome symptoms, it's important to seek out solutions that are the least toxic and most effective.

References

1. Kessler RC, et al. "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication." Archives of General Psychiatry. 2005;62(6):617-627.
2. https://www.nami.org/learn-more/mental-health-by-the-numbers
3. Breslau, J et al. "Sex differences in recent first-onset depression in an epidemiological sample of adolescents." Translational Psychiatry. 2017;7(5):e1139. doi:10.1038/tp.2017.105
4. Hedegaard H, Curtin S, and Warner M. "Suicide Mortality in the United States, 1999-2017." National Center for Health Statistics. NCHS Data Brief No. 330. Nov. 2018.
5. Amen DG, Prunella JR, Fallon JH, et al. "A comparative analysis of completed suicide using high resolution brain SPECT imaging." The Journal of Neuropsychiatry and Clinical Neurosciences. 2009;21(4):430-9. doi: 10.1176/appi.neuropsych.21.4.430
6. Velten J, Lavallee KL, Scholten S, et al. "Lifestyle choices and mental health: A representative population survey." BMC Psychology. 2014;2(1):58. 10.1186/s40359-014-0055-y
7. Oertel-Knöchel V, et al. "Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients." Eur Arch Psychiatry Clin Neurosci. 2014 Oct;264(7):589-604.
8. Rao TS, Asha MR, Ramesh BN, Rao KS. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry. 2008;50(2):77-82. doi: 10.4103/0019-5545.42391
9. Choudhary D, Bhattacharyya S, Joshi K. Body Weight Management in Adults Under Chronic Stress Through Treatment With AshwagandhaRoot Extract: A Double-Blind, Randomized, Placebo-Controlled Trial. J Evid Based Complementary Altern Med. 2017 Jan;22(1):96-106; Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul;34(3):255-62; Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014 Dec;20(12):901-8; Andrade C, Aswath A, Chaturvedi SK, et al. A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera. Indian J Psychiatry. 2000 Jul;42(3):295-301.
10. Hidese S, Ota M, Wakabayashi C, et al. Effects of chronic l-theanine administration in patients with major depressive disorder: an open-label study. Acta Neuropsychiatr. 2017 Apr;29(2):72-79; Hidese S, Ota M, Wakabayashi C, et al. Effects of chronic l-theanine administration in patients with major depressive disorder: an open-label study. Acta Neuropsychiatr. 2017 Apr;29(2):72-79; White DJ, de Klerk S, Woods W, et al. Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients. 2016 Jan 19;8(1; Unno K, Tanida N, Ishii N, et al. Anti-stress effect of theanine on students during pharmacy practice: positive correlation among salivary ?-amylase activity, trait anxiety and subjective stress. Pharmacol Biochem Behav. 2013 Oct;111:128-35; Yoto A, Motoki M, Murao S, et al. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012 Oct 29;31:28; Ritsner MS, Miodownik C, Ratner Y, et al. L-theanine relieves positive, activation, and anxiety symptoms in patients with schizophrenia and schizoaffective disorder: an 8-week, randomized, double-blind, placebo-controlled, 2-center study. J Clin Psychiatry. 2011 Jan;72(1):34-42; Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol. 2004 Oct;19(7):457-65; Kimura K, Ozeki M, Juneja LR, et al. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45.
11. Barbadoro P, Annino I, Ponzio E, et al. Fish oil supplementation reduces cortisol basal levels and perceived stress: a randomized, placebo-controlled trial in abstinent alcoholics. Mol Nutr Food Res. 2013 Jun;57(6):1110-4; Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15;32(2):568-75; Robinson DG, Gallego JA, John M, et al. A potential role for adjunctive omega-3 polyunsaturated fatty acids for depression and anxietysymptoms in recent onset psychosis: Results from a 16?week randomized placebo-controlled trial for participants concurrently treated with risperidone. Schizophr Res. 2018 Sep 18. pii: S0920-9964(18)30556-5; Kiecolt-Glaser JK, Belury MA, Andridge R, et al. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011 Nov;25(8:1725-34; Jacka FN, Pasco JA, Williams LJ, et al. Dietary intake of fish and PUFA, and clinical depressive and anxiety disorders in women. Br J Nutr. 2013 Jun;109(11):2059-66; Matsumura K, Noguchi H, Nishi D, et al. Effects of omega-3 polyunsaturated fatty acids on psychophysiological symptoms of post-traumatic stress disorder in accident survivors: A randomized, double-blind, placebo-controlled trial. J Affect Disord. 2017 Dec 15;224:27-31; Su K-P, Tseng P-T, Lin P-Y, et al. Association of use of omega-3 polyunsaturated fatty acids with changes in severity of anxiety symptoms. A syatematic review and meta-analysis. MA Network Open 2015;1(5):e182327
12. Mischoulon D, Papakostas GI, Dording CM, et al. A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. J Clin Psychiatry. 2009 Dec;70(12):1636-44; Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr 2009;28:525-42; ; Lespérance F, Frasure-Smith N, St-André E, et al. The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62; Rondanelli M, Giacosa A, Opizzi A, et al. Long chain omega 3 polyunsaturated fatty acids supplementation in the treatment of elderlydepression: effects on depressive symptoms, on phospholipids fatty acids profile and on health-related quality of life. J Nutr Health Aging. 2011 Jan;15(1):37-44; Jamilian M, Shojaei A, Samimi M, et al. The effects of omega-3 and vitamin E co-supplementation on parameters of mental health and gene expression related to insulin and inflammation in subjects with polycystic ovarysyndrome. J Affect Disord. 2018 Mar 15;229:41-47; Sublette ME , et al. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011 Dec;72(12):1577-84. doi: 10.4088/JCP.10m06634. Epub 2011 Sep 6; Haberka M, Mizia-Stec K, Mizia M, et al. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacol Rep. 2013;65(1):59-68.
13. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database Syst Rev 2008:CD000448; Fava M, Alpert J, Nierenberg AA, et al. A Double-blind, randomized trial of St John's wort, fluoxetine, and placebo in major depressive disorder. J Clin Psychopharmacol. 2005 Oct;25(5):441-7; Sarris J, Nierenberg AA, Schweitzer I, Alpert JE, Rosenbaum JF, Iovieno N, et al. Conditional probability of response or nonresponse of placebo compared to antidepressants or St John's wort in major depressive disorder. J Clin Psychopharmacol 2013;33:827-30.
14. Yang X, Chen X, Fu Y, et al. Comparative efficacy and safety of Crocus sativus L. for treating mild to moderate major depressive disorder in adults: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat. 2018 May 21;14:1297-1305; Kell G, Rao A, Beccaria G, et al. affron® a novel saffron extract (Crocus sativus L.) improves mood in healthy adults over 4 weeks in a double-blind, parallel, randomized, placebo-controlled clinical trial. Complement Ther Med. 2017 Aug;33:58-64; Lopresti AL, Drummond PD, Inarejos-García AM, et al. affron®, a standardised extract from saffron (Crocus sativus L.) for the treatment of youth anxiety and depressive symptoms: A randomised, double-blind, placebo-controlled study. J Affect Disord. 2018 Feb 26;232:349-357; Jelodar G, Javid Z, Sahraian A, et al. Saffron improved depression and reduced homocysteine level in patients with major depression: A Randomized, double-blind study. Avicenna J Phytomed. 2018 Jan-Feb;8(1):43-50.
15. Williams AL, Girard C, Jui D, Sabina A, Katz DL. S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med 2005;28:132-9; Sarris J, Papakostas GI, Vitolo O, et al. S-adenosyl methionine (SAMe) versus escitalopram and placebo in major depression RCT: efficacy and effects of histamine and carnitine as moderators of response. J Affect Disord. 2014 Aug;164:76-81; Papakostas GI, Mischoulon D, Shyu I, et al. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry. 2010 Aug;167(8):942-8; Shippy RA, Mendez D, Jones K, et al. S-adenosylmethionine (SAM-e) for the treatment of depression in people living with HIV/AIDS. BMC Psychiatry. 2004 Nov 11;4:38; Bell KM, Plon L, Bunney WE Jr, et al. S-adenosylmethionine treatment of depression: a controlled clinical trial. Am J Psychiatry. 1988 Sep;145(9):1110-4; Salmaggi P, Bressa GM, Nicchia G, et al. Double-blind, placebo-controlled study of S-adenosyl-L-methionine in depressed postmenopausal women. Psychother Psychosom. 1993;59(1):34-40; Bell KM, Potkin SG, Carreon D, et al. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-8; Delle Chiaie R, Pancheri P, Scapicchio P. Efficacy and tolerability of oral and intramuscular S-adenosyl-L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Am J Clin Nutr. 2002 Nov;76(5):1172S-6S; Sharma A, Gerbarg P, Bottiglieri T, et al. S-adenosylmethionine for neuropsychiatric disorders: a clinician-oriented review of research. J Clin Psychiatry 2017 June;78(6):e656-e667.

People with serious mental illness, on average, die 25 years earlier than the general population.¹ This startling fact is largely ignored by both health and mental health providers. And yet, according to the Diagnostic and Statistical Manual of Mental Disorders, one in four Americans has been diagnosed with a mental disorder. Major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorders are the most common diagnosis. With these disorders comes an increased risk of death associated with a myriad of physical illnesses. Cardiovascular disease, gastrointestinal, metabolic, neurologic and pulmonary diseases are the top five causes of death. However, most people with a mental disorder have more than one major illness. A prevalence study indicated that of the clients who participated, thirty percent were treated for three or more conditions, a fifth were treated with four or more conditions and some were treated with eight of more conditions.²

Few psychiatrists or mental health providers understand the nutritional needs of the brain. Rather than address physical conditions, antipsychotic medications are prescribed as the first line of treatment. The underlying physical causes are often ignored. Although the psychiatric symptoms may be ameliorated with the antipsychotic drugs, severe side effects can contribute to or exacerbate existing illnesses. The medications can induce weight gain and worsen other metabolic and cardiovascular disease risk factors. With weight gain and poor diets, for example, the prevalence of diabetes in persons diagnosed with mental illness increased from three percent at onset to 16.5 percent as patients’ age. People who were prescribed antipsychotic medication were also at greater risk for coronary heart disease and stroke. A comprehensive study found a 1.99 – 2.26 fold increase in sudden death in current users of antipsychotic medications.³

Mental disorders are increasingly being connected to malnutrition. Common deficiencies occur in omega-3 fatty acids, B vitamins, amino acids and minerals. Omega-3s are vitally important for brain health. As our food choices have moved from natural, whole foods to processed foods, our diet is dominated by omega-6 fatty acids. The ideal balance of omega-3 fatty acids to omega-6 fatty acids is a range from 1:1 to 1:4. The balance today, because of the abundance of omega-6s in processed foods, is 1:20. Excessive omega-6s cause cardiovascular disease, cancer, and inflammatory and autoimmune diseases.

The B vitamins support many brains functions. Deficiencies can cause low energy and problems in activities of daily living. Eighty percent of people with bipolar disorder have some B vitamins deficiencies. The B vitamins also affect cognitive impairment.

Proteins are the source of amino acids and form the foundation for cell formation and the production of neurotransmitters in the brain. The neurotransmitters function as behavior and mood regulators. They affect serotonin and dopamine the “feel good” hormones. People with schizophrenia often exhibit disturbances in the synthesis of amino acids.

Minerals are often overlooked as necessary for brain health. Chromium, magnesium, selenium and zinc affect our moods and low levels are correlated with depression. ^4,5

A new paradigm is slowly emerging. New research indicates that nutritional supplements are often effective in reducing psychiatric symptoms. Nutrient dense diets combined with targeted omega-3 fatty acids, amino acids, and vitamins and minerals have been shown to be effective for controlling and to some extent, preventing depression, bipolar disease, schizophrenia, among many others. ^5,6

In the early 1960’s Abram Hoffer, a Canadian biochemist and medical doctor, pioneered an approach that was mindful of the role of nutrition in schizophrenia and other diseases. Called orthomolecular therapy, he defined it as the provision of the optimum environment of the mind. He treated patients with prescribed B vitamins, vitamin C, vitamin E and the minerals selenium, zinc and chromium. He also had his patients eliminate all foods containing sugar along with foods that might cause an allergic reaction.⁷

Nutritional studies in the 1970s and 1980s continued to explore the role of nutrients in mental health but were discontinued because of lack of funding.⁹ The money was invested instead in the pharmaceutical industry where the emphasis was on investigating and producing synthetic drugs. Most nutritional therapies could not be patented and owned and therefore were not profitable. However, nutritional therapy is experiencing a comeback as more evidence indicates that good nutrition is directly connected with brain health and cognitive functioning.⁸

As a result, more psychiatrists and other providers are beginning to advocate for and practice nutritional therapy, addressing diet and lifestyle along with prescribing vitamins, minerals and other supplements.^9,10 Placing more emphasis on the whole person is necessary to prevent or treat the co-occurring physical disorders that accompany a mental disorder. Persons with a diagnosis of a mental disorder are entitled to a life expectancy that is comparable to that of the general population. As we continue to expand our understanding of what the brain needs and the role of nutrition to improving and maintaining mental health, hopefully their life expectancy will improve over time.

References:

1. Parks, J., Svendsen, D., Singer, P., & Tate, M.E. (2006, October). Morbidity and Mortality in People with Mental Illness. National Association of State Mental Health Program Directors (NASMHPD). Medical Director Council. Retrieved from www.nasmhpd.org.
2. Jones, D.R., Macias, C., Barreira, P.J. et al. (2204). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services 55:1250 – 57. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15534013.
3. De Hert, M., Dekker, J.M., Wood, D. et al. (2009, August 13). Cardiovascular disease and diabetes in people with severe mental illness position statement paper for the European Psychiatric Association (EPA). European Psychiatry, 24, 412–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19682863.
4. Sathyanarayana Rao, T.S., Asha, M.R., Ramesh, B.N. & Jagannatha Rao, K.S. (2008, April–June). Understanding nutrition, depression and mental illness. Indian Journal of Psychiatry. 50(2): 77–82). doi: 10.4103/0019-5545.42391.
5. Goldstein, M. (2013, April 22). Nutritional approaches and diets safely cure mental illness. Natural News. Retrieved from http://www.naturalnews. com/nutrition.html.
6. Logan, A.C. (2007). The Brain Diet. Nashville, TN: Cumberland House Publishing.
7. Abram Hoffer. Retrieved from http://en.wikipedia.org/wiki/Abram_Hoffer.
8. Lakhan, S.E. & Vieira, K. (2008, January,21). Nutritional therapies for mental disorders. Nutrition Journal, 7:2 doi:10.1186/1475-2891-7-2.
9. Robert J. Hedaya. Retrieved from https://www.psychologytoday.com/experts/robert-j-hedaya-md-dfapa.
10. Campbell-McBride, Natasha. (2010). Gut and psychology syndrome: natural treatment for autism, dyspraxia, A.D.D., dyslexia, A.D.H.D., depression, schizophrenia. Cambridge, U.K.: Medinform Publishing.