I have been interested in depression for a while now and thought I should write a blog post about this topic to make others aware of its occurrence and how to find hope in what might feel like a hopeless situation or experience.
In Bongiovanni’s book he looks at a method of harnessing the power of personalized medicine, modern neuroscience and nutritional psychiatry to help one overcome depression. Bongiovanni’s book starts off with the historic/current views on depression; he suggests 16% of Americans suffer from major depression at some point in their lives, which are 34 million Americans.
He proves that researching depression is vital as there is a need for improved assessment and treatment of depression. The treatment of depression is changing in relation to research, culture, patterns of illness, treatment and economic conditions. He says researchers are discovering mood disorders are influenced by, genetic, dietary, hormonal and environmental factors which manifest in different expressions of depression and more importantly that every depressive state is unique to the biology of the patient.
In Chapter 2, Bongiovanni mentions the state of the science or nature of depression through the following bio-psycho-social factors such as drug therapies, diet, digestion and detoxification, nutrition, stress hormones, brain chemistry, other hormones, the immune system connection, exercise, sleep, psychotherapy, mindfulness and genetics.
- Drug therapies: He suggests that drug therapies in the 1950’s using re-uptake of serotonin has failed to induce full recovery in more than 50% of patients, these drugs also have limitations such as side effects, cost, treatment resistance, drug interactions, length of time to effective cost for instance drugs like Prozac, lexapro, Zoloft. These drugs work by inhibiting the re uptake of serotonin i.e. they take the serotonin the brain is already producing and helps it to stay around longer, this is not helpful if you have low levels of serotonin to begin with, in that case, the drug is ineffective.
- The 3 D’s: diet, digestion and detoxification: Diet is important as food sensitivities, delayed sensitivities to food can lead to serve as a stress for some patients. Digestion, stress hormones can be a major trigger to gut barrier dysfunction (leaky gut). Digestion imbalances can also predispose to nutritional deficiencies. Toxins have an effect on depression. Toxins from chemicals, mold, microbes, foods, drugs, hormones and more can have an effect brain function and mood.
- Nutrition: There are many nutritional deficiencies in depressed patients, about a third of depressed patients have nutritional deficits. Relapse rates are higher in nutritional deficit patients. Patients should have B vitamins, fatty acids from fish oils, magnesium, vitamin D, zinc, iron, selenium, iodine, tryptophan and tyrosine.
- Hormonal Imbalances: such as stress responses and the hypothalamic pituitary adrenal (HPA) axis imbalances, trigger and is a mediator for depression. The HPA regulates many physical processes (digestion, immune system, mood, energy storage and expenditure) and controls as well as adapts to stress. The common denominator is a deregulated stress response.
- Other hormones: such as estrogen and testosterone can have mood-altering effects for many different reasons.
- Immune system dysfunction and deregulation: have significant relationships with depression.
- Exercise: the brain derived neurotrophic factor (BDNF), this is essential for maintaining healthy neurons and creating new ones. Brain activity during exercise accounts for changes in the brain, the proteins secreted from muscle cells are the driving force. This leads to maintenance of a healthy mood.
- Sleep: depression may cause sleep problems and sleep problems may cause depression. Sleep problems are associated with more severe depressive illnesses. People with insomnia, may have 10 fold risk of developing depression compared with those who sleep well, the risk for developing depression is highest among people with insomnia. Regular sleep also secrets cortisol, however about 50-70% of Americans sleep poorly a few nights per week, one must promote quality sleep and sleep rituals, constant bedtime as well as ensuring the bedroom is dark and quiet may help improve sleep habits.
- Psychotherapy: Cognitive Behavioural Therapy (CBT), is a psycho-therapeutic approach that addresses dysfunctional emotions. Most therapists use a CBT approach in dealing with anxiety and depression. CBT is problem focused and action oriented. CBT teaches the patient how to exercise his/her cognitive muscles in the same way a personal trainer would teach us how to exercise our physical muscles, the result is the patient learns how to manage their thoughts and emotions on their own.
- Mindfulness: is effective at preventing and treating psychiatric disorders and has fundamental effects on the brain that may decrease depression. Research shows that mean scores for two depression scales (MADRS-S & HADS-D) decrease by 50% in mindfulness groups.
- Genetics: gene variations modify the body’s response to certain drugs and therapies therefore personalized medicine is needed.
In Chapter 3, The Bongiovanni method is explained as a system based approach and the steps are as follows:
Step 1: Comprehensive physical and emotional medical history (is 60-90 minute interviews designed to elicit and understand each patient’s unique story and symptom development inclusive of all triggers)
Step 2: Test, don’t guess (thorough biological assessment, includes conventional laboratory workup such as blood count, metabolic profile and thyroid function and a lab evaluation looking at level of vitamins, hormones, gene markers, food sensitivity panels etc.)
Step 3: Benchmark your data (measurement based care with validated psychiatric scales as such Hamilton &/or Becks depression scales in addition to validated scales on perceived stress. These scales can be used to monitor and track progress.
Step 4: Partner on goals (patients need to be partners in their treatment where both doctor and patient are committed to the same goals and outcomes)
Step 5: Personalize and implement (use personalized interventions that are evidence based and are recommended by evaluating individual factors and imbalances. Implement natural interventions using genetics, dietary, nutritional, herbal, hormonal, exercise, sleep, mind- body, psycho-social methods)
Step 6: Continue monitoring with regular appointments as well as follow up laboratory tests and clinical psychology scales, we refine, adapt as we go to ensure every variable is tightly regulated, measured and attended.
Bongiovanni goes on to state that this method is beneficial as it lowers reliance on pharmaceutical medications, depression is multifaceted and it can lead to additional health problems, this method holds the potential to improve depression as well as additional related conditions, outcomes are improved, side effects are reduced, increased work productivity, both patient and clinician is satisfied and it reduces the public health burden.
He concludes by suggesting overall, that this method is suitable as it involves active listening, is systems based, detective like approach while working in a partnership with the patient to identify underlying causes for their depression, you cannot manage what you cannot measure, and it is an extremely valuable in this model. Each person is evaluated and as a unique treatment plan tailored to meet their biological needs to restore function to the physical and emotional level of the nervous system.
The positive aspects of this approach is firstly, that it is broad encompassing several factors in treating depression whereby the biological and psychological factors are treated equally. Secondly, the method is also person centered and focuses on the uniqueness of the patient including his/her history which is excellent in creating unique and effective treatment. Thirdly, it helps the patient to seek hope and not to become dependent on drug treatment which could cause harm. In terms of South Africa, I would like to think this approach would be suitable for us as South Africans however, the negative aspect of this approach, due to consulting a team of specialists; may be too costly for the average income earners of South Africa. The implementation of regular appointments and partnering on goals may not be as fully effective depending on the individual’s outlook on treatment and finances as one may look for a temporary solution that is cost effective instead of long term treatment. Greater research would have to be done to implement this approach into South Africa as well in the rural community clinics etc. to ensure cost effective treatment.
In conclusion, this post have summarized Bongiovanni’s method in treating depression and reviewed its ineffectiveness to a South African population. If any of you have suffered from depression or know of anyone with depression, please share this post to create awareness and to share knowledge with helpful tips on overcoming depression.
I have read once that someone who is depressed lacks hope and meaning in life. I pray that this post will be helpful to you and your loved ones, that you cling to hope and know that your days will be brighter; you can overcome depression and find joy in your darkest situations.
Bongiovanni, B (2015) Retrieved January 27, 2016 from Ebookee website, http://readmaygo.pl/chemistry-12/why-am-i-depressed-and-how-can-i-overcome-it-the-bongiovanni-method-harnessing-the-power-of-personal-40566.php (http://wmsoa.com/depression-ebook/DepressionFreeReport.pdf)