1. Dr Lily Tomas discusses an integrative approach to treating depression using nutritional supplements, lifestyle changes, and conventional medications. 2. Key neurotransmitters involved in depression include serotonin, dopamine, GABA, and histamine, which can be balanced through amino acids, B vitamins, minerals, and fatty acids. 3. There are different biochemical subtypes of depression related to histamine, methylation, copper levels, and other factors that require individualized treatment plans. 4. A case study demonstrates how addressing diet, hormones, supplements, and conventional care can help manage a woman's depression and digestive issues over time.

1. Dr Lily Tomas
INTEGRATIVE TREATMENT OF
DEPRESSION

2. Exercise
Purpose,
Body
Passion,
image
Pleasure
Social/
Diet
Spiritual
Environ. Neurotrans
Influences mitters
Herbal Integrative V&Ms
Treatment
of
Depression
Homeo
Hormones
pathy
Psycho
EFAs
logical
BSLs Drugs
Heavy
Sleep
Metals

3. Anti-Depressant Medications
 Tricyclics : May block re-uptake of serotonin,
noradrenaline, dopamine and histamine.
 SSRIs and SNRIs : Block serotonin and
noradrenaline uptake
 MAO Inhibitors : Inhibit Monoamine oxidase,
Type A blocks the breakdown of serotonin and
noradrenaline
Type B blocks the breakdown of different
neurotransmitters, including adrenaline,
dopamine and noradrenaline

4. Nutritional Treatment
Options for Depression
 Important neurotransmitters include:
 Serotonin
 Dopamine, Adrenaline, Noradrenaline
 GABA
 Histamine
 Neurotransmitters are derived from amino
acids sourced from quality proteins.

5. Nutritional Treatment
Options for Depression
 Depression can be the result of imbalances in
neurotransmitters- deficiency or excess
 Determine neurotransmitter imbalances and/or
specific amino acid deficiencies
 Serotonin deficiency – Tryptophan, Vit B6 or zinc
deficiency, malabsorption
 Oxidative stress can increase serotonin
requirements

6. Serotonin Pathways
Iron, Folate Vit. B6
Vit. C, Calcium Zinc
5 Hydroxy Serotonin
Tryptophan
Tryptophan Melatonin
(from Food/ Supplement)
Vitamin B3

7. Dopamine Pathway
Iron, Folate Vit. B6
Vit. C
Tyrosine DOPA Dopamine
(From Food/
Supplement) Vit. C
Copper
Adrenaline NorAdrenaline

8. GABA Pathway
Vit. B6, Taurine
Zinc
Glutamine Glutamate GABA
( From Food/
Supplement)
Glutathione

9. Histamine Pathway
Vit. B6
Histidine Histamine
( From Food/
Supplement)

10. Tryptophan
 Tryptophan (5HTP) 100-200mg bd
 Vitamin B6 100mg or Activated B6(P5P) 25mg
 Zinc 40mg nocte
 Magnesium 250mg bd
 B Complex

11. Tryptophan
 Trial at this dose for 1 month, then reduce to
half as per patient’s own judgement.
 Do not use tryptophan with anti-depressant
drugs unless under professional supervision.

12. Tyrosine
 Precursor to Dopamine, Noradrenaline,
Adrenaline
 These neurotransmitters have a role in
depression and drug dependence
 Can be in excess, however, in schizophrenia
 Tyrosine 500-100omgs coupled with co-
nutrients (Predop ingredients)
 Tyrosine also used to enhance thyroid
function

13. Glutamine
 Related to the neurotransmitter, GABA, our
primary inhibitory neurotransmitter
 Therefore aids in mental anxiety and
relaxation
 Glutamine 500mg-1000mgs coupled with co-
nutrients (Pre-GABA ingredients)

14. Pfeiffer Treatment Centre
 Health Research Institute, Illinois, US.
 Extensive database of information regarding
all mental health conditions
 3500 patients with depression
 Highly individualised nutritionally-based
approach to treating depression and other
health conditions (e.g. Autism, ADHD,
Alzheimers etc)

15. Pfeiffer Treatment Centre
 5 main biochemical subtypes of depression
 High Histamine (Undermethylation)
 Low Histamine (Overmethylation)
 Pyroluria (Genetic condition resulting in Zinc, Vit
B6 deficiencies)
 Hypercupraemia (High Copper- Excess Oestrogen)
 Toxic Overload (High levels of Heavy Metals)

16. Histamine
High Histamine
 Under methylated
 Deficiency of methyl groups/ Neurotransmitters
(Serotonin, Dopamine, Noradrenaline)
 Generally a good response to SSRIs
 May have adverse reactions from benzodiazepines

17. Histamine
High Histamine
 Low methionine, zinc, Vitamin B6, calcium with
high folic acid.
 Benefit from SAMe, P5P, zinc, methionine,
Vitamin C, calcium, magnesium
 Potentially harmful supplement : folate
 Improvement expectation: 8-12 months.

18. Histamine
Low Histamine
 Over methylated
 Excess of methyl groups/ Neurotransmitters
(Serotonin, Dopamine, Noradrenalin)
 Generally a good response to benzodiazepines
 May have adverse reactions to SSRIs, anti-
histamines, oestrogen

19. Histamine
Low Histamine
 Low folate, Vitamin B12, B3
 Benefit from folate, vitamin B12, B3,P5P, zinc,
Vitamin C, E
 Potentially harmful supplements : methionine,
SAMe, tryptophan, tyrosine, St John’s Wort.
 Improvement expectation : 3-6 months

20. Histamine, Methylation and
SAMe
 Histamine is intricately connected to the
Methylation pathway.
 The process of Methylation is a major factor
in the synthesis of serotonin, dopamine and
noradrenaline in the brain.
 SAMe is the primary source of methyl for
most reactions in the body

21. Methylation and SAMe
 The primary way humans receive most of
their methyl groups is from dietary
methionine (egg white, halibut fish, orange
roughy fish, salmon, tuna, ling, turkey)
 SAMe : 400-800mg daily
 Trial at this dose for 1 month

22. Essential Fatty Acids
 Omega 3 fatty acids are essential
components of brain cell membranes.
 Alter signal transduction and electrical
activity in brain cells, controlling the
synthesis of chemicals such as eicosanoids
and cytokines which may have a direct effect
on mood.
 Humans do not make their own Omega 3
EFAs!
 WE ARE WHAT WE EAT!

23. Essential Fatty Acids
 Our change in diets (land animal fats and
many vegetables oils) from 4:1 to 16:1
Omega6: Omega 3 ratio.
 EFA levels can now be measured directly
through blood tests performed in specialised
laboratories.
 Plethora of studies demonstrating the
benefits of adequate EPA/DHA to our mental
state.

24. Essential Fatty Acids
HOWEVER
 There is a subgroup of people with
depression that may get worse from
EPA/DHA supplementation.
 These are people who are deficient in
arachidonic acid, an Omega 6 EFA – Evening
Primrose Oil.
 These are people who produce and excrete
kryptopyrroles in their urine.


25. Kryptopyrroluria
 Genetic disorder linked to depression,
anxiety and mood swings
 Approx 10% population produce KPs,
indicating higher needs for Vitamin B6 and
zinc .
 Zinc and Vitamin B6 necessary to produce
serotonin and GABA
 Vitamin B6 necessary to produce dopamine,
noradrenaline and histamine.

26. Kryptopyrroles
 First discovered in late 1950s by Hoffer
 1960’s : research on schizophrenics,
“mentally retarded” and “disturbed” children
and criminals
 1970’s : Dr Carl Pfeiffer devised a simple
quantitative urine test and demonstrated a
reduction in kryptopyroles and clinical
improvement with high doses of vitamin B6
and zinc.

27. Kryptopyrroluria
 Pale appearance, white marks on nails, poor
dream recall, heightened sensitivities –
bothered by bright lights, loud noises, tags on
clothes, skip breakfast, food/chemical
allergies.
 Testing by SAFE Laboratories in QLD.

28. Kryptopyrroluria
 Tend to do better on Omega 6 EFAs (evening
primrose oil) rather then Omega 3 EFAs (fish
oils) secondary to low levels of arachidonic
acid.
 Beneficial supplements: zinc, P5P, Vitamin
B6, Vit C
 Improvement expectation: 1-3 months

29. Hormones and Depression
 Progesterone – Like serotonin, another “Feel
good” hormone.
 Produced in the luteal phase
 Most women are oestrogen dominant.
“How much of your depression do you relate to
your hormones?”

30. Hormones and Depression
 Oestrogen dominance is often associated
with copper overload.
 During pregnancy, blood copper levels more
than double.
 Soon after birth, copper levels return to
normal.
 Subgroup of people who have a genetic
tendency for copper overload.
 Excess copper leads to decreased dopamine
and elevated noradrenalin in the brain.

31. Hormones and Depression
POST-NATAL DEPRESSION
 Many women with PND exhibit an excess of
copper and a deficiency of zinc.
 The cause appears to be genetic; abnormal
functioning of the metallothionein/
glutathione system resulting in an inability to
regulate copper/zinc metals in the body.

32. Hormones and Depression
 Serum copper and plasma zinc.
 Stop pregnancy supplements containing
copper.
 Beneficial supplements: Zinc, Manganese,
Vitamin B6, Vitamin C, Vitamin E.

33. Putting it all together:
Case History
 36 year old woman presents with history of
depression and IBS for 2 years
 Prescribed conventional anti-depressant 6
months ago, but wishes to wean.
 Not suicidal
 Full history and examination

34. Case History
 Management:
 Mental Health Care Plan (Item 2710)
 Pathology testing
 3 morning temps during periods

35. Case History
 Management:
 Probiotics
 SAMe 400mg morning
 Continue current anti-depressant
 Review in 1 month

36. Review after 4 weeks
 Feeling better wrt moods and digestion
 36.2, 36.4, 36.5
 Food Elimination Regime (not all IBS
symptoms resolved)
 Mental Health Care Plan (continued)
 Continue probiotics and SAMe. May trial half
dose of anti-depressant over next month.

37. Review after further 6 weeks
 Realisation of gluten intolerance, resulting in
bloating , fatigue and low moods associated
with these symptoms.
 Still depression 1 week prior to periods
 Patient still keen to cease anti-depressant
 Commencement of 3 month regime
Magnesium 250mg twice daily, B Complex
and Vitex agnes castes 1g twice daily
 Regular exercise

38. Review after further 8 weeks
 Feeling much better
 Continuing to avoid gluten
 SAMe reduced to 200mg morning
 Future dosing of SAMe and probiotics
according to patient’s judgement
 After another month, may halve hormone
balancing regime
 Mental Health Plan Review