Biotypes of Depression – Walsh
I am convinced that Dr William Walsh’s biotypes of depression will become mainstream psychiatry! It’s just a matter of when. But in my humble opinion, this shift can not come soon enough given the often silent suffering of people with depression and anxiety.
The eloquent nature of Dr Walsh’s work is unavoidably effective in the assessment of depression and anxiety, explaining why many people do not respond to conventional medications. According to Dr Walsh only about 38 – 50% of people suffering with depression will respond to conventional Selective Serotonin Reuptake Inhibitors (SSRI’s) and similar, which correlates well to the available research. This, however, in most cases leaves more than half of this population battling major side effects of the medication they are prescribed, with sometimes fatal consequences.
Although the details of yesterdays tragic school shooting in La Loche, Saskatchewan are unknown, it has become clear in other school shootings that medications have been associated to these violent acts, making it clear that psychiatry needs to be more diligent in assessment of mental health conditions, especially in youth. And with today’s ability to biochemically and genetically asses people that suffer from depression, or even people that are at risk of suffering from depression and/or may be intolerant to conventional medications, this assessment needs to be a medical priority.
Undermethylation – 38% of Depression and Anxiety; Low serotonin, dopamine biotype; Better with SSRI’s
Nutrients often required: SAMe, Methionine and other methylators; also tryptophan ,vitamin B6, 5-HTP, Vitamin A, C and E)
Avoid: Folate, Choline, manganese, copper and DMAE since they increase chromatin acetylation
Indicators: low SAMe/SAH ratio; high blood histamine, high basophils, high homocysteine
Traits: OCD, seasonal allergies, perfectionism, adverse reaction to folic acid, good SSRI response, self motivated. low pain tolerance, strong willed, high suicidal tendency, sparse chest leg and arm hair, denial to depression, family history of depression, high accomplishments, rumination over past events, seasonal allergies, high libido, high fluidity, competitive, addictive, calm, frequent headaches, non-compliance, oppositional defiance.
Notes: Most undermethylators have 2 traits with makes successful treatment difficult,
Folate Deficiency/Overmethylation - 20% of Depression and Anxiety; Elevated serotonin, dopamine
Nutrients often required: Folic acid, Vitamin B12, Niacinamide, Choline, DMAE, manganese (reduce dopamine synaptic activity), zinc, pyridoxine-5-phosphate and vitamin B6 which increase GABA; Augmenting nutrients include vitamin C
Avoid: SAMe and methionine; 5-HTP; tryptophan
Indicators: High SAM/SAH ratio, low blood histamine, low homocysteine
Traits: Major anxiety in addition to depression, 20% history of panic disorder or anxiety, adverse reaction to SSRI’s, food sensitivities, highly artistic, nervous legs and pacing, noncompetitive sports, games, hyperactivity, upper body/head/neck pain, improvement after benzodiazepines, absence of seasonal allergies, low libido, hirsutism, sleep disorder, underachievement, high pain threshold, estrogen intolerance, copper intolerance. May be caring and generous in nature noncompetitive.
Pyroluric Depression – 15-17% of Depression and Anxiety; Reduced serotonin, dopamine and GABA
Nutrients often required: Glutathione, Vitmain C , Vitamin E, Zinc and Vitamin B6
Indicators: Elevated urine pyrroles
Notes: Odd combination of symptoms that make the diagnosis relatively straightforward. Quick to respond to nutrient therapy. Common in antisocial personality disorder (sociopaths).
Traits: Severe mood swings, inability to cope with stress, rages, absence of dream recall. Sunburn tendency, inability to tan, morning nausea, sensitivity to bright lights and load noises, menstrual disturbances, amenorrhea; delayed puberty and significant growth after age 16, reading disorders and academic underachievement, fear and pessimistic ; isolate themselves, Tend to be obsessed with disaster
Copper overload – Elevated Norepinephrine
Nutrients often required: Zinc, Vitamin C, chelation, low copper diet
Traits: Lack of energy, disruptions in sleep, high anxiety, reduced interest in previously enjoyed activities, suicidal, homicidal, depression after childbirth, increased estrogen during pregnancy, ringing in the ears, sensitivity to cheep metals, inability to tan
Toxic Metal Overload
Nutrients often required: NAC, alpha-lipoic acid, zinc, glycine, chelation
Notes: Difficult to diagnose; rule/out undermethylation, folate deficiency, copper overload, pyrrole disorder, casien and gluten intolerance, thyroid imbalance first
Traits: Headaches and muscle aches, Low Energy, Failure to respond to counseling and psychiatric medications.
Although these biotypes seem complicated, to a medical professional this simply boils down to providing a few tests. Assessment should include SAM/SAH ratio, genetic evaluations for methylation issues and SSRI intolerance, serum histamine, urine pyrroles, organic acid testing, ceruloplasmin, serum or urine copper and a complete blood count. If all else fails, assessment for heavy metals might be warranted.
In a careful evaluation of Dr Walsh’s work along with my own clinical experience in the area of functional psychiatry, I am confident that these evaluations need to be a priority in support our population suffering with depression and anxiety. This is especially important for the large majority of people in this demographic that do not know what else to do, when the medication they are taking is not working!