What If Your Depression Wasn't All in Your Head? The Real Reason You Can't Just "Feel Better"

When I first started in practice as a functional medicine practitioner, I was blown away by the amount of people I met who were dealing with depression. I say "dealing with" because although many of them were on medications and quite a few of them had been through at least one type of therapy, most of them were just getting by at best. Certainly none of them were living their best life, and most of them agreed that they wanted to stop taking their medications but were afraid that if they did all their issues would just come right back.

I decided that this could not be the only way for these people to live. There had to be more to it.

When it comes to depression, we often hear explanations involving trauma, brain chemistry, genetics, or other factors that can influence mental health. And while these things can certainly be part of the picture, I think they leave us with another important question: Why?

Why do some people experience significant trauma or hardship and eventually move through it, while others become stuck in a cycle of depression and hopelessness? Why do some people develop persistent mood symptoms while others don't? And could there be physical factors contributing to the way someone is feeling that aren't being considered?

I believe the answer is yes - and one of the places worth looking is the gut.

The Gut-Brain Connection

The missing connection is in our belly. Yup, the old gut. This is known as the gut-brain axis, and it's a hot topic among researchers in the fields of functional health and psychology alike. You see, for a long time, traditional western medicine has looked at the body as a bunch of different and mostly separate systems and created specialists for each of these systems. If you have a heart problem, you see the cardiologist, if you've got a gland disorder like diabetes you see the endocrinologist and so on. The problem with this way of thinking and treating patients is that it usually doesn't address the "why" aspect. Why do you have a heart issue? Why are you diabetic?

If we focus only on reducing symptoms, however, we can sometimes miss the opportunity to ask what else may be contributing to those symptoms in the first place.

That's where a functional medicine approach can be helpful. Instead of looking at one system in isolation, we look at the body as a whole and ask what factors may be contributing to the problem.

A functional and integrative approach looks in the other direction. We look to find the root causes of the health conditions that we treat so that a patient can experience a full and permanent recovery whenever possible. This requires us to look at the body as a whole, not just individual systems, since most health issues are really a cascade of issues.

To explain that further. Let's get back to our gut-brain axis. The gut, or digestive tract, is filled with millions of bacteria in thousands of different species. In a perfect world all of these species are in balance and get along with one another. Unfortunately, due to many factors in our current lifestyles, this Utopian gut scenario is not the case. Many people develop what is called gut dysbiosis. That's just a fancy way of saying that the balance of microorganisms living in the gut has become disrupted. Some types may become more abundant than they should be, while others that normally help maintain a healthy balance may be reduced. Think of it like the wrong people moving into the neighborhood, taking up residence, and pushing out some of the neighbors you actually want around.

When this is happening to someone, it is the first domino to fall in the cascade that can lead to a whole host of health conditions. Gut dysbiosis has been associated with a wide range of health concerns, including digestive problems, immune dysfunction, metabolic issues, food sensitivities, and… changes in mood. And that's where the gut-brain connection becomes particularly interesting.

Gut Dysbiosis and Neurotransmitter Imbalance

Some of this connection from gut to brain/emotion is due to poor nutrient uptake. If you don't have the right bacteria to break down food, there's little possibility of taking up the right nutrients.

The larger way that this connection occurs is through the ability of gut bacteria to produce and influence neurotransmitters and other signaling molecules that communicate with the brain and help regulate mood, emotions, and other functions. If these substances are not being properly produced or regulated, it can affect the way the brain and body communicate and potentially influence how we feel and respond to the world around us.

The gut and brain also communicate continuously through multiple pathways, including the vagus nerve, immune system, and metabolic signaling. In other words, what's happening in the gut doesn't necessarily stay in the gut. There is a constant conversation happening between the digestive tract and the brain.

So no, depression isn't simply "all in your head." The brain is part of the body, and the body and brain are constantly communicating with one another. That doesn't mean that gut health is the sole cause of depression - or that therapy or medication aren't valuable. It means there may be additional physical factors worth investigating, particularly when someone is struggling with persistent symptoms or isn't getting the improvement they hoped for.

The great news is that supporting the gut doesn't have to mean completely overhauling your life or following another complicated diet. The first step is figuring out where to look.

As a functional medicine practitioner, I look at the bigger picture and consider factors such as digestion, diet, food sensitivities, gut microbial balance, nutrient status, and other underlying contributors. Depending on what we find, that may include targeted nutrition, supplements, functional laboratory testing, or other integrative approaches.

This inside-out approach allows us to look beyond the symptom and ask what may be contributing to it in the first place.

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About the Author

Dr. Caroline Ricker, DC, DABCI, MTAA, is the founder of Whole Health & Wellness in St. Louis. Her practice combines functional medicine, clinical nutrition, functional laboratory testing, chiropractic care, acupuncture, and other integrative approaches for patients with chronic and recurring health concerns.

Learn more about Dr. Caroline Ricker and Whole Health & Wellnes