The Inflammation-Depression Connection Approach and The Science Based Natural Approach to Depression

THE TODAY SHOW! Anthony Field Shares How an All Natural Approach and Surviving Depression, click here

The prevalence of depression has increased 10% every decade since 1910
How do you describe depression?
There are many theories of depression and its causes.
There are many types of depression such as endogenous depression, existential depression, perinatal depression, neurotic depression, atypical depression, geriatric depression, anxious depression, unipolar depression, maternal depression and even college depression.  There are songs about depression, quotes about depression and depression blogs and forums.
I treat the causes of inflammation which are linked strongly to depression.  
No matter what the link is like depression and relationships, depression and work or how you describe depression, science says that higher than normal levels of chronic inflammation could be a link to an increased risk of depression.
First, I don’t treat depression.  
Second, I never recommend a patient reduce or get off antidepressants.  
That is a choice the patient makes with their doctor.  
Many scientists have stated the connection between inflammation and depression and are recommending treatment to reduce inflammation.  The studies are here for you to review.  Has your doctor reviewed this science with you? Are you doing everything, “naturally” to ease your depression?
Here is an important question for you…
Does your doctor practice empathy when treating your depression?  or does your doctor treat your depression like the common cold and just give you pills? If you feel your doctor has no empathy for your depression and only prescribes you pills, I hope this presentation from Bangkok helps you learn more about the Inflammation-Depression Connection and what you can do to reduce depression symptoms naturally.
Depression is a mood disorder that affects serotonin levels in the brain. Because of its physiological cause, many people believe that clinical depression must be cured through chemical intervention.  High levels of chronic inflammation have been linked to lower levels of serotonin.  In fact if you go to Pub Med and search the database of scientific papers there are over 2000 articles or studies that connect inflammation to depression.

In fact, many scientists state that depression is an inflammatory disorder.
Read this paper “Is depression an inflammatory disorder?” by Charles L. Raison from the Mind-Body Program; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine who summarizes all the studies for you.   The paper is offered free here from this link. 
Instead of recommending that you reduce inflammation by attacking the sources of inflammation in your body like muscle and joint inflammation, dietary inflammation, inflammation from airborne particles and inflammation caused by stress, many doctors just give you antidepressants to keep the serotonin from being recycled and away you go.
Do you know there is a drug approved in Europe that does the opposite of the selective serotonin inhibitors (antidepressants) that claims to be just as effective?
Confusing?   Of course it is!
Maybe you need to do more research!
Watch Below as Dr. Stoxen gives his lecture presentation, The Empathy Deficit in the Treatment of Depressed Patients and The Inflammation-Depression Connection Approach at The 4th Anti-Aging And Regenerative Medicine Conference, Bangkok, Thailand, September 7-9, 2012)

Dr Stoxen reviewed over 2000 of the latest scientific papers extensively before he did this presentation.  
That saves you a time but you should still do more research.
This is especially true if the only remedy your doctor gives you are anti-depressants.
If your depression is connected to inflammation, aggressively reducing inflammation may not provide total relief  but it could help patients to reduce their dosage of antidepressants.
The best natural treatment for depression that is connected to inflammation involves attacking all sources of inflammation.
This includes:

• This includes treating dietary inflammation with a healthy diet.
• Treatment includes reducing lung inflammation with a reduction in airborne particles.
• Treatment may require reduction in other inflammation producing activities like sunburn, gingivitis etc
• It also includes treating muscle and joint inflammation with treatment.

For more in depth information about the effects of chronic high levels of inflammation read this article:  Video Tutorial #37 Aches, Pains, Allergies, Fatigue, Brain Fog, Diseases of Aging Have One Common Thread… INFLAMMATION
How do I ease depression, connected to dietary inflammation with a healthy diet?

Below is the Lecture and Power point notes used for Dr. Stoxen’s lecture to assist you in connecting the Inflammation-Depression Connection Approach;

“Scientific studies have found there is a connection between inflammation and depression.

People with depression are always talking about the aches and pains that they have with. “Depression Hurts” What we have found is that a lot of these patients that have these aches and pains are actually being treated with anti inflammatories, the patient might have a chronic condition that is left untreated or they have an inflammatory disorder that is treated less than optimal.” 

“In this presentation i’m going to outline for you the different incidences found in connections between inflammation and depression in research.”

“I first discovered the connection between inflammation and the diseases of aging in 2005 at The Asia Pacific Anti-Aging conference in Bali Indonesia. It was during a presentation given by Bill Anton from Melbourne, Australia.

–Dr. James Stoxen DC

Incidence of Depression

• The prevalence of depression is increasing 10% every decade since 1910
• The leading cause of disability in the United States
• The number of Americans taking antidepressant drugs doubled in the decade from 1996 to 2005, from 13.3 million to 27 million.
• Today 10% of every man, woman and child in America takes an antidepressant or some drug.

“This would answer the question why so many people in the United States and around the world are depressed. If 10% of every man woman and child in the United States takes a pill for some sort of depressive disorder. In the last decade over 150 million prescriptions have been given for anti depressant medication.” 

“Is depression being treated like a common cold?“

Have a cold?  Take these…

Have depression? Take these…

–Dr. James Stoxen DC

Olfson M, Marcus SC. National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry. 2009;66(8):848-856.

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Is this Your Office Visit with the Doctor for Depression?

The doctor reviewed tests conducted by the nurse and then spent less than 10 minutes with the patient.

“Here’s something to help your cholesterol, something for your blood pressure, and for your depression, here is an antidepressant. Shouldn’t have too many side effects ,though you might experience a loss of sex drive, but we have a drug for that. Would you like me to add that to your prescriptions? Good luck and I’ll see you in three months when your prescription runs out.” 
–Dr. James Stoxen DC

“It’s unfortunate that with the demands on doctors that our office visit are only 8-10 minutes. Many doctors are are dealing with patients with very complex problems with very little empathy” 
“Empathy is being able to connect with that patient to be able to feel what that patient feels. When your able to feel what the patient is feeling your able to respond with true care and love. These 8-10 office visits where people come in with depression should not be treated as if they have a common cold. and prescribed anti-depressants.” 
“Empathy is not something your born with it’s a learned skill. The Dali Lama said, ‘This is a learned skill and if you learn it and practice it then it can improve your life as well’. I know it’s improved my life. 
“In fact, Richard Davidson studied Tibetan Monks who used meditation and practiced empathy and said there was significant activity in the insula of the brain, the region of the brain that mediates bodily representation of emotional states of others who empathize.” 
–Dr. James Stoxen DC

What is depression?  

How to describe depression:  The DSM-iv Criterion for Major Depression or to Define Depression is… 

• A period of at least two weeks during which there is either a depressed mood or the loss of interest or pleasure in nearly all activities.
• In children and adolescents, the mood may be irritable rather than sad.
• The individual must also experience at least four additional symptoms drawn from a list that includes changes in appetite or weight, sleep, psycho motor activity, decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions, or recurring thoughts of death or suicide, plans or attempts.
• The episode must be accompanied by clinically significant distress or impairment in social, occupational, or important areas of functioning.
• It’s normal for people to feel a range of moods.
• It’s not realistic for people to be in a great mood all the time.

“I don’t know if you heard about this incident we had in Aurora, Colorado, United States. There was a young man and he was suffering from depression. He took out a gun and shot people in a theatre. This is a serious problem.” 
“According to the prescription labeling it states that 3% of those that take anti depressants will have feelings of suicide or perhaps killing others. With 30 million people taking these medications that adds up to be 900,000 people at any given time feeling like killing themselves or maybe even killing others.”
–Dr. James Stoxen DC

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV).
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Cytokine-Induced or Sickness Syndrome

The administration of high concentration of pro-inflammatory cytokines often leads to a condition known as systemic inflammatory response syndrome (SIRS) which are the same feelings of depression as those who have not had cytokines induced.  People define the effects of depression as those we define depression as the same DSM depression symptoms.

“If you ever talk to someone that is depressed, many of them share that they feel like they have a cold all the time. They don’t feel like getting out of bed, they want to keep on sleeping and they are re numerating in their minds all day and night their troubles.” 
“As doctors it would benefit our patients if we just asked ‘what is bothering you’, ‘what is troubling you’. Perhaps show an interest and ask how they like their career. Ask them about their family. Try to show some empathy. 
–Dr. James Stoxen DC

Myers JS. Pro inflammatory cytokines and sickness behavior: implications for depression and cancer-related symptoms. Oncology nursing forum. 2008;35(5):802-807

Inflammation and Depression Painful and Silent Arthritic Inflammation

• After reviewing over 1,000 citations linking inflammation to depression we can make the assumption that inflammation is linked to and perhaps a leading cause of depression.
• When our bodies release inflammation that leads to chronic pain, worry or have stress our bodies release low-grade inflammation.
• When we have chronically high levels of inflammation, feel chronic pain, worry or have stress our bodies release comforting levels of serotonin to help us cope.
• The body feels as if it is being attacked. We also have depression when we are unable to meet the demands or challenges of these attacks, leading to more stress.
• Patients consciously and subconsciously feel hopelessly locked up by three conditions, inflammation, chronic pain and depression.

“Science has proven that if we are put in a room with negative thoughts then inflammation will increase. They can prove this with blood tests.” 
–Dr. James Stoxen DC

Copeland W et al. Cumulative Depression Episodes Predict Later C-Reactive Protein Levels: A Prospective Analysis. Biological Psychiatry. 2012;71(1).

Unemployment

Finnish scientists found that stress-induced low-grade inflammation might be a link between unemployment and ill health.
Hintikka J et al. Unemployment and ill health: a connection through inflammation? BMC Public Health. 2009; 9:410.
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 Coronary Artery Disease

In a study of over 677 participants, 433 had no depressive symptoms, 86 had depressive symptoms at one assessment, and 138 had depressive symptoms at two or more annual assessments. Across all three groups, greater depressive symptoms were associated with higher subsequent levels of IL-6.

“This is a study where they found people with high levels of Interleukin 6 (IL-6), which is a cytokine is found in coronary artery disease and depression.“
–Dr. James Stoxen DC

Dulvis HE et al. Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study. Am J Psychiatry. 2011;168(9):913-20.
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 Pollution

In experiments, mice subjected to the same particulate matter as that of a major city displayed more depressive-like responses and impairments in spatial learning and memory as compared with mice exposed to fresh air.

“As I discussed earlier, encourage your patients to get out into the fresh air. This may seem like a simple recommendation because it is! The answer is not to just whip out the prescription pad and prescribe these antidepressant medications. They may become psychologically addicted to these.“
–Dr. James Stoxen DC

Fonken LK et al. Air pollution impairs cognition, provokes depressive-like behaviors and alters hippocampal cytokine expression and morphology. Mol Psychiatry. 2011;16(10):987-995
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Cigarette Smoking

Lifelong cigarette smokers have a higher prevalence of common diseases such as atherosclerosis and COPD with significant systemic impact.
A low-grade systemic inflammatory response is evident in smokers as confirmed by numerous population-based studies. Some inflammatory mediators are still significantly raised in ex-smokers up to 10 to 20 years after quitting, suggesting ongoing low-grade inflammatory response persisting in former smokers.
Yanbaeva DG, Dentener MA et al. Systemic effects of smoking. Chest. 2007;131(5):1557-1566.
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Gut Inflammation Vagus Nerve – Blood-Brain Barrier

• Peripheral pro-inflammatory cytokines such as IL-1 and IL-6 can affect central nervous system functioning by penetrating the blood-brain barrier directly through active transport mechanisms.
• Inflammation can move from the periphery to the brain directly through activation of the afferent through the Vagus nerve.
• A group of studies have shown that the primary cause of inflammation may be a dysfunction of the gut-brains axis. This is a bidirectional mechanism.

“It’s kind of strange that while I was lecturing at many medical conferences around the world and I asked the doctors who were at the top of their field, how is it that these cytokines pass the blood brain barrier? Do you know that I could not get a straight answer? There are some hypothesis, however, one doesn’t know how this happens.“
–Dr. James Stoxen DC

Wilson CJ, Finch CE, Cohen HJ. Cytokines and cognition–the case for a head-to-toe inflammatory paradigm. J Am Geriatr Soc. 2002;12:2041-2056.

Memory

Low performances in immediate verbal recall and delayed verbal recall are associated with higher IL-6 levels in women with recurring major depressive disorder.
The results of this study it suggests the existence of an association between inflammatory imbalance and cognitive impairment in major depressive disorder.
Grassi-Oliveira R, Bauer ME et al. Interleukin-6 and verbal memory in recurrent major depressive disorder. Neuro Endocrinol Lett. 2011;32(4):540-544.
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 Suicide

The results of studies demonstrate for the first time that suicidal patients display a distinct peripheral blood cytokine profile compared to non-suicidal depressed patients. This study provides further support for a role of inflammation in the pathophysiology of suicide.
Janelidze S, Mattei D et al. Cytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain Behav Immun. 2011b;25(2):335-339.
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Post-Stroke Depression 

The cause of post-stroke depression is still not clear. However, studies have indicated that immune dysregulation plays a role in the pathophysiology of depression. What was found was a significant increase in the cytokines:

• IL-6, IL 10
• TNFa
• Interferon Y
• The ratios of IL-6/IL10 TNFa/IL10 were also elevated.

Su JA, Chou SY et al. Cytokine changes in the pathophysiology of poststroke depression. General hospital psychiatry. 2012;34(1):35-39.
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Overweight and Obesity

• Depression (and the inactivity plus diet changes associated with it) cause obesity.
• The obesity leads to inflammation, which cycles back around to lead to depression.
• Depression may lead to inactivity and dietary changes, which leads to obesity, which leads to inflammation.
• Obesity associated inflammation that affects the brain may promote addictive behaviors, leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol and gambling.
• Targeted diet and exercise programs are beneficial

Shelton RC, Miller AH. Inflammation in depression: is adiposity a cause? Dialogues Clin Neurosci. 2011;13(1): 41-53.
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Anxiety vs Depression:    The Mind-Body Inflammation Connection

There are effects of depression which lead to more depression
There are depression effects that lead to other diseases

• Inflammation Leads To Stress
• That Can Lead To Depression
• Depression Can Increase In Inflammation

“As I mentioned before it’s beneficial to recommend to your patients to try to get their mind off of whats depressing them and go outside or exercise.
Every time they start bringing up those negative thoughts up more inflammation occurs which makes it increasingly difficult to take care of the patient.” 
–Dr. James Stoxen DC

Weil, A. The Depression-Inflammation Connection. The Huffington Post. 4 Nov 2011.
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The IDO Pathway

QUIN (quinolinic acid), kynurine and glutamate are linked to Alzheimer’s, Parkinson’s, ALS and dementia.
In 2011 a study stated that the kynurine/tryptophan ratios or the kynurine production may be influenced by the inflammatory process and may be implicated in the pathophysiology of suicidal behavior.
Shelton, RC, Miller, AH. Eating Ourselves to Death and Despair: the Contribution of Adiposity and Inflammation to Depression. Prog Neurobiol. 2010;91(4):275-299.
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Inflammation and the IDO Pathway

• Idoleamine 2.3-dioxygenase IDO + tryptophan 2.3-dioxygenase (enzyme) competes with tryptophan metabolism which reduces serotonin.
• Tryptophan is metabolized to kynurine by kynurine hydrxygenase to kynurine acid (KYNA) which antagonizes A7 nicotinic acetylcholine receptors, which leads to striatal dopamine release, which is in the brain of depressed patients.
• Kynurine is converted with enzyme kynurine 3-monoxygenase (KMO) to quinolinic acid (QUIN).
• QUIN activates N-methyl-D-aspartic acid (NMDA) receptors and releases glutamate.
• This leads to the formation of neurotoxins such as the glutamate agonist quinolinic acid and contributes to the increase in apoptosis of astrocytes, oligodendroglia and neurons.
• QUIN, kynurine and glutamate are all implicated in pathophysiology of Alzheimer’s, Parkinson’s, ALS and dementia.

Shelton, RC, Miller, AH. Eating Ourselves to Death and Despair: the Contribution of Adiposity and Inflammation to Depression. Prog Neurobiol. 2010;91(4):275-299.
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 Selective Serotonin Reuptake Inhibitors

• In mild to moderate depression, the benefit may be mild to zero.
• In severe depression the improvements may be more substantial.
• Sometimes the drug takes 6-8 weeks to work.
• In studies, there are sexual side effects in approximately 17% to 41% (likely to be overestimated when there are no placebos).
• There is a decrease in dopamine and norepinephrine which could lead to erectile dysfunction.
• However, the sexual side effects may be the same with another drug.
• There is dependence withdrawal, which may be severe.

“What is interesting is that according to some of these studies slight to zero improvement in mild to moderate depression and sometimes I think that if we would just work with the patient and show that we are doing something for them then sometimes patients actually get better.” “
We all have our bad days where we might not want to go to work or talk to patients and there are other days that we are more positive and want that interaction with people. How about start by asking the patient how they are feeling and really meaning it?”  
–Dr. James Stoxen DC

1. Hu XH et al. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. Journ Clin Psy. 2004;65(7):959-65.
2. Landén M et al. Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. Journ Clin Psy. 2005;66(1):100-6.

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Selective Serotonin Reuptake Inhibitors

• At first people feel wonderful.
• They feel as if the cloud lifted.
• They feel they can handle minor issues more easily.
• They are hopeful, confident and feel improved self-worth.
• These drugs are not addictive but patients do feel dependent.
• When they want to wean themselves off the drug without healing the body of inflammation and other causes, they experience withdrawals which are severe.
• Patients expect you to put them on antidepressant drugs.
• When you suggest options to these drugs patients are relieved they have these options.
• If you do have to put patients on antidepressants, it is not a sign of failure, but never give up trying to help the patient be self-sufficient.
• This is best for everyone.

“Patients expect you to put them on these medications but is that what is best vs what is convenient?“
–Dr. James Stoxen DC

Selective Serotonin Reuptake Inhibitors

• A study of 22 studies data showed that while pharmacological antidepressant treatment reduced overall depressive symptoms, it did not reduce levels of TNFa.
• However, antidepressant treatment did reduce levels of Il-1b and possibly IL-6.
• While efficacious for depressive symptoms, it did not appear to reduce cytokine levels.

“While drugs conserve the serotonin, what is being done to reduce the high levels of inflammation that actually create problems with these other chemicals that lead to diseases such as Alzheimer’s, Dementia and Parkinson’s Disease.” 

–Dr. James Stoxen DC

Hannestad J, DellaGioia N, Bloch M. The Effect of Antidepressant Medication Treatment on Serum Levels of Inflammatory Cytokines: A Meta-Analysis. Neuropsychopharmacology (2011) 36, 2452–2459.

What Happens if You Take a Drug to Lower Serotonin?

There is a drug that lowers serotonin and it has the same effectiveness as the drugs that increase available serotonin. It has been shown to be as effective as some selective serotonin reuptake inhibitors.
So how can it be that one drug lowers it and one drug raises it and they both have the same effect on depression?
Most serotonin reuptake inhibitors are not as effective as you think.

• JAMA 2002 article about a study in the NIH stated a particular popular SSRI had about the same or a little better results than placebo.
• JAMA 2010 January 6, 2010 stated the real biochemical effect of SSRIs as nonexistent to negligible for severe depression.

1. Walsh BT, Seidman SN, Sysko R, Gould M. Placebo response in studies of major depression: variable, substantial, and growing. JAMA. 2002;287:1840-1847.
2. Fournier JC, DeRubeis RJ, Hollon SD et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53.

 Antidepressants

• Research has shown that these antidepressants are effective in the short term and can lose effectiveness in the long term.
• Patients want relief now: that’s what you prescribe them.
• I don’t feel the standard of care provides an adequate treatment protocol to adequately reduce levels of inflammation.

“Patients want relief right away but there are other alternatives.“
–Dr. James Stoxen DC

Inflammation Approach to Treating Depression

• Treat Inflammatory Diseases- Like Hepatitis, Heart Disease
• Reduce Pulmonary Inflammation
• Inflammation of the Skin-Psoriasis – 60% have depression in their life
• Dietary Inflammation
• Arthritic Inflammation

We reduce pulmonary inflammation by helping the patient to quite smoking as well as getting the patient outside into nature.
Treat all of the above, aggressively!!

–Dr. James Stoxen DC

Miller AH, Maletic V, Raison CL. Inflammation and Its Discontents: The Role of Cytokines in the Pathophysiology of Major Depression. Biological Psychiatry. 2009;65(9):732-741
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Where I Attack Depression – Inflammation

Prescribe a cholesterol-reducing drug – you talk about diet.
If you prescribe in antidepressant, do you talk about inflammation?
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Diet, Supplements, Exercise, and an Aggressive Attack on Inflammation

Diet can have a profound affect on inflammation and therefore depression.

Discuss how food is the patient’s new drug.
What they eat could be a drug that increases or decreases depression.

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Comfort Food Can Cause the Brain to be Uncomfortable

Comfort Food – Simple Carbohydrates

• Candy
• Ice cream
• Chips
• White flour
• Potatoes
• Crackers

Increase blood sugar —–> Increase beta endorphins
Beta endorphins help us ease physical and emotional pain
The Crash – Decrease Beta Endorphins

• Crave sugar
• Feel overwhelmed
• Can’t tolerate pain
• Feel isolated

Remedy: switch the patient to complex carbohydrates
Westover AN, Marangell LB. A cross-national relationship between sugar consumption and major depression? Depress Anxiety. 2002;16(3):118-120.
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Fat

Decreased cholesterol below 160 can lead to depression

Omega 6 fatty acids – increase inflammation

• Vegetable Oils
• Corn Oils
• Egg Yolks

• Omega-3 fatty acids – decrease inflammation

Fish
Omega 3:Omega 6 used to be 1:1
Now 1:25 last 100 years
Omega 3 is for reduction of inflammation and nerve cell function

1. Tanskanen A, Hibbeln JR, Tuomilehto J et al. Fish consumption and depressive symptoms in the general population in Finland. Psychiatr Serv. 2001;52(4):529-531.
2. 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;25(8):1725-1734.

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Omega 3 

• Brain behavior Immunology 2010 – This study showed that 2.5 g of EPA–DHA mirrored the proportions of fatty acids in the typical American diet and that by supplementing patients with this amount there was a 14% decrease in IL-6 production and a 20% reduction in anxiety symptoms.
• Studies suggest that maternal DHA deficiency may lead to the development of major depressive disorder in pregnancy and postpartum. These studies are suggesting clinical benefit for supplementation with EPA in major depressive disorders.

1. 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;25(8):1725-1734.
2. Mozurkewich E, Chilimigras J, Klemens C et al. The mothers, Omega-3 and mental health study. BMC Pregnancy Childbirth. 2011;11:46.

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Food Sensitivities and Food Allergies

Common examples are:

• Wheat (Gluten)
• Corn
• Coffee
• Sugar
• Dairy
• Eggs
• Lettuce
• Beef
• Pork
• Chicken

Elimination diet and blood tests
Genuis SJ. Sensitivity-related illness: the escalating pandemic of allergy, food intolerance and chemical sensitivity. Sci Total Environ.2010;408(24):6047-6061.
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D/L Phenylalanine for Norepinephrine Deficiency

• D/L-Phenylalanine is converted to Tyrosine.
• Tyrosine is converted to Dopamine.

• D or L-Phenylalanine creates Dopamine and Norepinephrine.
• Tyrosine is the parent compound for Adrenaline.

• Norepinephrine- and Phenylalanin- like compounds exist in chocolate – That is why we crave chocolate when depressed.

• Some studies say D/L-Phenylalanine is as good as antidepressants.

• D/L-Phenylalanine – 500mg/day and up to 2-3000 mg/day.

Ruhé HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies. Mol Psychiatry. 2007 Apr;12(4):331-359.
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Supplements That Support Mood

• B6 helps in production of serotonin from 5HTP

100 mg/day

• B12

100 mg/ day
500 mg/day with poor absorption

• 5HTP
• Antioxidants
• Mineral Supplements

CA+ 500 mg/day
Chromium 200-300 mg/day

• Fish Oil

Normal 1000 mg-5000 mg
Asthma, diabetes, heart disease, arthritis, cancer, injury, chronic pain – 5000 mg
Bipolar – 10,000 mg
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Curcumin

Is a plant derived dietary spice with various biological activities including anti-carcinogenic and anti-inflammatory effects. Its therapeutic applications have been studied in a variety of conditions including rheumatoid arthritis, colon cancer and depression.
Guimarães MR, Coimbra LS, de Aquino SG et al. Potent anti-inflammatory effects of systemically administered curcumin modulate periodontal disease in vivo. J Periodontal Res. 2011;46(2):269-279.
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Pain Exorcism

Sometimes we work for 30 – 40 hours on a patient with hands on treatments and vibration therapy to reduce silent inflammation. In these cases a few anti-inflammatories are not good enough to reduce this much inflammation.

“I have patients that take 10-20 anti-inflammatories a day and still they are loaded with inflammation.” 
–Dr. James Stoxen DC

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Levels of Inflammation

“This is a chart I developed about 20 years ago showing levels of Inflammation. In the red you see painful areas of the body, yellow is silent inflammation and green is normal.”
“There is a way to feel the patients body and determine where the silent inflammation is. You may have felt this when you have gotten a massage.”
–Dr. James Stoxen DC

Levels of Silent Inflammation vs Painful Inflammation

Inflammation Patterns

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Painful and Silent Arthritic Inflammation

• It is low-grade inflammation.
• Low-grade inflammation is what research is telling us contributes to depression.

• Painful Arthritic Inflammation
• Silent Arthritic Inflammation

We know how to find painful arthritic inflammation.

• How do we examine for silent arthritic inflammation?
• How do we treat silent arthritic inflammation?

Kojima M, Kojima T, Suzuki S, Oguchi T et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Rheum. 2009;61(8):1018-1024.
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Breakdown of Biomechanics

• Accelerated aging
• Pain
• Silent inflammation
• Wear and tear
• Stress and strain
• Compensating abnormal movement
• Drop and lock of the spring mechanism
• Weakness in spring suspension system

“On average each person takes 10,000 steps per day. That adds up to 3.5 million steps in a year. In the first 30 years a person will have had 100 million impacts or collisions with the ground. Any subtle abnormal walking mechanics can lead to a tremendous amount of inflammation that is released in their life.“
–Dr. James Stoxen DC

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Gait Analysis

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Compensating Motion

Remembering to keep your second toe pointing towards the target will allow you to accomplish many important positive changes in your gait.
1. It will allow you to have an alignment that will keep your knee hinging at the angle it was designed to hinge at reducing stress on the knee.
2. It will align your leg to allow the calf muscles to be aligned for the maximal contraction up the middle. This will maximize the venous return via the contraction of the calf to squeeze the blood back to fill the heart.
3. It will allow you to get maximum spring from your muscles.
4. It keeps your bodyweight from rolling over the inside edge of your big toe. This forces the big toe laterally and squeezes the rest of the toes together causing bunions and mortons neuromas
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External Forces and Internal Compressive Forces on the Human -Body Mapped Out

Internal and External Forces and Conditions

“This is how levels of silent inflammation maps itself out on the human body and the conditions that it can lead to. Compressive injuries such as hip and knee joint degeneration and ultimately in the end, hip and knee surgery.” 
“If you think about it. If someone needs hip replacement surgery there had to be at least 30-40 years of abnormal movement patterns causing inflammation leaking into the body which could cause cardiovascular disease and other diseases of aging.”
–Dr. James Stoxen DC

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Take a look at the footwear

“Modern society has changed forcing us to wear shoes causing weakness”
“One of the simplest things you can do for your patients is to take a look at their footwear.  As you can see this one is not very well designed. It’s got a gap in the middle that allows the arch to collapse. The front and back end comes up as well. That’s not very beneficial to the patient. 
“Prescribing a shoe with an extended medial counter can actually help them stay in the safe range. Especially those patients who are on their feet all day. That may be you, doctors. I know I use a shoe that has an extended medial counter support.”
–Dr. James Stoxen DC

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 Keep the foot in the safe range

Unsafe Range vs Safe Range

“It’s very important for the foot to stay in the safe range. If it rolls outside of the safe range as you can see above on the left then it creates the stress and strain, wear and tear and the release of inflammation.” 
–Dr. James Stoxen DC

“When you go to a doctors office normal standard of care is approximately 20 minutes of re education per visit. That is what is covered by the health insurance.
Then I go back to Empathy. Empathy means that even though the health insurance only covers 20 minutes of care the patient needs about an hours worth of deep tissue work to actually get out of the pain and reduce inflammation.”
–Dr. James Stoxen DC

Vibration Therapy 

Vibrational Massage from the feet to the head 

• 45 minutes before treatment
• Stimulates circulation to flush the inflammatory chemicals out of the body
• Increases the levels of Oxygen, nutrients and hormones

“Our VIP patients fly in on Saturday and at 9:00 am we start the deep tissue treatment and vibratory therapy. Vibratory therapy is a vibrational massage from the feet all the way to the head for approximately 45 minutes before the treatment.”  These treatments can last all day for several days straight.”  
–Dr. James Stoxen DC

Biomedical Stimulation – Vibration Therapy

Vibration therapy reduces plasma IL-6 and muscle soreness after downhill running inflammatory markers were assessed pre-run, post-run, 24 hours and 120 hours post run.
IL-6

• 24 hours decreased 31%.
• 120 hours decreased another 31%.

Histamine 

• 24 hours decreased 50%.
• 120 hours decreased another 48%.

The treatments were once a day on the upper and lower legs ONLY.
 British Journal of Sports Medicine 2008
Broadbent S, Rousseau JJ, Thorp RM. Vibration therapy reduces plasma IL6 and muscle soreness after downhill running. Br J Sports Med. 2010;44(12):888-894.
________________________________________________________________________________________________

Deep Tissue/Self-help

Removes painful and silent inflammation muscle spasms

“I apply deep tissue treatment on the patient with a goal to remove every single painful and silently inflamed muscle spasm I find according within the pattern of abnormal movement which causes these compressive forces on the joints that lead to inflammation.”  theory
–Dr. James Stoxen DC

Exercise 

• Alleviates stress and anxiety
• Increases confidence
• It’s a distraction from negative thoughts and feelings
• Elevates mood
• Boosts serotonin over the long term
• Increases stress tolerance
• Decreases fear of tragedy
• Improves social interaction

• Aerobic exercise – 30 minutes per day
• Resistance exercise – 30 minutes per day

The goals should be to improve mood so patients can get free from dependency on drugs.
“Don’t give up!”
–Dr. James Stoxen DC

Daley A. Exercise and depression: a review of reviews. J Clin Psychol Med Settings. 2008;15(2):140-147.

Exercise and Depression:  Exercise is a Powerful Anti-depressant

Depression and exercise:  A 1999 study by researchers at Duke University, published in the Archives of Internal Medicine, compared exercise, medication, and a combination of the two among a group of 156 middle-aged and elderly patients with non-suicidal depression. Medication was a selective serotonin reuptake inhibitor.

• The exercises were performed three times a week for 45 minutes and included 30 minutes of brisk walking or jogging.
• After 16 weeks all three groups showed similar improvements.

A follow a to this study published in psychosomatic medicine in 2000 check back on how the patients were doing six months after the study.

• The exercise-only group was actually doing better than the other two.
• Fewer than one third of the medication-free exercisers had relapsed back into depression, compared to over half of the patients in the med and the med/exercise groups.

“When your talking with patients about depression take the time to do a careful history and show some empathy. Find out what is going on in their life, consult with them and do whatever you can with natural therapies before you are so quick to prescribe anti depressant medication.“
–Dr. James Stoxen DC

Blumenthal JA, Babyak MA, Moore KA. Effects of exercise training on older patients with major depression. Arch Intern Med.1999;159(19):2349-2356________________________________________________________________________________________________

What is empathy? 
The definition of Empathy is the ability to understand another’s experience, to communicate and confirm that understanding with the other person and to then act in a helpful manner.
There is increasing evidence in medical practice that emotional interactions/clinical empathy with patients are fundamental to patient healing. Medical effectiveness does not merely rely on technical expertise but also on interpersonal communication between the patient and physician.
Doctors who practice detachment seem to miss important cues about what patients were thinking and feeling with regard to their diagnoses and treatment and this wastes time, leads to missed diagnoses, and an inadequate adherence to treatment. Thus, physicians should strive to be empathic and engage in communication with their patients as soon as possible and communicate with them until solutions are achieved.

Showing “clinical empathy” to patients can improve their satisfaction of care and motivate them to stick to their treatment plan. One example of showing empathy might be as simple as truly listening to your patients, not just hearing them.  By really paying attention to your patients, talking one on one and honing in on what your patients are sharing, you will be able to make a better diagnosis.
Studies have also been shown that Doctors who take the time to listen and understand what their patients are going through could actually have a positive effect on their patients’ pain tolerance and stress levels. To read more about this study look at this article from the Huffington Post; Doctor Empathy Could Decrease Stress, Pain Sensitivity In Patients: Study, click here
Clinical empathy is an essential medical skill.  Showing empathy and sympathy can produce changes in physician behavior and patient outcomes.  Physicians must also model an empathetic approach to patient care. Practicing empathy can also help with the treatment of Chronic Depression or mood disorder by showing that you care.

“Our profession now needs to incorporate the teaching of clinical empathy more widely into clinical practice at all levels beginning with the selection of candidates for medical school,”
“The behavioral aspects of empathy and sympathy – the empathic response – can be assessed and integrated into medical schools’ core communication skills training.”, Dr. Robert Buckman, Princess Margaret Hospital and the Faculty of Medicine, University of Toronto Canada Medical Association Journal

Empathy is the ability to identify with and/or feel another’s feelings. It is the act of imaginatively standing in another’s shoes and seeing the world through their eyes. It creates feelings of deep connectedness with others. Love can’t happen without it. Neither can justice or peace or any other kind of beneficial relationship. Empathy is the glue that holds us together. And in a world that encourages self interest and mindless consumption above all else, it’s a commodity in short supply.
Read how Anthony Field reduced his clinical depression in his book, How I Got My Wiggle Back.
Not only can clinical empathy help your patients it can help you as a Doctor too. An example of this is Wiggles frontman Anthony Field who  shares about his inspiring, behind-the-scenes story of how he overcame depression, chronic pain and more with the help of Dr. James Stoxen DC in a healing memoir book written by Anthony Field and Greg Truman entitled, How I Got My Wiggle Back. To order How I Got My Wiggle Back on Amazon.com, click here

Dr. James Stoxen DC and The Team Doctors Staff in Chicago, IL have always ascribed to a similar principle, placing high value on every single patient interaction from the initial examination or phone call to each and every treatment visit.  We practice empathy and  treat our patients the same way we would want to be treated and daily. Empathy has always been among our most valuable treatment tools.

Do we have an “empathy deficit”? We see the costs of our “me-first” mindset: record breakdowns in relationships, endemic corruption, environmental degradation, inequitable social structures, and a whole generation increasingly unable to deeply connect–to anything or anyone. Now, scientists have confirmed we’re experiencing a steep decline in our capacity for empathy.
Empathy is at the heart of human connection. It’s the glue that keeps us together. With it in short supply, what will become of us as a species?
To find out the answers, we’re hunting down the best and brightest “social revolutionaries”–empathic leaders who are transforming the lives, structures and organizations around them.

“Physicians are treating depression like the common cold giving out anti-depressants in a rushed office visit not showing empathy for their patients.”  >

Dr. Stoxen also speaks about Richard Davidson, one of the world’s top brain scientist, who began an ongoing study of the brains of Tibetan monks, the so-called “Olympians” of meditation, each of whom had accomplished at least 10,000 hours of meditation.
The scans revealed significant activity in the insula, which is extremely important in detecting emotions. Increased in the temporal parietal juncture, particularly the right hemisphere. Studies have implicated this area as important in processing empathy, especially in perceiving the mental and emotional state of others.
Buddhist monks believe mental attributes and positive emotions such as compassion, loving kindness and empathy are skills that can be cultivated.
Science is beginning to back that up.
Dr. James Stoxen DC is one of the “social revolutionaries” who is tackling some of our most pressing world problems from an empathic perspective.
Stand In My Shoes is a crowd-fuelled social change film about exposing what President Barack Obama coined the “Empathy Deficit” in our world, and the global hunt for social revolutionaries dedicated to creating a countermovement of kindness.
Other ‘social revolutionaries’ include the Dalai Lama and Marianne Williamson (One of TIME’s 50 Most Influential Women), both of whom advocate for a more compassionate culture; Bill Drayton (Ashoka), who teaches entrepreneurs to be empathic leaders; David Jones (CEO, Euro RSCG, One Young World) and Craig Davis (Publicis Mojo, Brand Karma), business moguls who argue that doing good is good business; Blake Mycoskie (TOMS), pioneer of the one-for-one movement; Mary Gordon (Roots of Empathy), founder of programs to teaching children empathy; organisational change architect Margot Cairnes, author The Moral Molecule and neuro-economist Dr Paul Zak, Roman Krznaric, cultural thinker and Julianne Moore, Mark Ruffalo, or Meryl Streep, celebrities who speak out for a more empathic media culture. We’re also on the hunt for fresh-faced social revolutionaries to feature
More research that suggests inflammation may contribute to depression
Dowlati Y, Herrmann N, Swardfager W, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67:446–57. [PubMed]
Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71:171–86. [PubMed]
Pasco JA, Nicholson GC, Williams LJ, et al. Association of high-sensitivity C-reactive protein with de novo major depression. Br J Psychiatry. 2010;197:372–7. [PubMed]
Liukkonen T, Silvennoinen-Kassinen S, Jokelainen J, et al. The association between C-reactive protein levels and depression: results from the northern Finland 1966 birth cohort study. Biol Psychiatry. 2006;60:825–30. [PubMed]
Danner M, Kasl SV, Abramson JL, Vaccarino V. Association between depression and elevated C-reactive protein. Psychosom Med. 2003;65:347–56. [PubMed]
Eisenberger NI, Inagaki TK, Mashal NM, Irwin MR. Inflammation and social experience: an inflammatory challenge induces feelings of social disconnection in addition to depressed mood. Brain Behav Immun. 2010;24:558–63. [PMC free article] [PubMed]
Wright CE, Strike PC, Brydon L, Steptoe A. Acute inflammation and negative mood: mediation by cytokine activation. Brain Behav Immun. 2005;19:345–50. [PubMed]
Harrison NA, Brydon L, Walker C, et al. Neural origins of human sickness in interoceptive responses to inflammation. Biol Psychiatry. 2009;66:415–22. [PMC free article] [PubMed]
Dantzer R, O’Connor JC, Freund GG, et al. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9:46–56. [PMC free article] [PubMed]

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