Hypoglycemia
Melissa, the patient with CFS, also had hypoglycemia. This disorder is often related both to stress and to poor eating habits, both of which affect the adrenal glands. As we saw in Chapter 3, our adrenal glands produce hormones that allow us to deal with emergencies. One of these hormones, cortisol, raises blood-sugar levels temporarily. After a while, though, blood-sugar levels plummet. When this cycle repeats itself enough, the overtaxed adrenal glands are exhausted-and so are we.

Hypoglycemia can present itself in a variety of ways: depression, irritability, anxiety, panic attacks, fatigue, "brain fog," headaches (including migraines), insomnia, muscular weakness, and tremors, all of which may be relieved by food. There can be cravings for sweets, coffee, alcohol, or drugs; in fact, many addictions are related to hypoglycemia. In Melissa's case, in addition to the CFS therapy, I prescribed a diet in which sugar, white flour, coffee, and alcohol were to be eliminated, and replaced by small, frequent meals containing complex carbohydrates, high fiber, and protein.

Hormonal Imbalances and Pollution Effects
Imbalances in either sex or thyroid hormones can cause depression. Sex hormone imbalances are more common in women because of the complications presented by the menstrual cycle, as we can see in Lonnie's case.

Lonnie, a 40-year-old secretary, was still depressed, anxious, irritable, and tired despite six months of weekly therapy sessions, after which her therapist had referred her to me. Lonnie was dissatisfied with her job, her family, and life in general, and had severe PMS. Blood tests showed that she was premenopausal, that time period prior to menopause when hormone levels are already beginning to change. I prescribed the female herbal remedies dong quai, vitex, and black cohosh. I also had her take two hormones, natural progesterone and dehydroepiandrosterone (DHEA), plus vitamin B6, magnesium, and evening primrose oil. Considering her level of depression and anxiety, I added St. John's wort and kava, both noted for their effects on PMS and menopausal symptoms. After about six weeks on this regimen, not only did her PMS go away, but so did her depression and irritability. Her energy level and sexual response both improved. We see how in Lonnie's case, addressing the physical problem had a positive effect on her emotions.

Natural hormone therapy is far more preferable than the usual synthetic hormone replacement therapy. Unlike the synthetic hormones, natural progesterone and estrogen have few side effects, and are available at compounding pharmacies.

Low levels of thyroid hormone, produced by the energy-generating gland located below the Adam's apple, can also cause depression, as in Randi's case.

When Randi, a 34-year-old guidance counselor, came to see me, she was depressed, tired, unable to get up in the morning, and feeling overwhelmed by her job. She was often cold, especially her hands and feet. She also had thinning hair, dry skin, and constipation. When I asked about thyroid disease, she said that it had been suspected before, but her tests had been normal. an underactive thyroid, however, can often hide behind "normal" blood tests. Although Randi's thyroid hormone levels were normal, she did, in fact, have hypothyroidism, or low thyroid function. I prescribed thyroid hormone from natural sources and asked her to monitor her body temperature so I could adjust her dosage. She asked whether this would suppress her own thyroid function and whether she would need supplementation for life. The answer was "no" to both questions. The treatment actually supported her own thyroid gland, allowing it to heal. Within ten days of starting the program, Randi's mood and energy lifted, and she was feeling alive again.

Dr. Broda Barnes has developed a technique of monitoring thyroid function through body temperature that is used by many alternative health practitioners. If the temperature is consistently low, the patient is treated with thyroid replacement therapy, and progress is monitored both by clinical signs and symptoms, and by a rise in temperature.

Depression can be caused by a wide variety of pollutants, especially the heavy metals: lead, mercury, arsenic, and bismuth. Aluminum, though technically not a heavy metal, is also toxic. Other pollutants can cause problems, too. Carbon monoxide reduces the brain's oxygen supply, which causes a variety of psychiatric and neurological symptoms, including psychotic depression. Insecticide exposure can result in depression, confusion, drowsiness, and decreased concentration. Other volatile substances, such as paint and solvents, can also result in depression and other psychiatric symptoms when the fumes are inhaled for prolonged periods of time. The best way to avoid exposure to pollutants is to minimize your risks.

The psychiatrist can be not only a healer, but an educator and facilitator as well, helping people to make wise choices in lifestyle, diet, supplements, and medications. Rather than curing depression, the goal is balance, in body as well as in mind and spirit. Imbalance in one area is reflected in problems in other areas, and the weakest link shows first. Ideal treatment is holistic: Evaluate the whole person and treat each imbalance accordingly. Address as many areas-physical, emotional, and spiritual-as possible, thereby encouraging shifts that move the individual toward balance and health.