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Depression, anxiety and insomnia are among the most frequent reasons for consultations with General Practitioners, but the side effects, expense and discontinuation syndrome associated with addictive medications have left many people seeking more natural alternatives.

A recent study published in the Journal of the American Medical Association on January 6, 2010, concluded that prescription antidepressants provided little benefit for patients with mild or moderate depression. The authors also stated that patients and practitioners "may not be aware that the efficacy of medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression." Yet the adult use of antidepressants tripled in a decade.

The National Academy of Science Committee recommended anxiety medications, sedatives and hypnotics should have only a limited place in contemporary medical practice. The report stated “it is difficult to justify the current prescribing of sleeping medication, and should be used for a few nights at a time.”  This report was published in 1979 and yet today benzodiazepines and sleeping pills are one of the most commonly prescribed medications. The withdrawals can be extremely challenging after continual use for several weeks.

The role of Point of Return is to assist the patient in conjunction with their physician to taper  safely. Once the taper is completed, it is our hope that the medical professional will test the patient for any underlying symptoms to determine what physical issues need to be addressed.

Various tests can be performed to identify if vitamin deficiencies or medical conditions play a role in a patient’s depression, insomnia and anxiety. The extent of laboratory testing is dependent on the patient's circumstances.

The following list of diagnostic tests may assist in ruling out certain medical conditions:

1. Complete Blood Count (CBC): A CBC test analyzes the numbers of various types of cells found in blood including anemia and infection, both of which may cause symptoms of depression, lethargy and fatigue.

2. Thyroid Function: This test measure the blood levels of the hormones produced by the thyroid gland. If the thyroid is either over or under active, it can contribute to symptoms of a mood disorder. The Thyroid Stimulating Hormone test (TSH) is the standard analysis. However, testing TSH and T4 levels are poor measures of tissue thyroid levels. TSH and T4 levels should not be relied upon to determine the tissue thyroid levels. According to Dr. Bill Code, the following is a more accurate diagnostic tool than the TSH:

Reverse T3 (rT3) and the T3/rT3 ratio test- Low T3 syndrome, with low T3 and high Reverse T3, is most often missed when using standard thyroid function tests. The T3 level may appear in the low normal range and the Reverse T3 is in the high normal range, making the T3/rT3 ratio the most useful marker for tissue hypothyroidism and as a marker of diminished cellular functioning.

3. Hormones (Estrogen, Progesterone, Testosterone)

Estrogen

– Estrogen boosts Serotonin, which fights depression and promotes sleep. Estrogen also increases GABA, the calming neurotransmitters. Low Estrogen can cause feelings of sadness and hopelessness.

Progesterone– Progesterone helps to balance Estrogen, promotes sleep and has a natural calming effect. Abnormal progesterone levels can cause insomnia and contribute to low moods.

Testosterone– Testosterone has a number of effects on muscles, bones, the central nervous system, bone marrow and sexual function. Low Testosterone in either men or women can put them at risk for depression.

4. Folic Acid and Vitamin B12 Levels: Low levels of either folic acid or vitamin B12 are common with pernicious anemia, which can cause symptoms of depression and lethargy. Both Vitamin B12 and Folic Acid are necessary for the formation of red blood cells as well as the synthesis of DNA. Vitamin B12 is also necessary for normal nerve function and unlike most other vitamins Vitamin B12 is stored in the liver for use by the body. Therefore, by the time anemia has developed, the stores of Vitamin B12 have been exhausted for years.

5. MTHFR Variation - MTHFR variations can cause insomnia, anxiety, depression, inflammation, heavy metal buildup, increased pain, neurological symptoms, chronic fatigue, elevated homocysteine levels, heart disease and many other conditions. MTHFR also interferes with the production of Glutathione. Read more on MTHFR...

6. Vitamin D - 25-hydroxyvitamin D determines if bone weakness, bone malformation, or abnormal metabolism of calcium (reflected by abnormal calcium, phosphorus, PTH) is occurring as a result of a deficiency or excess of vitamin D. However, mood swings and depression can occur when Vitamin D levels are low. Vitamin D has nuclear receptors in the brain and is involved in the biosynthesis of neurotrophic factors, synthesis of nitric oxide synthase and increased Glutathione levels. Treating low Vitamin D levels with Ergocalciferol is not recommended, as it is a significantly less potent form of Vitamin D than the naturally occurring Vitamin D3, Cholecalciferol.

7. Candida -  Candida Albicans is a yeast that occurs naturally in the human body and generally lives in harmony with the other microorganisms. However, when the balance of bacteria is upset, Candida can proliferate and invade healthy cells. It normally resides in the intestinal tract, mouth, throat and genitals, but can burrow holes in the intestinal tract, enter the blood stream and then make its way into any organ of the body. The brain is the organ that is most frequently affected by Candida Symptoms, but it also has profound negative effects on the digestive, nervous, cardiovascular, respiratory, reproductive, endocrine, urinary and musculoskeletal systems. Candida is the fourth most common cause of nosocomial bloodstream infection in the United States, and Invasive candidiasis is the most common invasive fungal infection.

The criterion standard diagnostic tool for mucocutaneous candidiasis is a culture. Cutaneous or mucosal scrapings can be used for a potassium hydroxide smear or Gram stain, which shows hyphae, pseudohyphae, and budding yeast forms. The sensitivity of wet mount is as low as 39.6%. CHROMagear is a specialized media for Candida isolation, which distinguishes C albicans, C tropicalis, and C krusei based on the species' distinctive pigments. Nonculture diagnostic techniques are frequently used to aid in diagnosis. The 1,3 beta-glucan assay, which measures the fungal cell component, has a sensitivity of 70% and specificity of 87%.

8. Leaky Gut -  Leaky Gut can cause symptoms including migraines, depression, heartburn, abdominal pain, muscle cramps and pain, poor exercise tolerance, gluten intolerance, arthritis, fatigue, headaches, increase in allergies, asthma, insomnia, weight changes and mood alterations. Read More...

8. Fasting Blood Glucose: Measuring how much sugar is in the blood after an overnight fast can detect prediabetes and diabetes. While the exact link between depression and diabetes is unclear, some studies seem to indicate that those with diabetes are at a greater risk of depression. Conversely, low blood sugar (Hypoglycemia) can also cause mood swings, blurred vision and confusion.

9. Heavy Metal Toxicity: Heavy metals - such as cobalt, iron, copper, manganese, vanadium, strontium and zinc in trace amounts are essential to health. Other non-essential metals are non-essential and can be harmful in excessive amounts. These include cadmium, antimony, chromium, mercury, lead, and arsenic. The last three are the most common in cases of heavy metal toxicity. Symptoms of heavy metal toxicity include headaches, insomnia, depression, irritability, restlessness, anxiety, mental confusion, pain in muscles and joints, weakness and many others.

There are 3 Heavy Metal tests available today:

The Provoked Post Chelation Urine Test can assess the heavy metal burden. The provocation test involves taking effective detoxification agents and collecting urine over a period of 6 hours. These agents bind to and release some of the tissue stores of heavy metals, allowing them to be excreted via the kidneys. Collected urine is analyzed for heavy metals.

Blood Tests will only show elevated levels if the person has had a very recent heavy metal exposure. It will not reflect tissue levels.

Hair Analysis will reflect the excretion of exposure over recent months but does not indicate tissue levels of toxic metals. Hair analysis alone should not be relied upon to rule out heavy metals.

10. Sleep Apnea:  The cessation of breathing during the sleep cycle can cause sleep deprivation, particularly if the non-breathing episodes are high in number. And yet several studies have demonstrated that insomnia is a frequent complication of sleep apnea. Many common medications can interfere with the breathing reflex and contribute to sleep apnea, including sleeping pills, tranquilizers and short-acting beta-blockers.

11. H. Pylori: It is estimated that 20% of the public under 40 years old and 50% over 60 years are infected with the H. pylori bacteria. Although most who are infected with H. pylori do not have ulcers, it is believed that this bacteria is responsible for the majority of peptic ulcers.

H. pylori can cause severe fatigue, anxiety, insomnia, depression, nausea, gas, heartburn, acid reflux, bloating and many other symptoms. Helicobacter pylori tests are used to detect an infection in the stomach and upper part of the small intestine (duodenum).

Urea Breath Test - checks to see if the H. Pylori bacteria are in the stomach.

Stool Antigen Test determines if substances that trigger the immune system to fight an H. pylori infection are present in the stool.

12. Lyme Disease: Lyme disease is a rapidly emerging bacterial infection that is spread by ticks. It can cause a rash, flu-like symptoms, aching joints, tiredness, chills, fever, headache, muscle and/or joint pain, heart issues (such as irregular heartbeat), Bell's palsy, eye inflammation, anxiety, depression,  and other symptoms.

Lyme disease suppresses the immune system and in turn affects all major cell types of the immune system. But it impacts a specific subset of the natural killer cells called (CD-57). As the HIV infection suppresses T-cell counts, Lyme suppresses the natural killer cell count known as (CD-57). As abnormally low T-cell counts are routinely used as a markers of the HIV infection, in Lyme disease, it's the CD-57 count that indicates how active the Lyme infection is and when Lyme is active, the CD-57 count is suppressed. Through this antigen test, the activity of a Lyme infection can be easily determined.

Following is the criteria for the CD-57 Test:

>200 is normal
< 20 severe illness
 0-60 is seen in chronic Lyme disease
> 60 Lyme activity indicates improvement

12. Laboratory Testing Facilities: (list from Dr. Mark Hyman's The Blood Sugar Solution Book - a great read)

Quest Diagnostics
http://www.questdiagnostics.com/
A resource for most conventional laboratory testing needs.

LabCorp
https://www.labcorp.com/wps/portal/ A resource for most conventional laboratory testing needs.

LipoScience
http://www.liposcience.com/
Innovative nuclear medicine spectroscopy for the assessment of lipid particle size and improved accuracy in assessing cardiovascular risk factors.

Doctor's Data
http://www.doctorsdata.com/home.asp
Experts in testing for heavy metal toxicity and other nutritional and metabolic disorders.

Metametrix
http://www.metametrix.com
Leaders in nutritional and metabolic testing.

Genova Diagnostics
http://www.gdx.net/
Leaders in nutritional and metabolic testing and genetic testing of SNP—single- nucleotide polymorphisms—to help identify disease predispositions that can be modified with lifestyle interventions.

Immunolabs
http://www.immunolabs.com/patients/
IgG food sensitivity testing.

Prometheus Labs
http://www.prometheuslabs.com/
Leaders in testing for gluten-related disease.

DiagnosTechs
http://www.diagnostechs.com
Testing for adrenal stress hormones.

IGeneX
http://igenex.com/Website/
Specialized testing for detecting chronic infections such as Lyme disease with PCR technology.

Melisa
http://www.melisa.org/laboratories.php
Testing for the toxic immunological effects of mercury and other heavy metals.

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