Some practitioners believe that most people on antidepressants could really just use a better diet.

By Karin Evans

By the time she turned 44, Rebecca Jones (this name has been changed) felt like she was falling apart. "Some times I was plagued by a crushing fatigue, I was moody, and just moving through my day was a major chore," she says. "I wasn't sleeping well, had lots of headaches and a sluggish libido, and my memory was often foggy." Jones chalked up some of her woes to perimenopause, so she followed some of the standard advice for that, like cutting out caffeine, for instance. But she still felt wobbly and low.

A clinical psychologist by profession, Jones recognized that some of her symptoms pointed to depression. She figured she needed some serious attention, so she made an appointment with Los Angeles psychiatrist Hyla Cass.

Like most psychiatrists would, Cass asked Jones how she was feeling. But that was just the beginning. Jones soon found herself detailing what she ate for breakfast, lunch, dinner, and in between. She was asked to describe her energy and mood swings throughout the day, her sleep patterns, and any worrisome symptom she could think of.

Cass sent Jones for a battery of tests -- blood tests that went far beyond the usual screeningsѴo look for anemia, blood sugar levels, and thyroid function, factors widely believed to contribute to depression. Cass also tested Jones for candida and checked her chromium, magnesium, and estrogen levels, as well as her adrenal function and her risk for toxic overload, among other things.

After analyzing the results, Cass opted not to recommend antidepressants. Instead, she told Jones to start taking supplements, including chromium, which evens out blood sugar levels, and magnesium, vital for brainpower. She gave her a specific supplement for candida, plus a menopause support formula, and another remedy to help restore adrenal function.

"Within the first week of following her program, I felt much better," says Jones. After three weeks she went back for more tests, and Cass prescribed additional supplements. "It's still unbelievable to me," says Jones, "but after six weeks, my mood swings and anxiety disappeared completely." These days, she continues to take supplements to control her depression and boost her energy, and has yet to take a single antidepressant.

For those accustomed to the notion that therapy means talking through problems and getting a prescription for antidepressants, this may seem an unusual approach. But Cass, an expert in nutritional medicine and an assistant clinical professor at UCLA, long ago became convinced that no form of psychotherapy can be fully effective if the brain isn't functioning properly. And to do that the brain needs optimal nourishment, something she says is increasingly hard to come by in the typical American diet. "Depressed, tired, overweight women are often told they need Prozac," Cass says, "when in fact all they really need to get their brains and bodies on track is a steady supply of real food." She recommends that her patients drink lots of water and eat organic vegetables and fruits, whole grains, and lean protein. "Diets high in refined foods, sugars, and unhealthy fats can actually interfere with our natural brain chemistry," says Cass.

Modern eating habits are part of what makes many people depressed, says Michael Lesser, a psychiatrist in Berkeley, California, who also bases his treatment on an evaluation of a patient's diet and lifestyle. "Ironically, though we live in a wealthy society, our diets are deficient in crucial nutrients," says Lesser, author of The Brain Chemistry Plan.

Nutritional deficiencies can contribute to chemical imbalances, like anemia and hypothyroidism, which in turn can lead to anxiety, insomnia -- and depression. Cass has observed that people with depression are commonly diagnosed with low levels of zinc, magnesium, B vitamins, essential fatty acids, and amino acids. In fact, Lesser firmly believes that most cases of depression in this country are either caused or exacerbated by poor nutrition.

Indeed, the last few years have seen increasing numbers of studies finding that specific nutrients can help manage, and even reverse, depression, along with anxiety, attention deficit hyperactivity disorder (ADHD), schizophrenia, and even autism. One of the most compelling, a study from Harvard, found that omega-3 fatty acids in conjunction with medication worked so powerfully on manic depression that the study was halted so every subject could take them.

The new research has inspired the launch of at least one scientific journal devoted to the subject, Nutritional Neuroscience, and dozens of books -- ten of them by Cass, including Natural Highs: Feel Good All the Time and the just-released 8 Weeks to Vibrant Health. "There have been huge advances over the past few years finding that nutritional intervention can treat many behavioral and mental conditions we used to think were untreatable," says Lewis Mehl-Madrona, associate professor of clinical psychiatry at the University of Arizona College of Medicine.

Why so much interest? Experts say nutritional therapy is catching on in part due to growing discomfort with antidepressants: Physicians are realizing they're not as effective long-term as was once hoped, and they often have nasty side effects, such as loss of libido and nausea. "We're becoming more realistic about the limitations of drugs," says Susan Lord, director of nutrition programs for the Center for Mind-Body Medicine in Washington, D.C. "They're not the magic bullets we once thought."

Much of the interest is also coming from patients themselves, says Cass. As more people realize they need to pay attention to what they eat in order to feel good, more are asking their doctors for nutritional help. Lord sees this in the growing popularity of the "Food as Medicine" workshops her center hosts for health care practitioners.

Within five years, she predicts, the demand among doctors for education about nutrition will be huge. "Most physicians already see the writing on the wall," she says, "and are in the uncomfortable position of not knowing the answers, but feeling they should."

While it's clear the brain can be greatly influenced by what we eat, researchers are just beginning to figure out why. The answer has at least something to do with the composition of neurotransmitters, whose intricate wiring controls thinking, actions, and moods; these chemicals are made of amino acids, and certain vitamins and minerals play critical roles in their formation. The very makeup of brain cells also depends on nutrients -- omega-3s are part of every cell membrane.

When a person's diet is deficient in some of these nutrients, neurotransmitters aren't made correctly or don't get what they need to function properly, and various emotional and mental disorders can result. For instance, low blood sugar can contribute to some forms of depression, and so can low levels of zinc in some people.

For all the recent research, Lesser and Cass are still among a maverick few who focus primarily on nutritional interventions for mental health problems. For most psychiatrists, drugs are better known, despite their problematic side effects -- and therefore less risky.

Both Lesser and Cass arrived at the notion that nutrition can influence brain chemistry early in their medical careers. Lesser, who was conventionally trained at Cornell and Albert Einstein Medical Center in New York City in the 1960s, started tinkering with nutrients after becoming frustrated by his field's emphasis on drugs.

Shortly after he'd finished his residency, Lesser came across a report that treating schizophrenics with niacin tended to improve their symptoms. He figured that if the niacin worked, he should also experiment with other dietary strategies that have been linked to mood.

So he tried the approach on a patient of his own and put the young man on a high-protein diet, gave him a slew of supplements, including niacin, vitamin C, and zinc, and told him to cut out caffeine and cigarettes. Soon after his patient showed dramatic improvement, Lesser founded the Orthomolecular Medical Society, with the stated objective of emphasizing natural substances such as vitamins, minerals, amino acids, and essential fats in the prevention and treatment of diseases.

As for Cass, even before she began her training she was predisposed to the idea that drugs aren't always the answer. The daughter of an old-fashioned family physician in Canada, she was drawn to a personalized kind of medicine that honored both mind and body. Shortly into her practice, she found that the standard "couch and Prozac" combination of talk therapy and pharmacology only goes so far.

Over time, she eventually developed the approach she uses today, which is to start by evaluating the patient in a number of ways -- emotionally, physically, and biochemically. Then she supplies specific health prescriptions, which include supplements and food, often in tandem with exercise, natural hormones, and mind-body techniques.

The approach isn't for everyone. It requires that a patient be a full partner in his or her care, and not everyone is motivated enough to make what can amount to pretty daunting lifestyle changes, including shopping for organic food, preparing meals without using a lot of salt, sugar, and unhealthy fats, and taking all those supplements -- especially people who are depressed to begin with.

Sometimes the best option is indeed medication, says Cass, particularly with severe cases of depression. "The most important thing is to help the patient," she says.

But even small changes -- like cutting out processed foods, or adding daily fish oil pills -- can make a big difference, they say. And once started, the process can develop its own momentum. "People start eating a little better or taking a few supplements, and they often start feeling a little better," says Lord. "That's when they become open to trying more changes."

Many of the patients who do manage to stick to the program say it is worth the effort. After a couple of months on Cass's regimen, Rebecca Jones is certainly convinced. She hasn't had to make many dietary adjustments -- she was already eating reasonably well to begin with and exercising a few times a week. So the only change she's made was to start taking supplements. But the results have been dramatic.

The supplements are costly, she admits, running about $100 a month. "But that's all it takes -- I don't need any expensive prescription drugs." She expects to stay on some of the supplements for the rest of her life, and to continue to consult with Cass periodically. "But that's okay," she says. "My mood has evened out considerably -- all of the depressive symptoms I had are gone. I'm much, much better now."

Karin Evans is a contributing editor.