Why Antidepressants Don’t Work for Treating DepressionPosted on March 4th, 2008 |
Categories: Mood Improvement | Government Policies | Functional Medicine | Depression
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Here’s some depressing recent medical news: Antidepressants don’t work.
What’s even more depressing?
The pharmaceutical industry and Food and Drug Administration (FDA) have deliberately deceived us into believing that they DO work.
As a physician, this is frightening to me. Depression is among the most common problems seen in primary-care medicine and soon will be the second leading cause of disability in this country.
The study I’m talking about was published in a recent issue of “The New England Journal of Medicine.”
It found that drug companies selectively publish studies on antidepressants. They have published nearly all the studies that show benefit -- but almost none of the studies that show these drugs are ineffective. (1)
That warps our view of antidepressants, leading us to think that they do work. And it has fueled the tremendous growth in the use of psychiatric medications, which are now the second leading class of drugs sold, after cholesterol-lowering drugs.
And it’s even worse than it sounds, because the positive studies hardly showed benefit in the first place.
For example, 40 percent of people taking a placebo (sugar pill) got better, while only 60 percent taking the actual drug had improvement in their symptoms. Looking at it another way, 80 percent of people get better with just a placebo.
That leaves us with a big problem -- millions of depressed people with no effective treatments.
Let’s take a closer look at depression.
“Depression” is simply a label we give to people who have a depressed mood most of the time, have lost interest or pleasure in most activities, are fatigued, can’t sleep, have no interest in sex, feel hopeless and helpless, can’t think clearly, or can’t make decisions.
But that label tells us NOTHING about the cause of those symptoms.
In fact, there are dozens of causes of depression -- each one needing a different approach to treatment.
==> Depression is not one-size-fits-all.
But it’s very common.
Women have a 10 to 25 percent risk and men a 5 to 12 percent risk of developing severe major depression in their lifetime. (2)
One in ten Americans takes an antidepressant. The use of these drugs has tripled in the last decade, according to a report by the federal government. In 2006, spending on antidepressants soared by 130 percent.
But just because antidepressants are popular doesn’t mean they’re helpful.
Unfortunately, as we now see from this report in “The New England Journal of Medicine,” they don’t work and have significant side effects.
Most patients taking antidepressants either don’t respond or have only partial response.
In fact, success is considered just a 50 percent improvement in half of depressive symptoms. And this minimal result is achieved in less than half the patients taking antidepressants.
That’s a pretty dismal record. It’s only made worse by the fact that 86 percent of people taking antidepressants have one or more side effects, including sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain.
No wonder half the people who try antidepressants quit after 4 months.
Now I want to talk to you about the reasons why doctors and patients have been deceived by the “antidepressant hoax.”
==> Despite what we have been brainwashed to believe, depression is not a Prozac deficiency!
Drug companies are not forced to publish all the results of their studies. They only publish those they want to.
The team of researchers that reported their findings in “The New England Journal of Medicine” took a critical look at all the studies done on antidepressants, both published and unpublished.
They dug up some serious dirt.
The unpublished studies were not easy to find. The researchers had to search the FDA databases, call researchers, and hunt down hidden data under the Freedom of Information Act.
What they found was stunning.
After looking at 74 studies involving 12 drugs and over 12,000 people, they discovered that 37 of 38 trials with positive results were published, while only 14 of 36 negative studies were published.
And those that showed negative results were in the words of the researchers, “published in a way that conveyed a positive outcome.”
That means the results were twisted to imply the drugs worked when they didn’t.
This isn’t just a problem with antidepressants. It’s a problem with scientific research. Some drug companies even pay or threaten scientists to not publish negative results on their drugs.
So much for “evidence-based” medicine!
Most of the time, we only have the evidence that the drug companies want us to have. Both doctors and patients are deceived into putting billions of dollars into drug companies’ pockets, while leaving millions with the same health problems but less money.
The scientific trust is broken. What can we do?
Unfortunately, there is no easy answer.
But I do think Functional Medicine, on which my approach of UltraWellness is based, provides a more intelligent way of understanding the research.
Rather than using drugs to suppress symptoms, Functional Medicine helps us find the true causes of problems, including depression.
I see this in so many of the patients I have treated over the years. Just as the same things that make us sick also make us fat, the same things that make us sick also make us depressed.
==> Fix the causes of sickness -- and the depression takes care of itself.
Just look at these few cases:
A 23-year-old had been anxious and depressed most of her life and spent her childhood and adolescence on various cocktails of antidepressants.
Turns out, she suffered from food allergies that made her depressed. Food allergies cause inflammation, and studies now show inflammation in the brains of depressed people.
In fact, researchers are studying powerful anti-inflammatory drugs used in autoimmune disease such as Enbrel for the treatment of depression.
So after she eliminated her IgG or delayed food allergies, her depression went away, she got off her medication -- and she lost 30 pounds as a side effect!
Here’s another.
A 37-year-old executive woman struggled for more than a decade with treatment-resistant depression (meaning that drugs didn’t work), fatigue, and a 40-pound weight gain.
We found she had very high levels of mercury. Getting the mercury out of her body left her happy, thin, and full of energy.
A 49-year-old man with severe lifelong depression had been on a cocktail of antidepressants and psychiatric medication for years but still lived under a dark cloud every day, without relief.
We found he had severe deficiencies of vitamin B12, B6, and folate. After we gave him back those essential brain nutrients, he called me to thank me. Last year was the first year he could remember feeling happy and free of depression.
These are just a few of the dozens of things that can cause depression.
The roots of depression are found in the 7 keys to UltraWelless and the 7 fundamental underlying imbalances that trigger the body to malfunction.
As we now see, taking antidepressants is not the answer to our looming mental health epidemic.
We need different solutions. I am very excited about my next book, “The UltraMind Solution” (coming out next year), which will address this important topic.
In the meantime, here are a few things that account for a lot of depression -- and how to fix them.
- Try an anti-inflammatory elimination diet that gets rid of common food allergens (see “The UltraSimple Diet”)
- Check for hypothyroidism
- Treat vitamin D deficiency with at least 2,000 to 5,000 U a day of vitamin D3
- Take omega-3 fats in the form of 1,000 to 2,000 milligrams (mg) a day of purified fish oil. Your brain is made of up this fat.
- Take adequate B12 (1,000 micrograms, or mcg, a day), B6 (25 mg) and folic acid (800 mcg). These vitamins are critical for metabolizing homocysteine which can play a factor in depression.
- Get checked for mercury
- Exercise vigorously five times a week for 30 minutes. This increases levels of BDNF, a natural antidepressant in your brain.
These are just of few of the easiest and most effective things you can do to treat depression. But there are even more, which you can address by simply working through the 7 Keys to UltraWellness.
Now I’d like to hear from you…
Have you been diagnosed with depression?
How have antidepressants worked for you?
Do you plan to try any of the approaches mentioned here?
Please let me know your thoughts by leaving a comment.
To your good health,
Mark Hyman, M.D.
P.S. For more information on this and other blogs, please go to http://www.ultrawellness.com/blog.
Resources
(1) Turner EH et al. 2007. Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine. 358: 252-260.
(2) Eaton WW, Kalaydjian A, Scharfstein DO, Mezuk B, Ding Y. 2007. Prevalence and incidence of depressive disorder: the Baltimore ECA follow-up, 1981-2004. Acta Psychiatr Scand.116(3):182-188.
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anti-dep. med problem
I agree with the info that anti-dep meds don't cure depression. That said, I have been trying to get help for chronic fatigue from my Dr. for 10 yrs now to no avail. I have taken every concoction of supplements, including the ones Dr. Hyman recommends (alpha lipoic, etc.) with the exception of the D-Ribose as I could not find it until recently, so I will begin that soon.
I gave this info because several years ago my Dr. put me on anti-depressants though I insisted I was not depressed. They said that sometimes having prolonged stress can trigger a hormonal fluctuation and that it was worth a try. The first one they gave me, Celexa, made me more tired and my Dr. kept saying to give it time, until finally I was told many people have complained of this drug causing fatigue and they switched me to Effexor XR. It did not fix the problem but did not seem to make it worse. However, now each time I forget to take it, I remember as soon as I fly off the handle. I get easily frustrated and have a hard time calming down.
I have followed the ultra plan for a while but fluctuate with how well I follow it, I eat mostly organic, whole foods but I do occassioally eat bad (pizza & tacos are my downfall).
I am afraid to go off the meds now because I have 2 chn, 9 & 11 years old and a high stress job as an investigator for child protection svc's and I really hate the feeling when I have difficulty controlling my temper. It usually causes me to internalize it as I do not want to take it out on my chn and that manifests itself in yet more fatigue.
HELP!
Joanie
Amherst, NY
PS I also have not been able to locate a Dr. in my area who practices functional med AND takes my ins. (BCBS)
Effexor
Please consider switching meds. After 3 months on Effexor I cut myself from head to toe and felt like I had lost complete control of myself. I have been on every sort of antidepressant for panic attacks and all it does it make me a walking zombie. Except of course for the Effexor which made me mentally unstable!
Anti-depressants
Mark,
I am a "senior adult" (64) with elderly parents. My Dad died 6 months ago (age 95) and since then I have felt overwhelmed with paperwork and sadness. I asked my M.D. for some antidepressant help and I am now on Effexor 25 mg. I also recently started taking Synthroid because of a low thyroid result on tests. I have been referred to a Psychiatrist to help balance the medicines and what I really want is to get off both medicines and let my body return to "normal" by itself. What can I do to help myself get well again?
My experience
I have had depression my entire life. I have been on and off anti-depressants. When I am on them, I feel better and can handle life's issues. After being off anti-depressants for over five years, I went back on last October because I was suffering from major depression. I tried diet and exercise alone but it did not help. I am on Wellbutrin XL and it is literally like night and day.
I disagree with the study saying they do not work. Anti-depressants work for me.
Anti-depressants help me function
I have been taking anti-depressants for years. The first time was after the birth of my 5th child (1972). Before then, I didn't know there was medication for depression. I so depressed that I cried day and night. I had 2 little boys ages 2 and 4 who just played in the house while I sat and held the baby. My husband traveled a lot and was gone most of the time. One day a friend from church came to my house and told me that a doctor could help me, that she had suffered depression and needed medication. I thought the doctor would laugh if I told him I was depressed, but he knew right away that I needed help. It took a few months, but I finally came out of depression, and I was able to see that I had been depressed for years. I lost my first 3 babies at birth, and I guess I was affected by that more than I realized. After a few months on the medication, I thought I could make it on my own and fight depression with prayer. I wasn't aware that I had a chemical imbalance in my brain that required treatment.
I went to a clinic in 1988 when my youngest child was 6 years old. I had suffered depression and anxiety nonstop since I stopped breast feeding her in 1982. I was there a month so the doctor (a female GYN and a psychiatrist) could test hormone levels through a whole cycle. I had very low levels of progesterone and high levels of estrogen. I was litterally mentally exhausted by then, and I couldn't read simple charts or comprehend what I was suppoed to learn. The medication that was prescribed (Tofrinel) replaced norapinephrine, and I was also given something for anxiety...one full time and the other 7 days prior to menses to control PMS symptoms. She also prescribed a natural progesterone available only in supositories, but late in capsules. It took about a year to start feeling stable, and many years go gain some control in my life. My husband gave up one me and left me to find someone new in his life. I went under again for a while but eventually began to progress. I still had difficulty concentrating on what I was doing.
My family was concerned about the amount of medication I was taking, so a sister took me to a psychiatric hospital to be monitored (June 1991). I was already seeing a psychiatrist regularly, and he was on the staff at the hospital. I told him about the medication I took the first time (1972), so he changed my treatment to include that one. My husband came to visit me at the hospital and told me he wanted me back. He had me discharged and we went to a new state to look for a house. I didn't know until after we moved that he had planned to marry another woman, but she called it off because our divorce wasn't final.
I have read about the neurotransmittors in the brain that need to be replaced. One doctor did a test to determine what neurotransmitter I was lacking, and the result was not seratonin, but norepinephrine (?). He prescribed Effexor beginning with low doses. That was in the spring of 1994. In July I began to have chronic pain, so I thought it was a side-effect of the medication. I left that doctor to find one who could help with pain. I went for months without an anti-depressant before I went to a psychiatrist. I had seen a neurologist for the nerve pain, as well as a neurosurgeon, both of whom told me it was all emotional. That was almost 14 years ago and I still have the pain.
I tried to go off medication in early 2001, tapering down a little at a time. In May 2001, I went to a doctor for a yearly exam, and I explained that I was suffering from depression and anxiety. He prescribed Effexor because I told him about taking it before. After a few months on that, I reached a therapeutic level and began to have more energy and motivation.
I also have an inner-ear problem that causes me to hear noise in my head. It started sometine in 2004 and continues to be a problem. I know that medications can contribute to tinnutis, so I try to limit what I take to only what I really need. It is also a symptom of fibromyalgia, along with depression and chronic fatigue. I was diagnosed with that in 1997, 3 years after the onset of my chronic pain. When the noise makes me extra nervous, it increases my pain level. I don't take much for that, but I was given a medication called Seroquel to help me control the panic attacks. I was told it is also used as an anti-depressant, and anti-depressants can help with pain.
As far as I know, I will need medication for the rest of my life; so it is disheartening to read from Dr. Hyman that anti-depressants don't work. I have been received his newsletters, visiting blogs, and reading his "Ultrasimple Diet" book; and I am trying to follow his advice about a healthy diet. I started eating healthy way back before I went to the Women's clinic in 1988, but I am trying to learn as much as possible about how to become healthy. Certainly, I would prefer not to take anything. Nothing would please me more than being able to control my emotions and my thoughts. The way I understand it, depression needs to be treated, much the same as diabetics needs to take insulin.
I would like to say something about topaz1456's comments. I have a good friend who has been taking Wellbutrin for years, and she can't think straight without it. I find the same to be true for me, but I am open to suggestions.
Depression
I'm very concerned about these latest findings.
I was first diagnosed in 1980. Since then I have been on many, many different antidepressants. Some had terrible side effects and others worked...for ...at the most 2 years.
I would try anything to feel better. If your methods could help me, I will definitely try them.
I would love to go to a Functional Doctor, but fees and insurance is the problem.
Natural Approaches to Depression Relief
If fees and insurance are barriers (and they are for many of us), consider the option of learning more about your own body and how it operates. One highly effective approach to depression and anxiety relief is to use amino acid therapy to replenish and rebalance your neurotransmitters. Anti-depressants (SSRIs) don't create more serotonin, they simply prolong the life of those few molecules of serotonin you may already have. As most serotonin is created in the digestive tract, should you have any dysfunction in that regard, it may also exacerbate your neurological issues. Julia Ross has written an excellent book, The Mood Cure, that distills 15 years of clinical work in this area. I recommend it because it contains very clear directions for anyone who wants to work on correctly identifying and rectifying their own neurotransmitter imbalances. She gives coherent and easily adaptable guidelines for how to do this. TAKE BACK YOUR BODY AND YOUR BRAIN. TUNE INTO REALITY. As our soils have become depleted of minerals and the system of food processing and distribution has been maximized for efficiency, rather than nutrient density, many of us are deficient in one or another micro- or phyto- nutrient. And these deficiencies first create sub clincial problems that take time to become full blown systematic dysfunctions. Functional medicine is a definite improvement over mainstream allopathic medicine, still it's your body and mind. You can turn it around. The information is out there.
antidepressants
I agree that nutrition, exercise and all that you mention is very important. Since going on a gluten free diet several years ago, improving my diet, regularly taking a good multi vitamin, minerals and fish oil, I have felt much better and much more clear headed. However, most of my life I have been prone to anxiety. About 10 years ago I took antidepressants and there is no doubt in my mind that it helped. I was off them for about 1 1/2 years, and a few months ago started having severe panic attacks again. Upon starting back on an SSRI, I quickly improved.
I know your post is about depression and not about anxiety disorders, but as someone who has experienced anxiety and as a licensed clinical social worker, it greatly concerns me that people may use your post as a reason not to take medication that they could in fact benefit from. I believe that people with depression and anxiety disorders, by what they read on the internet, can very easily come to blame themselves for not "healing" themselves when they try using meditation, cognitive behavioral therapy, etc. I worry that people who read this post will feel down on themselves because they cannot afford to see a functional doctor or get a mercury test. They may feel very hopeless that now even antidepressants will not help them. So again, it is their fault that they do not feel better. I strongly believe that a lot of mental illness is related to brain chemistry. Regardless of what research finds that is negative or positive about antidepressants, they do help some people.
Antidepressants, et.al.
Dr. Hyman,
Your video today was very interesting. Although I feel I have been helped to a degree by (various) antidepressants, I also feel really disappointed in their ability to continue to help. You would think that if they truly helped, the first one prescribed for me would have been the only one I would ever have to take! Just the opposite has happened over the past 15 years ... one works for awhile and then simply doesn't work any longer.
The first one ever prescribed for me was Zoloft in a low dose, for Fibromyalgia pain and fatigue. I must say that within a week after starting this medication I was feeling much better physically and did not feel the nagging sense of morbidity I had experienced for some time. Was this simply a placebo effect? Or do these classes of drugs actually give you a boost for a period of time until your brain adjusts to them, then stop working?
Now, years later, I am still struggling -- even more so -- with which antidepressant is right "for me." Are you familiar with NeuroScience Labs (neurorelief.com)? For well over a year I have been on their rather costly protocol for depression, along with an antidepressant. At this time I feel worse than ever (pain, fatique, lethargy). If I feel this badly ON the meds, I fear that I will feel much worse without them ... is that foolish?
I have had allergy testing done and am allergic to just about everything! The allergist did not suggest eliminating foods; rather they gave me drops to take each day that are supposed to immunize me against these allergic reactions. Is that what you would recommend?
Thank you for any advice you can afford. I appreciate your blogs and enjoy reading your books.
Mercury and depression
Dr Hyman, two months ago I discontinued use of Lexapro (2 years) for anxiety and depression caused by my 17 yr old son. I have not experienced depression symptoms since I discontinued it. While on the Lexapro I felt like my brain was wrapped in cotton and my business suffered because I could not care enough to work as hard as I need to. The antidepressant helped at the time, but I gained 25lbs (the psychiatrist said it was weight neutral then said I should exercise more b/c my adrenaline was no longer helping to keep the weight lower...it was still too high before I gained 25lbs). I am now working out regularly with a personal trainer, but my weight remains up. I was also found to have elevated mercury, lead and copper levels about 2 years ago and the naturopathic doctor gave me a regimen to chelate/detox, but then scared me by saying to wait until I could have the time to be tired all the time (hello...when is that???). I never did it, but I am wondering what you would suggest since you gave as one of the steps to get mercury levels checked, but didn't address specifically what to do if they were elevated. Btw, I also take Crestor, Synthroid and last week routine blood tests showed elevated liver enzymes.
I Cured My Depression With raw Foods
Thank You for this blog on Why antidepressants do not cure depression. As someone who suffered from depression for many years and never touched any of these drug's, I found the cure by living a Raw Food Lifestyle! Within day's of starting my new lifestyle I noticed a profound difference in my total wellbeing. Gone is the depression that tried so hard to take over my life! I now start my day with exercise and then a green smoothie that consists of all organic.......banana, avocado, celery, blueberries, strawberries, spring greens, coconut oil, raw cacao powder, MACA powder, hempseed protein, Vitamineral Green powder and reverse osmosis water. As my day progresses I might consume a large leafy green salad with raw almonds or raw sunflower seeds, cherry tomatoes, cucumber, red onion, raisins, asparagus, raw apple cider vinegar and raw EVOO. For dinner I may have a raw nut pate rolled in Nori sheets along with a variety of shredded veggies or I may have a raw veggie pizza that I make in my dehydrator or how about raw flax crackers with homemade guacamole? The variety of raw food is endless and so are the many health benefits of consuming raw foods! The cure for depression being one of them
I posted your blog to my rawfood support board in hopes that others will come here and comment as well.
Antidepressants
Dear Dr. Hyman,
In this article you say that nothing can be done about these big companies. Which is false. Just exposing them and their activities and intentions with an article like this and bringing up the public awareness level is doing something about it. I know all of the facts to be true as I support an organization which you probably heard of called Citizens Commission on Human Rights which also actively documents and exposes these outrageous studies, findings and individual abuse cases. For more information please log onto www.cchr.com and let your public research the data further which supports your statements in this article that addresses the ANTIDEPRESSANT PROBLEM.
Thank you.
Antidepressants
Hi :
I am a 59 3/4 yr old woman who has been on antidepressants of one kind or another since the age of approximately 21 years old.
I don't smoke and don't drink, but am extremely overweight. Some days I feel Ok , never really good, others I don't want to get out of bed, yet, when in bed, cannot sleep.
I believe that antidepressants have helped a tiny bit, but I still am a very depressed, confused woman who should be able to enjoy her life now.
Antidepressents
I was on antidepressents for a short while after my sister died and had suffered alot from depression in my late twenties and thirties. I found out after she died that many members of my family were on thyroid medication for hypothyroid disease. When I found out and I had it and got on it, my depression went away. I developed some severe joint pain from the synthroid and when I switched to armour thyroid, then my joint pain went away too. Be proactive about your health and the things doctors give you. Listen to your own body!
Antidepressants
I usually find your newsletters and blogs helpful and informative. However, I have to disagree with your opinion that antidepressants do not work. I am an RN and in the past was always skeptical about these drugs. Then after a long period of personal loss and professional stress, I went to my primary physician for an annual exam. I simply broke down in her office. She recommended a low dose antidepressant. She knew my feelings about these drugs ,but I respected her judgement and accepted the offer. It has made a positive change in my emotions and outlook on life.
SAMe does work for depression
After 30 years of being depressed (ages 10 to 40), I found out about and started taking SAMe (S-adenosylmethionine), and felt better in less than 24 hours. I had already (8 months earlier) switched to a gluten-free diet, was walking 20 miles or more per week, getting plenty of sun (I live in California and spend a lot of time outside), and got treatment for my low thyroid -- but none of those did anything to really help my depression. I had also had years of therapy. The only "side effects" are reduced inflammation, more energy, and improved liver function. SAMe is a methyl-donor compound that is naturally present in the body. Extra SAMe allows the body to "recycle" neurotransmitters more quickly. For me, there is a direct dose-response relationship; if I take less than 800 mg/day, I start to feel worse. The maximum recommended dosage is 1600 mg/day (if there is no response after 3 week at this level, SAMe will not benefit you). Many people who have a response can lower their on-going dosage to as little as 200 - 400 mg/day on a sustained basis. Supposedly SAMe has about a 70% response rate. I have shared it with 5 friends (everyone of them also felt a response within less than 1 week), and every one of them benefitted, although one of them can't tolerate well because it gives her too much of a "buzz".
Also be aware that depression co-exists with anxiety in the majority of the cases, and that once you get of your depression, you may feel your anxiety that the depression has been masking (and vice-versa, by the way). There are many options for anxiety (if exercise, meditation, and an anti-allergy diet aren't enough), Relora is especially helpful if you are prone to managing your anxiety through eating.
Timely topic
This is quite timely for me. I'm 46 and have been depressed since college (at least that's when I recognized it). I have been on every SSRI, I started out on tricyclic antidepressants, was having panic attacks so was on buspar, lorazepam, etc., etc. There is no doubt that some worked and quite possibly saved my life during crisis periods.
I've also had IBS and a horrible skin condition since college. I literally would tell people that there is NEVER a time when I'm not itchy somewhere. Drs. were baffled, called it eczema (which may well be the case) and gave me moisturizers, all of which made the situation worse.
Despite all this, I've had a good career and life, but lots of meds, therapy, and difficult times. I'd chalk it all up to "life" and deal with it. However, over the last 6 years, as stressors piled up, and weight gain increased, my health deteriorated with no known cause. I had become a different person - physically and emotionally. I went through menopause early. Then I had fairly minor surgery. After the surgery I spiraled downhill physically. I'd already been through a million tests and a variety of things had shown up, but as each was treated and/or resolved, I still felt lousy. Alternating diarrhea/constipation, increased cholestrol/BP, high levels of anxiety, chronic moderate level depression, fatigue, difficulty breathing, body pain becoming increasingly worse, arthritis, and anemia which almost stopped the surgery and later almost necessitated a transfusion "just to feel better" for awhile.
Having had lifelong moderate eating disorders and a generally bad died, out of desperation, I totally revamped my diet and used the 1 week ultra-weight loss book as a guideline. By virtue of following that way of eating in general, I eliminated all processed flour, sugar, caffeine and many other things and added healthy vegetables and fruit, supplements and a heavy metal detox product called NDC Zeolite. I had been "hobbling" around the house, went to a rheumatologist who diagnosed me with fibromyalgia - then told me there was nothing he could do about it; it was all up to me. Basically lose weight and exercise. He also diagnosed something called "Chronic Pain Syndrome".
When I got home and read on the internet what it was, I was hugely depressed. Fibromyalgia had finally gained "legitimacy" as a real medical condition, and now - in my interpretation - they came up with a NEW way to tell women it's all in their heads, they are hypochondriacs, etc. I finally got mad enough (and got out of bed...) and said "fine, if he says their is nothing wrong with me, then there's nothing wrong with me. I'll just walk down these steps like a 'normal' person with no hobbling!" And I did!
While this does say something about the power of the mind to heal - and contribute to - illness, what really had happened is I had changed my diet gradually over the previous 2 weeks and was then taking the supplements and vitamins I needed. I was eating no sugar, no wheat, no dairy, no artificial anything, and lots of fruits, vegetables, beans, legumes, soy, miso, and then I did add back brown rice.
It seemed like overnight (but was probably 2 weeks) but I felt much better. I continued and lost 25 pounds without "dieting", but by eating healthy and cutting out sodas, etc. I was able to get off many meds, my dr. is looking at lowering/eliminating my heart meds as my bp is great, I've gotten off 1 of 2 antidepressants and am working on getting off the second, don't need anti-anxiety or sleep meds anymore. But while it was great, I tend to like to know "why" something happens. I'd pin it on the supplements, or the zeolite, or the elimination of dairy, sugar, processed flour. I wanted a pat answer.
Then, as is easy to do, I started "slipping" back into bad habits - just a little. And I had added back whole wheat and some dairy (yogurt). And I felt like crap. I then eliminated all wheat and an amazing thing happened. It took about 5 days to "clear", but I felt great. So I continued on gluten-free and my depression also evaporated.
I don't suggest that gluten-free is everyone's solution. In fact, I feel like crap today myself... But I'm confident that it's because I've slacked off on some of my good habits and/or slid back on a 'bad' habit or two and that I can turn it back around (I'm drinking my hot water with lemon and a few drops of stevia right now. The hot lemon water really makes me feel better). For the first time in 25 years, I'm not depressed! And, remarkably, in the middle of a cold Nebraska winter - my skin isn't itchy at all and there is no more yucky eczema everywhere on my legs and arms. And, even more remarkably (silly as it may sound) I've been "Mt. Dew free" for 4 - 5 months. I was addicted to that since college. Drank 4 or more a day sometimes. I was "known" for having a Mt. Dew in my hand. I stopped it cold turkey with all the sugar. I do have an occasional coke, which is more a morning "coffee"/stress thing which I am still working on. But it's all progress. My Dr. was AMAZED when she saw me last week.
A final observation - while I'm not depressed anymore (no crying, no not getting out of bed, no negative spiraling thinking patterns, no sense of hopelessness), I have been depressed for 20+ years, and significantly so over the last 5. I had always been considered a "high functioning" depressive for the first 15 - 20 year, but the last 5, my functioning in life had dramatically decreased. I'm back to "high functioning" and can work, go to the store, run errands, enjoy other people (things I could not do much of over the last 5 years). However, I have discovered I still have 20+ years of "depressed person behaviors" - habits - to overcome. It's not overwhelming-feeling, as the overwhelming part was- for the most part - part of the depression. But I still "act" like a depressed person in many ways. I have to work on routines for exercise, for cleaning, for everything that just fell by the wayside when I was so depressed and physically in pain and fatigued.
But I much prefer having those challenges ahead of me and not the sense of hopelessness and persistent sadness. And while meds definitely helped and got me through crisis, they were not going to "solve" the root of the problem. For me, it appears that eliminating inflammation, toxins, and providing my body with healthy things it needs, as well as staying gluten-free, is the solution!
B2
Depression, redux
As an integrative psychiatrist, functional medicine trained, I'd say Dr. Hyman's comments need tweaking. His suggestions are all great and very useful, however, depression is complex: for instance, an agitated depression might need natural NMDA receptor blockers such as magnesium or NAC, a bipolar depression would need more inherent stabilization, such as larger amounts of omega 3 fats. All of this is important and may make all the difference in the world.
Antidepressants
Having taken antidepressants for years, I wonder what will happen if I quit even slowly. I have done everything but the anti-inflammation diet and I would be willing to try that.
depression
i have had a lifelong battle with depression..have tried different antidepressants over the years but none really seemed to help..feeling desperate i made an appt. with you and found out i had a gluten intolerance and very high levels of mercury in my system..for a couple months i was really strict with gluten free diet..but have slipped on and off for 2.5 years..i had the mercury [safely]fillings removed from my teeth and had vit.c iv's twice after removal [thats all i've done as far as mercury]i went to your office twice..i had further testing at the northampton wellness center[for money reasons]and urine test revealed i was very very low in serotonin..i have been taking tryptophan,l-theanine,b vitamins and inositol since about aug. because in this past year my depression has become severe..i feel hopeless,physically not well and have a horrible time falling asleep..avery good friend of my family [a psyhciatrist] talked me into starting on a small dose of effexer xr..and continue to take the tryptopan..i started effexer 2 days ago and recieved your blog on depression today..i know i have to exercise and clean up my diet[i did ultrasimple diet for 1 week..felt good but then started eating the old way.w/o all the gluten..i've often thought of making another appt. with you but i sometimes wonder if i'll ever really feel better..i'm going broke with everything i've tried..i know i have to be consistent with diet and exercise [food is my drug of choice and yes i'm overweight and very unhappy about it] can you HELP????? what do you think of the effexer and tryptophan...tryptophan with other supplements did nothing..how do yo feel about effexer in general..again HELP!!
Depression/anxiety
I'm wondering if dr. hyman has ever heard of NeuroScience? a few years ago i was suffering big time with anxiety and depression, crying all the time, suicidal thoughts etc. it was the first time in my life i thought i had to have antidepressants or i would hurt myself. i was really at the bottom. i went to see my naturopathic doctor and she gave me a saliva and urine test to take home. the neuroscience kit tests all of your brain chemistry and then they put together a vitamin protocol for your brain. as the doc put it, it is the "raw materials" for the brain. no joke, it took about three weeks and i was noticeably feeling better. within three months i realized that i had most likely been suffering with depression and anxiety since i was a teen. i have now been on the neuroscience for two years and i am completely 100 percent sane and feeling amazing. now i know what it is like to have things roll off my back. i feel like i have my life back after years of yo yo emotions. i must say, i never knew i was a layed back person. i'm still on the neuroscience supplements, and i may be for a lot longer, but nothing could make me want to stop them before they have done everything they could for me.
I can't get a feeling for these...
I've been taking the Neuroscience supplements for 6 months and I can't tell if they are worth the $, if they are helping or agitating. Test results indicate that even on Lithium for Bipolar disorder and with a very clean diet & exercise I have very low seratonin levels. I wonder if I couldn't just use 5 HTP and DHEA... The feedback my Doctor is getting is inconsistent. It ws interesting to see your comments.
Depression
I purchased Ultrametabolism last year around this time and can't wait to get the paperback version in a couple of weeks. I've lost 35lbs. by following your whole food, healthy fats, and sugar elimination/restriction diet and even though the holidays took a toll on my mid section, I've still been exercising and my goal weight is 190lbs. I currently weigh 267lbs. But this e-mail isn't about me. It's about my wife. Her name is Jennifer and she has anxiety/depression/panic attacks; not to mention she's been diagnosed with high blood pressure, fibromyalgia, bi-polar disorder, among many other things. She takes Cymbalta, Neurontin, Clonodine, Seroquel, and many other drugs to help her sleep and get rid of the panic attacks. Her main problem is being overstressed. She's the type of person who never says "No" to people (mostly family) who constantly run over her and rule her life. Every moment of every day her family has to call or show up at our door to see her and they always want something from her be it money, or babysitting the nephew, or etc. She's always in a state of worry. Extreme worry. Last year, she lost 75lbs. and now weighs around 120lbs. But the problem is, she basically starved herself to get that way. She hardly eats anything and every time she has a piece of fruit in the middle of the night, she asks me if she's going to gain weight. That's borderline anorexia to me.
I kept telling her about the way our bodies work to store fat if we starve ourselves and it's better to graze throughout the day as you said. I even tried to get her to take normal vitamins like a multivitamin and B-complex vitamins to help with stress, but she's so brainwashed by the Psychiatrists and doctors that she won't listen to me even though I'm "outside the box looking in" so to speak and can clearly see the problems. She's just now finally able to go into Wal-Mart, but still can't go to the back of the store--oh, I forgot to mention she's got agoraphobia as well. I've read all the success stories in each chapter of Ultrametabolism, but I honestly can't see anything to compare to what she has. Do you have any information on how to treat these problems with natural resources, foods, and supplements that would also be very practical?
Here are some of her symptoms not mentioned above:
• Goes to bed about 9 or 10pm every night; like clockwork gets up around 3 or 4 am with the munchies (light snack); goes back to bed and wakes up every morning around 6 am
• Drinks the equivalent of at least two or three 20oz. caffeinated beverages a day
• Deals with stress and has a very low tolerance for it.
• Her mom died around 3 years ago and ever since her whole family (dad, siblings) look to her to be the "mother"
• Her dad is in worse shape than her: gets refills every month for Lorazepam (Ativan, which she has also taken before when she has panic spells and probably still does), he always, and I mean always runs out 2 weeks before he's supposed to and stays in a drunken stupor as a result, not to mention he drives in this condition. She's always worrying about him and his state of mind/health
• Her dad smokes at least 1/2 carton of cigarettes a day (this is another example of how she stresses out and what caused her to inherit panic attacks in the first place)
• Her dad is extremely bi-polar and often cusses her out and tries to make up for it by calling and leaving messages in his drunken voice saying he loves her and for her to come over and see him.
I don't mean to be too personal here, but I'm at my wit's end. It's a new year and I want it to be the best year of both of our lives. She's suffered with this all of her life and all of our nearly 7 years together. Please help if you can. Much thanks.
Your devoted fan, Eric.
Can diet really help my family's depression?
I have been suffering from "diagnosed" depression for over 12 years. It was first diagnosed as post-partum depression and then "situational" depression. I have tried again and again over the years to stop taking medication and always end up suffering terribly both from withdrawal and from relapse. My 13-year-old son is also, much to my chagrin, being treated for depression with anti-depressants. I give him omega 3-6-9 in hopes that this will help, but a recent attempt to take him off his medication had extremely negative effects. I would be very interested in knowing, specifically, how I can change our family's eating habits to help us both fight what we have been genetically stacked for...depression.
Feedback on many of these posts...
Responding to some of the posts herein, I share these tidbits, as an individual and an Alternative Psychotherapist. I am not an MD, these are from my experience and my research. I lean more toward complementary medicine and alternative methods, for the most part.
I experience occasional depression as a part of S.A.D. (Seasonal Affect Disorder), due to living in a northern latitude, with short winter days, and when there are too many cloudy days in a row. The solution is a lot of light (including wide spectrum/full spectrum fluorescent tubes in ceiling fixtures, or inexpensive shop light fixtures, placed where the light reaches me. SAD can make one want to eat more, which can add weight. When the sun is out, I feel great, have good ambition and good energy.
As everyone, I experience stress; at times when stress has been severe it has caused weight gain, via the stress hormone cortisol, which usually prefers to land around the abdomen. Handling our stress in healthy ways helps; B, C & Calcium are stress vitamins, as well. For more on stress and cortisol, please see: http://stress.about.com/od/stresshealth/a/cortisol.htm. Inflammation is mentioned there, and I agree is an important aspect.
In my proprietary model therapy program, I teach clients to deal with their feelings through feeling them, rather than avoiding them (which most Rx therapy tries to help one do); drugs mask your feelings rather than getting at and helping you to deal with their causes. Among other tools, my clients are taught to journal daily. No matter what one's drug of choice is, whether street drugs or prescription, or alcohol – all are ways we run away from our feelings. That includes any addiction, whether it is sugar, food, cleaning, running, work-aholism, gambling... anything that is out of balance. The solution is to write through one's feelings, and work through the old causes of things that keep recurring in one's life.
Grief is a normal feeling; it's a process, and something that needs to be worked through, not covered up with an anti-depressant. No matter what one is grieving (and any change in one's life, or loss of a relationship involves a grieving process) a loss needs to be acknowledged, given time to feel one's feelings, and assuaged in emotionally healthy ways. Take good care of yourself. It will get better.
Yes, one has to eat healthily, and find out what that constitutes for oneself. I have food sensitivities (wheat (probably all glutens), corn & derivatives, white potatoes, tomatoes and other nightshades, including peppers, and perhaps soy). I tried going off all of these for twelve weeks, but unfortunately it was two Chrismases ago that I went off that diet, tried everything on the table, and not long after all the sensitivities were back. Such should be done gradually, trying one thing at a time.
Food sensitivities cause internal inflammation, and over-stress the immune system. All must be healed in order to have any chance of eating 'normally' again. Normally doesn't mean unhealthily, though...
My sister is on a whole food diet as much as possible. My brother-in-law was, too, but resisted the regimen; each time he went off it, his bone cancer remission would end. He died in 2006.
We would all do better if we could eat fresh, natural foods, unadulterated by humans. We need to band together to disallow the irradiation, genetic modification and all the other things they are now doing to our meat and other foods... especially when they refuse to tell us what they are doing. We have given up our freedoms and need to take them back.
Those who are willing to read labels can help themselves greatly by avoiding everything that contains High Fructose Corn Syrup – an unnatural food (Google on it and read all the information available) and Hydrogenated or Partially Hydrogenated shortenings (Trans Fats). I am convinced that HFCS is the major cause of obesity and diabetes in our society. My husband and I are both diabetic and overweight. I gave up these two culprits long ago, have gotten my husband of almost three years to do so, as well.
I have recently had to adjust my Armour thyroid, due to back muscle pain, going off for a while (can take at least a couple weeks to clear from the body), then adding back slowly. My current doctor is an endocrinologist. He works with me, and lets me adjust my own thyroid and a couple other meds, based on how I feel; he monitors and makes sure it is safe. A former physician had increased my thyroid to 2 Grains of an alternative, called Natur-throid, which caused the pain, I later learned (too high a dose; and he'd not forewarned me). I'd been on thyroid when I was young, my mother took me off it when she thought I was becoming too hyper; and when I was in my early twenties, I had a miscarriage, the doctor tested my thyroid, and found it low; told me that one either cannot get pregnant or will miscarry when the thyroid is low. I've been on it ever since. I've also found good information and drawings of the eyes of a person with too low or too high thyroid online. I also had some feedback about the T3 needing to working correctly, and that one should ask to be tested for that, not just a typical metabolism test. These are now done by blood tests, when they used to be the more complicated basal metabolism test.
Do you know that too much thyroid can be lethal? My MD years ago told me about keeping my thyroid meds away from where my children could get at them. He told me a young boy had taken a lot of his parent's thyroid, and by the time they discovered it, it was too late to do anything about it; he 'burned up' from the inside. One can also overdose on Iron, and some other supplements. Learn about all that you take.
Please, all, when you read and like this blog, click on the green stars to rate it (far right is a '5'). We tend to forget that part.
Jannette Robert Murray, RC, CCHt www.inspiredcounseling.com/deprdrug.htm
(this page will be back up within 24 hours)
depression
I have not been diagnosed with depression. I have struggled with symptoms of depression for years, but I never went to see a doctor about it. Many reasons, one of which being that I did not want to be on mind-altering medication just to function. I just kept reading and researching nonmedicating ways to treat depression and have tried many things. But I truly could not find a "cure" that worked for me. (which of course led to more depression and hopelessness) It wasn't until I had finally gained so much weight and was in search of healthy weight loss plans that I "discovered" you, Dr Hyman. When I began exercising regularly, I began to see a pinpoint of light at the end of the tunnel (and I wasn't afraid it was a train!) For several months, that seemed to be enough for me. Then I realized that while I didn't feel bad anymore, I still didn't feel good. Reluctantly, I began to modify my eating habits- amounts and types of food I ate. After about two weeks I noticed that I had more energy. I actually wanted to go places and do things. Two and a half months later I am still feeling great and I have not had any days of depression at all. I must admit I didn't fully believe you at first, but I cannot argue with my own results! I am so glad I didn't run to get medication for what my body could do naturallly! Thanks Dr Hyman!
Antidepressants
Kudos to Dr. Hyman! I am always happy to see doctors that are trying to find the cause of a disease or condition rather than just treating the symptoms. Although I am a veterinary physician, I was a researcher first. I want to find the cause of my patients problems. I have been amazed at how difficult it is to find human physicians that are willing to search for a cause. They are out there, and Dr. Hyman is one of them. I was thought to have depression. I had some of the symptoms: fatigue, irritability, supposed lost of interest, and difficulty concentrating. I simply told my doctor that I was not depressed. I knew that my problem was related to the situation I had myself in. I was basically happy, but I was overwhelmed and exhausted. I needed fewer things on my proverbial plate and more sleep. I had my own veterinary clinic, I took my own emergencies, I had recently had a hysterectomy, I was planning my wedding, trying to sell my practice, suffered back pain, and suffering increasing hip pain due to an injury. The wedding was joyous, but the practice sale did not go through until after I was released from the hospital for hip replacement surgery. My house literally sold in a day and we moved witin two months of my surgery. Phew! Life just sometimes comes at you fast! Fortunately, I have a very helpful and understanding husband and he let me cry on his shoulder when things were just too much for me to handle. I got through it all with out drugs. Exercise and eating right certainly helped. Enough sleep was crucial. Emotional support was essential. As physicians we sometimes need to step back and look at the situation. Look at the bigger picture, and not just throw up our hands and prescribe pills. I know that my story is not like everyone's but there are people out there that are on antidepressants that need to just change their lifestyles for better health and wellness.
depression
I was treated for depression 2x in my life and both times it worked with 2 different medications, once my father was dying and it changed my life so much I could help him through it all, the second time I had postpartum depression. I believe PostPartum Depression is caused from lack of sleep and also believe alot of depressive symptoms stem from lack of adequate sleep. I was told by my dr. if I had another (or no.3) depressive episode I would have to be on meds for the rest of my life. I just went through a trauma in my life(found out my husband has been a drug addict for almost all of our 23 years of marriage) with legal issues, social concerns, everything that is involved in Drug Addiction and I did not need the antidepressants. Anyways, Id like to know what you think about all this. My husband is on antifepressants and when he used to start and stop them I would know, his behavior was like night and day, appetite, sleep patterns, attitudes, etc.
husband's behaviors
The changes in your husband's behaviors may have also been related to his use of drugs. Also, use of other mood-altering substances (drugs, alcohol) interferes with the effectiveness of the anti-depressant, making it hard to decipher whether the med is helpful.
Depression
I have been clinically depressed, suicidal & ultimately diagnosed as a- typical, rapid cycling bi-polar. Lithium changed my life. It sure isn't perfect however I can't imagine living without it. Prior to Lithium (age 36) I thought everyone was suicidal. I am now 50. I have a variety of health challenges and have had pretty much success with UltraMetabolism. However, I don't loose weight on it. It does cut down Fibromyalgia pain. I wonder about food combining issues....& alkaline, acidity. I do notice a difference in mood with wheat & grains...also with sugar and dairy. But I wouldn't be here to notice this without Lithium. Also, of note is that Lithium was the last of at least 30 drugs tried.... and a last ditch effort before Electric Shock Therapy. This also seems to be a family "crisis".
dangerously dismissive
I believe that you are an incredibly knowledgable doctor with the best interests of your patients in mind. I love learning more about these natural methods for obtaining and maintaining well-being. That said, I was very disappointed when I read this blog on depression. While I don't doubt for a moment that anti-depressants are abhorently over-prescribed (as are many medications), it sounded like you are dismissing ALL anti-depressants as no more effective than a placebo (would you not agree that there is a difference between Prozac and Lexapro, for example?). As a person who has had the unfortunate experience of terrifying panic attacks (I had worked as a counselor for 12 years and had NO idea how awful a panic attack really was!), I have a hard time buying into the idea that all of a sudden I was experiencing a debilitating food allergy or mercury surge. My doctor did a battery of blood tests, urine tests, etc to rule out other factors (I know for sure that my thyroid was one thing checked) and none indicated the problems you mentioned. Thank goodness I hadn't read your blog at that time -- I would have been left feeling as though I was "selling out" by agreeing to take a medication. Since I took the medication doubtful that it would help, how can the relief I soon felt be due solely to a placebo effect? (I don't drink alcohol or caffeine, don't smoke and am only moderately overweight -- BMI of 27) PLEASE respond. I want to understand this and can't wait for next year's book.
depression
How does heredity factor in someone being depressed?
What about seasonal affected disorder?
depression
I am a female, mid 40s, and have gained over 80 lbs in the last 18 months. I gained 60 of those while still teaching aerobics 3x a week and playing tennis regularly. I was diagnosed as hypothyroid (which I had to push to get anyone to even look for) and am now taking a high dose of Synthroid. I have been on Wellbutrin for quite some time, but have NEVER felt like it "evened out" my emotional state, as the prescribing dr promised. Even though I now take 150 micrograms of Synthroid daily, I still appear to be symptomatic and wonder if there is anything else I can do to help my cause. Any recommendations are welcomed!
Antidepressants
I have been on and off antidepressants for about the last 7 years. I had gone on them when I was going through a nasty seperation and then divorce. I had been off of them for about a year and a half when suddenly I found myself slipping back into "the black hole". I would love to get off Zoloft if I could. I hate taking chemicals!! But I am afraid to let go. Would it really be ok to try to get off it again? I have had great success with it.
Antidepressants
I am a clinical psychologist in private practice. I have long been frustrated with the overuse of antidepressants. Even before this new finding, it has long been known that expertly conducted cognitive behavioral therapy for depression is as effective as medication. With this new information on medication, I guess that means that therapy is significantly MORE effective! In the field of mental health, connections between underlying health and nutrition has been so overlooked as a contributing or primary cause. I am THRILLED to hear about your upcoming book. I would love to know if your Functional Medicine institute is planning on adding education for mental health providers. It is difficult to find solid researching making these connections. To offer credentials to mental health providers to practice knowledgeably in the area of mental health prevention and wellness would be phenomenal. I will be watching!
Treatment for Depression
I find exercise more important than any drug, but some people may need a boost to get started as they become so debilitated in their depression.
depression
I have suffered from depression for the past several years. I am going to give your suggestions a try. Prozac isn't working. The only thing it does is to put weight on me.
Cymbalta
Hello, my father sent this article about why antidepressants don't work and I have been treated for depression for most of my adult life. I found this information very helpful. Even though I have been on medication I am still depressed and at times have very dark thoughts, I have told my doctors ( I see Several) they just take a note and say "Let's watch it and if you have suicidal thoughts, call me.) Anyway, I plan to take action and try some of the advice in this article. Thank you
Dear Dr. Hyman: Thank you
Dear Dr. Hyman:
Thank you for your newsletter dealing with depression and the inadequacy of SSRIs and other pharmaceutical treatments.
I have suffered from episodic anxiety and depression for much of my adult life, and have tried numerous medications, none of which has provided a sustainable answer. I have investigated other forms of treatment, as my psychiatrist seems reluctant to do anything but prescribe medications.
You are familiar with the litany of complaints about psych meds: SSRIs such as Zoloft often cause weight gain, and also cripple the sexual response – causing impotence and/or difficulty in achieving orgasm. Welbutrin – although it has fewer sexual side effects – caused me to be aggressive and edgy. It worsened, no helped my anxiety. Like others posting here, I have also noticed that meds such as fluvoxamine - an older SSRI - cause me to become complacent, and lacking in initiative. I also feel less creative when taking it.
Cognitive therapy has been helpful to me, especially drills from the book “Felling Good,” by Dr. Burns. I have also found that martial arts are superb for enhancing and maintaining emotional equilibrium. Exercise is not a panacea but it most certainly helps a great deal. I also discovered that I have had a magnesium deficiency; addressing this has helped. Lastly, taking 3-4 grams of omega-3 fish oils and a small spoonful of pure coconut oil daily has worked tremendously. An added benefit is that I have better skin and hair, too.
I just finished your previous books, and plan to use your dietary recommendations beginning soon. I have already begun to cut back/eliminate wheat, processed foods and sugars, and diary products from my diet. Thanks to eliminating and then re-introducing various foods, I have discovered that I am sensitive to dairy products. Soon after eating or drinking milk, for example, my sinuses fill up. I was astounded; I have lived with clogged sinuses for years and thought the condition was due to pollution or infections. Although I am already in pretty decent shape, I lost some weight and feel less bloated since enacting your recommendations. My wife and I now shop organic as much as possible.
Depression and anxiety meds have their place, but I am full of hope that the above non-pharaceutical methods will work. Will I stay off depression/anxeity meds for good? I do not know, but I plan to try!
PS - Have any of you tried HRT? I did a short course of hGH therapy under a physician's supervision, and it improved my mood considerably. It took it as an off-label therapy for a stubborn, slow to heal nerve injury (which it helped), and a side benefit was improved mood. Of course, thanks to the whole PED scandal in baseball, i.e. Barry Bonds et al., legitimate sources of hormones are getting tougher to find than ever, and many providers are reluctant to prescribe them.
All the best to you -
GaBoy61