“I see you checked depression on your intake form. Because depression can be a symptom of an underlying health problem, I’m going to check your blood levels for B12, B6, and vitamin D. I’m also going to test your thyroid and iron levels. And finally, even if your B-12 levels are normal, I recommend you try a B-12 shot. For some patients, this makes a noticeable difference in their mood — and since it’s very safe, there’s no downside to trying it out.”
These are the words that I heard exactly never during 20+ years in and out of the mental health system. Not when I had severe depression accompanied by physical health problems at the age of 19. Not during 7 years of psychotherapy. And not in any of dozens of doctor’s offices, where I dutifully checked “depression” and “OCD” on my intake forms. Every few years, someone mentioned checking my thyroid and iron, but the first time I received a B12 shot was at the age of 37 — even though B12 shots have been a documented treatment for depression for over 40 years.
That it took 20 years of suffering with depression before I received a modicum of relief from a basic B12 shot baffles and infuriates me. It’s a simple, safe treatment, well-documented in the medical literature, and unlike most mental health treatments, it’s extremely affordable.
Now, let me be clear: depression is often very complex. Any number of physical, environmental, or experiential triggers, alone or in combination, can be the straw that breaks the proverbial camel’s back.
However, while acknowledging that some instances of mental illness can be very complicated, some are also very simple, and because of this, the obvious and basic root causes should be ruled out at the start. Treating mental illness without checking for physical illness . . . is like treating someone for double vision without looking at their eyes. It is, quite simply, negligent.
If depression did not still have such stigma in our society, we would be able to see it for what it is: a symptom. And, like any other symptom, it may be pointing to a more profound underlying disease.
Any patient who presents with mental illness should go through the Rule Out the Simple Stuff Protocol. If the practitioner is a medical doctor, this can be done in the office; counselors can provide patients with referrals. This R.O.S.S. protocol would test for the most obvious common physical contributors to depression, including:
- Low B12 levels (and all patients should receive at least one B12 shot regardless of labs, to see if it’s helpful)
- Low B6 levels
- Low Vitamin D levels
- Thyroid problems
Perhaps there are additional common problems that should be tested — I would love to see a group of physicians create a commonly-agreed-upon checklist.
I would also recommend a general discussion with the patient to get a sense of their overall physical health. If they say, “My depression started about the same time I hurt my head in a car accident,” then that’s a very important clue to some next steps for their treatment.
This R.O.S.S. protocol goes back to the idea of Using What You Have. We may not have all the answers for all presentations of depression, but we certainly know some of the causes and some of the treatments right now — and we’re not using that knowledge effectively.
It’s time we start.