Course Description:

This course is intended for clinicians of all specialties who seek to redefine the model by which they characterize, assess, and treat depressive illness.  Through four separate modules, an integrative functional medicine model of depression will be introduced, one in which depression is understood to arise from underlying biologic abnormalities associated with nutritional, metabolic, genetic, and environmental factors.  Recommendations for the implementation of testing and augmentation strategies will provided alongside research elucidating the roles that key nutrients play in maintaining neurologic health, providing registrants with evidence-based, integrative strategies that can be incorporated into existing therapeutic protocols.

CME Accreditation (AAFP)
This Enduring Material activity, Integrative Medicine for Depression, has been reviewed and is acceptable for up to 5.00 Prescribed credit(s) by the American Academy of Family Physicians.  AAFP certification begins 09/01/2019.  Term of approval is for one year from this date.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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1. A Biologic Model of Depression

In Module 1, Dr. Greenblatt will explore the scope of the depression crisis – its prevalence, recent trends in incidence, and the sobering statistics which reveal that the current treatment model is woefully inadequate when it comes to achieving remission and recovery.  Flaws inherent in a therapeutic paradigm devoid of etiologic considerations will be objectively discussed, and the limitations of pharmacologic interventions so commonly – and ineffectively – employed as part of this symptom-focused approach. Dr. Greenblatt will then present evidence in support of a functional medicine model of depression, a model supported and substantiated by overwhelming scientific research that he has used with great success in his own practice.  Biomarker testing and biochemical individuality will be discussed in detail as they relate to the practice of functional medicine, bringing to light a concept of depression as the observable result of underlying biologic abnormalities.  Finally, some of the keystone biomarkers of “depressogenic” processes – genetics, inflammation, and dysbiosis – will be reviewed, with an emphasis on elucidating the mechanisms by which they impact brain function and describing integrative interventions to rebalance abnormalities that may be identified through testing.

2. Macronutrients: Proteins, Fats, and Carbohydrates

Module 2 is devoted to an exploration of nutrients which, far too often, are overlooked in assessments of physical and psychiatric health.  The exclusion of proteins, fats, and carbohydrates from functional medicine considerations – particularly in cases involving depressive illness – is a potentially costly omission, for these macronutrients are anything but basic when it comes to the impacts they have on human cognition and brain function.  Dr. Greenblatt will begin Module 2, then, with an examination of the various roles amino acids play in physical and neurologic health, the clinical implications of research studies employing tryptophan or phenylalanine depletion, and the rationale for the use of free-form amino acids as part of an integrative protocol for depression.  The lecture will the turn to an in-depth analysis of essential fatty acids (EFAs) and cholesterol, lipids vital for human life which scientific research has unequivocally linked with neurologic and behavioral health. Studies revealing powerful associations between cholesterol and EFA levels, depression, and suicide will be objectively reviewed, along with evidence from clinical trials that demonstrate the antidepressant effects of EFA supplementation. Finally, Dr. Greenblatt will unravel connections between depression and sugar consumption, further strengthening the argument for incorporating dietary interventions into functional medicine treatment protocols for depressive illness.

3. Micronutrients: Minerals

In Module 3 Dr. Greenblatt will examine lithium, iron, magnesium, zinc, and copper, minerals which exert powerful influences on brain function and neurologic health through a variety of pathways. The function of each mineral in cellular and biochemical processes will be discussed, with an emphasis on specific functions impacting neurotransmission.  Intrinsic and exogenous factors that affect mineral absorption, metabolism, and/or bioavailability will be explored according to a functional medicine conceptual framework, as will the often-delicate ratios between mineral levels that must be maintained for optimal health.  The physical and cognitive ramifications of a deficiency (or excess) of each mineral will be elucidated, as will scientific evidence which demonstrates the causal and contributing roles that mineral deficiencies play in depressive pathophysiology. Dr. Greenblatt will review clinical tests that can be utilized as part of an integrative approach to accurately assess mineral status in patients presenting with depressive illness, and provide his recommendations for supplementation protocols that can be used to rectify imbalances.

4. Micronutrients: Vitamins

Module 4 will continue students’ explorations of functional medicine interventions for depression, focusing on vitamins and the ways in which these important micronutrients can augment, rebalance, and optimize neurotransmission.  Dr. Greenblatt will provide an in-depth examination of vitamins that research has strongly associated with mood and depressive pathophysiology through their influences on neurotransmitter synthesis, cell receptor activation, and neuroendocrine response.   The roles of B vitamins on DNA methylation and synthesis, monoamine oxidase production, and cell membrane maintenance will be explicated, with especial focus vitamin B12 and the often-overlooked neurologic ramifications of B12 deficiency.  Dietary and biochemical factors that can precipitate B vitamin deficiency, including elevated pyrrole levels, will be reviewed, as will functional strategies for achieving repletion. Next, Dr. Greenblatt will re-examine a familiar vitamin – folate – through an orthomolecular lens, unraveling the complex processes by which dietary folic acid is rendered biologically active in order to fulfill its many essential functions.  Variants of the MTHFR gene and their effects on folate metabolism will be reviewed, as will studies demonstrating correlations between folate deficiency and depression which, together, provide a powerful rationale for the incorporation of genetic testing into integrative protocols.   The module will conclude with an examination of vitamin D, one of the most important nutrients when it comes to the maintenance of cellular and neurologic health and one of the most commonly-deficient in today’s patient populations.  Risk factors for vitamin D deficiency will be discussed along with studies which firmly establish the association between vitamin D status, depression risk, and suicide. Guidelines for testing, level interpretations, and supplementation in accordance with Dr. Greenblatt’s integrative functional medicine approach will be provided.


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Learning Objectives

Upon Completion of This Course, Students Will Be Able to:

  • Elucidate the clinical utility of a functional medicine model of depression
  • Identify dietary, metabolic, genetic, and environmental risk factors for depression, and explain the mechanisms by which these factors influence mood and cognition
  • Elucidate the role of systemic inflammation in ‘depressogenic’ processes
  • Elucidate the acute and chronic physiologic ramifications of malnutrition and trauma, and identify biologic pathways by which these factors influence suicidality in eating disorder populations
  • Substantiate the physiologic associations between diet and depression
  • Describe the roles that amino acids play in regulating appetite and satiety
  • Elucidate mechanisms by which low cholesterol and essential fatty acid intake precipitate depressive pathophysiology
  • Discuss the functional differences between pharmaceutical and ‘nutritional’ lithium, and describe biologic mechanisms through which lithium confers neuroprotection
  • Identify best practices for magnesium and folate testing in accordance with a functional medicine model
  • Identify genetic variants of the MTHFR gene, and describe the ways in which MTHFR polymorphisms impact folate metabolism
  • Evidence-based interventions focused on inflammation, the gut microbiota, dietary macronutrient balance, and micronutrient supplementation for supporting methylation and drug-induced nutrient depletion
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