Some of the MD's in this newsgroup have been riding my butt pretty good (maybe in some cases with good reason).  In this post on depression, I'm  laying it all out.  I'll continue to post here because I think that I have  some knowledge that could be useful.  Once you have read this post, you  should know where I'm coming from when I post again in the future.  In article <123552@netnews.upenn.edu>, lchaplyn@mail.sas.upenn.edu (Lida Chaplynsky) writes: >  > A family member of mine is suffering from a severe depression brought on > by menopause as well as a mental break down.  She is being treated with > Halydol with some success but the treatments being provided through her > psychiatrist are not satisfactory.  Someone suggested contacting a > nutritionist to > discuss alternative treatment.  Since she is sensitive to medication, I > think this is a good suggestion but don't know where to begin.  If anyone > can suggest a Philly area nutritionist, or else some literature to read, > I'd appreciate it.   Lida, I can emphasize with your situation.  Both my wife and I suffered from  bouts of depression.  Her's was brought on by breast cancer and mine was a  rebound stress reaction to her modified radical mastectomy and  chemotherapy.  Lida, I used my knowledge of nutrition to get her through  her six months of chemotherapy(with the approval of her oncologist).  When  severe depression set in a few months after the chemo stopped, I tried to  use supplements to bring her out of it.  I had "cured" her PMS using  supplements and I really thought that I knew enough about the role of diet  in depression to take care of her depression as well.  It didn't work and  she was put on Prozac by her oncologist.  Two Winters ago(three years after  by wife's breast cancer) I got hit with severe depression(pretty typical and  one reason why many marriages break up after breast cancer or another  stressor).  I tried to take care of it for several months with  supplementation.  Didn't work.  My internist ended up putting me on Prozac.  I was going to give you a list of several studies that have been done using  B6, niacin, folate and B12 to "cure" depression.  I'm not going to do that  because all you would be doing is flying blind like I was.  Lida, I do believe that depression can have a dietary component.  But the  problem is that you need to know exactly what the problem is and then use  an approach which will "fix" the problem.  For chemotherapy, I knew exactly  what drugs were going to be used and exactly what nutrients would be  affected.  Same thing for PMS.  I was flying blind for both of these  stressors but the literature that I used to devise a treatment program was  pretty good.  Depression is just too complicated.  What you really need is  a nutritional scan.  This is not a diet analysis but an analysis of your  bodies nutrient reserves.  For every vitamin and mineral(except vitamin C),  you have a reserve.  The RDA is not designed to give you enough of any  nutrient to keep these reserves full, it is only designed to keep them from  being emptied which would cause clinical pathology.  Stress will increase  your need for many vitamins and minerals.  This is when your reserves become  very important.  Lida, without your permission, I'm going to use your post as a conduit to  try to explain to the readers in this group and Sci. Med. where I'm coming  from.  I have taught a course on human nutrition in one of the Osteopathic  Medical schools for ten years now.  I've written my own textbook because  none was available.  What I teach is not a rehash of biochemistry.  I  preach nutrient reserves(yes my lectures in this course are referred to by  my students as sermons).  Here is what I cover:  Indroduction and Carbohydrates 			Lipids  Proteins I					Proteins II  Energy Balance					Evaluation of Nutritional 						Status I, A Clinical  						Perspective  Evaluation of Nutritional Status II,            Evaluation of Nutritional		 A Biochemical Perspective			Status III, Homework  						Assignment Using the  						Nutritionist IV Diet and  						Fitness Analysis Software  						program  Weight Control					Food Fads and Facts  Age-Related Change in Nutrient Requirements	Food Additives,  						Contaminants and Cancer  Drug-Nutrient Interactions			Mineral and Water Balance  Sodium, Potassium and Chloride			Calcium, Magnesium and  						Phosphorus  Iron						Zinc and Copper  Iodine and Fluoride				Other Trace Minerals  Vitamin A					Vitamin E  Vitamins D and K				Vitamin C  Thiamin and Niacin				Riboflavin and Pyridoxine  Pantothenic and Folic acids			Biotin and B12  Other Nutrient Factors				Enteral Nutrition  Parenteral Nutrition  Every three years I spend my entire Summer reviewing the Medical literature  to find material that I can use in my nutrition textbook.  I last did this  in the Summer of 1991.  I read everything that I can find and then sit down  and rewrite my lecture handouts which are bound in three separate books  that have 217, 237 and 122 pages.  Opposite each page of written text(which  I write myself) I've pulled figures, tables and graphs from various  copyrighted sources.  Since this material is only being used for  educational purposes, I can get around the copyright laws (so far).  I can not  send this material out to newsgroup readers(as I've been asked to do).  I am now in the process of trying to get a grant to setup a nutrition  assessment lab.  This is the last peice of the nutrition puzzle that I need  to make my education program complete.  This lab will let me measure the  nutrient reserve for almost all the vitamins and minerals that are known to  be required in humans.  The Mayo clinic already uses a similiar lab to  design supplement programs for their cancer patients.  Cancer Treatment  Centers of America, which is a private for-profit organization with  hospitals in Illinois and Oklahoma(Tulsa) also operates a  nutritional assessment clinical lab.  I also believe that the Pritikin  Clinic in California has a similiar lab setup.  For physicians reading this post, I would suggest that you get the new  Clinical Nutrition Textbook that has just been published(Feb) by Mosby.  I  have been using Alpers Manual of Nutritional Therapeutics(a Little Brown  series book) as a supplemental text for my course but Alpers is geared more  to residency training.  Two M.D's have written this new Clinical Nutrition textbook and it is geared more towards medical student education and it  does a good job of covering the lab tests that can be run to assess a  patient's nutritional status.  Let me quote a few sentences from the  Preface of this new text:  "So-called nutrition specialists were in reality gastroenterologists,  hematologists, or pediatricians who just happened to profess some knowledge  of nutrition as it related to their field of practice."    "Unfortunately, about two thirds of the medical schools in the United  States require no formal instruction in nutrition."  "But times and medical practice have changed.  More than half of the  leading causes of death in this country are nutrition related."  "... this monograph should accomplish the following two objectives: (1) it  should complement your medical training by emphasizing the relevance of  nutrition to your medical practice; and (2) it should heighten your  awareness of nutrition as a medical speciality that is vitally important  for both disease prevention and the treatment of diseases of essentially  every organ system."  Roland L. Weinsier, MD, DrPH   Lida, my advise to you is that you tell your family members to try to find  a physician who has an understanding of the role that vitamins and minerals (yes even magnesium may play a role in depression) play in depression and  who could get a nutritional profile run.  Menopause is often a time when  women suffer depression.  There are a lot of hormonal changes that are  occuring but they are not the same ones that occur during PMS.  A  nutritionist may also be able to help.  Not too long ago a poster mentioned  that his nutritionist had diagnosed a selenium deficiency based on a red  cell glutathionine peroxidase test(the specific test for the selenium  reserve).  Most clinical labs will not run this test and I advised him to  try to make sure that the lab that did the test was certified.  There are  also a lot of hair and nail analysis labs setup to do trace mineral  analysis but these labs are not regulated.  Checks of these labs using  certified standards, and also those doing water lead analysis, showed some  pretty shoddy testing was going on.  If you or anyone else finds someone  who will run these speciality nutrition tests, make sure that they are  using a lab that has been certified under CLIA(the Clinical Laboratory  Improvement Act).    A diet analysis may be helpful since many nutrient reserves have been shown  to correlate fairly well with the dietary intake as monitored by food logging  and software analysis(Nutritionist IV and other software programs).  But  there are still about half of the nutrients required by humans that do not  show a very good correlation between apparent dietary intake and reserve status. Until we have more nutritional assessment clinical labs in operation in the  U.S. and physicians who have been trained how to use the nutritional  profile that these labs provide to devise a treatment approach that uses  diet changes and supplementation, anti-depressants will probably continue  to be the best approach to depression.  Martin Banschbach, Ph.D. Professor of Biochemistry and Chairman Department of Biochemistry and Microbiology OSU College of Osteopathic Medicine