DEPRESSION: A ROOT-CAUSE GUIDE

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Depression at RootPsych: Looking Beyond “Chemical Imbalance”

Depression isn’t just simple sadness but rather it’s a whole-body condition involving energy, cognition, mood, sleep, appetite, and motivation.

At RootPsych we assume:

  • Your symptoms are real

  • There may be biological factors that standard care doesn’t check for

Addressing these factors can improve outcomes

What Is Depression?

Common symptoms:

  • Low mood

  • Loss of interest

  • Fatigue

  • Sleep problems

  • Appetite changes

  • Brain fog

  • Irritability

  • Feelings of guilt or hopelessness

    • Brain chemistry shifts

    • Nutrient issues: B12, folate, zinc

    • Thyroid dysfunction, including reverse T3

    • Inflammation affecting neurotransmitters

    • Gut–brain disturbances

    • Chronic stress

What Is Treatment-Resistant Depression?

Usually defined as:

  • Trying two adequate antidepressant trials

  • Still experiencing significant symptoms

This doesn’t mean you’re untreatable — often something important has been missed.

    • Subclinical B12 or folate issues

    • Low zinc impairing neuroplasticity

    • Suboptimal thyroid function

    • Inflammation biasing mood

    • Gut dysbiosis

Vitamin B12 & Depression

Low or borderline B12 is common in depression and especially in treatment-resistant depression.

What We Evaluate:

  • Serum B12

  • Methylmalonic acid

  • Homocysteine

  • Sometimes “active B12”

Zinc & Depression

Low zinc is associated with:

  • Worse depression symptoms

  • Lower antidepressant response

  • Reduced neuroplasticity

How We Approach Zinc:

  • Fasting serum zinc

  • Copper:zinc balance

  • Adjunctive zinc (~25 mg elemental) when appropriate

    • Traditional ranges only screen for severe deficiency

    • Psychiatric symptoms can appear at low-normal levels

    • Functional markers (MMA, homocysteine) reveal early deficits

Thyroid (Including Reverse T3) & Mood

Even normal TSH can hide low T3 activity or high reverse T3.

Symptoms may include:

  • Fatigue

  • Low mood

  • Brain fog

  • Weight or temperature sensitivity

  • Slowed thinking

What We Test

  • TSH

  • Free T4

  • Free T3

  • Reverse T3

  • Antibodies (as needed)

    • Chronic fatigue

    • Brain fog

    • Long-standing depression

    • Atypical depression symptoms

Inflammation: TNF-Alpha & CRP

Inflammation can directly affect mood and neurotransmitter signaling.

We often check:

  • High-sensitivity CRP

  • TNF-alpha

High levels may suggest an inflammatory subtype of depression, which responds to targeted treatment.

Gut Health & the Microbiome

Gut imbalance can increase stress, anxiety, and depression.

Psychobiotics (specific probiotics) show:

  • Modest mood improvements

  • Reduced anxiety

  • Better sleep and stress resilience

Especially helpful for those with GI symptoms.

What a RootPsych Work-Up Includes

Clinical history

  1. Targeted labs:

    • B12 panel

    • Zinc

    • Thyroid with reverse T3

    • CRP, TNF-α

    • Optional gut-related markers

  2. Tailored plan combining:

    • Current meds/therapy

    • Nutrients

    • Anti-inflammatory strategies

    • Gut–brain tools

    • Lifestyle & integrative care

Will This Replace My Meds or Therapy?

No — this approach is additive.

Many people feel better when root causes are addressed alongside their current treatments.

When to Get Evaluated

You should consider a deeper assessment if:

  • You’ve tried multiple treatments without relief

  • You’re fatigued or foggy without clear explanation

  • Symptoms fluctuate unpredictably

  • You feel like “something else is going on”

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Clinically Reviewed By:

Dr. Akash Kumar, MD

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