Picture (edited) by Anh Nguyen
Circumstance is forcing me to publish this prematurely — circumstance being that I come across so many people who have reached the end of their tether after years of depression and failed treatment.
This post is about the basic diet-and-supplement regime which a number of friends are now using. It’s not a miracle cure, but it has helped to noticeably lift their mood. It works by addressing some of the common underlying cofactors to depression in autistic people (and probably in many non-autistic people too). Here and there I’ve provided links to medical literature to give the background to the approach.
My main disclaimer or caveat is that the approach is likely to need individual tweaking — for example, if you’re bipolar or you have a seizure disorder, or a CBS gene mutation (and so on!). Also missing from here are all the ‘psychology’ things that are needed to deal with depression. I’m just focusing on a few key aspects of the biology.
But without much more ado, here are the basics. In case you’re too depressed and exhausted to do them all, I’m giving them to you in order of priority (based on my learning to date). That’s so that you can at least start somewhere, instead of doing nothing at all.
Carnitine is commonly deficient in autistic people, and I honestly don’t feel like linking to any of the studies now, because the easy-to-find ones are framed as autism causes and autism cures. (Google will help you out.) The more interesting point is this, though, and this isn’t autism-specific:
Investigators at Stanford and elsewhere have shown, for the first time in humans, that low blood levels of acetyl-L-carnitine track with the severity and duration of depression.
How to begin
Buy acetyl-L-carnitine (not regular L-carnitine).
Follow the instructions on the container. If necessary, increase your dose after a few days so that you are taking slightly more than they say on the label, then taper off slightly as your mood improves.
The label will say that you should take this on an empty tummy, and you should start with that. I find that if I do that, I get a headache, so when I take it, I take it with food. (I haven’t suffered from prolonged depression myself for many years now, but I occasionally take this to help me with energy and concentration.)
This is a type of Vitamin B12. It’s often deficient in people with ADHD, and this deficiency can be a cofactor for depression.
There is a whole lot more I should say about individualising the regime with other B-vitamins, and how to tweak it if you have a seizure disorder or some bothersome MTHFR allele. But… I’ll leave that for another day.
I use a Vitamin B complex myself, and that’s a one-size-fits-many (because the B-vitamins work together), but the ratios required many differ for different people.
How to begin
Get methylcobalamin. Take as instructed.
Other types of Vitamin B12 are OK for some people (e.g. hydroxycobalamin), but don’t get cyanocobalamin.
Besides needing magnesium to calm anxiety, to improve sleep and constipation, you will also need magnesium if you are taking potassium to treat sensory overload, otherwise the potassium won’t go in and stay in. Reduce the dose (or stop taking it) during bouts of diarrhoea.
There are many ways to buy this, and they actually all work differently in the body. Magnesium citrate is a common form, or magnesium glycinate (one of my own favourites) which is good for getting into the brain. You can also bathe in large quantities of Epsom salts. (Not recommended with some forms of epilepsy.)
If you are treating sensory overload, then A. Vogel’s Multiforce or some equivalent is a good idea, because that way you get your potassium in as well. If you are going to use Multiforce, then take it on an empty tummy so that it doesn’t mess with your digestion.
The most common equivalent for Multiforce in the USA is called Tri-Salts — but note, apparently there are two versions of Tri-Salts. Most people (but not all) would be wanting the version without sodium. And some people shouldn’t be supplementing with potassium at all.
My friends and I ramp up the dose slowly, till we start noticing the difference.
I don’t need potassium regularly, because my sensory overload is in remission. I just take a bit when I feel the early signs that could turn nasty a few days later. I use a variety of forms of magnesium, from a cheap magnesium and calcium combination, to Multiforce to magnesium glycinate.
How to begin
Get either Multiforce (or equivalent) or any magnesium supplement which the pharmacist tells you is designed for good absorption.
This is a nice-to-have for many reasons, including the improvement of calcium metabolism and reduction of inflammation, which are cofactors in both sensory overload and depression. Taurine deficiency is also relatively common in autistic people and people with ADHD.
Taurine is one of the active ingredients in Red Bull, and I think that should be a clue to one of it’s functions in this regime: it gives you focus and energy.
How to begin
Buy taurine capsules. Take as prescribed, or increase the dose for extra energy. If you feel shaky or awful, stop. Taurine supplementation is problematic for some people who have issues with sulphation.
I have hectic ADHD and the usual dose isn’t enough for me; I take three times the recommended amount per day, and my doctor is OK with that.
5. Low-carbohydrate diet
I left this till last, not because it is unimportant, but because the idea of changing a diet can be overwhelming if you are depressed and if comfort foods sometimes save the day for you.
Ideally, most humans should be on a low carbodyrate diet with most of their energy coming from animal fat and some from protein. (If you’re searching for tips and recipes, try keywords like Banting, keto and LCHF.)
There are many tweaks to be made over time — for example, if you have any of the other health issues common in autistic people, such histamine dysregulation (which then means tweaking the diet to make it a low-histamine diet), or phenol intolerance, or oxalate sensivity. If you are on an antidepressant medication which is an oxalate (e.g. Citalopram, Cipralex, or Lexapro), then I would really want to figure out a way of weaning yourself off that. Many autistic people develop all sorts of mental health problems on oxalates, including increasing their already elevated risk of Parkinson’s Disease.
By the way, did you know that healthy gut bacteria is important for producing serotonin, the neurotransmitter of happiness? OK, I’m getting distracted, and if I don’t stop now, I’ll write a book.
My own diet is a low-carbohydrate, medium-fat, casein-free, lactose-free, gluten-free diet. I also try to keep salicylates and oxalates lowish. This may sound overwhelmingly restrictive and awfully difficult to stick to, but it is actually very easy for me unless I travel. I eat a lot of eggs, which are also a good source of choline.
How to begin
Don’t be hard on yourself if you are not ready to make a dietary change now. But do start reading about the benefits of a low-carbodydrate diet (for most humans) and its effect on mental health, because in the long run, dietary changes will be one of the most important things you do.
For a start, even if you don’t do the complete transformation, at least try to include more eggs in your diet, and add liver, if you can handle that. These foods include some of the nutrients needed to combat the cofactors of depression.
As with anything, there are exceptions; the CBS mutants will probably have a problem with eggs.
This is a summary of what to buy, in order of priority if you are starting the process.
- Foods for a low-carbohydrate diet, e.g. eggs, meat, not-too-starchy vegetables.
I hope this helps to get you a step closer to where you’d like to be!
Did they run any tests?
If you’re seeing a psychiatrist, and you’re not being sent to the lab once every six months or so, something is very wrong. There are many physiological factors which can contribute to depression, especially in autistic people and their relatives. These range from mast cell disorders to thyroid problems, Vitamin D deficiency, testosterone deficiency, and… oh, I could go on and on.
My advice? Get to a doctor who can do some digging. Typically a systems medicine specialist or functional medicine GP would be a good place to start, but be aware that there are good ones and bad ones. Also, be sure to get a medical doctor who has been to medical school and who has hospital experience — not a “doctor of homeopathy”!
This doctor would need to develop some hypotheses, and then send your blood or urine or sputum to a lab for tests.
I prefer to stay away from medical doctors who call themselves “integrative” practioners (although some are not altogether nuts). That is simply because many of them throw sensible medicine out of the window and do hocus pocus stuff when there actually is a researched answer to the problem!
Let me reiterate: if you’ve been treated for depression for years and nobody has done any kind of lab tests yet, there is a big, big problem.
It’s not all just cells and supplements
I mentioned at the onset that I would be dealing with the biological side of depression. But sometimes this is not the main thing that’s propelling the problem. Sometimes it genuinely is something in Life, the Universe and Everything else. And sometimes it is all these things — physiology, psychology, philosophy, and basic awful circumstances like being poor, having your family hate you, or the fact that climate change is going to wipe out a lot of people and animals if we don’t do something now.
Carnitine is great. It’s helping many of my friends. But it can’t cure a sick society. Listen to an autistic child talk about how she turned around her depression.