Functional Medicine as defined by the Institute of Functional Medicine as a systems biology–based approach that focuses on identifying and addressing the root cause of disease. Each symptoms or differential diagnosis may be one of many contributing to an individual’s illness.

As the graphic illustrates, a diagnosis can be the result of more than one cause. For example, depression can be caused by many different factors, including inflammation. Likewise, a cause such as inflammation may lead to a number of different diagnoses, including depression. The precise manifestation of each cause depends on the individual’s genes, environment, and lifestyle, and only treatments that address the right cause will have lasting benefits beyond symptom suppression.

So looking at depression we can see that different deficiencies of omega-3, thyroid hormones, or Vitamin D, can all lead to a feeling of depression. Think about seasonal effective disorder it happens when we are outside less and indoors more, it gets dark earlier, so what is a popular way to self treat seasonal affective disorder. Take some Vitamin D or better yet take some Cod Liver Oil if you can tolerate it. It contains Vitamin D, Omega-3, and Vitamin A.

The point of functional medicine is to treat the underlying cause of depression. This can only happen when we take a look at the entire condition and not just the depression. From a traditional treatment approach we would look at depression, then look at the symptoms, and find a suitable treatment option for the symptoms.

Traditionally we would use-

A benzodiazepine (alprazolam) for a two-three week period while the SSRI (paroxetine) starts to work in the body. Unfortunately, over half the people will switch to a second SSRI due to side effects from the first one. So now the benzodiazepine may need to be continued or increased as a patient waits another three – four weeks for the second SSRI to kick in.

This is the frustrating part for the patient and for myself as the practitioner. From the time of diagnosis or labeling of the condition until now all we did was focus on the symptoms. In traditional medicine, if the symptoms improved we did our job. Within the pharmacy, if a patient picked up their medication every 30 days or every 90 days they were compliant with their medications we did our job. But did we?

In my practice the beauty of functional medicine is that by addressing the cause of one condition we maybe able to indirectly affect so many other causes or conditions. Let’s take a look at the depressed patient again.

So with just a few questions we can learn so much more about a patient for example:

• Over the last so many years how frequently have you taken antibiotics?
• Do you consume fish in your diet or take any omega-3 supplements? What omega 3 supplement do you take?
• Do you have a thyroid condition?

These questions if asked could have saved how many years of sub optimal treatment for depression?

Let’s look at these questions in more detail

• Why antibiotics- because we know that antibiotics taken for a longer period of time deplete vitamins and bacteria utilized in the gut needed to produce other vitamins utilized in neurotransmitter production.
• Why Omega-3- Omega contains both DHA and EPA, DHA is commonly found in prenatal supplements to help brain development in children. Once we are born are brains don’t stop developing, but usually because we don’t consume a lot of fish we do not continue nourishing our brains with DHA. DHA in combination with antidepressants in both kids and adults have shown an improvement in depressive symptoms than just antidepressants alone.
• Why thyroid- If we are under a lot of stress and our cortisol is off, and our thyroid condition isn’t corrected a lot of times it can leave a person feeling depressed and tired.

So does this matter?

I think this is up to each patient to look at individually and decide what their health goals are. If it can be accomplished over the long term by just treating the symptoms, and traditional medicine accomplishes this than fine. However, if multiple medications for depression are needed, or if someone would like to address the cause for depression than I think a functional approach is a good way to go too. In the end, I think when we take control of our health and are looking for ways to improve it, some of the questions that need to be answered include:

• How can I help my patients make positive changes in their life?
• What nutrients could provide the same benefit as the antidepressant without the additional side effects
• What additional benefits would the nutrients or supplements provide above that of the prescription medication alone?

So what does functional medicine look like in a pharmacy?

• Drug Induced Nutrient Depletion is a really good start. If we are really looking at the causes of illnesses within the traditional model than we need to undo the damage done by medicine.
• For example in the case of the patient with depression in our traditional model. If we had discovered the patient was a 19 year old who had 7 rounds of amoxicillin over the previous 19 years. We would find out that amoxicillin has depletes B6, B12, and B7, and B3 all of which can lead to depressive symptoms.
• By starting with B vitamins or a good multivitamin that contains the b vitamins we could have temporarily avoided two prescription medications and add b vitamins rather than utilizing a benzodiazepine and multiple courses of SSRI’s.
• Additionally, the b vitamins could have additional benefits beyond just helping with depressive symptoms.

By taking a biological approach to health as in functional medicine a pharmacist could uncover the causes of a lot of future problems by:

• reviewing previous medications used, the nutrients they could have depleted
• help prevent somebody from needing more medications in the future
• help achieve quicker results