Revivelife Clinic I Naturopath in Ottawa

The 4 Key Integrative Tests for Anxiety, Depression & Mood


If you are feeling blue and don’t know what to do, consider advanced testing to understand the root cause and add targeted therapies to your wellness plan.  Although we often talk about ways to support your physical health including healthy nutrition and exercise, we do not want to neglect the importance of addressing your and your children’s mental health. We believe that taking care of your lifestyle, nutrients, hormone balance and taking time to build community can significantly improve one’s mood.

Traditional drugs have their place, but come with a host of side effects.1-5  The For more on mood medications & their risks of nutrient depletion. 

The goal is to help you feel your best using natural treatments guided by the most recent scientific research. The first step is to understand the root cause and important contributing factors of your mood by testing for mood health. Diagnostics that we recommend discussing with your Naturopathic Doctor include: Adrenal Health, Hormones, Neurotransmitters, Nutrients and your Microbiome.

Your adrenal glands sit on top of your kidneys and produce hormones such as cortisol that respond when you are under stress. Extreme disorders of the adrenal gland include conditions such as Cushing’s disease (excess cortisol) or Addison’s disease (deficient cortisol). More often, one may experience functionally low or suboptimal adrenal function, commonly known as “adrenal fatigue”. Adrenal fatigue can be associated with a variety of symptoms ranging from chronic fatigue, depression or anxiety, poor stress tolerance, insomnia, loss of appetite, muscle weakness, weight gain, digestive concerns, low blood pressure or darkening of the skin.

Cortisol should be highest first thing in the morning, approximately 30 minutes after waking, and should slowly decline throughout the day. The best way to assess adrenal function and evaluate adrenal fatigue is to look at cortisol levels at multiple times throughout the day. Not only does saliva’s ease of collection facilitate this, but the cortisol levels present in saliva are only the bioavailable fraction of the hormone. These two factors make salivary cortisol the gold standard for assessing adrenal function and diagnosing adrenal dysfunction.

The three main adrenal testsused at Revivelife include:

  • Adrenal Check (4 Point Cortisol Test): measures the levels of salivary cortisol collected at various times of the day, as well as the level of DHEA (the precursor molecule to cortisol production) and helps evaluate adrenal gland function and hormone balance. This test may be recommended if you are experiencing fatigue, feeling stressed or nervous, insomnia, dizzy spells, headaches, decreased stamina, irritability, fibromyalgia, sugar cravings and or anxiety/depression.
  • HPA Check (Cortisol Awakening Response (CAR) 3 Point Test): measures the levels of cortisol collected from saliva at 3 times upon waking to assess your endocrine function of the hypothalamus pituitary adrenal (HPA) axis. Normally upon waking cortisol will increase about 50% in the first 30 minutes. By 60 minutes after waking, cortisol levels have peaked and begin to decline the remainder of the day. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. The HPA is vital to hormone health of stress, thyroid, and sex hormones. 6-8This testing is often useful for cases of burnout, seasonal affective disorder (SAD) or depression, anxiety, headaches, sugar or salt cravings, thyroid dysfunction, blood pressure issues, sleep apnea or poor sleep in general, PTSD, sexual dysfunction, chronic fatigue syndrome chronic pain, digestive concerns and immune weakness or autoimmune diseases. 6-10
Low or blunted CAR is associated with This can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
Elevated CAR can be a result of an over-reactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD).
  • Adrenal + HPA CAR Test: This test combines a 4-point cortisol test with a 3-point cortisol awakening response (CAR) for evaluation of adrenal gland and hypothalamus pituitary adrenal (APA) axis health. Recommended for a complete evaluation of adrenal and HPA function. This lab is indicated for those with chronic fatigue, feeling stressed or nervous, insomnia, dizzy spells, headaches, decreased stamina, irritability, fibromyalgia, sugar cravings, anxiety/depression, and or PTSD.

The hormones estrogen, progesterone and testosterone are produced by the gonads (the ovaries and testes) in response to other precursor hormones found in the pituitary gland and other brain areas. These gonadal hormones impact brain chemistry and circuitry, and hence influence emotions, mood and behaviour. Hormones affect every cell in your body and impact your overall health as well as play a role in disease prevention. Testing and then balancing hormone levels, including stress hormones (cortisol, DHEA), thyroid hormones (TSH, fT3, fT4) and sex hormones (progesterone, estrogens (estrone, estradiol, estriol), DHEA, testosterone, and pregnenolone), are important for wellness especially mood. Advanced hormone metabolites can be assessed to help in cancer prevention strategies. Hormone testing is available by blood, saliva, or urine.

Common Symptoms of Hormone Imbalance

The three main hormone tests used at Revivelife include:

  • Hormone Blood Test – is a simple and cost-efficient test that offers a snap-shot in time of total or free fraction sex, adrenal and thyroid hormones. Serum testing is best used for peptide hormones such as Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Insulin-like Growth Factor-1 (IGF-1, and some thyroid hormones. Serum is also used for our Testosterone Metabolites profile. Serum testing is best used for peptide hormones such as Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Insulin-like Growth Factor-1 (IGF-1, and some thyroid hormones. Serum is also used for our Testosterone Metabolites profile. Serum testing is best used for peptide hormones such as Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Insulin-like Growth Factor-1 (IGF-1, and some thyroid hormones. Serum is also used for our Testosterone Metabolites profile.It is the preferred method of testing for LH (luteinizing hormone), FSH (follicle stimulating hormone, and a complete thyroid panel. General health markers available as an add-on. This test supports balancing hormones that can impact metabolism, hair loss, acne, migraines, bone density or prostate health.
  • Hormone Saliva Test – offers a reflection of hormone levels in the actual tissue. Hormones can be detected in saliva, as hormones pass through the saliva gland tissues before entering saliva. It is the preferred method of testing for those using hormones in a cream form. This test may be recommended for those with fertility or breast health concerns, in which free hormone levels, multiple samples or a monthly map of hormone levels are required for optimal therapy.
  • DUTCH (Dried Urine Test for Comprehensive Hormones) Test – is the most advanced test for bioavailable (free and conjugated) sex, adrenal and sleep hormones. In addition, add on options of OATS (organic acid test) –select nutrients with neurotransmitters or thyroid hormones are available. It is the preferred method of testing for those who wish to have a complete overview of their hormone and hormone metabolite health in detail. Monthly mapping option is available. This test is key for therapies for targeting all hormone imbalances including male andropause or female menopause, PMS (premenstrual syndrome), PCOS (poly-cystic ovarian syndrome), breast health, osteoporosis, adrenal fatigue, depression, anxiety, insomnia, weight gain, cognitive decline, low libido or hair loss.

Deficiencies in neurotransmitters such as serotonin, dopamine, noradrenaline, and γ-aminobutyric acid (GABA) are often associated with depression.11-16 For those with depression, anxiety, bipolar disorder, ADHD, and other conditions that involve the brain or mood, neurotransmitter testing can be a helpful step in identifying which neurotransmitters are out of balance and need to be targeted through supplementation and/or herbal support.  As reported in several studies, the amino acids tryptophan, tyrosine, phenylalanine, and methionine are often helpful in treating many mood disorders including depression.17-22  For more on neurotransmitters.

The two main neurotransmitter tests used at Revivelife include:

  • Neurobasic Urine Test – A test to assess the neurotransmitters serotonin, dopamine, GABA, epinephrine, norepinephrine, and glutamate. Because neurotransmitters are linked to sex and adrenal hormones for optimal care we recommend partnering this test with our Hormone 1-Blood Test. This test may be recommended if you have energy, mood, or brain health concerns including attention deficit, traumatic brain injuries (TBIs) or a concussion. Note – a referral will be made to one of our nurse practitioners to order this test.
  • OATS Test – A comprehensive general health urine test measuring organic acids (also linked to inborn errors in metabolism) that offers a metabolic snapshot of overall health with 75 markers of Digestion, Detoxification, Longevity, Nutrients, and the Neurotransmitters that regulate mood and behavior– epinephrine, norepinephrine, serotonin and dopamine. May be recommended if you experience any of the following concerns: Digestive – bloating, gas, diarrhea or constipation, Sensitivities – foods, environmental; Detoxification – liver health, hormone imbalances, Longevity – overall health, Immunity – colds, flus, allergies; Nutrient Deficiencies – fatigue, brain fog, skin concerns; Stress & Brain Function – anxiety, depression, insomnia and or Traumatic Brain Injuries (TBI) – weak memory, concentration, mood changes; Weight Concerns

Nutrition can play a key role in the onset, severity and duration of depression and mood disorders.24 Nutritional neuroscience is an emerging discipline shedding light on the fact that nutritional factors are intertwined with human cognition, behavior, and emotions.

Those suffering from mental disorders ae often deficient in vitamins, minerals and amino acids.24 Studies have indicated that daily supplements of vital nutrients are often effective in reducing patients’ symptoms.25 Supplements containing amino acids have also been found to reduce symptoms, as they are converted to neurotransmitters which in turn alleviate depression and other mental health problems.25

According to a study reported in Neuropsychobiology,34 supplementation of nine vitamins, 10 times in excess of normal recommended dietary allowance (RDA) for 1 year improved mood in both men and women.

Common nutrients that impact mood include:

  • Tryptophan: is an amino acid that converts to serotonin with the aid of vitamin B626
  • Tyrosine: is the precursor to dopamine and norepinephrine. Dietary supplements that contain tyrosine and/or phenylalanine promote alertness and arousal. 27
  • Phenylalanine: converts to tyrosine and then to dopamine and norepinephrine27
  • Methionine: combines with adenosine triphosphate (ATP) to produce S-adenosylmethionine (SAM), which facilitates the production of neurotransmitters in the brain.28-31
  • Omega-3 Fatty Acids: The two omega-3 fatty acids, eicosapentaenoic acid (EPA) which the body converts into docosahexanoic acid (DHA), found in fish oil, have been found to elicit antidepressant effects in human.32 In depressed patients, daily consumption of dietary supplements of omega-3 fatty acid that contain 1.5-2 g of EPA has been shown to stimulate mood elevation.33
  • B Complex Vitamins: According to a study reported in Neuropsychobiology,34 supplementation of nine vitamins, 10 times in excess of normal recommended dietary allowance (RDA) for 1 year improved mood in both men and women. The interesting part was that these changes in mood after a year occurred even though the blood status of nine vitamins reached a plateau after 3 months. This mood improvement was particularly associated with improved vitamin B2 and B6 status. In women, baseline vitamin B1 status was linked with poor mood and an improvement in the same after 3 months was associated with improved mood.
  • Vitamin B12 and Folate: It has been observed that patients with depression have blood folate levels, which are, on an average, 25% lower than healthy controls.35 Randomized, controlled trials that involve folate and vitamin B12 suggest that patients treated with 0.8 mg of folic acid/day or 0.4 mg of vitamin B12/day will exhibit decreased depression symptoms.36,37
  • Calcium: A recent study showed that selective serotonin uptake inhibitors (SSRIs) inhibit absorption of calcium into bones.38 In addition to this, the SSRIs can also lower blood pressure in people, resulting in falls which may lead to broken bones.38
  • Magnesium: The results of several case studies where patients were treated with 125-300 mg of magnesium (as glycinate or taurinate) with each meal and at bedtime led to rapid recovery from major depression in < 7 days for most of the patients. 39
  • Chromium: Many studies on the association of chromium in humans depression have been recorded which indicate the significance of this micronutrient in mental health.40,41
  • Iodine: Iodine is critical to mental and thyroid health. The iodine provided by the thyroid hormone ensures the energy metabolism of brain cells.
  • Iron: Iron is necessary for oxygenation, to produce energy, and for the synthesis of neurotransmitters and myelin. It is vital to mood health as deficiencies are known to cause fatigue, depression and rapid fatigue when exercise.42 Testing for anemia can be tested for in a basic blood test called a complete blood count (CBC) or it is included in nutrient panels.
  • Lithium: The therapeutic use of Lithium may support depression, scizoaffective disorder, aggression, impulse control disorder, eating disorders, ADDs, and in certain subsets of alcoholism with professional prescription. 43
  • Selenium: Deficiencies of selenium are associated with low mood.44 In a large review, Dr. David Benton of the university of Wales identified at least five studies, which indicate that low selenium intake is associated with lowered mood status.45[Intervention studies with selenium with other patient populations reveal that selenium improves mood and diminishes anxiety.46,47
  • Zinc: Multiple studies have shown that zinc levels are lower in those with clinical depression.48 Furthermore, intervention research shows that oral zinc can influence the effectiveness of antidepressant therapy.49 Zinc also protects the brain cells against the potential damage caused by free radicals.

The three main nutrient tests used at Revivelife include:

  • Micronutrients 1 – A blood test that assesses 16 key nutrient markers (A, B1, B6, B12, C, D, E, Calcium, Chloride, Copper, Ferritin, Folate, Potassium, Sodium, Magnesium, Zinc). If you have fatigue, shortness of breath, take medications, wonder if you are missing nutrients or if the supplements you are taking are the right ones, consider nutrient testing. Elite Athlete Add On is Available: Iron, CK, K, Alkaline Phosphatase, BUN Creatinine, Bilirubin. This test may be recommended for fertility, pregnancy, children, athletes, longevity, overall health and anyone who wishes to review their nutrient status.
  • Micronutrients 2 – An advanced blood test for measuring 31 key vitamins, minerals, antioxidants, amino/fatty acids and metabolites (A, B1, B2, B3, B5, B6, B12, biotin, folate, C, D, K, Calcium, Copper, Magnesium, Manganese, Zinc, Asparagine, Glutamine, Serine, Oleic Acid, Alpha Lipoic Acid, CoQ10, Cysteine, Glutathione, Selenium, E, Chromium, Choline, Inositol, Carnitine, Carbohydrate Metabolism, Immunidex, Spectrox) within an individual’s white blood cells (lymphocytes) for a more accurate representation of what is bioavailable over an extended period of time to the body. It is the gold standard for this type of test. This test may be recommended for the most comprehensive approach to nutrient status which is vital for competitive athletic performance, longevity, and overall health.
  • Fatty Acids – This blood test is an assessment of fatty acids to determine the right balance of these vital nutrients for your optimal health. Tests for the following markers: Fatty Acids Profile, Free (serum), Total Omega-3, Total Omega-6, EPA+DHA, OM3/OM6 Ratio, OM6/OM3 Ratio, AA/EPA Ratio. This may be recommended if you have inflammatory and or nutrient concerns.

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