From "Dr. Atkins' Nutrition Breakthrough" by Robert Atkins, M.D.:

Chapter 10

   Depression can manifest itself in a myriad of symptoms.  A depressed
patient usually suffers from more than one of what has become known as
"the constellation of depressive symptoms." Most clinically depressed
patients suffer both from an inablility to enjoy anything (anhedonia) and
from some form of sleep disorder, whether too little or too much sleep. 
Some patients feel tired all the time and complain of vague aches and
pains.  Others develop specific pains or a mildly agitated feeling. 
Constipation, reduced sex drive, gastrointestinal complaints, avoidnace of
social functions, withdrawal, feelings of hopelessness, helplessness, and
inadequacy are all symptoms, too.  It's rare to see a depressed patient
without some combination of these symptoms. 

Depression May Feel Like a Physical Illness

One of the most interesting facets of clinical depression is that most
depressed patients don't recognize that they are, in fact, depressed. This
may lead to their embarking upon an endless medical search for both the
cause of their symptoms and relief from them. 
   This search may be especially fruitless and confusing to both doctor and 
patient, because the physical symptoms are real and because symptomatic relief 
may provide some temporary help, though it will not get at the real cause.
Even a very knowledgeable diagnostician may fail to identify depression as the 
primary problem after he has ruled out the more obvious physical maladies upon 
which the symptoms could be blamed.

Fay Smith was one of those "hopeless" patients who was sure she was going to 
die of her mitral valve prolapse a usually benign heart condition; 
or her fatigue, weakness, or chest pain. After years of seeing 
cardiologists who prescribed propanolol and other heart medicines, 
psychiatrists who prescribed tranquilizers, and this nutrition doctor who
prescribed my standard vitamins and diet, she finally blurted out to me, "I'm 
so depressed."
   I reacted immediately by increasing her intake of niacinamide, tryptophan, 
and pyridoxine to much higher levels, and within two days the entire syndrome 
began to clear. In a few pages I will explain how this happened.
   Whatever its manifestations, from clinical depression to just feeling
low, depression is a culture-wide illness of devastating proportions. It
accounts for many visits to physicians' offices and many more days lost
from employment.  It may be at the root of marital difficulties, of kids'
failure to do well in school, and of on-the job problems. 

Treatment of Depression Has Changed with the Times

Generations ago, doctors had no choice but to wait out depression. In the 
1930s, amphetamines ("pep pills") were touted as the answer to depression. Now 
we all know better.
   Then along came electroconvulsive therapy (ECT), popularly known as shock 
treatment, for more severe cases. Although this frightening technique has been 
refined to the point where it maybe beneficial in some cases, I would limit 
its use only to the most severe depressions and only as a last resort.
   The 1950s psychopharmacology boom produced a class of drugs known as 
monoamine oxidase inhibitors, or MAOls, including isocarboxazid (Marplan), 
phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate). These drugs 
seemed to be tremendously effective against depression, except that they 
displayed certain sometimes disastrous drawbacks.

You Must Avoid Certain Foods When You Take MAOls

In the flrst place, the drugs did not mix with tyramine, a breakdown
product of the amino acid tyrosine.  Tyramine is notable for its presence
in putrefied foods such as aged cheese, beer, and wine, and in yeast, ripe
bananas, avocados, pickled herring, and chicken livers. In addition,
chocolate, excess caffeine, and a rather long list of foods and other
drugs may also cause reactions. 
	Unfortunately, when a patient taking an MAOI ingested a food containing 
tyramine, significant elevations in blood pressure often occurred. Sometimes 
this would be accompanied by blinding headache and might be followed by a 
fatal intracerebral hemorrhage. Other side effects of MAOIs include dizziness 
upon getting up from a sitting or reclining position (orthostatic hypotension) 
which has caused some patients to fall, and resulted in disturbances in heart 
rate and alpha-rhythm in others. Also constipation, headache, overactivity,
hyperreflexia, tremors and muscle twitching, mania and mania like states, 
jitteriness, confusion and memory problems, insomnia, peripheral edema, 
weakness, fatigue, dry mouth, blurred vision, anorexia, gastrointestinal 
disturbances, excessive sweating, and skin sensitivity reactions which show
up as rashes. Less commonly occurring side effects include euphoria, blood 
cell changes, incontinence, sensitivity to light, sexual disturbances, and 
urinary retention, among others.
	To my patients who are inclined to be overweight, weight gain was a 
particularly distressing side effect.
 	MAOls are hardly agents with which to play games. Obviously, another
drug was needed. 

Enter tke Age of the Tricyclic Antidepressant (TCA)

When they were first introduced, the pharmaceutical industry proclaimed 
tricyclic antidepressants safe and effective.* In point of fact, the 
tricyclics fulfilled the wildest dreams of the medical orthodoxy: a seemingly 
safe, seemingly effective pill to combat depression.
	But how safe are tricyclics really?
	Reports of side effects and adverse reactions have included
reduced blood pressure, hypertension, tachycardia, palpitations,
arrhythmias, confusion, disturbed concentration, disorientation. Dry mouth
and blurred vision are quite common, as are increased pressure wiithin the
eye, constipation, urinary retention, and increase or decrease of sex
	Quite a list for a "safe and effective" new agent!
	Tricyclics include: doxepin (Adapin, Sinequan), nortriptyline
(Aventyl, Pamelor), amitriptyline (Elavil, Endep), imipramine (Imivate,
Tofranil, Presamine), desipramine (Norpramin, Pertofrane), and
protriptyline (Vivactyl). 
	But despite these possible reactions, tricyclic anti-depressants
have been hailed as substantially safer than MAOls. Taking them often
requires faith, since the side effects are usually felt within the first
few days, while the benefits may take several weeks to accrue. 
	And again, my patients experience weight gain on these drugs.
Many have come to me for overweight that began when they started to take 
tricyclic antidepressants. And I have followed several patients who had been 
doing well on my diet until they were prescribed tricyclic antidepressants 
while under the care of another doctor. All of them gained an average of ten
pounds in the first month without any cheating on their diets.  They all 
reported an absolutely frightening increase in their appetites and an 
insatiable craving for sweets and other carbohydrate-rich foods. This 
convinced me that tricyclics carry with them a very real risk of weight gain.
	Originally it was believed that the weight gain experienced by patients 
taking tricyclics was due toa resurgence of appetite following the clearing 
of depression.  But this has been disproven in part, and tricyclics are now 
known to cause weight gain unrelated to relief of depression. Rather, the 
weight gain seems to be the result of some metabolic side effect inherent in 
the drug's pharmacologic properties.
	I have since helped patients to lose weight and shed their
depression by taking them off TCAs and MAOls while showing them how to
accomplish the same thing nutritionally. 
	There are now on the market several combination drugs that include 
amitriptyline, some combining it with a "major tranquilizer," perphenazine 
(Etrafon, Triavil), and another with a "minor tranquilizer" or antianxiety 
agent, chlordiazepoxide (Limbitrol). The rationale for adding the tranquilizer 
is to help deal with the anxiety that so often accompanies depression. (By 
now you must know that if I think one drug is bad, then two must be worse!)
	Essentially, these drugs have about the same side effects as the
tricyclics alone, added to which are the potential side effects of the
tranquilizer tagalongs. 
	This is not to deny the fact that tricyclic antidepressants do
work for many individuals. They work because they block the action of
norepinephrine, a neurotransmitter (i.e., a chemical involved in carrying
biochemical signals to and from the brain).  The drugs are slow to act and
relatively slow to be excreted.  Thus, if side effects develop, the
symptoms may take some days to abate after the drug has been discontinued. 

Many confuse the antianxiety agents (see page 79) with antidepressants. But 
they are different in that they affect different neurotransmitters. Neither 
class of drug as it stands today is an "upper," and neither works in all 
patients all of the time.
	I have other ideas about treating depression.

If Drugs Are Out, What Is In

The blood sugar control diet is the cornerstone of the therapy I recommend for 
my patients. Why? Because it succeeds and because a majority of my depressed 
patients show unstable glucose tolerance curves.
	One patient told me, "l feel as though I just got off an emotional
seesaw," after being on a low-carbohydrate diet and vitamin-with-mineral
regimen for just one week. And this patient was no stranger to psychiatry,
either. She had been in supportive therapy, analysis, drug therapy, and
the like. But her first real breakthrough came during her first week of
carbohydrate restriction. 

Nutrients Are Helpful, Too

During the years I have been treating depressed patients and following the
nutritional literature, I have found that certain nutrients inparticular
are of benefit in treating depression. These include l) vitamin B6, 2)
vitamin B3 (niacin or niacinamide), 3) tryptophan, 4) zinc, 5) manganese,
6) vitamin Bl2 7) folic acid, 8) vitamin Bl5 9) pantothenic acid, and
sometimes 10) thyroid. (Although thyroid is a hormone and not, strictly
speaking, a nutrient, it is a substance normally found in the body and as
such falls within the purview of orthomolecular medicine.)
	With these nutritional aids, I have been able to devise a protocol
for my depressed patients. 
	It starts with blood sugar control, along with the basic
vitamin-and-mineral formula which you'll find on page 322. 
	I do a hair analysis to check for copper elevation and zinc/manganese 
deficiency. Dr. Carl Pfeiffer was the first to point out that the most common 
mineral imbalance among the clinically depressed was high levels of copper and 
low levels of zinc and manganese. Further, administration of zinc and 
manganese along with vitamin B6 in significant doses leads to excretion of 
copper in the urine and thus lowers blood copper levels. This lower blood 
level will ultimatety be reflected in the hair analysis.
	With the copper/zinc problem in mind, I add chelated zinc to the
basic formula to bring the daily total to 150 mg per day (this is an extra
100 mg or so) and another 50 mg of manganese beyond the basic formula.
Then, I give 500-1500 mg vitamin B6 because it helps restore the
zinc/copper balance. 
	I base the B6 dosage on whether or not the patient remembers their
dreams. For example, if a patient remembers only one or two dreams per
week (even a fragment of a dream will do), I start with 1000 mg (1 gram)
of B6 in addition to what's in the basic formula. But if, on the otherhand
there's less dream recall, I may start with 1500 mg. For those patients
who remember more, I may start out with only the 200 mg in the basic
formula and increase the dosage gradually if it seems necessary. 
	Pyridoxine (vitamin B6) has been used quite successfully in
treating the depression that is so common among women who are on The Pill.
Half of them responded to B6 with a dramatic lifting of the depression. 
	Folic acid is another essential nutrient for treating depression. 
I usually give 10 mg, including what is in the basic formula. It is
important to note, however, that some people are of a biochemical type
characterized by a high level of histamine in the blood.  (Histamine is
the body chemical that is responsible for dilation and increased
permeability of blood vessels, and plays a major role in allergic
reactions.) The histamine level of such people would be made worse by
folic acid. So you must evaluate your response carefully. 
	Usually, if the depression is a mild one, I send my patient home
with the above regimen and when they come in a week later I ask if there
has been any improvement in mood. 

Tryptophan for Depression

If, in my judgment, further treatment is necessary, I prescribe tryptophan and 
niacinamide in a ratio of approximately 2:1.  I usually start with 1-2 grams 
and increase to 2-8 grams of tryptophan daily in divided doses with the 
greatest portion given at bedtime.
	Dr. Guy Chouinard and his associates at McGill University in
Montreal recognized that the life-span of tryptophan can be prolonged by
administering niacinamide along with it. They devised a program in which
depressed patients newly admitted to their hospital were started on small
doses of tryptophan and niacinamide and built up to an ideal dosage of 4
grams of the former and 1 gram of the latter. (I prefer the 2:1 ratio to
take advantage of the fact that niacinamide has an antidepressant effect
of its own.  The study confirmed that the tryptophan- niacinamide
combination at optimum dosage was at least as active as imipramine, a
tricyclic antidepressant, alone. The advantage of the niacinamide was that
the amount of tryptophan could be reduced by one third. 
	Some patients respond dramatically to Bl5, though I am not as yet quite 
certain what mechanism is operating here.
	And some have responded to rutin (one of the full spectrum
constituents of the vitamin C complex) while many have had great results
on injections of vitamin Bl2, which I usually administer along with folic
	The B12 injections are very quick-acting, and my patients are able
to report how they reacted on the very next visit. Some patients tell me
that the shot made no difference at all, while others say the results were
	When the injections do the trick, I add vitamins Bl2 and folic
acid in tablet form to the basic formula and supplemental nutrients.
Further, I try to ascertain when the effect of the shot wears off so as to
give injections as often as necessary to avoid a let down. Some patients
need them as often as every day, and others no more than every month or
	When B vitamins such as B6 and niacinamide (B3) are given, it is
usually necessary to administer other members of the B complex to maintain
balance.  Thiamine (B1), pantothenic acid, and vitamin C are all important
and may have antidepressant effects of their own. (See Vitamins at a
Glance, p. 325, for Anti-Depressant formula.)

Tkyroid as an Anti-Depressant

Sometimes depression may be the manifestation of an otherwise "silent" 
sluggish thyroid. The answer, in addition to proper nutrition, may be the 
use of thyroid hormone, or perhaps kelp to provide iodine for thyroid function.
	One patient of mine, Marjorie Knox, was a real problem case until
we finally tried thyroid. 
	When Marjorie came to me, she complained of doing everything at a
snail's pace" and "being unable to get anything together." She had dropped
out of architectural school because she didn't have the energy to keep
going and complained that her mornings were the worst--typical in clinical
depression.  Although she did have a few good hours in the late afternoon,
these just were not enough to make up for the rest of the day. Marjorie,
who had lifelong acne, also had crying spells and lived on a cola and
candy bar diet. 
	She had been to a chiropractor who had told her she had
hypoglycemia, but the diet he gave her wasn't strict enough. So she then
tried the Atkins Diet from one of my previous books. 
	Suicidal, depressed, and extremely cold-intolerant, Marjorie told
me she wanted to "become a person again. "
	Marjorie's glucose tolerance test showed a fasting blood sugar of
104, with a rise to 177 at half an hour and a low of 88 in the fourth
hour. The test was virtually normal, although she spilled sugar in her
urine. Because she wasn't overweight, I put her on the Meat and Millet
Diet and supplemented the basic vitamin formula with 100 mg of B6, 150 mg
Bl5, 3 mg folic acid, and 1000 mg PABA. I also added 800 units of vitamin
	I was a little disappointed when at the end of the first week Marjorie 
reported that she was no better.
	So I added 1500 mg of vitamin Bl and suggested a little patience.
	There was no change in the second week, except that her skin had
cleared up, and I then suggested that Marjorie take her basal temperature
(in the armpit first thing in the morning). I also had my nurse draw blood
for a thyroid function test. 
	The next week she still felt no better, and the lab results were back. 
Marjorie's thyroid was borderline low only for one thyroid hormone and well 
within normal limits for the other.
	Her basal body temperature had averaged about 96.3, which is low (in my 
experience, 97.8 is an average reading).
	At this point, I reviewed Marjorie's chart very carefully and noted her
extreme intolerance to cold. This was the final tip off.  Perhaps the cold
intolerance and low basal temperature were the key to Marjorie's problem.
 	Sometimes the only way to be sure about the need for thyroid is by
therapeutic trial--give it and evaluate the result. By the time the basal
body/temperature has risen .4 degrees, we can assume that a significant
dose level has been achieved and can, at that point, evaluate its merit. 
 	I wrote Marjorie a prescription for supplemental thyroid hormone as a
therapeutic trial, just a small dose which could be increased gradually if
 	On her return visit the following week, a different person came into my
offlce. Marjorie reported that about three days after starting the thyroid
supplement she began to feel better. 
	And after six days she had begun to feel that she could put the
pieces of her life back together. Which she did. Marjorie has now returned
to school, is studying architecture, and has not been plagued a bit by her
old depressive symptoms. 
	In Marjorie's case, as in so many I have observed I found again
that medical practice is supplemented by good laboratory studies but must,
in the flnal analysis, often rely upon the doctor's better intuitions. 

High-School Teacher Plays Truant

Another depressed patient of mine, Harold True, came to me when he was thirty
two years old and feeling like an old man. He was a high-school drama teacher 
and simply could not find the energy to coach his classes.
	He described himself as "incredibly depressed." He said, "I am a
zombie. I'm unable to show up for work sometimes. Recently I told my
class, 'You may see me, but I'm really absent!' "
 	He was having great difficulty just dragging his body out of bed in the
morning. When he finally did manage to get up, he always felt fatigued and
often experienced nausea and headache. After reporting this he made a
feeble attempt at humor "At least I know my nausea and headache aren't due
to pregnancy. But the bad side is that what I've got has lasted more than
six months."
 	Harold's first GTT (not done in my offlce) had been unremarkable, but
that may be because he had only a three-hour GTT and a flve or six-hour
test is usually required. He was told he had "border-line hypoglycemia"
and was given the American Diabetic Association's diet, a plain balanced
diet.  And of course Harold didn't get any better. He had not given up
there, though. He went to a second physician, a topflight professor at a
major medical school and teaching hospital. When his nurse looked at
Harold's GTT she told him,"I see you have hypoglycemia, but you won't get
any help here. The doctor just doesn't believe in it."
	Harold left that office with no help at hand.
	The astonishing thing about Harold's encounters with the medical
profession thus far was that no one had asked about his eating habits and
no one had prescribed vitamins or a really modified diet. 
	When I received Harold's history, one of the first things evident
was that Harold had virtually every hypoglycemic and depressive symptom in
the book. He had nightmares too. In fact, the only dreams he was able to
recall were nightmares, to the point where he dreaded going to sleep. 
	Since Harold's weight was only 147 and he is five feet nine inches
tall, I put him on the Meat and Millet diet, in which he was allowed
unlimited vegetables. He also received the usual vitamin formula, with
1500 mg of B6, 6 mg folic acid, 3 grams tryptophan, and 1 gram of
pantothenic acid to supplement *. On top of that he received an injection
of folic acid, vitamin B6, and vitamin Bl2. 

Harold's Return Visit

The second time I saw Harold, he looked a little better and said he felt 
only 80 percent as awful as before. He had all the same problems but a 
"little less so." He received another injection, and was advised to supplement 
his nutritional regimen with 60 mg of zinc and 1500 of niacinamide.
	Two weeks later Harold was only 'sixty percent as awful.'
	Thus, although I was elated by his 40 percent improvement in only
three weeks, I added 300 mg of Bl5 to his regimen and another vitamin
injection. Just two weeks later he reported, "Man, this is pretty
terrific. I only feel twenty five percent as awful as I did when I first
walked in here." He commented that the Bl5 had "done a real number on my
energy levels."
	At this point, Harold's nightmares became much less frequent and
he began to remember dreams. 
	A month later Harold came back and said, "I feel normal, 100%
better!". There were no signs of depression that I could see, and Harold
reported once again loohng forward to going to school and meeting the
challenge of converting would-be thespians into accomplished young
	If I had a conjecture about the nutritional precursors of
depression, I would identify them as the Modern Coke and CandyBar Diet. I
feel that I can say this with impunity because so many of my depressed
patients seem to survive on just this lethal combination. 

Cynthia's Depression

Although l treat many depressed patients, Cynthia Gill is remarkable for 
her history. At twenty-eight years old, she stood five feet eight and weighed 
in at a whopping 228 pounds. She had been on a major tranquilizer (sometimes 
used to treat depression, anxiety, and psychosis) for eleven years and told me 
she had been "constantly ill" for the past eleven months. When Cynthia was 
eleven, she had mononucleosis complicated by coma and encephalitis. During 
her recovery she gained fifty pounds, and by the time she was fourteen, she 
weighed 185. She had never been below that since. She also had anxiety attacks, 
lost hair by the handful, suffered from severe, blinding headaches, and felt 
run-down when she stayed away from milk and oranges.
	Her father was an alcoholic, her mother diabetic, and this led me
to think of a family history of carbohydrate intolerance. 
	Her thyroid was a bit low. She'd had four pregnancies, with three
miscarriages and one surviving child who weighed ten pounds thirteen
ounces at birth. That made me think of Cynthia as prediabetic, at the very
	Sure enough, her blood sugar was 142--in the diabetic range--and
her hair analysis showed that she was low in zinc, high in copper. The
usual ratio of zinc to copper is 8:1; hers was 1.4:1. 
	It appeared to me that Cynthia had adequate cause for depression,
and it wasn't something that could be cured by talking and listening. 
	Cynthia's regimen started with a no-carbohydrate diet, 3 mg folic
acid, 1-2 grams pantothenic acid, 1 gram B6, 3-4 grams inositol, and three
kelp tablets, plus the basic vitamin/mineral formula. 
	During the first week she lost eight pounds, and over the first
six weeks twenty-two pounds. Her diet seemed to help a bit, as did the
vitamins and minerals, but she really didn't make much progress for a
	Tben I added chelated zinc to her diet and 2 grams of tryptophan.
Carefully watching her serum blood zinc levels, we awaited results. 
	The improvement took place week by week, but the progress was not
unbroken.  As her condition improved she experimented with forbidden
foods. Whenever she went off her diet her hair started falling out again.
But over a period of time she learned to stay on her diet, took the folic
acid, B6, Bl2 shots, added Bl5 and PABA to her regimen. She didn't really
shed the exhaustion and nightmares, however, until 1500 mg of niacinamide
was added. 
	These three case histories demonstrate that there are many keys to
the nutritional management of the depressed patient. Note that all our
agents helped a little, but in each case it was a different natural
substance that turned away the darkness. 
	I believe that nutritional medicine can relieve depression a full
85 percent of the time, yet there is probably no single nutrient that
would perform much better than a good placebo, particularly if the test
was designed by someone trying to prove nutrition therapy invalid. 
	These cases and hundreds of others from my files show that the
real secret lies in understanding the teamwork of the nutrients and the
biochemical individuality of response.