Allergy, Depression and Tricyclic Antidepressants A. Hoffer, M.D., Ph.D.1 INTRODUCTION causes a variety of symptoms of which mood Psychiatrists have been very reluctant to disorder is one. The patient with asthma is not accept the idea that depressions, which they depressed because it is hard to breathe—the know so well, may be caused by allergies to depression and the difficulty in breathing are common environmental molecules such as both expressions of an allergic reaction to one foods, airborne particles, and chemicals in or more foreign types of molecules. water. When patients were depressed and Many years ago allergists recognized that it anxious, and at the same time suffered from was possible to be allergic to foods as well as diseases accepted as allergic, psychosomatic to pollens or dusts, and described the mood explanations were used. This usually meant symptoms which were also present. The that a psychological explanation for the depression and anxiety was recognized as a presence of the allergic reactions was invoked. reaction to the allergen, but prime emphasis The mood disorder was looked upon as a was given to the non-psychiatric symptoms. natural reaction to the discomfort of the Clinical allergists who are now practicing allergic reaction. Asthma for a long time was clinical ecology went one step further when one of the seven major psychosomatic they recognized that allergic reactions could diseases. Most psychiatrists still believe cause depression and anxiety as the main schizophrenic patients can not be allergic, at symptom with minimal somatic reactions. least not when they are ill, but it was accepted Dr. T. Randolph (1961, 1966) observed a that schizophrenia and allergic reactions could large number of allergic depressions. Manic- alternate. depressive psychosis, in his opinion, is a A few physicians have concluded that al- cyclical reaction to a number of allergens lergic reactions are much more common than ranging from foods to airborne pollutants. But one would assume from the psychiatric psychiatrists are unaware of the contributions literature, and that the allergic reaction made by clinical ecologists such as Randolph (1965), Mandell and Scanlon (1979), and reject the observations of clinical 3-A 2727 Quadra St. Victoria, B.C. Canada V8T4E5 164 ALLERGY AND DEPRESSION psychiatric ecologists such as Newbold (1975) years of somatic allergies. As children they and Philpott (1974, 1979) as well as Sheinkin, had eczema or rashes, frequent upper Schacter and Hutton (1979). respiratory problems, and asthma or hayfever. In this communication I will summarize the Most were aware of these symptoms which evidence which supports the conclusion that a had been treated by their physicians but none large fraction of depressions are responses to associated the history of allergic reactions environmental molecules, and that the with their current mood disorder. I checked tricyclics are effective in many patients this with a colleague who was known as a because of their antihistaminic properties, not specialist in depression but who did not because they act upon the serotonin or practice Orthomolecular psychiatry. He too sympathomimetic amine pathways. was amazed at the high incidence of somatic allergies in his depressed patients. The association is so high that any psychiatrists DEPRESSION IS A SYMPTOM OF will corroborate it in a few months of obser- ALLERGIC REACTIONS vation. All that is required is to include aller- gies in the history of the patient. Most patients with somatic symptoms of Allergic reactions may become addictive allergy have a mood disorder, usually reactions. This is the basis for the craving for depression and anxiety. I can not recall a sugar, alcohol, and even for foods such as patient with asthma, with a severe allergic milk or meat. The most accurate way of itch, or suffering from hives, who was happy. diagnosing a food allergy is to deprive the They all had depression and anxiety ranging patient of food for a number of days; usually from slight to very severe. Psychosomatic four but sometimes many more are required. explanations have a long and honorable This is done by fasting the patients or placing history but are no more firmly established them upon a diet of foods that they have used today than they were when they were so very rarely (Mandell, 1979). Deprivation of popular thirty years ago. They have no the food until all traces are gone from the predictive value, do not indicate treatment, gastrointestinal tract will result in a reduction and no patient is better because of them. The of all symptoms or in their complete removal. fact that it makes sense that depression should Patients who have food allergies often feel be a response to the somatic symptoms does normal toward the latter part of the fast. When not make this true. I fasted four days about six years ago I Clinical ecologists who had little interest in expected to feel hungry and irritable the whole psychiatry described depression as a common four days. For two years I had suffered from a problem in allergic reactions. Rowe and Rowe chronic cold and difficulty in breathing. I was (1972), pioneers in establishing food unaware I had an allergy and fasted for other deprivation tests to locate foods which were reasons; to my surprise I was euphoric the being reacted to, wrote that symptoms include fourth day and my cold was gone. I "lack of energy and ambition, drowsiness, subsequently discovered I was allergic to milk loginess, depression, inability to think and products. concentrate. Temper tantrums and emotional instability may be present." The first part of the fast is generally un- I became interested in the relation of aller- pleasant; there is a withdrawal reaction like gies to depression about ten years ago. I also that suffered by a heavy smoker when observed that patients who were found to be smoking is stopped abruptly, or like 'cold- allergic usually were depressed. A psychiatrist turkey heroin withdrawal of which the addict who neglected to take a history of allergic is so fearful. During these few days, patients reactions would have diagnosed them as a miss the repeated stimulus of the foods they mood disorder. Later I observed that over half normally eat to which they are allergic; in a of all the patients who were referred to me few patients the withdrawal from these foods because they were depressed, and who were in has been very severe. One of my patients fact depressed, had a history going back many consumed twelve glasses of 165 ORTHOMOLECULAR PSYCHIATRY, VOLUME 9, NUMBER 3, 1980, Pp. 164-170 milk each day-it kept her going. I was then cigarette smoking. inexperienced in the technique and results of Subjects who are free of depression will note food deprivation and I advised her to dis- a sudden resurgence when they eat those foods continue milk immediately. Within five days they have been avoiding either by accident or she was in a deep psychotic depression and I deliberately. I have found that January tends to had to admit her to hospital to protect her from bring back a large number of my patients who killing herself. Since then I have withdrawn were well but who gave way to the holiday patients slowly, over a period of a month, if foods so abundant in December, primarily they consume large quantities of any foods. junk foods or food artifacts. The consumption of large quantities of food— I have referred to a number of associations bread, pastry, sugar—is a clear indication to which support the contention many depres- suspect these foods as one of the causes of sions are symptoms of allergic reactions. depression and anxiety. 1. Clinical ecologists observed a high Withdrawal depression will also account for incidence of depression in their allergic the diurnal rhythm of depression. Most patients. illnesses are made worse by fatigue; schizo- 2. I observed that a large proportion of phrenia and physical illnesses tend to become depressed patients had earlier in life worse in the evening as patients become more suffered from a variety of somatic allergies. tired. Depression, in sharp contrast, tends to 3. Removal of offending foods or other become better at night. It is common for molecules resulted in relief from depressed persons to feel awful in the depression. morning; they are tired, anxious and 4. The typical diurnal pattern of deep de- depressed. As the day continues they gradually pression in the morning and relief in the feel better; after supper they often feel almost evening can be explained by the overnight normal. What likely happens is this: in the withdrawal from foods one is allergic to. morning the patients are suffering from 5. Depression is common following exposure withdrawal, having had no food for 12 hours to allergic foods and may come on within a or so; during the day foods to which they are few minutes. allergic are consumed, and by evening there is no further withdrawal reaction. Each day the THE TRICYCLIC ANTIDEPRESSANTS cycle is repeated. Treatment of the allergy will, in most cases, The tricyclic antidepressants are third gen- "cure" the depression. I have seen this in eration antihistamines. The discovery of the several hundred patients over the past six antihistamines was followed by their use as years and can no longer doubt this conclusion. tranquilizers. Dr. H. Laborit (Caldwell, 1970) About six years ago a chronic psychotic was looking for a centrally active sedative. As depressive patient was referred; he had been a direct result of his interest chlorpro-mazine deeply depressed for four years. During that was given to the first patient January 19, 1952. time he had failed to respond to a series of It is curious that our first use of large doses of ECT in a psychiatric ward.