Is it really treatment-resistant depression? Parasympathetic and sympathetic dysfunction as a treatable contributor to depressive symptoms

Depressive disorders (DSM-5) and disorders having depression-laden symptoms (e.g., bipolar disorder) often include several physiologic symptoms that involve the parasympathetic and sympathetic nervous systems (P&S). At least two P&S disorders are associated with these symptoms: 1) alpha-sympathetic withdrawal (SW), and 2) parasympathetic excess (PE). Both involve poor cerebral perfusion (PCP), which is known to contribute to depression-like symptoms. P&S function was assessed noninvasively using the Physio PS (Atlanta, GA) software (ANX 4.0 P&S Monitor). Patients diagnosed with autonomic dysfunction, including those with depression or depression-like symptoms, were followed with more than one assessment over six years. Patients reported an average of 23.2/28 autonomic symptoms at baseline, including fatigue, brain fog, lightheadedness (syncope/pre-syncope), headache/migraine, sleep difficulties, memory/cognitive difficulties, sensory disorders, upper or lower GI upset, rashes or hives. Interventions included prescription-grade or nonprescription-grade interventions. Relieving P&S dysfunction resulted in relief of depression or depression-like symptoms in 95% of the subjects. Patients reported an average of 5.2/28 at final follow-up, with 33% achieving up to three symptoms. P&S guided therapy was associated with improved patient outcomes and quality of life, reduced risk of suicide, reduced healthcare costs, and aided the psychiatrist in focusing on the etiology of the remaining “depressive” symptoms.