Lecture Video and Power Point Notes for New Approaches To Disconnecting The Inflammation-Depression Connection, Kuala Lumpur, Malaysia, April 27 – 29, 2012


Depression ICD-9 296.3 

You may have seen all the media on ABC, CBS, NBC, CNN, FOX, The Today Show, and many others about how Wiggle front man, Anthony Field, one of many celebrities with depression and feelings of depression, that was handicapped by chronic pain, chronic fatigue, misdiagnosed fibromyalgia and clinical depressive disorder during his 20 years on the road.

Watch Anthony Field’s interviews on CNN and The Today Show where he discusses the inflammation-depression connection approach;


CNN Shanon Cook Interviews Anthony Field, a celebrity with (signs of depression) who had what he called a mental breakdown but not a nervous breakdown.  He healed himself by disconnecting the Inflammation-Depression Connection, one of the theories of depression Dr Stoxen mentions in this article and presentation. click here


THE TODAY SHOW! Anthony Field Shares How an All Natural Approach helped him discover the cause of depression, symptoms of depression and the cure for his agitated depression click here


Depression represents a major public health problem. It is estimated that up to 16 – 20% of the population has had an incidence of depression at any one time and that 5 to 7% of the population is assumed to suffer from major depression. (thats a lot of depressed people)Studies have also shown that there is a correlation between chronic depression and the development of Alzheimer’s, Parkinson’ and dementia in later life.

“There is substantial literature linking inflammation with the risk for depression. The purpose of my presentation is to list the inflammatory mediators and their link to depression. Patients with inflammatory disorders such as musculoskelital disorders, cardiovascular disorders, rheumatoid arthritis and osteoarthritis can be expressed with an increase inflammatory cytokine expression.  

The development of concurrent psychiatric symptoms were initially observed after administration of cytokine therapy to patients afflicted with cancer hepatitis and MS.”

-Dr. James Stoxen DC

It has been found that patients who are affected by depression or have a history of depression have high levels of inflammatory biomarkers. This suggests that inflammation can be a mediator for depression or what depression can lead to.

The purpose of this presentation is to review these studies and determine their potential to lead to interventions and to find a depression solution which may reduce the risks for inflammatory diseases of aging such as osteoarthritis cardiovascular disease and symptoms related to varying degrees of levels of depression.

Aging is also associated with increased likelihood of chronic pain and inflammatory conditions. A part despite improving knowledge is an underlying mechanisms of chronic pain.  Many patients who have chronic pain receive inadequate care both short-term and long-term. In this lecture I discuss some novel ways to reduce chronic pain, chronic inflammation and reducing overall inflammation and possibly reducing the risk of the development and exacerbation of chronic depression.

I also discusses the treatments, which may help reduce being depressed. There has been no drop in depression rates as currently antidepressants only a small drop in depression, remission in 30% of patients. Part of the problem is that the pathophysiology of depression has not been well understood and treatments are based on empirical data and not on the mechanisms or causes of action. Many research studies suggest that addressing pro-inflammatory cytokine production represents a possible strategy to treat depression besides the use of psychotropic drugs.

(What is Depression)?

Depression is a mood disorder that is linked to the serotonin levels in the brain.

What chemical causes depression?

Serotonin levels are linked to the levels of inflammation or what doctors and scientists call cytokines.

Because of its physiological cause, many people believe that clinical depression must be cured through chemical intervention. Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders and some personality disorders.

In many cases, doctors only approach depression with selective serotonin re-uptake inhibitor drugs with the thought that the patient has depression and this is the drug for depression.  In this case, the patients tissues could be soaking in inflammation from many sources but this approach is not even discussed.  How do I know?  My patients tell me so.

Because there is a strong link between inflammation and depression doctors and patients should understand how inflammation fatigues patients and how effects the levels of serotonin.  Doctors should understand what causes higher than normal levels of inflammation, how to test for it and how to reduce it.  

By reducing inflammation as much as possible you could help lower the dosage of selective serotonin re-uptake inhibitor drugs or eventually get off them completely 

Drug Free Therapy for signs of depression might include:

  1. A healthy diet which plays an important part in healthy brain depression symptoms. Eating vitamin-rich foods balance out chemicals in the brain and provides a natural intervention for depression for some who experience severe depression syndromes. Avoiding complex sugars and too many carbohydrates, which lead to mood swings, helps stabilize emotions.
  2. Adding exercise cannot go overlooked as an important aspect of a drug-free depression treatmentTalk therapyCognitive behavioral therapy and interpersonal therapy are also very effective in overcoming chronic depression.
  3. Drug less depression treatments vary from person to person. However, herbal supplements and intervention have helped some patients.
  4. One of the most overlooked sources of inflammation is arthritic inflammation.  This kind of inflammation can be silent or frank inflammation.

One can have large amounts of inflammation in the body and not know it.Consulting with a knowledgeable specialist can help you make the right choice for your specific diagnosis and treatment plan.

The centerpiece of my approach is to explain the causes of inflammation and to defeat inflammation. I share the connection between inflammation and depression and ways to decrease the threat of diseases caused or fueled by inflammation, such as dsm iv depression.

I hope you can gain more insight into the connection between inflammation and depression.  Then, it is up to you as to how aggressive and what approaches you wish to take to have the best chance of reversing it.

Watch Below as Dr. Stoxen gives his lecture presentation, ‘New Approaches To Disconnecting The Inflammation-Depression Connection’, Kuala Lumpur, Malaysia, April 29, 2012

Dr Stoxen reviewed over 2000 of the latest scientific papers extensively before he did this presentation.

“If your depression is connected to inflammation, aggressively reducing inflammation may not provide  total relief  but it could help to reduce the dosage of antidepressants. This is especially true if the only remedy your doctor gives you are anti-depressants.”

“In my clinical opinion, besides talk therapy, the best natural treatment for depression involves attacking all sources of inflammation.”

Dr. James Stoxen DC

This includes:

Answering the question what is inflammation and what causes it as well as what is depression and what depression can cause;

  • Treating dietary inflammation with a healthy diet.
  • Reducing lung inflammation with a reduction in airborne particles.
  • Treatment may require reduction in other inflammation reducing activities like sunburn, gingivitis etc
  • Treating muscle and joint inflammation with treatment.

How do I ease depression, connected to dietary inflammation with a (anti depression diet?)

Following an anti depression diet by eating vitamin-rich foods balance out chemicals in the brain and provides a natural intervention for depression for some who experience severe depression syndromes. Avoiding complex sugars and too many carbohydrates, which lead to mood swings, helps stabilize emotions.

Drug less depression treatments vary from person to person. However, herbal supplements and intervention have helped some patients. Consulting with a knowledgeable pharmacist or herbal treatment specialist can help you make the right choice for your specific treatment plan.

How do I ease depression, connected to inflammation by getting examined for muscle pain,  joint inflammation and silent inflammation in the musculoskelatal system?

Read this article for more information:  Video Tutorial #37 Aches, Pains, Allergies, Fatigue, Brain Fog, Diseases of Aging Have One Common Thread… INFLAMMATION

How do I ease depression, connected to inflammation with healthy exercise?

Adding exercise cannot go overlooked as an important aspect of a drug-free depression treatment. Talk therapy, cognitive behavioral therapy and interpersonal therapy are also very effective in overcoming chronic depression.

There are many reasons why people get depressed one of the reasons someone might have feelings of depression is employment depression.

Stress, such as job loss, increases inflammation and inflammation is connected to depression.  

Because of the economic depression, many have lost their jobs leading to what I call unemployment depression.  It is depressing to lose your source of income.  When symptoms of stress increase inflammation this is what I call double depression which has led to a lot of depressed people.  If you have this kind of reactive depression or anxious depression, you need to pull yourself out of it so you don’t spiral into an alcoholic depression or start to show signs of a nervous breakdown.

Below is the lecture and power point notes used for Dr. Stoxen’s lecture to assist you in 
connecting The Inflammation-Depression Connection Approach:


  • Increasing 10% every decade since 1910.
  • The leading cause of disability in the United States.
  • The number of Americans taking antidepressant drugs doubled in the decade from 1996 to 2005, from 13.3 million to 27 million.
  • Today 10% of every man, woman and child in America takes an antidepressant or some drug.

“According to the CDA’s 2011 Long-Term Disability Claims Review11, the following are the leading causes of new disability claims in 2010:

  • Musculoskeletal/connective tissue disorders caused 27.5% of new claims. *
  • Cancer was the 2nd leading cause of new disability claims at 14.6%
  • Injuries and Poisoning caused 10.3% of new claims
  • Cardiovascular/circulatory disorders caused 9.1% of new claims
  • Mental disorders caused 9.1% of new claims.

Dr. James Stoxen DC

Olfson M, Marcus SC. National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry. 2009;66(8):848-856.

DSM Criterion for Major Depression

  • A period of at least two weeks during which there is either a depressed mood or the loss of interest or pleasure in nearly all activities.
  • In children and adolescents, the mood may be irritable rather than sad.
  • The individual must also experience at least four additional symptoms drawn from a list that includes changes in appetite or weight, sleep, psycho motor activity, decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions, or recurring thoughts of death or suicide, plans or attempts.
  • The episode must be accompanied by clinically significant distress or impairment in social, occupational, or important areas of functioning.
  • It’s normal for people to feel a range of moods.
  • It’s not realistic for people to be in a great mood all the time.


“I don’t know if you have any kids that might be irritable but when I look back in my teen years,  I know at times I was irritable for more than two to three weeks and looking at this criteria that doctors are using weather or not kids should be put on anti-depressants, it does not seem 100% accurate.”

“In my clinical opinion, after seeing many patients, it’s quite normal  for them to have an array of moods that are affecting them.  Especially if they are in chronic pain, chronic inflammation or they may have episode of stress in their life. Maybe they lost a loved one or they are dealing with a sick child or they are sick themselves. It’s not realistic for people to be in a good mood all of the time.”

“Your life doesn’t have to always be like a TV episode of ‘friends’. Where every week it’s fun and everyone is laughing. That is certainly not realistic. People that are addicted to television may compare their lives to those that are on TV.  The patient might just be having a bad day or a rough couple of weeks.”

“As doctors it’s important to evaluate if it is just a few bad days or weeks in a row or if there is a true biochemical abnormality. There may be other alternative therapy other than anti depressant medications that could help the patient.  

1.  “Psychotherapy and talk therapy can be very helpful to discover exactly what is happening with the patient.”

2.  “The next most important stage should be to evaluate what sources of inflammation the patient is exposed to and how much of the patients tissues are effected by this inflammation.” 

Dr. James Stoxen DC

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV).

Office Visit for Major Depression?

The doctor reviews tests conducted by the nurse and then spends less than 10 minutes with the patient.

“Is this your typical doctors visit?”

“Here’s something to help your cholesterol, something for your blood pressure, and for your depression, here is an antidepressant. You shouldn’t have too many side effects ,though you might experience a loss of sex drive, but we have another drug for that. Would you like me to add that to your prescriptions? Good luck and I’ll see you in three months when your prescriptions run out.”

“Certainly that is not how most of the people in this room practice nor do I but this is the reality we are dealing with in some doctors offices, today.”

Dr. James Stoxen DC

Cytokine-Induced or Sickness Syndrome

The administration of high concentration of pro-inflammatory cytokines often leads to a condition known as systemic inflammatory response syndrome (SIRS) 

“As doctors it would benefit our patients if we just asked ‘what is bothering you’, ‘what is troubling you’.  Perhaps show an interest and ask how they like their career. Ask them about their family. Try to show empathy. Try to encourage your patients to get out into nature or take up a hobby or sport and spend more time with their family, friends and pets.”

Dr. James Stoxen DC

Myers JS. Pro inflammatory cytokines and sickness behavior: implications for depression and cancer-related symptoms. Oncology nursing forum. 2008;35(5):802-807.

Inflammation and Depression Painful and Silent Arthritic Inflammation

  • After reviewing over 1,000 citations linking inflammation to depression we can make the assumption that inflammation is linked to and perhaps a leading cause of depression.
  • When our bodies release inflammation that leads to chronic pain, worry or have stress our bodies release low-grade inflammation.
  • When we have chronically high levels of inflammation, feel chronic pain, worry or have stress our bodies release comforting levels of serotonin to help us cope.
  • The body feels as if it is being attacked. We also have depression when we are unable to meet the demands or challenges of these attacks, leading to more stress.
  • Patients consciously and subconsciously feel hopelessly locked up by three conditions, inflammation, chronic pain and depression.

If you ever talk to someone that is depressed, many of them share that they feel like they have a cold all the time. They don’t feel like getting out of bed, they want to keep on sleeping.”  These are similar symptoms of patients who have inflammatory disorders.   

Dr. James Stoxen DC

Copeland W et al. Cumulative Depression Episodes Predict Later C-Reactive Protein Levels: A Prospective Analysis. Biological Psychiatry. 2012;71(1).



Finnish scientists found that stress-induced low-grade inflammation might be a link between unemployment and ill health.

Hintikka J et al. Unemployment and ill health: a connection through inflammation? BMC Public Health. 2009; 9:410.


Coronary Artery Disease

In a study of over 677 participants, 433 had no depressive symptoms, 86 had depressive symptoms at one assessment, and 138 had depressive symptoms at two or more annual assessments. Across all three groups, greater depressive symptoms were associated with higher subsequent levels of IL-6.

 This is a study where they found people with high levels of Interleukin 6 (IL-6), which is a pro-inflammatory cytokine which is also found elevated in patients with coronary artery disease and depression.

Dr. James Stoxen DC

Dulvis HE et al. Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study. Am J Psychiatry. 2011;168(9):913-20.


In experiments, mice subjected to the same particulate matter as that of a major city displayed more depressive-like responses and impairments in spatial learning and memory as compared with mice exposed to fresh air.

“If your living in a big city it might be adding additional amounts of inflammation from pollution.” 

Dr. James Stoxen DC

Fonken LK et al. Air pollution impairs cognition, provokes depressive-like behaviors and alters hippocampal cytokine expression and morphology. Mol Psychiatry. 2011;16(10):987-995


Cigarette Smoking

Lifelong cigarette smokers have a higher prevalence of common diseases such as atherosclerosis and COPD with significant systemic impact.

A low-grade systemic inflammatory response is evident in smokers as confirmed by numerous population-based studies. Some inflammatory mediators are still significantly raised in ex-smokers up to 10 to 20 years after quitting, suggesting ongoing low-grade inflammatory response persisting in former smokers.

Yanbaeva DG, Dentener MA et al. Systemic effects of smoking. Chest. 2007;131(5):1557-1566.


Gut Inflammation Vagus Nerve – Blood-Brain Barrier

  • Peripheral pro-inflammatory cytokines such as IL-1 and IL-6 can affect central nervous system functioning by penetrating the blood-brain barrier directly through active transport mechanisms.
  • Inflammation can move from the periphery to the brain directly through activation of the afferent through the Vagus nerve.
  • A group of studies have shown that the primary cause of inflammation may be a dysfunction of the gut-brains axis. This is a bidirectional mechanism.

“When you have an inflamed gut you may have depression.  It might come in the form of a bad day or several days or weeks of listlessness or brain fog.”

“If you have low grade inflammatory reactions in your gut, how do we know that these low grade inflammatory reactions are not supplying the necessary inflammatory chemicals to actually create depression in the brain? The gut is a very important area to examine and treat to try to dissipate as much inflammation as much as possible before giving out an anti depressants.” 

Dr. James Stoxen DC


Low performances in immediate verbal recall and delayed verbal recall are associated with higher IL-6 levels in women with recurring major depressive disorder.

The results of this study it suggests the existence of an association between inflammatory imbalance and cognitive impairment in major depressive disorder.

“Brain fog and memory loss were also found with people suffering with depression.”  

Dr. James Stoxen DC

Grassi-Oliveira R, Bauer ME et al. Interleukin-6 and verbal memory in recurrent major depressive disorder. Neuro Endocrinol Lett. 2011;32(4):540-544.


The results of studies demonstrate for the first time that suicidal patients display a distinct peripheral blood cytokine profile compared to non-suicidal depressed patients. This study provides further support for a role of inflammation in the patho physiology of suicide.

“This certainly is valuable to know. What this means is that we can check depressed children and adults for higher than normal levels of inflammation with blood tests to determine weather or not they are at risk  for suicide.”  

Dr. James Stoxen DC

Janelidze S, Mattei D et al. Cytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain Behav Immun. 2011b;25(2):335-339.


Post-Stroke Depression 

The cause of post-stroke depression is still not clear. However, studies have indicated that immune dysregulation plays a role in the patho physiology of depression. What was found was a significant increase in the cytokines:

  • IL-6, IL 10
  • TNFa
  • Interferon Y
  • The ratios of IL-6/IL10 TNFa/IL10 were also elevated.

Su JA, Chou SY et al. Cytokine changes in the pathophysiology of post stroke depression. General hospital psychiatry. 2012;34(1):35-39.


Overweight and Obesity

  • Depressive disorder (and the inactivity plus diet changes associated with it) cause obesity.
  • The obesity leads to inflammation, which cycles back around to lead to depression.
  • Depression may lead to inactivity and dietary changes, which leads to obesity, which leads to inflammation.
  • Obesity associated inflammation that affects the brain may promote addictive behaviors, leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol and gambling.
  • Targeted diet and exercise programs are beneficial

“Clinically, I see that many patients with have metabolic disorder have a hard time sticking to their diet. There is not much will power. Obesity leads to inflammation. Inflammation can lead to listlessness and that could be why patients have lost the will to do what it takes to lose weight.  

This becomes a viscous cycle which includes depression. a patient might have feelings of low self esteem and a bad body image. The inflammation may amplify the levels of depression.” 

“We have found that a targeted attack on inflammation from all sources can help improve the patient compliance with their diet and exercise program.  Research has found that anti-inflammatory diet and exercise is very beneficial to  depressed patients.  

We make these changes first, before prescribing anti depressants, unless of course there is a sense of urgency such as the patient not being able to go to work or if they have some major problems with social interactions or suicidal thoughts or some other serious complications.”

Dr. James Stoxen DC

Shelton RC, Miller AH. Inflammation in depression: is adiposity a cause? Dialogues Clin Neurosci. 2011;13(1): 41-53.


 “I do not treat “depression”  “I evaluate for and treat sources of inflammation.”  

I am not opposed to anti depressants.  I never take a patient off of anti depressants because I feel the withdrawal symptoms are quite severe and certainly the patiently could get even more depressed.

It is important to be cautious with patients who are on anti depressants not to immediately stop them or even reduce the dosage without first attempting to do as much as you can to improve their overall physical health.”

“If you take a patient off anti depressants without employing some of these novel treatment approaches to reduce the inflammation in the body then your putting the ‘cart before the horse.”

“My recommendation is to employ these other approaches to improve the health of the patient and then monitor the patient at the same time while working with the team of councilors and physicians and the doctor who put the patient on anti-depresssants to wean the patient off of the anti depressants, responsibly.”

Dr. James Stoxen DC


Mind-Body Inflammation Connection

There are effects of depression which lead to more effects of depression

There are depression effects that lead to other diseases

  • Inflammation Leads To Stress
  • That Can Lead To Depression
  • Depression Can Increase In Inflammation

 “This is known as the “cascade” which is a spiraling downward effect involving many systems of the body. The patients life seems to be tumbling out of control. They don’t have control of their feelings or emotions and that’s when the patient comes in for help. Have the patient take a deep breath.  You may just have to take some extra time with these patients. ” 

“Why not have them come in as your last patient and sit down and just talk. Why do we have to rush through patients in 8-10 minutes? Some patients need more time than others.” 

Dr. James Stoxen DC


Inflammation and the IDO Pathway

  • Idoleamine 2.3-dioxygenase IDO + tryptophan 2.3-dioxygenase (enzyme) competes with tryptophan metabolism which reduces serotonin.
  • Tryptophan is metabolized to kynurine by kynurine hydrxygenase to kynurine acid (KYNA) which antagonizes A7 nicotinic acetylcholine receptors, which leads to striatal dopamine release, which is in the brain of depressed patients. This can be known as Tryptophan depression
  • Kynurine is converted with enzyme kynurine 3-monoxygenase (KMO) to quinolinic acid (QUIN).
  • QUIN activates N-methyl-D-aspartic acid (NMDA) receptors and releases glutamate.
  • This leads to the formation of neurotoxins such as the glutamate agonist quinolinic acid and contributes to the increase in apoptosis of astrocytes, oligodendroglia and neurons.
  • QUIN, kynurine and glutamate are all implicated in pathophysiology of Alzheimer’s, Parkinson’s, ALS and dementia.

 “The theory is that inflammation detours the levels of tryptophan. This leads to a lower level of tryptophan being supplied for serotonin production.”

Dr. James Stoxen DC

Shelton, RC, Miller, AH. Eating Ourselves to Death and Despair: the Contribution of Adiposity and Inflammation to Depression. Prog Neurobiol. 2010;91(4):275-299.


Symptoms of Serotonin and Norepinephrine Deficiency Depressions 

Possible Serotonin Deficiency Symptoms

  • Depression and Anger, anxiety vs depression
  • Insomnia
  • Anxiety
  • Binge Eating
  • Overactive Mind
  • Insecure
  • Impulsive
  • Low Tolerance for Stress

Can be supplemented with 5HTp – 50 mg first then 150 mg .

Possible Nor epinephrine Deficiency Symptoms

  • Depressed Mood
  • Increased Sleep
  • Fatigue
  • Poor Memory
  • Apathy

Can be supplemented with DL Phenylalanine.

Vogelzangs N, Duivis HE, Beekman AT et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry. 2012;2(e79).


The IDO Pathway

QUIN (quinolinic acid), kynurine and glutamate are linked to Alzheimer’s, Parkinson’s, ALS and dementia.

In 2011 a study stated that the kynurine/tryptophan ratios or the kynurine production may be influenced by the inflammatory process and may be implicated in the pathophysiology of suicidal behavior.

 “If we don’t take any steps to remove the inflammation then, kynurenine and quin (quinolinic acid) will continue to be made in the body.”  

Dr. James Stoxen DC

Shelton, RC, Miller, AH. Eating Ourselves to Death and Despair: the Contribution of Adiposity and Inflammation to Depression. Prog Neurobiol. 2010;91(4):275-299



“I work with the musculoskeletal system.  I have patients come in with chronic pain and they are desperate for relief from their pain.  They are so desperate that they are taking between 10 and 20 anti inflammatory medications to try to relieve that pain.  This is very scary and certainly not advisable but the problem is they just can’t take the pain.

 Maybe there is a financial reason or they are scared of doctors or they don’t have time or they are without health insurance.”

“When they come to see me and they are in chronic pain, and they have large amounts of inflammation as they’re tissues are just soaking the inflammation.  You can feel it by deep tissue palpation.

If you are skilled in bio mechanics you can actually pin point the area of the body which is affected by the abnormal movement patterns —> that create stress and strain, —> wear and tear, —> the release of inflammation and pain. This higher than normal amounts of inflammation has been found to accelerate the aging process as well as it may fuel this clinical depression the patient may be having.” 

“If we thought we may say we are going to try fish oil because it has anti inflammatory properties as well as anti inflammatories themselves well certainly that is one idea.  Why doesnt this alter the depressed state a great deal?

I theorize that this is not aggressive enough attack on inflammation because what I am finding clinically is these anti-inflammation approaches  don’t put a dent on the chronic full body arthritic and gut inflammation patients are coming in with lately.” 

Dr. James Stoxen DC


 Selective Serotonin Reuptake Inhibitors

  • In mild to moderate depressive episodes, the benefit may be mild to zero.
  • In severe depressed people the improvements may be more substantial.
  • Sometimes the drug takes 6-8 weeks to work.
  • In studies, there are sexual side effects in approximately 17% to 41% (likely to be overestimated when there are no placebos).
  • There is a decrease in dopamine and norepinephrine which could lead to erectile dysfunction.
  • However, the sexual side effects may be the same with another drug.
  • There is dependence withdrawal, which may be severe.

“What we are finding is doctors are prescribing medication for erectile dysfunction after they have prescribed the anti depressant medication. A patient might come in with a problem with their sex life when in essence they are really clinically depressed and they just don’t want to admit it because they may not want to share that information is very personal, there are stigmas and men are not as quick to admit to depression as women.

They may not mind getting a pill to improve their sex life. 

“Why not take a more complete approach and find out what is really going on so you can address the erectile dysfunction and depression at the true cause?”

Dr. James Stoxen DC

  1. Hu XH et al. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. Journ Clin Psy. 2004;65(7):959-65.
  2. Landén M et al. Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. Journ Clin Psy. 2005;66(1):100-6.


Selective Serotonin Reuptake Inhibitors

  • At first people feel wonderful.
  • They feel as if the cloud lifted.
  • They feel they can handle minor issues more easily.
  • They are hopeful, confident and feel improved self-worth.
  • These drugs are not addictive but patients do feel dependent.
  • When they want to wean themselves off the drug without healing the body of inflammation and other causes, they experience withdrawals which are severe.
  • Patients expect you to put them on antidepressant drugs.
  • When you suggest options to these drugs patients are relieved they have these options.
  • If you do have to put patients on antidepressants, it is not a sign of failure, but never give up trying to help the patient be self-sufficient.
  • This is best for everyone.

“Never give up looking for a natural solution for depression.”

“Patients expect you to put them on anti-depressant medication. However you can get them excited if you tell them that you have other options that you can employ together with them before rushing right to use of these medications.”

“There are other options. You can try to regenerate their mental health by cleaning up their physical health by lowering their inflammation.” 

“Patients have been elated when we tell them there are other options besides medications. You will be developing a bond with the patient and it will help them realize you care and are doing everything you can to help them.”

Dr. James Stoxen DC


 Selective Serotonin Uptake Inhibitors

Neuropsychopharmacology 2011

  • A study of 22 studies data showed that overall while pharmacological antidepressant treatments reduced overall depressive symptoms it did not reduce levels of TNFa.
  • However antidepressant treatment did reduce levels of Il-1b and possibly IL-6.
  • While efficacious for depressive symptoms, did not appear to reduce cytokine levels



  • Research has shown that these antidepressants are effective in the short term and can lose effectiveness in the long-term.
  • Patients want relief now that’s what you prescribe them.
  • I don’t feel the standard of care provides an adequate treatment protocol to adequately reduce levels of inflammation.

“We have had patients taking 10-20 anti-inflammatory medications for chronic pain and they are still inflamed and in chronic pain.”

“In other words when the body moves outside of it’s natural path,  ‘The Human Spring Mechanism’ that protects the body from impacts, then what happens is that the body creates a protective mechanism such as muscle tension and spasms.

You may feel this when you get a massage. The massage therapist massages an area that is very painful and you might have not realized it was even there. It’s sharp and excruciating and they might work on it for 20 minutes to try to relieve that inflammation. That might be inflammation we are un aware of which that could be adding to the depression. We could address this.”


“Before we put the patient on these anti-depressant medications.”

Dr. James Stoxen DC


What Happens if You Take a Drug to Lower Serotonin?

There is a drug that lowers serotonin and it has the same effectiveness as the drugs that increase available serotonin. It has been shown to be as effective as some selective serotonin reuptake inhibitors.

So how can it be that one drug lowers it and one drug raises it and they both have the same effect on depression?

Most serotonin reuptake inhibitors are not as effective as you think.

  • JAMA 2002 article about a study in the NIH stated a particular popular SSRI had about the same or a little better results than placebo.
  • JAMA 2010 January 6, 2010 stated the real biochemical effect of SSRIs as nonexistent to negligible for severe depression.

“It seems very strange and controversial that one drug does one thing and another drug that does the complete opposite are both approved for depression?”

“What is not controversial is that inflammation causes accelerated aging of the body’s systems. It causes aging of the cardiovascular system and it wreaks havoc in the body. We know this as anti-aging doctors. What we need to be doing is testing for the levels of inflammation and having a plan to reduce it.  If the treatment assists in reducing the symptoms of depression then lets call that a bonus”

Dr. James Stoxen DC

 L-Tryptophan and 5HTP and Cognitive Impairment

 Older adults with mild cognitive impairment had significant improvements in several measures of cognitive function when supplemented with an oily immersion of DHA–phospholipids containing melatonin and tryptophan for 12 weeks.


Inflammation Approach to Treating Depression

  • Treat Inflammatory Diseases- Like Hepatitis, Heart Disease
  • Reduce Pulmonary Inflammation
  • Inflammation of the Skin-Psoriasis – 60% have depression in their life
  • Dietary Inflammation
  • Arthritic Inflammation

“In the United States you can turn on the TV and the commercials are mesmerizing and exciting. They lead people to believe they can be more sexy or even stronger if they eat certain foods or drink, a certain soft drink or candy. Patients are confused by what they hear on television”

“The foods we are eating actually can cause a lot of dietary inflammation. I am a practicing chiropractor in Chicago and some of my patients feel like they are trapped in a food desert because they can’t find farm fresh vegetables and foods that are organic or that they are expensive.”

“I recommend telling your patients to pick  foods with color and to stay away from foods pre packaged, processed foods, in cans, bottles except water. Try to limit your portions.” 

Treat all of the above, aggressively!!


Dr. James Stoxen DC

Miller AH, Maletic V, Raison CL. Inflammation and Its Discontents: The Role of Cytokines in the Pathophysiology of Major Depression. Biological Psychiatry. 2009;65(9):732-741



“In my opinion the most common way inflammation occurs is through a poor diet rich in pro-inflammatory chemicals and arthritic inflammation.” 

“Even exercise can cause accelerated aging on a human body that’s not mechanically sound. In other words if you have a bad alignment of your biomechanics exercise can accelerate the aging.

The combination of dietary inflammation and muscle and joint inflammation forms a significant amount of inflammation that leads to premature aging and furthermore, depression.

These are indexes we can control. Genetics we can’t control.”

Dr. James Stoxen DC


Levels of Inflammation

Levels of Silent Inflammation

Levels of Silent Inflammation

“This is a chart I developed 25 years ago.  Think of the chart like a stop light.”

“The green area represents a healthy released Human Spring in good health and with a good anti inflammatory diet, in an anabolic state rather than in a catabolic state, good healthy aging, at a healthy weight, normal to high energy level, good concentration, executing self help to maintain your health.”

“The yellow area is to proceed with caution. What that means is silent inflammation. We can do blood tests to look for this and see if there are low grade inflammatory chemicals in the blood. However we can examine and treat silent inflammation. If you have silent inflammation accelerated aging occurs as well as weight gain and brain fog. Many people are in this yellow area and think they are healthy when in fact they are not.”

“Always work to move your patients to the green area or they can easily move into the red area which is painful inflammation. This is a pro inflammatory diet that creates cytokines and inflammatory chemicals that will increase the level of pain that they might already have as well as brain fog, perhaps depression and accelerated aging.” 

Dr. James Stoxen DC


Human Spring Model
Human Lever Model

  1. The human spring stores mechanical potential energy therefore it is an efficiency mechanism.
  2. The human spring absorbs forces of landings therefore it is a protective mechanism.
A lever mechanism cannot protect the body from impacts nor can it recycle energy through the mechanism. 

That is why the human body cannot be a lever mechanism. 

There is a tremendous amount of evidence that the body is designed as a spring mechanism. 

When the spring mechanism breaks down it turns into a less protective and less efficient lever mechanism.

“I believe there is a misunderstanding in human mechanics. The body is thought of as a lever system. Well, the body takes up 10,000 impacts with the ground a day. Thats. 3.6 million impacts or collisions with the ground in a year. That adds up to approximately 100 million impacts with the ground by your 30th birthday.” 

“How is it that our body is not completely destroyed after taking these 100 million impacts with the ground? Because our body has an elaborate spring mechanism that is built into it to absorb these impacts and protect you from the landings, as well as recycling the energy.”

Dr. James Stoxen DC


A study should be done as this is more theoretical and what I have been observing.”  

What I see in some of my patients that have an abnormal gait pattern is a tendency towards depression, aggression and anxiety. The constant bang and twist into the ground vs a more normal spring off the ground is found more commonly in clinically depressed patients.  

How would you feel if  somebody inflicted some sort of negative impact on your body such as hitting you with a stick or you keep banging your body into the hard ground with a locked stiff mechanism, 10,000 times per day with released levels of inflammation?” 

Dr. James Stoxen DC


Breakdown of Biomechanics

  • Accelerated agingBreakdown In Biomechanics
  • Pain
  • Silent inflammation
  • Wear and tear
  • Stress and strain
  • Compensating abnormal movement
  • Drop and lock of the spring mechanism
  • Weakness in spring suspension system


“The human body at the foundation has an elaborate suspension system similar to a suspension bridge except for the wires are elastic. Those are what I call the landing muscles. The suspension system can weaken by muscle contractions and joint damage.” 

“We were meant to move on uneven terrain. Think about it when we hunted for food. We did not have shoes on our feet that bound us. Our bodies were free to move in many different ways because we were hunting for food and remained active. If we stopped we might become the next meal for someone else.” 

“Now we stand too much and walk in a directed path. If we walk off the path such as a side walk or hallway we get in trouble. Our mechanism does not get a lot of exercise. We also bind it with a piece of leather and rubber on a daily basis which locks that spring even more. The shoe company then gives us a artificial spring or cushion to absorb the force of the impacts.” 

“This would include the heels that you ladies love to wear that hurt you at the end of the day. That is causing inflammation.”


Dr. James Stoxen DC



When our natural spring is locked then the body does not move in it’s natural pathway and we have compensated movement.”

“How can we predict the earliest detection of aging? Think of it this way. If your a baseball coach and you are evaluating a kid throwing a ball and the young man has poor technique you would advise him that if you keep throwing the ball that way then your probably going to have a shoulder problem and will probably not play much  baseball.” 

“The human body works the same way. Walking is a learned activity. Some people have a good walk and some people don’t. If you have a poor walk that creates abnormal movement patterns that leads to stress and strain, degenerate joint disease as well as inflammation with every single step. We must look at the gait!”

Dr. James Stoxen DC



“Have the patient take their shoes and socks off and do a simple gait analysis to determine how the body is ambulating.”

“If you look at the video above I can see that on the right side that the foot is stuck in supination and the left side is landing fairly straight.”

“You can do a gait analysis by watching the patient walk up and down a hallway. Have the patient walk towards you slowly then walk away. Repeat again walking as fast as they can without running.

Record the walking pattern with an inexpensive HD camera then play it back slowly on the computer.  Oftentimes, what you see will amaze you and the patient.  I did not think I walked that way is the most common thing patients state”

Dr. James Stoxen DC


Tibialis Posterior


“The arch of the foot is actually a leaf spring possessing spring energy in the engineering of the structure of the bones and ligaments that create the arch spring-like structure.

This leaf spring of the foot is further loaded and unloaded with spring energy with the tendons that support it from above in a muscular cuff I call the “pronator-supinator cuff” or the “spring suspension system muscles”

When we look at a very close view of the foot landing, we can see the tendons of the tibialis posterior stretching to lower the arch through spring loading. You can see the arch load. It becomes a spring configuration loading up the stretch energy of the tibialis posterior tendon and other cuff muscular tendons as other springs.

In other words, the human foot is a marvel of engineering.”

Dr. James Stoxen DC

F = M x A”

“When your watching a patient walk and evaluating their gait make sure you have them walk as fast as they can for the second pass because you will be employing Newton’s law of physics that states that the force of the impact is equal to the mass times the acceleration or the speed. There fore by asking them to walk faster means the force of the impact is greater.”  

“What your doing is testing the spring suspension system and the biomechanics with greater forces to determine how much the body can take. When the patient is walking the patient might seem to have good alignment and good spring. However when the patient walks faster they might have an over pronated position of the foot or supinated position of the foot.”


Because while walking the spring suspension system muscles might be able to  accept the forces of impact of 1.25 times the body weight or what is walking. But if you have them run on the treadmill that would be 3 times the body weight. An individual that is 120 pounds or 100 kilos is equivalent to 300 kilo impacts on their joints. Can the spring suspension system take up those impacts?”


Dr. James Stoxen DC



 “The word “exact” is very important.

If we exceed the yield strength of the mechanism then it stays in it’s deformed state.

If this happens even minimally over millions of impacts the the deformity progresses.  

The deformities in the foundation cause abnormal movement patterns that can cause abnormal wear and tear arthritis or chronic arthritis that affects the feet, ankles, knee, hips and spine and that means full body inflammation.”

Dr. James Stoxen DC

“Sports scientists in the soviet union were trying to enhance athletes performance in sports.

What they found was Plyometrics or jump training caused a major improvement in the performance in sport as well as reduced the risks of injuries.

The key to better execution of plyometric drills involves jumps with as little contact time as possible. The minimal contact time actually was what allowed them to have more improvement in the performance in sports. The quicker they got off the ground, the better.”

Some doctors say impacts are bad for you.  

It’s because when you look at the body as a lever system you can’t possibly understand how we can take up that many collisions.

Because a lever system can’t take up millions of impacts like that safely.

The body has to be a spring mechanism.”

Dr. James Stoxen DC



The long tendons of the spring suspension system medial and lateral

The long tendons of the spring suspension system medial and lateral

Supportive Cuff Muscles

supportive cuff muscles

supportive cuff muscles


Vericose Veins

vericose veins Dr James Stoxen Dc Chicago Celebrity Chiropractor

 “Here is a patient with an over pronated posture. Notice the level of veracities on the patient’s right side as compared the left. Certainly this has to play into the levels of inflammation that are released.”

Dr. James Stoxen DC

Preventive Medicine Is not working 

Preventive Medicine is Not Working

“By the time your 60 years old you have taken 200 million impacts into your body. If you have even subtle abnormal bio mechanics it can create a tremendous amount  of levels of cytokines leaking into the body causing these depressive symptoms as well as the possibility of the cartilage damaging to the point of where it cannot be repaired.” 

Take a look at the footwear 

Shoe Causing us weakness

 “Notice this shoe.

The toe is turned up in the front as well as a split sole.

I would not recommend this shoe.”

I would advise the patient to get a shoe  with an extended medial counter support that keeps the foot in the safe range.”  (see the illustration below)

Dr. James Stoxen DC

 Keep the foot in the safe range

Safe and Unsafe Zone

Safe and Unsafe Zone

Barefoot to Bedridden

  • Barefoot – No Supports
  • Footwear – 4 Supports
  • Motion Control – 4 Supports
  • Orthotics – 6 Supports
  • Orthopedic Shoes and Orthotics – 6 Supports
  • Cane – 7 Supports 
  • 4-Prong Walker – 10 Supports 
  • Wheel Chair – 4 Wheels
  • Bedridden – Bed 

“We were born barefoot but what happens is we start to think that the body is incapable of supporting itself.

4 supports – What we do is put footwear on the body that provides support on both sides of the heel.

6 supports – Then we add orthotics to that when the structure can’t maintain it’s mechanics because it’s a quick fix instead of regenerating the spring suspension system.

7 supports – Furthermore we add a cane which is 7 supports.

10 supports – We move on to a 4 prong walker, a wheel chair.

Bed – Finally the patient is bedridden.”

“Reclaim Your Youth!”

“Reverse this process and go barefoot!”

Dr. James Stoxen DC


Vibration Therapy 

Vibrational Massage from the feet to the head 

 “In my practice there is great results with this treatment. It involves a vibrational massage to the entire body focusing on the areas with the most inflammation for at least 30 minutes before treatment. 

This stimulates circulation, increases the levels of oxygen, nutrients, hormones which then leads to the decrease of inflammation and flushes the chemicals out of the body.”

Dr. James Stoxen DC

Deep Tissue

Removes painful and silent inflammation muscle spasms

“I apply deep tissue treatment on the patient to remove every single painful and silently inflamed muscle spasm according to the pattern and distribution of these compressive forces that lead to inflammation.” 

“This can take between 10 and 30 hours of aggressive treatment hours to rid the body of painful inflammation.” 

Dr. James Stoxen DC



Bang and Twist Walking VS Spring Roll Walking

Bang and Twist Walking VS Spring Roll Walking

“Muscle spasms approximate two joints and compress them.

This creates a locked spring that creates more inflammation.

That banging and twisting of the body into the ground is not a very comfortable environment.

It’s a hostile environment to be walking with that kind of a gait.”  

I believe some walking patterns that have hard landings can contribute to anxiety”  

More research needs to be done!

Dr. James Stoxen DC

“In medicine your taught to give one procedure which is 15 minutes of deep tissue work 3 times a week for approximately 6 weeks.

There is no way that I am going to be able to get all of the inflammation out of the patients body in that amount of time. That’s the standard of care that is currently practiced.” 

“This is why we are not having good results with these patients.

There has to be a more aggressive approach.” 

Dr. James Stoxen DC

Exercise is a Powerful And Safe Antidepressant

Depression and exercise:  A 1999 study by researchers at Duke University, published in the Archives of Internal Medicine, compared exercise, medication, and a combination of the two among a group of 156 middle-aged and elderly patients with non-suicidal depression. Medication was a selective serotonin re uptake inhibitor.

  • The exercises were performed three times a week for 45 minutes and included 30 minutes of brisk walking or jogging.
  • After 16 weeks all three groups showed similar improvements.

A follow a to this study published in psychosomatic medicine in 2000 check back on how the patients were doing six months after the study.

  • The exercise-only group was actually doing better than the other two.
  • Fewer than one third of the medication-free exercisers had relapsed back into depression, compared to over half of the patients in the med and the med/exercise groups.

“If you want to rid the body of as much inflammation as possible then institute an exercise program.” 

Dr. James Stoxen DC

“Try to do everything you can to decrease the levels of inflammation.

Be more aggressive with the therapies. Take time with the patient.”  

“Thank you very much for being such a great audience!”

Dr. James Stoxen DC


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