Depression, with the workup beneath it.
Functional medicine for depression in Bellingham — hormonal, inflammatory, thyroid, and metabolic drivers investigated before reaching for the next antidepressant.
A functional-medicine workup for depression in Bellingham — hormonal, inflammatory, thyroid, nutritional, neurochemical. We look for what's actually driving it before reaching for the next antidepressant.
Services we use to treat depression.
Ketamine therapyWhen SSRIs haven't workedNAD+ therapyMitochondrial + neurochemical supportHormone replacement therapyHormones drive mood more than most realizeReady to investigate the root cause?
Thirty minutes with Dr. Scribner. No exam, no charge — just a conversation about what’s actually going on.
Book free consultation →Depression, with the workup beneath it.
Functional medicine for depression in Bellingham — hormonal, inflammatory, thyroid, and metabolic drivers investigated before reaching for the next antidepressant.
A functional-medicine workup for depression in Bellingham — hormonal, inflammatory, thyroid, nutritional, neurochemical. We look for what's actually driving it before reaching for the next antidepressant.
What this looks like.
- Persistent low mood, flatness, loss of interest in things you used to enjoy
- Fatigue that sleep doesn't fix, brain fog, slowed thinking
- Loss of motivation, withdrawal, irritability
- Sleep problems — early waking, non-restorative sleep, insomnia
- Failed antidepressant trials — tried two or more without sustained relief
- Depression that started or worsened in midlife (perimenopause, andropause)
- Depression alongside fatigue, weight gain, brain fog (thyroid-pattern)
- Anxiety mixed in — often the same upstream cause
The standard depression workup is too narrow.
Most depression visits go: brief intake, prescription, follow up in six weeks. The screening questions are scored, the diagnosis is given, the medication is started. What's missing is the workup that would tell you whether the depression is actually being driven by something biochemically addressable — and which, in adults over 35, it very often is.
Hormone-related depression, perimenopause depression, post-partum hormonal depression, depression from low testosterone, thyroid-driven depression, inflammation-related depression — these get treated as one condition called "depression" and prescribed around as if root cause didn't matter. Root-cause depression work treats the version you actually have, not the average of all of them. Treatment-resistant depression that has failed two or three SSRIs is often a metabolic, hormonal, or inflammatory problem the SSRIs were never going to fix.
- ✓Comprehensive metabolic panel, full thyroid panel including reverse T3, inflammatory markers (CRP, homocysteine), B12, folate, vitamin D.
- ✓Hormonal panel — estradiol, progesterone, testosterone (men and women) — frequently in range for general health but suboptimal for mood.
- ✓Medication review — common medications including beta-blockers, statins, and finasteride contribute more often than people realize.
- ✓Sleep, gut, alcohol, body composition — addressed alongside, not separately.
What's actually causing this.
Six root drivers we work through systematically in the workup. Most patients have two or three of these contributing, and addressing them directly often resolves what years of SSRIs couldn't. This is the kind of investigation that lives inside functional medicine.
Estradiol, testosterone, progesterone.
Hormonal decline in midlife is one of the most-missed depression drivers. Estradiol "in range" doesn't mean optimized; testosterone in the 300s with low libido and low mood is not "fine just because it's not below normal."
Beyond just TSH.
Most thyroid workups stop at TSH. We run free T3, free T4, reverse T3, and thyroid antibodies. Subclinical hypothyroidism is a common-and-missed driver of depression in adults over 40.
The brain doesn't like inflammation.
Chronic inflammation — driven by gut issues, sleep apnea, body composition, autoimmune activity, or chronic infection — is increasingly understood as a major driver of treatment-resistant depression. Worth measuring.
B12, folate, vitamin D, iron.
Functional deficiencies in B12, methylated folate, vitamin D, and iron are more common than typically acknowledged, and they meaningfully affect neurotransmitter synthesis. Bottom-quartile-of-normal is not "fine."
The gut-brain axis.
Persistent IBS, SIBO, post-antibiotic dysbiosis — gut state and mood state are bidirectionally linked. For patients with documented gut symptoms alongside depression, treating the gut is part of the protocol.
What you're already taking.
Beta-blockers, statins, hormonal birth control, finasteride, some antibiotics — all can produce or worsen depression. A real medication review is part of the first visit, often surfacing causes the patient didn't know to ask about.
Treatment pathways.
There isn't one "depression treatment" here — there are four pathways, chosen based on what the workup shows. Most patients use a combination, in a specific order. The workup tells us which.
Functional-medicine workup.
Comprehensive labs, full medication review, lifestyle audit. This is the starting point for almost every patient. Often the workup alone surfaces the addressable cause — thyroid, hormonal, inflammatory — and the protocol writes itself from there.
Hormone optimization.
For midlife depression where labs show suboptimal hormones — most often estradiol, progesterone, or testosterone — the right intervention is hormone replacement therapy or testosterone replacement therapy, not adding a fourth SSRI on top. Most-missed driver.
Ketamine therapy.
For patients who've failed multiple antidepressants and whose workup doesn't reveal an addressable root cause, IV ketamine therapy is the most evidence-backed option available. We administer it in-office, physician-monitored, in the six-session protocol the trials studied.
Ongoing care.
Depression that's addressed and improved still needs follow-up — labs every 6–12 months, hormones monitored, medications reviewed, life circumstances tracked. The same physician across all of it. This is what concierge primary care is for.
Common questions.
The four questions we get most. Schema-eligible for AI Overview citation.
What causes depression in adults?
Depression in adults is multifactorial. The most-missed drivers in patients over 35 include hormonal decline (estradiol, progesterone, testosterone), subclinical thyroid dysfunction, chronic inflammation, nutritional deficiencies (B12, folate, vitamin D), gut/microbiome dysfunction, and medication side effects. Genetic predisposition and life circumstances are also real contributors. A proper functional-medicine workup looks at all of these systematically before defaulting to medication.
What is functional medicine depression treatment?
Functional medicine depression treatment is an approach that looks for and addresses the root biological drivers of depression — hormonal, inflammatory, thyroid, nutritional, metabolic, gut-related — rather than treating the symptom alone with antidepressant medication. It typically begins with a comprehensive workup including labs that standard primary care doesn't run, and uses interventions (hormone optimization, anti-inflammatory protocols, micronutrient repletion, lifestyle modification) chosen based on what the workup shows.
What if antidepressants haven't worked for me?
Treatment-resistant depression — typically defined as failure to respond to two or more adequate antidepressant trials — is more common than usually acknowledged, and often signals that either the diagnosis is incomplete (an addressable root cause was missed) or that conventional SSRIs aren't the right mechanism for this specific presentation. The functional-medicine workup looks for the missed cause; ketamine therapy is an evidence-based option for patients whose workup doesn't reveal one.
Can hormonal changes cause depression?
Yes — extensively documented. Estradiol decline in perimenopause and postmenopause, progesterone decline, and testosterone decline (in both men and women) are well-established contributors to depression onset or worsening in midlife. Hormonal optimization, when properly indicated by lab work and clinical picture, frequently resolves or substantially improves depression that hasn't responded to standard antidepressant treatment.
Start with a real conversation.
30 minutes with Dr. Scribner. No exam, no commitment, no charge. We talk through your history, what you've tried, what the workup would look like, and what real treatment paths might be available to you.
Or call(360) 498-7529