At the end of 2006, I fell off a cliff.

It wasn’t a real cliff, but it sure felt like one.

After four years supporting my daughter through a medical crisis that ended up with her surviving a three-organ transplant while also struggling with my own pending divorce, I was done. It felt like I couldn’t take another step.

I knew I was depressed. I had been a practicing psychologist for almost ten years then, and that was the only language I had at the time to describe what I was experiencing.

I was sad and sleepless. I worried all the time, was eating and drinking too much and thought that I would never feel better.

At the suggestions of loved ones, I sought out help. I went to my family doctor and followed his strong recommendation to start an antidepressant and begin therapy.

I kept up the routine of weekly therapy and medication for the better part of the year. I felt somewhat better, but still experienced most of the symptoms listed above and other challenging and persistent issues including: terrible fatigue, brain fog, food allergies, and anxiety that came on when I skipped meals.

When I went to my doctor to see if there was a connection between the new physical symptoms I was having and my depression, he just looked at me puzzled. So did my therapist.

By that time I was pretty frustrated and started searching for answers on the Internet. I had been depressed before, but this was different.

After weeks of research, one term just kept of coming up- Adrenal Fatigue.

I knew I was still depressed (boy had I been through a lot), but reading about Adrenal Fatigue helped explain the combination of physical, mental and emotional symptoms I was experiencing.

As I thought more about it, I wondered if I could be having a depressive reaction to all that I’d been through and also be experiencing the physical consequences of long-term stress.

That way of understanding just seemed right to me.

When I brought my discovery to my care providers, all I got were blank stares again. They had never heard of Adrenal Fatigue and didn’t seem very interested to learn more.

It was at this point I realized I had to find solutions on my own. After much searching, I found an integrative doctor who specialized in Adrenal Fatigue.

More accurately, what we think of as Adrenal Fatigue is known as Hypothalamic-Pituitary-Adrenal Axis (HPA Axis) dysfunction.  

The HPA axis is the intricate feedback system between brain and adrenal glands that governs our stress response. Going forward I will continue to refer to the downstream effects of HPA issues as Adrenal Fatigue.

With my integrative doctor’s help, and through specific functional testing, I learned that I did indeed have Adrenal Fatigue and that there were many tools to help me recover. These tools were simple but powerful lifestyle and dietary changes that over time help the adrenal glands mend.

Thus begun my journey to healing….

What are the adrenal glands?

The adrenal glands are part of the endocrine system, located just above your kidneys. They are small in size but produce hormones responsible for many basic life sustaining functions, including but not limited to:

-Converting fats and proteins into energy

-Maintaining normal blood sugar regulation

-Good cardiovascular, GI, and immune functioning

-Post-midlife (menopause in women), production of sex hormones

Through a mental health lens, the adrenals are central to our ability to cope with stress!

They produce two of the body’s main stress-buffering chemicals, the steroid hormones cortisol and adrenaline. Additionally, they make both norepinephrine and epinephrine, two important brain neurotransmitters linked with energy, focus, and depression.

When the adrenals are off, we don’t feel good, and our mood is one of the first things to be affected.

Adrenal glands and stress

Since the adrenal glands’ primary responsibility in the body is to help us cope with stress, high levels of stress over a prolonged period of time can wear down their ability to produce cortisol and other essential hormones.

What stresses the adrenals?

When most of us think about stress, the first thing we think about is psychological stress like I faced. Things like loss of a job, a divorce or a sudden trauma.

But much of the stress that the body faces is physical in nature, often things we are not even aware of like lingering infections, unstable blood sugar or hidden food sensitivities to gluten and dairy. All day, our adrenals are helping us deal with these different kinds of stressors on top of the stress of our daily lives.

So, it’s important to broaden our understanding of stress. The more stressors we have and the longer they last, the more likely our adrenal glands will be affected, and as a result, the worse we will become at handling stress.

And as you will see, this can become a big, big problem.

Stages of Adrenal Fatigue

Adrenal fatigue is more common than you think and it happens with ongoing stress in four progressive stages.

Often we don’t even become aware of this chronic stress condition until we are well into it. I only really woke up to it when the fatigue got so bad my daily functioning was compromised:

Stage 1 (the alarm goes off)

At this stage, high stress has been going on for awhile and the body is able to keep up demand for the stress hormones. At this point, if you had your stress hormones  measured, they would likely be high.

Often people in this stage report benefitting from increased arousal and alertness, but some sleep issues may be present as well as intermittent anxiety and tiredness (from fluctuating cortisol).

Stage 2 (the alarm stays on)

In stage 2 your body continues to be able to keep up with hormonal demand, but you start to feel the effects of prolonged stress on your adrenals. People commonly describe the experience of stage 2 as being “wired but tired.” Often including waking up and not feeling rested, being alert on and off during the day, and becoming very fatigued in the afternoon or evening.

In this state, one often experiences frequent anxiety or not being able to settle (remember the physical experience of too much adrenaline is anxiety or panic).

Stage 3 (breakdown)

This is where problems really begin. The adrenals begin to have difficulty buffering all the stress that the body faces.

To adapt to this, the adrenals begin to use up the raw materials slated for sex hormone production. This is commonly referred to as the pregnenolone steal.

As a result, sex hormones like testosterone, estrogen and progesterone begin to drop with increased symptoms.

Typical symptoms include feeling tired much of the time, low mood/lack of enthusiasm, and regular infections.

Stage 4 (burnout)

This is where the body can no longer keep up with chronic stress. Sex hormones, stress hormones and the neurotransmitters norepinephrine and epinephrine are low.

People in this stage usually experience extreme tiredness, irritability, low mood, apathy, and disinterest in the world around them. Hypoglycemia (or low and unstable blood sugar) is an issue at this state, as are chemical sensitivities and food allergies.

Is it Depression or Adrenal Fatigue?

If you look at the symptoms of depression and Adrenal Fatigue, they are virtually the same. It’s pretty clear how you (or the professional you are seeing) might confuse them:

DSM-V Depression Criteria:

-Depressed mood or irritability

-Decreased interest or pleasure

-Changes in appetite

-Changes in sleep

-Fatigue or loss of energy


-Problems with concentration

Psychological Symptoms of Adrenal Fatigue

-Low mood/ irritability

-Low sex drive


-Loss of motivation

-Self hate

-Poor sleep

-Low self esteem


There is no doubt that when I entered therapy at my doctor’s strong suggestion,  I was suffering from both depression and Adrenal Fatigue. But what do you think the therapist diagnosed me with and treated?

Of course, depression.

Remember, he had never heard of Adrenal Fatigue.

Many people go to a therapist for years or are treated with antidepressants and only get partially better. Could some of them actually have Adrenal Fatigue or a combination of both depression and Adrenal Fatigue?

Practitioners can only diagnose and address what they can see. And they can only see what they have been taught to see.

So, I only had partial healing of my depression symptoms, because only part of my problem was addressed.

I don’t blame the therapist or my family doctor. They were just doing what they knew how to do.

But, I do see this as a problem with our mental health system as a whole. Being part of that system for the last 20 years as a Psychologist, I know the the field lacks a cohesive methodology to understand the ways in which “root’ physical issues can cause or exacerbate mental health symptoms.

In my case what was missed was Adrenal Fatigue. For someone else it might be another physical trigger like food allergies or autoimmunity.

So why don’t most medical providers or psychotherapists know about adrenal fatigue?

Adrenal Fatigue is a controversial topic within mainstream medical circles.

What doctors learn in medical school is that there is only one adrenal deficiency disorder, which is called Addison’s disease. It’s a serious condition, which affects 4 out of every 100,000 people and is treated with lifelong steroid replacement.

Without treatment, Addison’s is a debilitating condition. Multiple systems in the body fail and stress buffering is rendered impossible.

But, if Addison’s is the only “real” adrenal deficiency disorder, what about all of the people experiencing symptoms of Stage 3 or 4 Adrenal Fatigue?

Unfortunately, these folks are NOT diagnosed or treated until they get bad enough to reach the threshold of Addison’s. In fact, most of these folks are labeled, often wrongly, as psychiatric cases, because their blood work comes back normal, and there is no way to understand their symptoms through a mainstream medical lens.

So, it’s no wonder that antidepressants and therapy were what was offered to me. There was no doubt that I needed therapy, but I needed a broader medical understanding as well.

How do you know if Adrenal Fatigue is contributing to your depression?

If you have been depressed for a while and have not responded fully to psychotherapy and/or medication (and especially if you have had prolonged periods of illness or life stressors), I would strongly suggest finding an integrative practitioner to help you understand whether Adrenal Fatigue is contributing to your depressive symptoms.

Here are a few databases to find qualified practitioners in your area with knowledge of mental health issues and physical root causes:

Integrative Medicine For Mental Health

Safe Harbor

In addition, I do phone consults around the world to help you identify and work with the “root” causes of your depression, including Adrenal Fatigue. To set up an initial phone consult click here.

My next blog will be on what to do next if you are depressed and find out that you have adrenal fatigue. Stay tuned…

If you like this post and want to hear more information about the “root cause” of depression, sign up for my email list. As a bonus, you’ll get my FREE “Nutrition For Mental Health Guidebook”.


In good (mental) health,


Dr. Josh




Share This