I doubt anyone would disagree that you must first repair the foundation before you can expect the house to be stable. When it comes to our mental and physical health, our neuroendocrine system is that very foundation.

Prescribing an antidepressant for depression without evaluating for and treating hormonal deficiencies is akin to giving pain medication for a nail in the foot without removing the nail. You are masking the symptom without addressing the root physiological dysfunction.

By optimizing the foundational hormonal milieu first, you give the body the necessary tools to regulate itself. If depressive symptoms persist after hormonal optimization, then and only then should an antidepressant be considered as an adjunctive therapy. We must treat the patient, not just the symptom.