Recently I interviewed Dr. Achina Stein, as she discussed depression, including how it relates to inflammation and thyroid autoimmunity.. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
With me, I have Dr. Achina Stein, who is an osteopathic physician, a board-certified psychiatrist, and has been in practice since 1994. She is a certified practitioner of the Institute for Functional Medicine, a distinguished fellow of the American Psychiatric Association, an Azarias energy healer. She was awarded the Exemplary Psychiatrist Award by NAMI Rhode Island in 2008. Located in Rhode Island, she is the co-owner of private practice Functional Mind LLC. She is the #1 Amazon best-selling author of What If It’s Not Depression? Your Guide to Finding Answers and Solutions. She has a YouTube channel and podcast by the same name. Thank you so much for joining us, Dr. Achina.
Dr. Achina Stein:
Thank you for having me, Dr. Eric. My pleasure.
Dr. Eric:
I’d like you to start off by giving your background. How did you start out in psychiatry and eventually getting into the functional medicine world?
Dr. Achina:
We’re going back almost 30 years.
Dr. Eric:
I guess we could focus more on how you made that transition to functional medicine and not just giving anti-depressant medication.
Dr. Achina:
That’s an easier question to answer. I was a traditional psychiatrist, working in a community health center. I have worked in the prison system. I have worked on consultation liaison in hospitals. I liked moving around because I loved having different perspectives. I worked on the child unit, on the geripsychiatric unit. I have basically treated all ages primarily with medications and psychotherapy. I am trained in psychotherapy.
I was finding that I was hitting a wall in treating certain people where they just weren’t getting better. I am one of those people who gets a thorough history, spending a lot of time with my patients, more than the average psychiatrist. I really want to try to figure out what’s going on. Why aren’t they getting better? I spent a lot of time already talking about diet, exercise, sleep, and habits. There was this feeling that in my gut and my heart that I was missing something.
Around that same time, coincidentally, I don’t believe in coincidences. At the same time, my son had a significant mental health crisis. This was back in 2010. He was 14 years old. He basically had a tiff with his brother that ended in a meltdown, resulting in him standing on a fifth floor ledge of a building ready to jump. That is the kind of thing that kids tend to do. They feel like it’s the end of the world in that age group, anywhere from 10-16. Something happens, and it’s the end of the world. He just lost it. It wasn’t something that we anticipated. It was just out of the blue.
He became severely depressed and very anxious, and he had insomnia. I thought, Oh well, this is it. This is my son who is now having an exacerbation of symptoms based on our family history. Both sides have pretty significant depression and suicidal ideation with attempts. Actually completed suicide attempts. This was very concerning for us. I was blindsided by this. Here I am, a psychiatrist, and my son is having a serious situation. I did not see it coming. It makes you think about your parenting skills and why you didn’t see it coming.
The thing that made me think that something else was going on was the fact that he was not able to read at all. This was a kid who was an avid reader and had really good memory skills. He would read it once and know it. He would hear songs once and know all thewords. That kind of memory. And he was not able to read and retain. I felt at that point, because of my skills, there is something neurological going on. I really honed in on this is a brain-based, neurological problem and not psychiatric, so to speak. I took him to many doctors, and they weren’t able to explain it.
I had to do a deep dive in research myself and find other practitioners to help me. Serendipitously, I came across a functional medicine practitioner and had him see my son. I asked him if I could shadow him because I was so intrigued by what he was doing. I shadowed him for a period of time, and that’s why I decided to have him see my son.
Long story short, he got him well. He made changes to his diet. He found that he was nutritionally deficient. He had Celiac Disease. He had a considerable amount of inflammation in his body as a result of having long-term, long-standing constipation since he was a baby; long-standing eczema since he was a baby. You take symptoms that are pretty serious and think that’s normal, but it’s not.
A lot of those symptoms, including the constipation and the eczema, completely resolved. It took a little while for the depression and anxiety to resolve. Mind you, he was on four medications at the beginning for psychiatric purposes. He was on an anti-depressant, anti-anxiety, sleep, and stimulant for concentration. He was not my kid. He was able to come off all those medications by the end of two years.
What we found was the reason he couldn’t read was because he had double vision. He had diplopia. His eye muscles became very inflamed, so much so he had double vision. That actually was the symptom that took the longest to resolve.
Once you learn those things, you can’t unsee them. You can’t practice. I became certified in functional medicine. I left my job as a medical director at a community mental health center to practice functional medicine with the gentleman, Dr. Levitan at Visions Health Care at the time, and started working for his organization. There was no other organization that did this kind of work locally, so I worked from them and learned functional medicine. Once that practice closed, I opened my own practice with my partner Sally Davidson. Here we are, almost five years later.
That’s all I do now. I have a handful of patients I see for psychotherapy. That’s my mission: to tell people about this. After we got my son well, I did the functional medicine approach to my own health issues. I have Hashimoto’s, which has been stable for a number of years. I had depression as a result of that and was on medication. I have since been able to taper myself off that medication as well and am doing great.
Dr. Eric:
A few things you mentioned. You mentioned inflammation, and you mentioned symptoms related to the gut, including constipation. It’s only been recent, and I can’t even say all psychiatrists, you would know better than myself, but many psychiatrists still think about depression as related to the brain. Same thing with anxiety. No relation to inflammation or the gut. It probably comes down to the training you also had in medical school. Would that be correct?
Dr. Achina:
As a DO, we are required to do a year internship in all other disciplines. I delivered babies. I saw kids in pediatric rotation. I did surgery. We are required to do an internship, which is followed by three years of psychiatric residency. I am very comfortable talking about medicines and medical issues, much more than the MD counterparts.
Like I said, I have always talked about medical issues with my patients, particularly in the community health mental center. Many patients do not like to go to doctors. They have to go to their psychiatrist to get their medications. They are either paranoid, or they don’t trust them. I would really talk about their medical issues and connect the dots for them. This is before I did functional medicine. I had that mindset talking about diabetes or weight or hypertension. There was a point where I would be monitoring some of these things for them. Now I really need you to see your primary care person. I can’t manage these things. It was such a logical transition for me to become a functional medicine doctor because that was a piece that was missing for me in caring for my patients. It made so much sense.
I remember seeing a patient at the community mental health center who said, “Is it normal to see pills in your stool?” Undissolved. I had to ask myself, Is it normal? I don’t know. No, it’s not normal! It’s not normal to see pills in your stool. Whole pills. That means you’re not digesting at all. It’s not normal to see large particles of food in your stool. You’re not digesting. That’s a major root cause of mental health issues. You’re not digesting and assimilating all your nutrients, fats, and proteins, which are so necessary for the brain and the rest of your body. With the brain being so sensitive, you absolutely need to be able to digest, absorb, and assimilate your food.
As I became a functional medicine doctor, there were patients in my mind. Oh, that’s why that person didn’t get better. All these people would pop into my mind about what I could have done differently. I am always thinking about them. Still to this day, there are puzzles that I have not solved. That’s how I approach people. I like to solve problems and issues and try to figure out what’s going on and keep digging and digging and digging and finding out what’s going on with that patient.
Dr. Eric:
Since a healthy gut microbiome is important for overall health, including mental health, everything is connected, that sounds like that’s a big part of what you do. We could talk about leaky gut, I guess, but do you want to try to find out the cause of the leaky gut, or the dysbiosis, the imbalance in the gut flora, and try to address that? When you see that, I’m guessing you see dramatic changes in your patients’ depressive-like symptoms.
Dr. Achina:
Absolutely. Depression is just a symptom of inflammation when it comes- That’s not 100% true. It’s the root of the root of the root really. It’s figuring out where the inflammation is coming from. We look at biological causes, psychological causes, social causes, and physiological or functional causes. It’s really connecting the dots.
The depression is just one manifestation of that complex of symptoms. If someone has an underlying autoimmune process going on, then the root cause for the depression really is that autoimmune process, or at least one layer. You want to find all the layers. It could be because your job is stressful. It could be that you have a toxic boss. It could be that you have three kids, and one of them has special needs. It could be that you had trauma from your early childhood. All of those things cause your cortisol levels to go up, which can cause a leaky gut.
It always comes down to in my mind five things: foods, infections, chronic infections, toxins, and stress. All of those really affect your hormones, particularly cortisol, your stress hormone. If you are looking with that foundation of issues at those five things, you will definitely find all the root cause. It’s looking in all of those realms. What most psychiatrists do is look at the biological and possibly the psychological and possibly the social. They don’t really connect the dots in terms of nutritional deficiencies.
I have a patient today who had a Vitamin D level of 18. Her primary care provider put her on Vitamin D, but only 1,000 or 2,000. She sees a psychiatrist. She has seasonal affective disorder. They don’t think about these nutritional deficiencies. Never asked what bloodwork had been done. At least hers never did, she says. Some psychiatrists have more training around this, looking at B12 and folic acid, which are highly connected not only to depression but other issues. It is looking at all this nutrition.
Nutritional psychiatry, believe it or not, is a brand-new field. Integrative psychiatry has been around for a decade, but it’s not really as accepted. But it’s coming around. People are learning more and more about these connections that are in the field. Especially the newer graduates are learning about inflammation, brain inflammation, BDNF alpha, and all of these things that are now in the literature. You might learn these things, but it doesn’t really come into practice honestly for 10 years. It takes 10-15 years to see it in everyday practice, where it’s common knowledge. But at least, it is moving in that direction.
I can say I was asked to be the plenary speaker for an American Psychiatric Association conference out of Oklahoma. I was asked to talk about my methods as a pioneer in the field doing this. They considered me a pioneer doing this. I have been doing it for 10 years now. It is good that they asked me. They could have ignored me, “Oh, she does that thing.” People want to learn. I am seeing shifts in a positive direction around this. It will take its time, but it will happen.
Dr. Eric:
I’m sure it’s moving in the right direction. More and more younger psychiatrists coming out of school are getting different types of training than you did when you were in school. It will be more than just dispensing medication in the future. Unfortunately, that sill happens probably too frequently.
You mentioned you had Hashimoto’s before the depression. I work with a lot of Graves’ patients and also had Graves’. Just like Hashimoto’s, it’s autoimmune. With Graves’, anxiety seems to be more closely associated, but Graves’ patients can also experience depression as well. That is tied into the inflammatory process as well as the leaky gut that is associated with autoimmunity. Essentially, anyone with any autoimmune condition, would you say they are at an increased risk of developing depression because of the increased inflammation and gut issues?
Dr. Achina:
Sure. Some more than others. Lupus, multiple sclerosis, MCI have higher incidence of depression as well as Hashimoto’s and Graves’. Much more than the other types of autoimmune diseases. Definitely Celiac. You will see certainly low levels of depression and anxiety across the board, but the more severe types of depression, you will see in lupus in particular. It can actually show up first as an initial symptom of lupus.
About 50% of patients with hypothyroidism have been given a diagnosis of major depressive disorder. Hypothyroidism is a major root cause. It happens to be the one illness that is searched for as a possible explanation for a major depressive disorder. If bloodwork is not done to look for that, then the average doctor is not practicing the standard of care. That’s been done for at least as I’ve known and even before my day that getting a TSH—there are certainly limitations with getting the TSH—but there was an effort to determine whether or not a person had the depression from hypothyroidism. There is certainly not enough data nowadays to know if you have a sub-clinical hypothyroidism that is playing a part, or just not looking at the entire thyroid panel. It’s so important to do a full thyroid panel. There are still many doctors today who don’t believe in getting a full thyroid panel.
Dr. Eric:
True.
Dr. Achina:
I have to convince doctors to do a full thyroid panel. It’s just a matter of not being educated about these things. Eventually, things like that will catch up.
Dr. Eric:
You mentioned sub-clinical hypothyroidism. For those who don’t understand, that would be an elevated TSH, and thyroid hormone levels are within the lab reference range. It might be lower than optimal. If someone has overt hypothyroidism, where the thyroid hormone levels are below the lab reference range, that could definitely increase the risk of having symptoms of depression. It sounds like if I heard correctly, if someone has sub-clinical hypothyroidism, that could also be a factor when it comes to depression even if the thyroid hormone levels are within the lab range.
Dr. Achina:
I think so, yeah. It depends on what the numbers are and what else is going on. I have seen when people have had high levels of adrenal-
Dr. Eric:
Cortisol?
Dr. Achina:
Cortisol levels. Their adrenaline is up all the time. They’re energizer bunnies and under a great deal of stress. The thyroid will downregulate to balance as a normal response to the adrenals. It’s looking at the whole picture. Why is that happening? Why is the thyroid putting on the brake? Sometimes the thyroid goes into hibernation and shuts down the metabolism on some level, so it goes into safe mode. Like our computers go into safe mode, our bodies go into safe mode. How? By downregulating the thyroid.
Not everyone needs to be treated. I wouldn’t necessarily say they have a disease or disorder, but it’s a dysfunction. In a way, it could be an appropriate function or a response to something else happening in the body.
Dr. Eric:
Some of the things we mentioned, they have Hashimoto’s, that inflammatory process, the gut microbiome, there are other things as well. You mentioned testing for the thyroid, but are there any other types of testing? You mentioned nutrient deficiencies. Do you do neurotransmitter testing? What type of testing do you do? It might vary depending on the person. If someone comes in, and you’re suspecting depression, what are some basics that most people get? If there are other tests that you might give some people, too.
Dr. Achina:
I get a stool test through GI Map. If I suspect SIBO, I will get a breath test through Aerodiagnostics. I get the organic acid test from Great Plains Lab. I will also get a whole battery of bloodwork: CBC, CMP (comprehensive metabolic panel), homocysteine, lipid panel. A cholesterol below 160 is very concerning with depression. Vitamin D, Vitamin A, copper, zinc, magnesium, selenium. Those are critical minerals that are needed under a stressful environment. Imbalances in those areas can cause depression and anxiety. HSRCP, DHEA, which is a marker for stress hormones like cortisol. This is bloodwork. An Omega 3/6 panel to see what the balance is of Omega-3s and 6s. I’m sure I’m missing something else.
Dr. Eric:
You don’t have to give everything. I was just trying to get an idea. But that is pretty comprehensive, even if you have left a few out.
Dr. Achina:
I don’t necessarily just treat the depression and narrow my focus as depression resolution. I treat the whole body. I have always treated the whole body. It’s the other symptoms that will help me to understand where the depression is coming from. If somebody has metabolic syndrome and insulin resistance, then depression can be caused by that. If they have a low cholesterol, and they have anorexia, then the depression can be coming from that. It’s really looking at patterns in the symptoms and patterns in the bloodwork that will help to find the root causes of the depression. I go after the root causes, and the depression resolves because I see the depression is a part of that pattern. It’s part of the manifestation of what is happening in the whole body.
The times where I really hone in in terms of specific symptoms is after doing a full gut restoration: removing what’s causing inflammation, repairing what’s missing, reinoculating the gut microbiome, repairing the gut lining. What happens is the fog clears. Then there are pieces of that depression we can then really focus on. It might be childhood trauma. It might be that their life is so stressful that they are not taking time to rest. Of course, we have already addressed sleep, exercise, movement, and diet by that point. It’s honing in and fine tuning the approach to specific things that are happening that keep triggering the inflammation, like the toxic boss or the marital problems or not knowing how to manage the kids at home or giving time to yourself or having chronic feelings of guilt, fear, shame, or anger.
You asked about neurotransmitter testing. I used to do it quite often earlier when I started doing functional medicine, but I don’t find them to be useful. It is a dynamic process. You can really figure out where there needs to be support by just getting a really good clinical history.
Dr. Eric:
I agree with the neurotransmitter testing. I don’t do it. I don’t use the organic acids testing on everybody, but I do it on some of my patients. That looks at some of the metabolites related to dopamine, serotonin, epinephrine, and norepinephrine. Of course, that gives so much more information like yeast and candida and mold markers and indicators of detoxification.
Dr. Achina:
The beauty of that test is that first page, the microbial organic acid, especially the clostridia. You can’t really pick that up without testing.
The thing about depression is that many of the symptoms of a major depression are things you would see in a classic sick syndrome: low energy, sleep problems, thinking problems, appetite problems, concentration problems. If somebody had the flu and was really sick, you would feel that way. It just happens to be that people with major depression feel that way every single day all day.
What I hadn’t been trained in is to look at that as this is a whole body illness that just happens to be affecting the brain. It’s the brain hardware and software. Why don’t we look at this as a whole body problem? If you had a problem with your computer hardware, it will glitch. Our brains are just glitching on some level.
I find that when people don’t feel well, their perceptions of what’s happening around them changes, including their perceptions of any trauma that they may have had in the past. When you’re not feeling well, you’re not processing things well. Things come up that in the past probably wouldn’t have come up if you felt well. Just the not feeling well shouldn’t necessarily be considered that you have major depressive disorder and completely isolate it from the body. Your head is connected to the body. It’s all connected. To treat it as a separate entity is a huge disservice to people.
Dr. Eric:
I definitely agree with that. With any type of condition from a functional medicine standpoint, you want to take a whole body approach. Pretty much all conventional medical doctors take the opposite approach. More and more practitioners are learning about functional medicine and keeping an open mind.
When it comes to diet, is that one of the starting points, too? Pretty much with all functional medicine practitioners, it’s changing diet. Where do you start when it comes to diet? Is it just eat whole healthy foods? Do you require your patients to go gluten-free or dairy-free?
Dr. Achina:
Ideally, I would want them to be gluten-, dairy-, and sugar-free in the beginning. I always start where the patient’s at. If they have never been gluten- and dairy-free and don’t have the resources or support around doing that, they have to start in baby steps.
If they are terrified of this deficit of things they have been eating, I’ll start with adding some fruits and vegetables. Generally, people who are on the standard American diet will be devoid of fruits and vegetables. Starting by adding things, it’s easier to add things first. That might not be the case for some people who have a really hard time with vegetables. It’s a negotiation.
With the patient, where are you willing to start? This is where you need to be. This is my experience in being gluten- and dairy-free. It’s worth doing an elimination diet. I have found that the whole 30 is something that people can wrap their heads around as a modern elimination diet. That might be a good place to start for some people.
Essentially, my goal is to get them to a Mediterranean diet. Then maybe a paleo. Then potentially, if they still need some more push or oomph in the clearing of brain fog, let’s say, I might push to keto. If they are still having energy issues or brain fog, the ketogenic diet. I don’t believe that people should stay on a diet long-term. Diets should evolve seasonally. They should evolve based on what other issues are happening. I use the diet as a way to shift the metabolism, shift the microbiome in order to heal.
Then you can start adding things back. I have had people be able to add things back in that otherwise they thought they would never be able to. A lot of times, you can reintroduce these foods, but there is a proper way to do these things.
Dr. Eric:
You mentioned low cholesterol. I’m glad you brought that up because it’s very common for people with hyperthyroidism to have low cholesterol. That could be a factor in depression. You mentioned you don’t like to see the levels below 160, correct?
Dr. Achina:
Correct. Below 160 can definitely be causing depression. Cholesterol is a building block of insulation around your brain cells. Your brain is 80% fat. Cholesterol is fat. You need enough cholesterol in order to make hormones, too. There are studies that show cholesterol levels below 100 or even 80 can cause chronic suicidal ideation daily. There are multiple studies that show that.
Unfortunately, when we have people in the hospital, it’s not even a test that’s drawn. In kids, teens, and young adults, it should be drawn. A lipid panel is rarely drawn in the younger age group. I think it should be part of every battery of tests when it comes to depression and suicidality.
Dr. Eric:
When it comes to low cholesterol, if someone has hyperthyroidism, they have to address the elevated thyroid hormone levels. It could take time for that to increase. When it’s not related to hyperthyroidism, do you have any strategies for low cholesterol? Sometimes it can be genetic. Do you mostly try to increase it through diet?
Dr. Achina:
Other than food, like eating eggs, cholesterol is made by the liver. Sometimes, the liver gets congested, and it doesn’t have the machinery running in terms of making cholesterol. There is a supplement that is made by a company called Sonic. You can get it from New Beginnings. There is only one company I know of that makes cholesterol pills. You can take some supplements to boost your cholesterol level. I have had a couple of patients with autism that have taken that. I see low cholesterol in quite a few kids with autism as well.
Dr. Eric:
When someone comes in with depressive-like symptoms, just to summarize, we know that you want to address the cause of the problem and treat the whole body. What were some of the first steps you would take? If someone is convinced they need to see you or a different psychiatrist that practices functional medicine, what should they expect?
Dr. Achina:
Doing a screening to make sure you’re not in an acute crisis. I would make sure that you’re safe and that you were able to function on some level because functional medicine does take work, and it is time. You have to be well enough unfortunately to do the work of changing your diet, doing exercise, and all of these habits that need to be in place.
If you are having an acute depressive episode, and you’re in crisis, you shouldn’t go to a functional medicine doctor to help you. You really should see someone who can stabilize you possibly with medications or even hospitalization if that is necessary. Sometimes people have called me, and they need to go to the hospital because they are safe and are not functioning. If you are hearing voices, if you are having chronic suicidal ideations, if you are paranoid, you should seek help right away and get stabilized first. Once you’re stable, then come see me.
I’m not going to be able to help you until you are able to do the work that is required. Your brain needs to think on some level. That doesn’t mean to say it might not be hard, but you have to be able to do a certain amount of work over time. You won’t get results immediately, but you could get results within 30-60 days. I see people feel so much better just by changing their diet in 30-60 days. Sometimes that’s faster than people who start an SSRI and didn’t change their diet at all.
I would say that making sure you’re safe, making sure you’re not in a crisis, and you do have to be willing to do the work and invest the time. Creating that space for yourself, putting yourself first, putting your oxygen mask on first, saying you deserve it, and you are worth it is a really important mindset change.
Having a destination. Where do you want to be? You need a destination. It’s not just, “I want to feel better.” It’s not about suppressing symptoms. It’s about being well. You have to have an idea of where you’re going in the process. I have people do this exercise to have in their mind’s eye, “This is where I want to be, and these are the things I want to be doing when I’m well.”
Dr. Eric:
Where can people find out more about you? There is your book I recommend getting, What if It’s Not Depression?
Dr. Achina:
You can find my book on Amazon. You can get it at my website, FXNMind.com. I have another website, AchinaSteinDO.com. I am also on Instagram and Facebook. On Instagram, @Dr.AchinaStein. On Facebook, it’s “What If It’s Not Depression? with Dr. Achina Stein.” I have a YouTube channel, too. You were one of my guests, so we can watch your video. Other experts in root causes of depression as well as tools to resolve symptoms of depression and anxiety. Thank you.
Dr. Eric:
Thank you so much, Dr. Achina. It was great chatting with you. We might have to have you on again in the future because there is so much totalk about, and I have so many other questions.
Dr. Achina:
Great. I would love that. Thank you so much for having me. It was my pleasure.
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Dr. Eric:
It’s just amazing how important the gut microbiome is when it comes to depression and anxiety. For years, practitioners would just focus on the brain. There are plenty of psychiatrists who still do this. I’m not saying there isn’t a time and place for medication. But it really is important to focus on the health of the gut.
If you or someone you know is suffering from depression, please have them check out this episode. Perhaps also send them to Dr. Achina’s YouTube channel so they can learn even more about how to overcome depression and anxiety without relying on medication.
That being said, here is a clip of Dr. Achina and I chatting about SSRIs:
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One thing I wanted to quickly ask you, as far as SSRIs, a lot of people are on medication, including a lot of children. What are potential long-term consequences of being on medications? One is just not addressing the cause of the problem and masking them with medications. Are there any side effects?
Dr. Achina:
First of all, medications do poop out. At some point, they really don’t work any longer. What it can do is cause some neurological problems in terms of this imbalance of serotonin and dopamine. You end up becoming low in dopamine, resulting in these neurological issues almost like Parkinson’s symptoms. It’s not called Parkinson’s, but there are people who have these neurological symptoms related to low dopamine. That is a long-term risk of being on SSRIs.
As a result of taking them for a long time, it really changes the balance in your brain on an almost permanent level. When you try to come off of these medications, many people do have a discontinuation or withdrawal syndrome that is really hard for many people. It’s very painful in many ways. People get zapping, ear ringing, tinnitus, dizziness, lightheadedness, nausea, upset stomach, headache, even neurological symptoms in terms of finger sensations. There is a whole list of symptoms that people can have. Dyskinesias, which is abnormal movements. Akathisia, which is a restlessness, ants in the pants feeling. These are not comfortable feelings. Unfortunately, people end up having to go back to the dose that they were taking. Although it’s not necessarily doing anything for their depression anymore, they have to take it because they can’t get off of it.
There are many doctors who don’t know how, and we’re certainly not trained, to be able to taper a patient off of these medications safely. When we were trained, and this was when I was working as a psychiatrist, our understanding is once you’re on a medication, you have to stay on it. Now you have this illness that will never go away. That is far from the truth.
If you address the root causes, you can absolutely bring the body back into balance. I have been quite successful in getting many people back into balance and getting them off of medications as well. It takes a while. It’s not for everybody.
If some people have been on four or five medications- That’s the problem. One medication poops out, so you get put on another medication, and another, and another. It’s this whole polypharmacy that at some point, the side effect combinations of these can cause side effects. The #1 cause of death in this country is being on all these medications and no one managing the drug-to-drug interactions that are occurring. The solution is to keep increasing the dose until a person is so frustrated that they just stop the medications without even discussing it with a doctor because the doctor won’t support that. That seems to be the trend.
Of course, you will find the occasional doctor that will work with you and try to reduce and discontinue these medications. For the most part, there is no training around what to do. It’s very important to find someone who knows how to do that.
Also, know there is definitely risks in taking these medications as well as benefits. I’m not suggesting that you shouldn’t take the medication. You have to look at the risks versus benefits at the time. These medications can be lifesaving, but you want to have the conversation and have good, informed consent around the decision. You also want to have aplan to come off of it when it’s time.
I liken it to rehab. If you ever had a car accident, and you had multiple broken bones, and you need the jaws of life to get you out of the car, you are going to want to be helicoptered to the hospital and be in surgery and fix whatever needs to be fixed, etc. But you know that you will come out of those casts. The plan is coming out of those casts once you heal.
There is no plan like that in psychiatry. There really isn’t. There will be crises. Things will happen. My son had an acute mental health crisis, and he was put on meds. Thank God there were meds. But there was no plan for him to come off of them. Fortunately, for him, I became a functional medicine doctor and was able to do that with him.
There is hope that can happen. I’m not anti-medication. I am pro-informed consent. There is certainly a place for them.
Dr. Eric:
Thank you so much for sharing that. It’s probably a good idea for someone who is taking a medication, and if their doctor isn’t willing to help them wean off, they probably should see someone like you. Would you say they need to have a functional medicine background, or is it just the fact that many conventional doctors refuse to help people wean off? Like you said, once they’re on it, it seems like all they do is over time increase the dose. Someone like you would definitely help them, but other conventional medical doctors that do help people.
Dr. Achina:
There are definitely organizations that do help people come off of SSRIs. There is one major one out of England that is a huge proponent of trying to get people off of SSRI medications. There are other possibilities. If you needed a supplement, there are things you can use like L-theanine and GABA. There is taurine, tyrosine, 5HTP, SAME, all of these natural formulations. There are combinations as well. A combination of vitamins and things that work really well and can help to stabilize you while you are searching for the root causes. It doesn’t have to be these heavy-duty medications.
In a severe crisis, you should try the medications. But if it is mild to moderate, sometimes there are risks in medications. Medications in certain populations like kids and adolescents can cause suicidal ideations or a manic episode. There are risks in taking them. You want to make sure the benefits far outweigh the risks when you are choosing to take a medication.
There are supplements you can take instead of taking medications. I don’t recommend taking them while you are on medications because there are drug to drug interactions. You want to avoid combining the two. That’s not safe at all. There are things like serotonin syndrome that can put you in a crisis. If you are listening to this, you need to work with someone who knows what they’re doing in this arena.