Mental Illness – A Different Approach – with Dr. Kelly Brogan

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In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Kelly Brogan talks about a different approach to treating mental illness.

Kelly Brogan, M.D., is a holistic women’s health psychiatrist, author of the New York Times bestselling book, A Mind of Your Own, and the children’s book, A Time for Rain, and co-editor of the landmark textbook, Integrative Therapies for Depression. Her latest book is Own Your Self. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College and has a B.S. from M.I.T. in Systems Neuroscience. She is board-certified in psychiatry, psychosomatic medicine, and integrative holistic medicine and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms.

Main Questions Asked about Mental Illness:

Why is that you see mental illness as a symptom not a diagnosis?
What are the five reversible drivers of mental illness that you speak of in your book?
What recommendations do you make to patients presenting with symptoms of mental illness?
Can you tell us more about the adverse effects of medication?
Why don’t’ more doctors prescribe thyroid medications for patients with mood disorders?
What else is important for us to understand?

Key Points made by Dr Brogan about Mental Illness:

Many people are walking around with an idea that we’ve worked out the taxonomy, so to speak, of psychiatry and mental health, and that we have all these discrete disease entities that are largely permanent but can be managed through lifetime prescription compliance.
It’s simply not true.
Remember, we don’t have any form of objective testing in psychiatry.
For several decades there’s been research that largely comes under the umbrella of psychoneuroimmunology (mind-brain-immune system), sometimes it’s called psychoneuroendocrinology (mind-brain-hormonal system).
Essentially, it’s a field of research that puts mental illness in the same category as other lifestyle conditions, e.g., heart disease, diabetes or autoimmune conditions.
All of them, chronic illnesses, representative of a kind of mismatch between our native biology, our genomes’ expectations and the exposures we have daily.
So, this is the concept that your symptoms are essentially messengers that allow you to learn the language of your own biology and begin to take control or the process of healing.
Think of the parable of eight blind men feeling an elephant. It’s this idea that if you are focused in a cordoned off, segmented area of exploration without an awareness of its connectedness to the whole you could get a really wrong impression; like thinking that you’re just feeling a rope when you feel the elephant’s tail.
So, it’s the same concept with psychoneuroimmunology, for a number of years they been studying the role of inflammation as a messenger system in the emergent phenomenon of psychiatric symptoms, whether that’s hearing voices or seeing things, whether it’s insomnia, poor concentrations, agitation or irritability.
The list of mood, behavioural and cognitive symptoms that can attend an imbalance is very long.
I found five drivers that are the most common reversible causes of what we’re calling psychiatric symptoms.
I call them psychiatric pretenders.
The first is blood sugar imbalance. Most, if not all of us to some extent, because of our stress exposures, the nature of processed food and the way we use food for our convenience rather than developing a more conscious relationship to the act of eating, are on a blood sugar roller coaster.
The relationship of blood sugar dips to fight or flight chemistry is such that you can end up having something as severe as a panic attack. I had one patient who was on three psychiatric medications, on her way to electroconvulsive therapy and was totally symptom-free within four weeks of basic dietary change.
Another one is thyroid imbalance. When you look at the symptoms of hypothyroidism and those of a major depressive disorder, they line up so completely that they’re virtually identical.
You wouldn’t want to treat a thyroid imbalance with Zoloft or Prozac but if you don’t have access to the information that can help you interpret labs you wouldn’t know to connect the dots.
Another big one is related to the adverse effects of commonly prescribed medications, including cholesterol medications, antibiotics, and birth control pills, and some very common over the counter medications, like Tylenol and Aleve.
Not only can they have effects on systems that affect mood, cognition, gut integrity and nutrient deficiencies, but some have been directed to have a direct effect on mood. That Tylenol you take for your pain, is affecting a whole lot more.
Then, there’s the realm of nutrient deficiency. While there are many deficiencies relevant to psychiatry, the one with the most jaw-dropping data is B12.
I read one case on a 27-year vegetarian diagnosed with catatonic depression. She was unresponsive to multiple medications, when finally transferred to an outside hospital she was found to have a low B12 level (still technically in the range). Two B12 shots later, she was symptom free.
Regarding the thyroid issue, we’re not trained to look beyond the TSH reference ranges and understand the relevance of antibodies.
In psychiatry, even if you have “normal” lab values for your thyroid hormone levels and the presence of autoimmune markers like thyroid peroxidase antibody, it’s relevant. There’s already an immune-inflammatory process at work that could be the real reason you’re presenting with symptoms like anxiety, brain fog or depression.
I was shocked by what I learned about psychiatric medications, because I had been such a die-hard believer in them.
I’ve since learned that the efficacy of these medications is grossly over-represented; and then I learned that the adverse effects can be jaw-dropping.
So, I started researching the other medications that I been a believer in, like statins. I found no evidence to defend the fact that any woman would ever take a statin. So many of my female patients taking statins had undiagnosed hypothyroidism, which is a document reason for elevated levels of cholesterol.
So, when you don’t understand all these relationships, it seems to make sense to take medication, why not? But when you learn about the innate intelligence of the body, it begins to make less and less sense to reach for a pharmaceutical fix.
What I’ve found is that once you engage basic lifestyle changes, it self-ameliorates and -remediates all the issues we’ve just discussed.
You can heal, and if you know that, then you can set your sights on that goal and you can achieve it. I believe that. That’s the most important ingredient, knowing it’s possible and wanting it because the success is nearly guaranteed.
I think we can get into this kind of self-critical place that is very paralyzing when we feel like we’ve made choices that weren’t good though you thought they were the best idea. Or you get into this place where what you’re doing is never good enough.
So, I think there’s a practice and collection of exercises that are a really important accompaniment to the healing path. They involve developing a relationship with the more tender parts of yourself, the more vulnerable aspects of your being. It is possible to do through relatively simple attention to the habitual ways we relate to ourselves.
That’s a lot of what I’ve tried to focus on in my most recent work and book.