As published by goop.com, June 2, 2016
The Roots of Mental Health. Maybe They’re Not In Our Heads.
The number of people—and women in particular—who are taking antidepressants worldwide has skyrocketed in recent years. In the United States, the count is at 30 million. One out of every four women in their forties and fifties takes them. And antidepressants aren’t just being prescribed for depression; they’re being given to those of us struggling with PMS, stress, irritability, anxiety, lack of sleep, and so on. But what if antidepressants aren’t a cure for any of these conditions, or even a safe way to treat the symptoms?
In her book, A Mind of Your Own,Dr. Kelly Brogan (board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine) argues that our common understanding of depression as a disease caused by chemical imbalances in the brain is…entirely wrong. Lifestyle imbalances, and inflammation, she explains, are actually at the root of depression and anxiety. Dr. Brogan’s case against conventional medicine—backed up by a veritable library of shocking research studies, along with personal stories we can all relate to—is very compelling. As are her suggested solutions (and 30-day action plan) for finally feeling well and like yourself, pill-free. Below, Dr. Brogan shares a new paradigm for mental health.
Q&A with Kelly Brogan, M.D.
One of your big arguments is that depression is not a disease, but a symptom—can you explain?
We have been told a story about depression: that it’s likely genetically driven and if it develops, it’s because of brain chemical imbalances that require management by chemical medications, often for the rest of our lives. This is a false tale that has been sold to us by an industry that has influenced the training of doctors and has spent billions on messaging patients through direct-to-consumer advertising. I invested my entire career in this narrative as a conventionally trained psychiatrist until I learned the truth.
In six decades, there has been no evidence of a discrete chemical imbalance that causes depression. This isn’t all that surprising, however, when you zoom out a bit to realize that depression is not one thing. It is an indication of imbalance. It’s as if your toe hurts—it can hurt because you have an infection in the toenail, you have a string tied around it too tight, or you dropped a hammer on it. The hurting is just an invitation to investigate further to identify the best way to resolve the problem.
It is time, even according to leaders in the field, to let go of the chemical imbalance theory and take a fresh look at what the science says. Depression is rooted in inflammation, not the brain. The human body interacts with its environment with deep intelligence. Your body creates symptoms for a reason. Depression is a meaningful symptom of a mismatch, biologically, with lifestyle—we eat a poor diet, harbor too much stress, lack sufficient physical movement, deprive ourselves of natural sunlight, expose ourselves to environmental toxins, and take too many drugs. Inflammation is the language that the body speaks, expressing imbalance, telling you that something is wrong somewhere that needs your attention. We usually suppress these symptoms with medication, but that is like turning off the smoke alarm when you have a fire.
What if your depression is actually a thyroid imbalance? Blood sugar instability? Food intolerance or a side effect of a medication? It makes little sense to treat any of these reversible conditions with a psychiatric medication, but it’s easy to fall into the trap of the quick fix, particularly if you are a woman. Women are twice as likely to be prescribed medication when they present to their doctors with complaints like flat mood, fogginess, poor concentration, poor motivation, and feelings of overwhelm.
Depression is an opportunity. It is a sign for us to stop and figure out what’s causing our imbalance rather than just masking, suppressing, or rerouting the symptoms. It’s a chance to choose a new story, to engage in radical transformation, to say yes to a different life experience.
Modern antidepressants are based on the idea that serotonin improves mood. But you make the case that this is all a myth—how?
Despite being taught, in my training, that antidepressants were to the depressed (and to the anxious, OCD, IBS, PTSD, bulimic, anorexic, etc.) what glasses are to the near-sighted, I don’t buy this anymore. I don’t think patients are getting the whole truth.
Here’s the deal: There is not a single human study that supports the “monoamine hypothesis” of depression, which is the idea that depression is caused by a certain kind of chemical imbalance in the brain, such as under-activity of serotonin. The only studies in which tryptophan (an amino acid precursor to serotonin) depletion resulted in depression were in patients who had previously taken antidepressants.
Imaging studies, post-mortem suicide assessments, and animal models have never yielded consistent patterns of neurotransmitter levels, metabolites, or receptor profiles. Compelling discussions by Drs. Joanna Moncrieff and David Cohen suggest that antidepressants actually create abnormal states rather than repair them. They use the analogy of alcohol’s disinhibiting effects: The fact that booze can ease one’s social phobia does not imply that alcohol is an appropriate treatment or a correcting agent.
Direct-to-consumer advertising in America has allowed pharmaceuti cal companies to “teach” the public about brain chemical imbalances and serotonin deficiencies through cleverly worded taglines and absent FDA-policing.
But they do work! Say many patients and their prescribers. And they do work! Sometimes. Thanks to active placebo effect or expectations of relief that manifest as actual physiologic changes—as demonstrated by Harvard’s Dr. Irving Kirsch, a placebo effect expert. (He also collected unpublished data to show that more studies demonstrated lack of effect compared to marginal benefit largely attributed to placebo.)
What’s the thread that connects our gut and brain to inflammation and depression?
I think that for most of us, the impact of the brain on the gut is intuitive. We’ve all had butterflies with excitement, lost our appetite when we’ve fallen in love, or had diarrhea before a big performance or event. What’s less intuitive, but now has been substantiated by two decades of medical research, is the impact of the gut on the brain. We now understand that the gut communicates information to the brain about the environment and that the microbial ecology of our gut—the microbiome—manages this communication. The language used by the body is inflammatory messengers.
In this way, depression joins the ranks of all of the diseases of modern civilization, including heart disease, autoimmunity, and cancer. The body is setting off alarm bells in the form of inflammation in an effort to adapt to perceived stressors. The most powerful way to send a signal of safety is to heal the gut through whole foods. Ancient medical practices from Ayurveda to Chinese medicine have known this for thousands of years. We are just learning about the complex interconnectedness between all of these systems we have come to believe are separate entities.
How does food affect our mood, and what kind of diet do you recommend to your patients struggling with stress/anxiety/depression?
We don’t eat food anymore. We eat food-like products, and when we eat actual foods, they have often been grown in depleted soil, shipped across the globe, and saturated with chemicals. Food is not just fuel, though. Food is information, and it speaks to our genes. We no longer can get away with eating food that screams at our genes. We need food that whispers a love song. The wrong food can impact your mood by driving blood sugar imbalance (which can masquerade as anxiety attacks, chronic fatigue, ADHD, and depression), by impacting your brain through your immune system in the case of dairy and wheat, and by depriving you of nutrients essential to balance hormones, your gut, your immune system, and your nervous system.
I work with a dietary template that I used to put my own Hashimoto’s thyroiditis into remission and that has worked with hundreds of patients. It is a diet high in natural fat, and organic foods, including those from animals. As a former ethical vegetarian, it has taken a lot of research, learning, and mentorship from the now late Dr. Nicholas Gonzalez to appreciate the role of animal foods in healing certain conditions. In the end, the dietary template I recommend often just “feels right” to the women it is meant to heal. It’s almost like I’m giving them permission to eat what they already know, deep down, that they should be eating.
What’s the latest research on the link between toxins and anxiety/depression?
We are swimming in a sea of 80,000+ unstudied chemicals that we never evolved, over 2.5 million years, to recognize. Our immune systems are ablaze because of it and our hormones are going haywire. I have grave concerns about endocrine-disrupting plastics, about fluoride in our tap water that directly affects the brain and thyroid, about pesticides that decimate healthy gut bacteria, and about neurotoxic metals like mercury and aluminum. Mostly, we are beginning to see that the dose doesn’t necessarily make the poison and that small amounts of these chemicals combine and interact with our systems in unique ways to cause significant problems, many of which manifest psychiatrically.
We have to also include medications, now the third leading cause of death in America, in this discussion. Medications from antibiotics to birth control pills to antacids to over-the-counter pain relievers to even antidepressants themselves are based on a one-size-fits-all model of human physiology. This can be Russian Roulette-causing, and perpetuate chronic mental illness.
What are other important lifestyle changes that can make a significant difference?
I put food first and I work with my patients to take this “prescription” very seriously. I want them to experience an internal shift through prioritizing nutrition. When they do, they understand that the power to change their experience was always just under their nose. They don’t need a doctor or a guru. They just need to get back to basics and honor themselves.
I also ask them to start with 3-12 minutes a day of a Kundalini yoga medical meditation. We have to rewire the nervous system, our perceptions, and release fear. In my experience, this ancient technology can take you there and beyond, very quickly.
I ask them to move. This can be 20 minutes a week of high intensity, low volume interval training on an elliptical. It can be dance or yoga.
I ask them to honor their sleep and we begin detoxification of their home environment—products, air, water, and electromagnetics.
We also engage in a mindset shift. Through this process, we remember what we have forgotten—that the body is best at self-healing if we just get out of our own way. We realize that we can reclaim something we gave away. Something that’s not available through a model of care based on life-long pharmaceuticals. It’s that feeling that we are always missing something even if our symptoms are “managed.” It’s our personal power and fearlessness. With this, anything is possible, including becoming medication-free after decades of exposure. Remember, this is your journey for a reason and there are no regrets.
Which medical tests can actually help pinpoint the root cause of what we commonly think of as mood disorders?
At the very start of treatment, as my patients begin my strict dietary protocol, I order the following tests:
- Thyroid function tests: TSH, free T3, free T4, thyroid autoantibodies, and reverse T3
- Underlying genetic variant: the MTHFR gene test (the MTHFR gene produces the MTHFR enzyme, methylenetetrahydrofolate reductase, which is essential for several bodily processes that directly tie into mental well-being)
- Signs of vitamin B12 deficiency: serum vitamin B12 levels and homocysteine levels, which can detect B12 deficiency as well
- Levels of inflammation: High-sensitivity C-reactive protein
- Blood sugar balance: Hemoglobin A1C
- Vitamin D deficiency: Levels of 25OH vitamin D in the blood
For people who are on antidepressant meds and who want to get off them, what’s your recommendation?
This has become my unintended specialty. I have learned that these medications can be some of the most challenging of all chemicals to detox from and that their withdrawal syndromes are serious. I believe everyone deserves a chance at a new chapter and a shift in mindset to one that embraces their human experience as meaningful and rejects the illusion of the magic pill that promises to keep you punching the clock. When my patients decide they are ready to taper off of medication, first we begin with healing their body. If you imagine yourself to be a bucket that is almost full, the stress of a taper is likely to cause overflow. If we can drain the bucket with lifestyle changes like those outlined in my program first, then the taper can be a relative breeze.
A typical pace can be determined after a “test dose” decrease of approximately 25% of the total daily dose. After 2-4 weeks, if this has been tolerated, this increment can be attempted at a pace of every 2-4 weeks. Many patients will need to drop down to 10% of the total dose, particularly closer to the final 25% of the total dose. Because withdrawal effects can be delayed and fluctuate, it can be challenging to identify whether symptoms are related to a recent dose decrease or even a previous one. Remaining stable for several months may sometimes be necessary before proceeding.
In my practice, I never taper if fear is the dominant emotion. We have too much data that tells us about the power of what is called expectancy (belief around what is happening in treatment) to determine the outcome of an intervention. If you are afraid of life without meds, life without meds will come back to scare you. If, on the other hand, you feel empowered, energized, and excited about awakening to your true self and moving through this window, then you will succeed. I do not start patients on meds under any circumstances, so if they struggle after a completed medication taper, we never return to meds. This means that we ask why they are struggling, we investigate whether it is physiologic and/or psycho-spiritual, and we commit to sitting in it for a bit, making space for it, until it becomes clear. This is a different mindset. It’s one of tolerance, patience, and trust. Fear is something we name, acknowledge, and allow, but do not engage or react from.