When we talk about depression, you know, to me, they use a term kind of beyond sadness, because it's almost this numb, paralyzing experience. It's almost unfeeling.
In today's episode, we are talking with one of my favorite doctors, and I am so excited to have him on the show. This is Dr James Greenblatt, and we are talking about depression, which is such an important thing for us to be discussing. I have long treated depression in my practice, and I have been so glad to have more tools in my toolkit to be able to treat this. And so many of these tools have come from the training and education that Dr Greenblatt has offered. So let me tell you a little bit about him. Dr James Greenblatt is a dual board certified psychiatrist and internationally recognized pioneer in functional and integrative psychiatry. This means he treats the brain from a holistic point of view, really utilizing all the tools that he can get. And I am so glad that he has taken the time to put all of his expertise into a book on depression called finally hopeful. And this book teaches us how we can take a holistic approach to depression and support our brain health. Today's episode is going to review a little bit about depression and what a significant impact it has on our society. That won't come as a surprise to any of us, because we all know someone who struggles with depression, but then he goes on to give us really clear advice about what we can do to help take care of the brain and help it to work better. So you will not want to miss this episode. Let's dive right in.
Nutritional deficiencies might affect brain function before other physical manifestations, before we get the other aches and pains.
Dr Greenblatt, I am so looking forward to this conversation. This is so timely and so important, and you are such a wealth of information. So thank you so much for being on and sharing your expertise and time with us.
Thank you for the invitation, and I really appreciate the opportunity to help people see there are some very significant advances in the treatment of depression.
For sure, now you are an integrative psychiatrist. Tell us a little bit about what that is, because it's not necessarily uniformly recognized.
Sure. I think over the years, I've evolved to maybe using the term functional psychiatrist. So integrative and functional medicine, looking at how to integrate kind of lifestyle and diet and mindfulness is important, but functional medicine looks at the root cause. So over the years, I've kind of evolved to kind of labeling myself as a functional psychiatrist, helping patients look deeper, look at root cause, and that would include many, many factors, but so genetic vulnerabilities, hormone deficiencies, and most of my work is on understanding nutritional deficiencies, how it affects the course and outcomes for depression.
So as we're talking then, I want you to start with telling us, why should people listen? Why should they trust you as you're talking about this? Because you've been doing this for a little while, but tell us a little bit more about how they can sort of buy into this.
Yeah, I guess I present myself as someone who's been trying to make a bridge. My entire career has been up until last year in what was referred to as inpatient and residential psychiatry. So seeing those with the most severe mental illness, schizophrenia, bipolar disorder, suicide attempts, addiction, withdrawal. That's been my life and career, and I've been training doctors in conventional psychiatry how to improve treatment. So I'm not just presenting a naturopathic alternative. What I've done, and fortunate is my career has taken these two paths for those 30 years in a traditional psychiatric model. So I understand the pain, the turmoil and the overwhelming frustrations patients have and families, and this dual life I've lived is I've always been in the integrative and functional space. So I've taught doctors for 30 years how to look at nutritional deficiencies and how to prescribe them, and many of the treatments can be done with or without medications. So I think it's important that everyone appreciates that we're bridging both worlds. It's not either or, and I have experience in training physicians in those both worlds, so that's the place that I come from, and that's where I want to be of some help.
Oh, and I love it at my
clinic at uplift, for her, we take the same approach. With women's health, of saying it's not anti medicine, but it's also using all the tools that we have at our disposal. So it's maybe medications when we need them, and then other supplements and supplemental care, adjunctive care, to really help people just feel better. And so I love what you do for the mental health space, before we dive into depression, if it's okay, I'd love to hear about the brain in general. What are the things that everyone should know about just taking care of our brains? Because, as I've learned from you, there's actually a lot of crossover between how we support the brain, dealing with anxiety or dealing with scattered thoughts or dealing with brain fog or dealing with depression, there's a lot of overlap. What are the key overarching pillars that you would say for taking care of our brains?
Well, I mean, the two that just scream out at me to share would be, one is to appreciate that this very tiny right, 2% of our body weight, organ, this brain utilizes 25% almost a quarter of our metabolic energy at any time. So it's this very active, incredible machine. So when you think about 25% of your metabolic energy and vitamins and minerals are required to run that metabolic machine. 25% is being utilized by the brain. So if you can appreciate that concept, you can appreciate the fact that nutritional deficiencies might affect brain function before other physical manifestations, before we get the other aches and pains. So our brain is metabolically active. A diet of Twinkies will affect the brain probably be more than other organs. And then the second thing that I think is just important is for everyone to just think of the brain is 60% fat, right? The dry weight of the brain is fat. So saturated fat and polyunsaturated fat, the brain does not function with optimal fat intake and the right kinds of fat. So I think that is critically important, because so much of our interventions involves looking at lipid levels and understanding omega threes. So the brain is fat and it's metabolically most active organ in the body.
I think that's so interesting to hear. I think in women's health, we talked so much about, do you have enough? We are recovering from diet culture of the 90s and 2000s of maybe, if you just cut out enough from your life, you'll be healthy, right? And so so many of my patients are underfed, under slept, under fueled, undernourished, under recovered, you know? And so really keeping in mind that if you have not enough of anything that is good for our bodies, then that brain is going to be one of the first things to take a hit Absolutely. Well, tell us a little bit more about the specifics of depression. What does a depressed brain do? How does a brain become depressed?
Well, that's both the simple and complicated answer, because the simple answer is, is is a different path for everybody, and that's the point of the book, to kind of share many of those pathways so we can experience depression from an emotional stress and trauma, and changes the chemistry of The body and changes the chemistry of the brain. We can experience depression if you're anemic, if you have low iron or low thyroid or inflammation due to an infection, whether it's covid, Lyme or the flu, and then the nutritional deficiencies, B 12, zinc, iron, folate. So there are many, many paths, when we think of the world of integrated functional psychiatry, to creating that depressed brain. And one of the common themes is anything that creates inflammation in the body could cause depression. And then the complicated part of that is that we just don't know, unless we test to understand what's causing depression for that individual, do
we have an understanding of how that actually plays out in the brain? Because I think for most of us, it's like, well, I have thoughts, and sometimes I have sad thoughts, but when people are struggling with depression, it's different than that, right? How does something like inflammation actually affect the way that we're thinking and feeling and the way that our brain is working?
Do we understand that? Well,
yes, I think we understand it very well. That's what's so frustrating, is. That we understand this nutritional psychiatry and the integrative, functional world better than we understand the medicines that we're using every day, which is kind of frightening, but you mentioned the word sadness, which is a human emotion that we all can experience and feel, and it's a feeling. When we talk about depression, you know, to me, they use a term kind of beyond sadness, because it's almost this numb, paralyzing experience. And you know, poets and writers have used, you know, different terms to explain this kind of deep, dark, numb. It's almost an unfeeling, and the many paths to depression. So we know things like inflammation can it affects neurotransmitters, the enzymes of the immune system can affect neurotransmitters, the nutritional deficiencies affect the synthesis of neurotransmitters. So there are many paths again, but I think the neurochemistry is kind of understood, which just leads to a path of correcting that neurochemistry.
Well, I want to get into your approach to this, but before we do that, maybe set the stage for us. Tell us about the landscape of of most conventional psychiatry and psychiatric approach to depression. Most of us with antidepressants, some sort of therapeutic modality as well. Tell us how successful that is. How many patients are actually getting a lot better with antidepressants plus minus therapy.
Well, if we, if we focus on depression now, again, we have many, many psychiatric disorders with some like eating disorders, you know, very poor outcomes and addiction, poor outcomes and high relapse. So if we focus on depression with traditional medications and therapy, about two thirds of people get better. And what does get better mean? Those are research terms for their checklists are better. Many of those patients that our researchers say get better still have sleep problems, maybe side effects from the medications. So it's still a concern, yeah, but it's that 1/3 that's a big number. I think it's close to 10 million individuals that we call treatment refractory. They don't get better with our treatment protocols. And look, think of the name for a minute, treatment refractory. We're blaming you. We're blaming the patient for not getting better, you're refractory to treatment, rather than flipping it on the head and saying, We don't have the right model. We don't have the right treatment approach.
Now tell us what the old thinking, because this is what most of us are familiar with right is like, Oh, I have an antidepressant. And I think the way that a lot of doctors frame it is the antidepressants are going to keep more serotonin around longer. Will you explain to us kind of what we thought or think the antidepressants are doing, and then the reality of what we may not know how they're working. Tell us more about antidepressants. Sure.
I mean the big picture, you know, we have to understand that the medication approach is simply a symptomatic based model, right? Yes, if someone is sad, regardless of the 10 or 15 different causes, we know whether you have low thyroid or you're of low iron, you're going to get an anti sad pill, an antidepressant. So there's no concept in our current model for looking at root cause, so it's symptomatic
based care. How can we make you feel less sad, correct? And it
works sometimes, not all the time. And the concept of these medicines mostly use the SSRIs. They do affect serotonin. We know that because we understand from animal studies and what happens if you stop them, but we're also understand that serotonin is not necessarily the cause of the Depression, so we have these medications that do profoundly affect the kind of homeostasis in the brain and This neurotransmitter serotonin, but it's not always the underlying cause, so we often have side effects, and many people struggling coming off these medications,
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Well, the reality is yes, and that's pretty sad, as you describe it. It's it's just educated guessing. First of all, we can't predict. Every doctor has their favorite antidepressant or their favorite anti psychotic, and so it's educated guessing. And in this world of both telemedicine and insurance companies looking for these 10 Minute med check visits that no one has time to stop a medicine. So as you describe, you go each visit, you just get a new medicine because the first medicine is not working well enough, or you're having side effects, or you go to a new doctor, and they don't want to stop a medicine, so they add the average number of medications for people coming out of a hospital are five psychiatric medications. So if
they've been hospitalized for a psychiatric condition, they're coming out with five medicines.
That's the average. I know some that come out with eight, and we've seen patients because there's some for sleep and some for helping you feel less tired, and some for the disorder, you know. And again, I haven't thrown away my prescription pad. There is some role, but I think the culture is quite overwhelmed with just prescribing a medicine and then another medicine. We call that polypharmacy, and there's no research to support that,
and no research to support to give us ideas of like, the ill effects of being on multiple psychiatric medications. We don't have studies where they say, correct me if I'm wrong, but we don't have studies where they say, for people who are on these three different medications together. These are the outcomes,
absolutely none. I mean, I have very well known colleagues who might criticize some of these nutritional approaches, like magnesium or B 12, and will say there's no research. And I just look at them and ask them, what's the research of these three medicines that your patient just came in to see me on yeah, there might be research on one saying it's helpful, but when they start adding the second or third, they're just in the Wild West, and it's really frightening, and I think it's sad for patients and families.
Well, I love that you
say you haven't thrown away your prescription, Pat because there is a place for medications, and I'm grateful we have them, but let's focus on how we can support patients outside of that. When a patient comes to see you with treatment refractory depression, right? What would you throw out there as a ballpark number of what are the chances that they will be able to get off of a psychiatric medication altogether. Do you have any guesstimates there? Like most or very few,
I think at this point in my career and the world that I've been in, I can more confidently say that the vast majority are going to feel better and their mood is going to improve, and they're going to function. I don't know what percentage might or might not need medication, but I'm absolutely confident we can eliminate side effects and we can improve mood. And many patients, let's say they have multiple nutritional deficiencies, and they might be on the medicines for another six months or a year as we treat these metabolic and nutritional factors, but then for some they can wean off and taper off these medications.
Now I want to ask another foundational question before we get too much into the details here. I think sometimes when we start talking about an integrative or function. Approach it can in our brains, we just think, what's the right supplement, right? And that's kind of a that's just taking the same paradigm and plugging in vitamin instead of prescription medication. People say, like a pill for every ill, right? Well, now I take this supplement for this and this supplement for this. Will you paint a picture? How much involvement do these patients who are getting better with your plan? How much involvement do they have to have? How much of it is just adding stuff in versus looking at, you know, deep held belief or toxic relationships or lifestyle changes, you know, really getting in and doing the work to make changes. How much of this is making change versus
supplements? You know?
Yeah, I think it's all important, and it might differ for each individual, but one of the reasons we started our educational platform psychiatry redefined, is because I got really frustrated with just what you described, is people using supplements, like medicines, just throwing out supplements, and many people seeing functional docs who aren't trained in mental health, leaving with eight supplements because they had these tests people not understanding one root cause and two mental illness. So yeah, I'm just as concerned about the symptomatic, growth based approach to supplements, but a functional psychiatry approach. We're not throwing many supplements at patients, we're testing and then we have this kind of personalized path that, you know, Johnny needs X and Sally needs y, and that's the treatment path, and that's the difference,
yeah, okay, well, let's
dive into it, then, what is the overall structure that you use to approach a patient with depression? I know that you've talked about hormones and metabolic health. Are there big categories that your brain is kind of thinking through when you see a patient with depression, of things that you want to test
well, the first kind of components of the evaluation is not necessarily the testing, it's one establishing the relationship and that therapeutic kind of alliance and instilling some hope. You know, hence the name of our book, finally hopeful, because that's really important. Because most people, whether they've seen multiple providers or not, are feeling pretty helpless and hopeless. So that first contact is is really important, and explaining the model. And then the other critically important piece is the family history that doesn't get discussed enough, and not three generations of family. I need to know what's what's happened, what's that genetic vulnerability is? And then there's no, you know, one kind of focus of my evaluation. It is really a multi pronged, multiple test approach, looking at all the kinds of many of the factors we've discussed. So looking at amino acids and fatty acids and hormones. Because I know a little bit from your history, if you're having asthma and irritable bowel, it tells me something, but I don't know all the details until I test. And so we test first, you know we're not guessing. And then after the testing, come back, including genetic testing, then I'm going to know, I'm going to have a kind of more precision focused path of how to plan a treatment path for someone with
depression. So are there tests that
you would say every person with depression needs to have? Absolutely? What would those be?
Well, it's a long list, you know, but the key ones, I think everyone on the planet, which won't cost any money, is vitamin D, right? It is just we think about it for bone health, and now we can talk about immune health, but it is one of the most critical micronutrients for mental health. 30 years of research depression, anxiety and suicide risk, yeah,
tell us a little more about vitamin D. I live in Utah, and I I don't know how often I see a normal vitamin or an optimal vitamin D in my patients. What, what is the range that you're aiming for with depression? And what percentage do you know any statistics on what percentage of people are actually vitamin
D, replete the number that's out there for the US is 70% are deficient. So that just deficient might be the numbers that are Laboratory, or these not necessarily optimal. So I mean, that's pretty significant, and particularly as we see the growing mental health crisis, and we think about the sunscreen and the, you know, staying indoors and everything else that is happening in our lives, I think it's a critical public health problem that people aren't addressing as it relates to mental illness. And the mechanism is simple. It's a. Rate limiting step in making serotonin and other neurotransmitters. And the research is astounding. How many research papers there are, but often ignored because of a few studies where they just gave everyone 2000 international units, and statistically, it didn't help with depression, right? Well, statistically, your child is not a statistic. Your child has a vitamin D that's low, and could be the major factor in why the depression is not resolving with traditional
treatment. What lab range do you aim for?
You know, I just kind of come up with trying to get people in that 40 to 60, you know, range. It seems simple, it seems safe. We rarely have people coming in to a psychiatric clinic with numbers like that. It's usually under 20. And with those numbers, both in my outpatient practice and hospital I've seen serious psychiatric illness,
yeah, and you don't quite know how much someone is going to need to come up. Some people, you have to give them a fair bit of vitamin D.
I think vitamin D is the example I use all the time when I stress the point of biochemical individuality. We're all different. There are many, many genes affecting how we absorb and utilize vitamin D. So absolutely, we just don't know if 5000 is going to be the best for you to optimize vitamin D. Other people might be okay with two, and some might need 10,000 international units a day.
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You know, I think B 12 deficiency is also I've used the term one of the greatest tragedies in all of medicine, because the lab slip is not even close to what optimal vitamin B 12 is. It says 200 to 1100 some labs say 150 and somebody could be seriously impaired with depression, anxiety and other major mental health challenges with a vitamin B 12 Level of 320 Yeah, they got the blood test, they went to the doctor, and the doctor said, it's normal. Don't worry about it.
I totally agree with you. What other nutrients are you looking for?
I think the big ones would be kind of hypothyroid, low thyroid anemia, iron deficiency anemia, you know, we see it mostly women, but also see it in men, and most commonly, I see it in men with those with celiac disease. So I think Celiac disease is one of the most overlooked, poorly understood in our psych community, direct path to depression, because it's this rapid path to malnutrition, B 12, zinc and iron deficiency.
So are you doing celiac testing on most of your patients with depression, or only if they in that circumstance where you're wondering if there's something going on with absorption?
No. In the old days, I used to wait and I get these results back. They're low iron, and they're eating meat and they're low this. And I do it now. It's part of the initial panel. Every psychiatric patient should be screened for celiac, at least, looking at antibodies, and if they're positive, then, you know, send them for a biopsy. But no, I'm the literature is so clear in my practice, anxiety, depression, a celiac screen is critical.
Any other key nutrients we hear a lot about zinc and magnesium?
Yeah, absolutely zinc deficiency. Magnesium are two that we would look at routinely, folate. You know. Serum folate is predictive of depression and suicide risk, but it's not the most accurate test. So we look at genetic testing as well. So we look at MTHFR variants that I think should be done on every psychiatric patient.
What about you mentioned amino acids earlier? Will you explain that connection? Because it's so important to recognize amino acids, but also getting adequate protein. You know, if people are under nourishing their bodies that you don't have enough amino acids. Tell us why that matters to the brain? Sure.
Well, the amino acids the breakdown products of protein, so the chicken, egg, fish or beans, these amino acids are the building blocks of every protein in the body, and they happen to be the building blocks of almost every neurotransmitter in the brain and and we've done studies 3040, years ago, if you have low levels of amino acids in the brain, particularly tryptophan and phenylalanine, you're gonna have low levels of these neurotransmitters, so we can affect those changes. And so one, as you described, might be just optimizing protein intake, but what we see a lot that gets ignored, is somebody eating adequate protein, so there'd be no suspicion from dietary intake. But when we look at the blood test, we see, they're very low because they're not digesting and absorbing the protein that they're eating. So it becomes a digestive problem.
And are you looking at just the comprehensive metabolic panel for that? Are you testing amino acids in a different way?
Again, as a functional psychiatrist, I strongly recommend looking at the levels of fasting levels of amino acids, because that tells me a lot about their ability to break down protein. Do they need digestive enzymes and why? And that's, you know, sometimes I think of myself as a gastroenterologist looking at digestion and absorption of food and micronutrients. When I'm treating depression,
talk to us about other aspects of food. We've talked about specific nutrients you're testing for and presumably giving dietary advice and also supplementation to get those nutrient levels optimal. What other things can we do in our diet to prevent depression or to start to support our brains if we're dealing with depression.
Well, I mean, similar to what I mentioned earlier, and don't be afraid of fat, particularly, you know, olive oil and the polyunsaturated fats, omega threes in fish and nuts and seeds, because we need fat. And then I guess, my biggest concern, and used to talk about this in the 90s, but I had no research, and now we can say this research is refined sugar and ultra processed food is associated with depression, anxiety, even suicide risk. You know, I like to describe to parents and patients. You know, think of some of these high sugar like, particularly the sugar sweetened beverages, as kind of nutritional vacuum cleaners, right? They're not only devoid of nutrients, but they have to steal the small amount of vitamins you have to metabolize that sugar. So really caution with the ultra processed foods and refined sugars.
And you've also mentioned in other areas, but I think probably true for depression as well as polyphenols, right?
Yeah, absolutely. I started using those phytochemicals, you know, in fruit, grape seed and pine bark and blueberry extract for ADHD and tremendous benefit, and we found that very helpful for depression. They're anti inflammatory antioxidants, and they also kind of feed the gut a microbiome. So some of the Polyphenols are one of the most helpful and simplest micronutrients to add to your diet.
Now you had mentioned too this importance of the gut and absorption and celiac and the ability to digest protein. We talk a lot, or we hear a lot about this gut brain connection, right? And we hear 90 to 95% of serotonin is produced in the gut. Will you break that down for us a little better, this idea of the gut and the brain and how they interact, and clarify for us, give us that the most accurate information about how specifically depression relates to our gut. Sure.
I mean, you know, all the nutritional deficiencies that affect brain function affect the gut, particularly we've mentioned zinc a couple times. Well, zinc is a micronutrients required for your taste buds to make digestive enzymes to make acid. And so if you're zinc deficient, your GI tract is not working optimally. Same with the B vitamins. So the micronutrients affect the gut. And the direct connection that I think people get confused. Asked about that we do have the vast majority of serotonin in the lining of the gut because there's nervous tissue that needs serotonin to function, but that serotonin in the gut is not regulating the brain, right? I mean, these chemicals are around for milliseconds, if you can appreciate that. And they do their thing. They talk to the next nerve next to them and help any aspect of gut function. So people make these huge assumptions that serotonin in the gut, you know, is the same as serotonin in the brain. They're different, and they actually have completely different mechanisms. We mentioned vitamin D, this is one of my favorite stories. Is that if vitamin D is low, the enzyme in the brain doesn't work, right? So we make less serotonin in the brain. But if vitamin D is low in the gut, it actually stimulates, we make more serotonin, so it kind of creates this inflammatory state. So they're separate systems. People get them confused, but there are many mechanisms of how the gut communicates with the brain and both, it's a two way highway and how the brain communicates with the gut. So it's important the microbiome is shown to be critical, and we need to support that,
because this is so blown out of proportion. I feel like on social media sometimes, how often do people heal their gut and then their depression gets better? Are you actually seeing an improvement directly with symptoms, or is it more you repair the physiology, and then other physiology works better.
You know, I think normal and healthy gut function helps everything. And there's some patients with depression where that is a significant problem, like celiac, malabsorption, or an overgrowth of certain yeast, Candida or an overgrowth of certain bacteria that produce chemicals that affect brain. So we can look at that. So those are a percentage. I don't know if it's 10% or 15% but it's not 100% of individuals that improve gut function is going to improve depression. There's a small minority, but that's why testing is important to find out if that's the driving force.
Yeah, I agree with you. I think when my patients come in with depression, I always want to do the vitamin D, the B 12 and the iron panel. And it is surprising how many people get better just with those core nutrients. But as you kind of dive deeper into these other areas, they there's so much opportunity to improve their health. Talk to us a little bit about metabolic health. I think Chris Palmer, dr, Chris Palmer and some others who have been talking a lot about metabolic health and mental illness have have brought the idea of sugar utilization to the limelight with with regards to mental health. Tell us what your experience and approach with that is specific to depression and sort of
blood sugar regulation.
Yeah, two thoughts. I mean, I've been very involved in, you know, training doctors on understanding metabolic health for a number of years, because it's so important. I think my summary, I just wrote an article on it. You know, you are what you don't eat rather than you are what you eat. Because when you think of these diets, ketogenic diet in particular, which is can be incredibly helpful, think about what they're not eating, right? They're not eating the ultra processed foods. They're not eating gluten, and they're eating, you know, protein and vegetables. So for many patients, I think it's what they're not eating. Is the improvement? For other patients, absolutely, a metabolic shift to burning ketones might be the key. I've seen it be very helpful in a wide range of disorders. So I just talk about ketogenic diet as a tool in our toolbox as comprehensive professionals. It's hard. Compliance is challenging for many with chronic mental illness, and so for those that think keto is the answer to every psychiatric problem, I just kind of question that, and I understand it and utilize it and teach clinicians how it can be a helpful tool.
I love the way that you're talking and it totally aligns with what I see. I love that you say it's what you what you're not eating, because I think that's true for when we're sick too. There's not a lot of people who eat a bunch of fast food who are also eating a bunch of fresh vegetables, right? There's not a lot of people who are eating tons of ultra processed foods who also happen to get tons of blueberries and phytonutrients into their diet. So I think it goes both ways. I want to spend just a couple minutes talking about these issues that are specific to. Women, because women, we have it a little tricky with all of our hormonal transitions. If you look at the puberty transition and increased rates of struggles, you know, depression and other struggles when we go through that transition, again with pregnancy and postpartum depression, and then with perimenopause, and then all scattered in between, we have PMS and PMDD. What can you tell us about, about those and and how to support those through these, these other things you're talking about?
Well, I mean, critically important question, maybe a 10 hour answer? No, I know. But you know, I think I can summarize. I'm very familiar with the changes in puberty as a child psychiatrist, and what we're seeing is significant nutritional deficiencies, particularly zinc, which I have spent 25 years in treating eating disorders, where I see zinc deficiency as the key in triggering anorexia nervosa, because when you go through beauty, you have a higher need for zinc, just like pregnancy. And so my career has been focused not on as much as adjusting hormones, but adjusting the precursors to support better hormonal function. So puberty, lots of micronutrient, zinc being the most particular, and then in the PMs and the postpartum world, again, clear hormonal changes. But if we have 10 women, they're all having hormonal changes, but only a few develop very severe psychiatric illness. And as we done these testing and dug deeper, we see often pretty significant nutritional changes. Postpartum, high copper and low omega threes, again, supporting, you know, or disrupting mood. And the same with menopause. I mean, there are hormonal changes, and hormonal therapy can be a great asset, but we've also found nutritional deficiencies that drive some of the abnormal responses, and particularly the psychological symptoms.
I love that you're saying that we offer in my clinic a preconception visit that is really intended for women to say, I'm thinking about getting pregnant soon. Let me see where I'm at. And it kind of as an OB, it kind of baffles me that we haven't done this better to say, how about we figure out if your vitamin D deficient, if you're anemic, if your B vitamins are low, before you get pregnant and become depleted, and you give all of your nutrients to your baby and then become postpartum and struggle like let's let's not wait till your struggle. Let's get you before you ever get pregnant, and just focus on your nutrition and optimize some of those easy things first. So I love that you're saying that I want to wrap up here, but I would be remiss if we didn't talk a little bit about your book. I know we've been talking about your book, but tell us how the book walks people through. What can people expect as they're reading your book?
You know, my favorite part, really is the title finally helpful. Because I just really want people to understand that depression can be treated, and I think with a functional, integrative approach, it just adds to medications. Doesn't attract and then it's just outlines. You know what functional medicine for depression is? Many of the things we've talked about looking at micronutrients, minerals, vitamins. There's sections on low dose lithium, nutritional lithium as an adjunct to treatment. So it's written in the same that path is finally focused to make it easy for patients to appreciate, and I think also clinicians who are new to the field can learn a lot about it. So I wanted a something to support and encourage patients to kind of look beyond the symptomatic based model.
Yeah, and there's so many things that they can do in there that don't require a doctor's supervision, you know, things like other lifestyle changes. But also you're so good at giving specifics about this is the test that we want to do. This is the type of supplement or the way to fix it. So I appreciate how much you share your knowledge,
yeah, and I think it's some, many of the things that you can do on your own or as your PCP, but there are times that you'll need, you know, professionals, and we were also, you know, based on the book, able to set up a clinic, a virtual, functional psychiatry consultation program now licensed in every state to be able to kind of offer consultation services so people can get the care they need and how do they access that. The clinic is called finally living, now based on the finally hopeful and finally focused. So we have finally living now, and it's finally living now.com
and it's on my website. James Greenblatt, md.com,
what a wonderful resource for people. Is there anything we've missed? Anything that that you want to shout from the rooftops and. Sure anyone either treating patients with depression from an integrative approach or from patients. Is there anything we've missed big, big pearls. Obviously, there's a million smaller pearls we've missed today.
I think we hit the big ones, which is biochemical individuality. You're unique. Everyone's different. Don't take the supplements your neighbor is taking. You know, find a doctor, and then the biggest thing that I want to share is functional medicine. Doctors are providing an incredible service for either their specialty or helping with chronic illness, but many aren't trained in treating depression or anxiety or OCD or addiction. So I just encourage if things don't follow a path with a recovery, with your primary care doctor, seek out psychiatrists, nurse practitioners or doctors who do have mental health training, because that's where I see things click, and that's where individuals can understand if medicine is helpful or not, but also this adjunctive nutritional and functional medicine add on.
I agree with you, and I'll say, as you know, functionally medicine trained, that a lot of practitioners who do functional medicine will say, Well, when we fix your gut, and when we fix these other things, that you'll get better. And sometimes that's true, but it does take a special lens of looking specifically at mental health. It's not quite the same thing of like, let's just test for a bunch of things and find what we see and fix everything. Some of those people will get better, but, but I do think that there's sometimes a specialty lens of understanding specifically mental health better, absolutely. Yeah. Well, thank you again for your time. You've shared with us where they can find you. I will, I will say, I don't know if I've read all of your books at this point, but I love your book on supporting anorexia. What is that? One? Called answers to anorexia? Yeah. And then finally, focused is for ADHD, and it's so wonderful and so cleanly laid out and so helpful children and adults. And then this new book is finally hopeful. I'm so grateful to you for spending your time and writing it, because it's such a good such a great tool for people. So thank you for your work, and thank you for sharing it with us
today. My pleasure, it's good to be with you. Thank you.
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