Finally Hopeful for Fixing Depression with Dr. James Greenblatt: Rational Wellness Podcast 449

Podcast: Play in new window | Download | Embed

Subscribe: RSS

Finally Hopeful for Fixing Depression with Dr. James Greenblatt and host Dr. Ben Weitz.  

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

---

---

Dr. James Greenblatt is a pioneer in using the Functional Medicine model in helping patients with psychiatric disorders.  Widely regarded as the leading expert on the clinical application of low-dose lithium for mental health, Dr. Greenblatt has written nine books, including his newest book, Finally Hopeful, and the bestsellers Finally Focused: The Breakthrough Natural Treatment Plan for ADHD, Answers to Anorexia (updated edition, 2021), Functional & Integrative Medicine for Antidepressant Withdrawal, and Nutritional Lithium: The Untold Tale of a Mineral That Transforms Lives and Heals the Brain—the definitive guide to lithium’s role in psychiatry.  In 2019, he founded Psychiatry Redefined, a leading educational platform training clinicians worldwide in functional and integrative psychiatry and he offers a range of excellent courses.  His website is jamesgreenblattmd.com

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

---

---

Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com.

Thanks for joining me and let’s jump into the podcast.  Today we’ll be speaking with. Dr. James Greenblatt, who’s a pioneer in using the functional medicine model in helping patients with psychiatric disorders widely regarded as the leading expert on the clinical application of low dose lithium for mental health.  Dr. Greenblatt has written nine books, including his latest book, Finally Hopeful, of which is just is it available Right now it’s just coming out. 

Dr. Greenblatt: Yeah, no, it’s available as we speak. Absolutely.

Dr. Weitz: Okay. And his other best sellers are finally focused to break through natural treatment plan for ADHD, answers to anorexia, functional and integrative medicine for antidepressant withdrawal and Nutritional Lithium: The Definitive Guide to Lithium’s Role in Psychiatry in 2019. Dr. Greenblatt founded Psychiatry redefined a leading educational platform, training program for clinicians worldwide in functional and integrative psych psychiatry, and he offers a range of excellent courses. Dr. Greenblatt, thank you so much for joining us today.

Dr. Greenblatt: Good to be with you. Thanks for the invitation.

Dr. Weitz: Absolutely. So let’s start with what is the definition of functional psychiatry?

Dr. Greenblatt: Sure. I mean, I think [00:02:00] people throw around a lot of terms. As, you know, integrative, functional, antiaging,

Dr. Weitz: holistic, natural, there’s a whole lot, right?

Dr. Greenblatt: Yeah. We’re restorative. I mean, we could keep going and you know, I’ve kind of boiled it all down to the two terms, integrative, which is kind of the mindfulness and the diet and the lifestyle. All things that I believe is available to, you know, patients. There’s good books and good courses and clinicians, but what was not being taught anywhere is a functional model for mental illness. And that just means looking deeper, looking at root cause, looking at genetics.  Looking at biochemistry, nutrition, hormones, gut, and being able to, you know, help those struggling with mental health challenges, depression or anxiety, looking at root cause

Dr. Weitz: And understanding that even though we’re talking about [00:03:00] things affecting the mind, it’s coming from the brain that these mental disorders are physical disorders.

Dr. Greenblatt: I mean, I used to start many of my talks with a slide just showing a picture of a neck, you know, anatomy or psychiatrist that, you know, we have a neck. You know, what happens in the body affects the brain. What happens in the brain affects the body. And our current model for treating psychiatric illness is just, you know, symptomatic based, you know, asking questions.  If you have symptoms, you get a pill.

Dr. Weitz: Yeah.

Dr. Greenblatt: And you know, the goal is to dig deeper and look at, nutritional biochemistry and other aspects that affect brain function.

Dr. Weitz: So let’s talk about what do you think about the dominant theory of depression and anxiety, which is a neurotransmitter theory?

Dr. Greenblatt: Well, I think, it was great to sell drugs, you know, in the eighties that we had this deficiency [00:04:00] of a chemical serotonin, and we have this new medicine with no side effects that’s going to help keep serotonin around. That was the eighties and Prozac and you know, the, then all the other SSRIs, so it did sell drugs, but over the years we’ve clearly realized.

The brain is a little more complicated. It’s not one neurotransmitter and one deficiency. So I think you know, we could list 10 or 15 different contributing factors to depression from, you know, ultra processed foods to inflammation, to, you know, abnormal genetics of the neurotransmitter serotonin.

So there are many paths. And I think it’s pretty clear that it’s not just based on the serotonin deficiency syndrome, if you will, which is how we marketed and sold drugs for 25 years.

Dr. Weitz: Right. And even when the antidepressants [00:05:00] work, if you’re expecting the body to have more serotonin, just because you take an SSRI that assumes that you’re actually producing enough of those neurotransmitters in the first place.

And if you’re. Body’s not working optimally. If you don’t, if you’re lacking in nutrients, if you have toxins, if there’s issues with the way your metabolism works, you’re not gonna be producing the antidepressant, the the neurotransmitters in the first place and keeping around something that’s not even there is not gonna be that effective.

Dr. Greenblatt: Absolutely. There are many vitamin and mineral co-factors as you described, that are critical. For serotonin synthesis. And if those are absent, these medicines are kind of meaningless and often cause side effects.

Dr. Weitz: So what if you were to just list like the top 10 biological drivers of depression?

Dr. Greenblatt: [00:06:00] You know, I would say vitamin B12 deficiency is missed a lot because levels that we consider normal many of us don’t think is normal.

So we have a lot of patients with B12 deficiency that we’re told by their doctors that their level is normal. So B12 deficiency a mutation in a gene for folate. The M-T-H-F-R gene. That gene doesn’t mean you’re gonna be depressed, but with other environmental factors that doesn’t get addressed.

Vitamin D deficiency, low thyroid, ultra processed foods. Stress, trauma, iron deficiency anemia is so common and just completely kind of ignored once we become an adult. And then and

Dr. Weitz: I would also say that it’s, it is probably a lot of people that have too much iron and don’t know it ’cause they don’t get tested for it either.

Dr. Greenblatt: Exactly. Right. [00:07:00] And then the last one that is common that we see is actually low levels of of amino acids, the precursors to these neurotransmitters. For some it’s, concerns about a vegan diet without adequate protein, but for many it’s eating adequate protein but not digesting and absorbing the protein that they’re eating.

Dr. Weitz: So, when somebody comes into your office and you do a history on them, and this is somebody suffering with mood disorders like depression what’s the next step that you usually take?

Dr. Greenblatt: Well, in terms of the history one thing that’s missed in my professional law is family history. So three generations of family history is really important because some of the micronutrients are based on family history and the second thing is some.

It, hence the name of the book is Hope. You know, helping people appreciate that. I’m confident that they could feel better. [00:08:00] Medicines might be part of the treatment, but if we look at nutritional deficiencies, first medicines work better, therapy works better, and there’s likely things that we can treat.

Dr. Weitz: So what are some of the favorite labs that you like to run or panels that you like to run on these patients? And I know it depends on the history and what things you suspect might be going on.

Dr. Greenblatt: Sure. I mean, I like to check amino acids and fatty acids, essential fatty acids. There’s one test that’s I don’t think has done enough crypto pyro which plays a huge role in depression.

It’s a urine test. And then we looking at organic acids for metabolites of bacteria, dysbiosis in the gut, and then kind of all the routine nutritional deficiencies. B12 D, zinc, magnesium, copper.

Dr. Weitz: Can you talk about that? What is it called? [00:09:00] Crypto pyro.

Dr. Greenblatt: Crypto Pyro. Yeah. That’s so urine tests that has been around for 60 years now?

Not a lot of research, but clinically it’s just been you know, amazing actually because it’s a urine test that measures. A molecule, a breakdown product of pyros and it should be very low in our body, so in our urine, but if it’s elevated it, it kind of leeches out vitamin B six and the mineral zinc.

So you end up with this kind of functional deficiency of B six and zinc. And usually there are psychiatric symptoms. Anxiety and depression are common because the body’s just been depleted of B six and zinc for so long. So it’s a simple test and it’s a simple treatment protocol B six and zinc, and people often feel better in a couple months.

Dr. Weitz: Interesting. That’s one I’ve not run. I’m gonna have to look into that. [00:10:00] Do you get that? It’s

Dr. Greenblatt: amazing.

Dr. Weitz: Conventional labs or functional medicine labs.

Dr. Greenblatt: Yeah, it’s done by DHA labs is one of the few labs that can do this test. And they’ve been doing it for I think 50 or 60 years.

Dr. Weitz: Huh. And when it comes to measuring neurotransmitters, we know that serum levels of a lot of neurotransmitters are not that accurate.

So you mentioned B12. I don’t cons personally, I don’t consider serum B12, all that great. A measure of B12 status. I think that methylmalonic acid and homocysteine among others are better measures of the functional status. And the issue has to do with the fact that the level of a nutrient in the bloodstream is not necessarily representative of the level of the nutrient in in the tissues.

So how do we best measure neurotransmitters? How do we not neuro, how do we best measure [00:11:00] micronutrients?

Dr. Greenblatt: Yeah, I mean it’s a really good question and we’re looking for the one test and the simple test. And it is usually not, I mean for like a trace mine like zinc magnesium in particular, you can’t measure easily ’cause it’s mostly in our tissues.

So you have, you like red

Dr. Weitz: blood cell magnesium.

Dr. Greenblatt: It’s better, better, but still not always accurate. And because 98% is in the tissues as you described. So for all these micronutrients, I think a good clinician has to be able to take a history ’cause there are clinical signs of zinc deficiency or magnesium.  For magnesium, we know things like constipation, anxiety, insomnia for zinc, frequent infections, acne. You know, and so, and then we look at these functional markers, we look at molecules that use these micronutrients, and then we compare that with whatever objective tests we [00:12:00] have, whether it’s RBC measures.  Sometimes I look at hair levels for certain micronutrients, and we’re putting a lot of data together. We’re not relying on just one test. And I think that’s the biggest mistake of new clinicians in this field. They just rely on one test for a micronutrient. And as you described, sometimes the flood levels are just not helpful.

Dr. Weitz: Have you looked at the Vibrant Micronutrient panel?

Dr. Greenblatt: I’ve seen it, yeah. I haven’t ordered it but I’ve seen patients come in with it. Yes.

Dr. Weitz: Yeah, I really like that panel.

Dr. Greenblatt: Yeah, they seems comprehensive.

Dr. Weitz: And you know, we used to use the SpectraCell one and there were always a few weird things about it.  You know, like for example, you would like to know what the Omega-3 fat levels are, but it would give you oleic acid.

Dr. Greenblatt: Right?

Dr. Weitz: So, what are some of the hormonal issues that can affect depression? [00:13:00]

Dr. Greenblatt: But I mean, I think any of the hormones can, certainly the ones as a psychiatrist that I try to screen out, you know, on the first visit is thyroid.

So hypothyroidism and for males testosterone. And, you know, I don’t do a full hormonal panel ’cause I don’t treat with hormones. But what has been essential for my practice is the precursor molecules, pregnenolone and DHEA. And those are often low in depression. And those are the precursor to all the steroid hormones in the body.

So if we optimize that. Oftentimes we can see a dramatic change in mood.

Dr. Weitz: What about adrenal hormones like cortisol and melatonin?

Dr. Greenblatt: Yeah, I mean, I don’t I think they’re all playing factors. I don’t routinely test melatonin. We do look at cortisol levels, and it’s usually not in the first visit [00:14:00] because I’m, I mean, we look at a serum level, but the cortisol and adrenal stress test.

I’m just assuming everyone walking into my office with a psychiatric problem either for them or their spouse or their parent, you know, is gonna have abnormal adrenal function. So, to me it’s not worth the initial test. And we do that down the road as they start to improve and we wanna fine tune their treatment.

Dr. Weitz: Okay. How important is the gut?

Dr. Greenblatt: You know, for some individuals it is the, you know, underlying contributing factor for the depression. Others might not be so much, and that is the frustrating part about talking about functional psychiatry ’cause everyone’s different. But for some individuals, the poor lack of hydrochloric acid in the stomach and affects digestive enzymes and poor absorption of micronutrients.

And amino acids, so that individual, [00:15:00] their depression is not gonna get better without digestive enzymes.

Dr. Weitz: So how do we tell if they have low hydrochloric acid?

Dr. Greenblatt: Usually, you know, it’s symptoms. The one test I do routinely is looking at amino acid levels. Okay. So look at casting amino acid levels.

Dr. Weitz: Is that in blood or in urine?

Dr. Greenblatt: That would be a blood test.

Dr. Weitz: Okay.

Dr. Greenblatt: You know, again, people eating adequate dietary protein, but their essential amino acids are all very low. So they have a digestion problem. They don’t have enough acid or digestive enzymes. So that’s the simplest path. And then, you know, many people think the they’re bloating and they’re indigestion and their gerd or due to low a due to high, too much acid.

But it’s usually due to lack of acid. And so certainly GI symptoms is reason to use digestive enzymes and with adults hydro with hydrochloric acid.

Dr. Weitz: Right. What do [00:16:00] you think about the urinary neurotransmitter testing?

Dr. Greenblatt: You know, I have to say I’m not a huge fan because it hasn’t been consistent. I think I’ve seen reports.

Where it has been incredibly helpful and made sense. I’ve also seen reports where, you know, it hasn’t had any relationship to what we were treating and how they were doing. So I think it’s iffy. So it’s not a standard test that I use.

Dr. Weitz: Is there a best diet for patients with depression?

Dr. Greenblatt: You know, I think, as humans, we’ve adapted to, you know, every potential diet on the planet in different parts. So I don’t, I think there’s a best diet for an individual. And but not for depression. I think the big picture things as we know, ultra processed food. Now the research is clear, contributes to depression.

We also have research demonstrating Mediterranean like diet improves, depressing symptoms. [00:17:00] So we know diet affects the brain. Diet affects depression.

Dr. Weitz: And there are some neurologists out there claiming that the ketogenic diet is the cure for depression.

Dr. Greenblatt: Well, you know, I’m a huge fan of the ketogenic diet as a therapeutic tool, and I think it has pretty tremendous implications with significant research now in the psychiatric community for schizophrenia and bipolar illness and for some individuals with depression.

So I, I just find it challenging for patients for long-term compliance, and I’m not sure it’s the healthiest diet for. Long term use, but as a short term intervention, I’ve seen pretty significant changes for individuals with depression.

Dr. Weitz: Okay. What about drinking coffee?

Dr. Greenblatt: You know, I think the research is pretty clear that it’s probably beneficial.

There’s some great chemicals and but you know, a lot of what we’re doing now is looking at [00:18:00] genetics and nutrigenomics and I think people already know those that metabolize caffeine very slowly and have side effects like anxiety and others. You know, that can have eight cups a day with no problem.

So there is a individual variation there.

Dr. Weitz: What about drinking alcohol?

Dr. Greenblatt: Yeah, I think you know, the ties have kind of shifted and I do think there’s an individual. Variation. I think the early studies saying that it was good for you, the two drinks have kind of been dismissed. So I think like any treat you know, there might be a row where alcohol is not harmful.

But I think the literature is not clear that it is beneficial.

Dr. Weitz: Alright. What about marijuana?

Dr. Greenblatt: You know, as child psychiatrist, I don’t have a lot of good things to say ’cause I’ve seen too many kids. Become addicted, become psychotic and really to see troubles and I, there’s tremendous variations.

So as a [00:19:00] psychiatrist, I’m concerned about the use and overuse. Certainly there are some incredibly powerful medicinal uses, but the indiscriminate use. Again, for that individual who’s genetically vulnerable, it can be tragic.

Dr. Weitz: I’ve really been enjoying this discussion, but I just want to take a few minutes to tell you about a product that I’m very excited about.

Imagine a device that can help you manage stress, improve your sleep, and boost your focus. All without any effort on your part. The Apollo wearable is designed to just to do just that, created by neuroscientists and physicians. This innovative device uses gentle vibrations to activate your parasympathetic nervous system, helping you feel calmer, more focused, and better rested.

Among the compelling reasons to [00:20:00] use the Apollo wearable are that users experience a 40% reduction in stress and anxiety. Patients feel that they can sleep. Their sleep improves up to additional 30 minutes of sleep per night. It helps you to boost your focus and concentration and it’s scientifically backed.

And the best part is you can get all these benefits with a special $40 discount by using the promo code whites. W-E-I-T-Z, my last name at checkout to enjoy these savings. So go to Apollo Neuro and use the promo code Whites today. And now back to our discussion. Let’s talk about some of the most beneficial nutritional supplements that can be helpful for particular patients with mood disorders like depression.

Dr. Greenblatt: Sure. I mean, again, it’s [00:21:00] individualized, so we’re looking at levels of D and B12, but I think the B complex where you’re getting folate, B six and B12 would be critical. You know, make, and

Dr. Weitz: once again you pointed out that if you run a CB 12 test or a CB six test that may not be interpreted properly or it may not really be indicative of how much a person needs.

Correct?

Dr. Greenblatt: Correct. Yes. That’s why we’re looking at many tests and clinical history to determine kind of nutritional,

Dr. Weitz: and if you are gonna get some hint from like a CB 12, what kind of number do you like to see?

Dr. Greenblatt: For the CB 12 we’ve been stressing we need to see everybody over 500 and even though the norms might be 200 to 1100, so that 500 is at least, and now there’s new research that’s actually demonstrating that the normals might be too low, which would be very good if we can shift that.

’cause as I [00:22:00] said. I’ve seen too many people been totally abnormal, B12 levels and struggle with depression, and when the B12 is repleted their depression lifts.

Dr. Weitz: Great. Let’s continue with other nutrients.

Dr. Greenblatt: Sure. One, one of the major supplements that we use a lot in our practice is the OPCs, the Oligomeric proin the dark blue seen after

Dr. Weitz: three times fast.

Dr. Greenblatt: That’s my one shot. But the, i’ve been using that for in, in our, my first book on a DHD. And then the research has just exploded and particularly helpful in depression as well. So it just provides these very powerful antioxidants, anti-inflammatory. And now we know gut promoting bacteria, you know, prebiotics and has tremendous implications for depression.

Dr. Weitz: So what exactly are you talking about? You’re talking about nutrients like grape seed [00:23:00] extract and pine bark extract. Correct.

Dr. Greenblatt: Exactly. Yeah. Yeah. And you know, I did research in the nineties on it and because it helped with A DHD and what we found is that and you’re right, so pine bark grape seed, blueberry green tea, curcumin, red wine extract. I mean all these things. What we found is combinations tended to work better. So rather than just give one supplement of pine bark or grape seed over the years I’ve always used combination products. They just tend to work better.

Dr. Weitz: And you have a product that you like to use.

Is it the CU Orb Mind Product A

Dr. Greenblatt: Absolutely yes. That’s one that we developed for pure Encapsulations based on our original work, yes.

Dr. Weitz: Okay. So what are some many other vitamins you mentioned vitamin D. Vitamin D is absolutely, probably one of the most important nutrients you can have for almost every aspect of your health.

Dr. Greenblatt: Yeah, but completely missed by mental health [00:24:00] clinicians. I mean, vitamin D is required to make serotonin and optimizing Vitamin D is critical. As you said. The other major micro macronutrient class would be fats. So the essential fatty acids are critical for our health in general, immune function, but also for brain function.

And we have 25 years of research demonstrating low levels of Omega-3. A higher risk of depression and suicide.

Dr. Weitz: So, do you prefer fish oil?

Dr. Greenblatt: Typically without testing a fish oil is what we’d recommend. EP and DHA. But there are times if we look closer, we might find individuals would need flax soil.

And oftentimes we see deficiencies of some of the, omega sixes as well. So again, testing is always the best path to knowing how to supplement, but fish oil is probably the simplest.

Dr. Weitz: So when would you, what would alert you that they need flax [00:25:00] oil?

Dr. Greenblatt: On the testing, if they had low levels of a LA.

Okay. Alpha oleic acid and we can see that. And then just recommending, you know, salad dressings with flax oil.

Dr. Weitz: Right. And I know you’re a big fan of amino acids by the way. You know, if you were to do the vibrant micronutrient tests, they include amino acid panel as well.

Dr. Greenblatt: Oh, really good. Yeah, no, it’s really important and it just, helps understand not just dietary intake, but what your body is absorbing and utilizing.

Dr. Weitz: Now. Now a lot of people like to use specific neuro trans amino acids like five HTP, to stimulate serotonin and you know, others amino acids to specifically stimulate other neurotransmitters.

Dr. Greenblatt: That’s what I would call step two in our functional psychiatry workup.

Step one might be looking at the deficiencies, and then step two [00:26:00] would be using the amino acids. I like to call them nutraceuticals that have a pharmaceutical effect, so absolutely we know. Five HTP is a precursor to serotonin and it crosses the blood-brain barrier. And we use that in depression. We use that in OCD and it’s particularly helpful in antidepressant withdrawal.

Dr. Weitz: And do you ever do tryptophan versus five HT P?

Dr. Greenblatt: I use trytophan as a sleep aid. So a short term use of trytophan long-term use has some complications and it doesn’t cross a bla blood brain barrier as easily as five HTP. There’s a feedback mechanism, so I’m really trying to increase serotonin.

I I stick with five HTP.

Dr. Weitz: Okay. What other individual, I know you like to use an amino acid blend.

Dr. Greenblatt: Well, for those patients that are low in amino [00:27:00] acids, which is common we use a freeform amino acid blend. And this has all the essential amino acids. So these are the building blocks to every protein in the human body and the precursors to the major neurotransmitters.

You mentioned tryptophan and pheno alanine and that’s kind of the. Step one in the amino acid supplements to give everyone the essential amino acids. And then we use five HTP and pheno alanine to support further neurotransmitter synthesis.

Dr. Weitz: Alright, what about some of the minerals?

Dr. Greenblatt: Yeah the list is long.

The big ones would be, you know, zinc and magnesium. Zinc deficiency has been shown to be related to depression and recent study suicide risk. So zinc deficiency is critical. Magnesium deficiency is probably the most common deficiency we see in a psychiatric practice. And then I spend a lot of my time and energy talking about the [00:28:00] micronutrient lithium.

So lithium deficiencies we often see in those with depression or family histories of depression.

Dr. Weitz: Let’s dive into lithium a little bit more. So lithium is used as a prescription drug for people with severe psychiatric disorders, but we’re talking about a very low dose lithium, something that would.

Typically be found in the water or food supply?

Dr. Greenblatt: Absolutely. Yeah. This is a essential mineral and it’s most easily obtained from our water ’cause it’s in rocks and bleaches out. And, you know, we’ve shown that it’s essential for brain function. There was a brand new study that Harvard just completed this year, multi-year study where they demonstrated that they dissected Alzheimer’s brains and that lithium was the only element out of 50 that were tested that was low.

So we know that it’s low into Alzheimer’s. And then they used mouse [00:29:00] models and they were able to reverse Alzheimer’s. So this essential micronutrient is critical for the prevention of Alzheimer’s. Of these new studies,

Dr. Weitz: do you test for lithium levels?

Dr. Greenblatt: Yeah. I look at trace mineral hair testing.  Some of ’em will show lithium. I’ve been doing that same test for 30 years and used to be. Like 25% of my practice. And now whether it’s the water, we’re not drinking or interference with other toxins, but now it’s probably over 50% where we get undetectable lithium in these hair samples.

Dr. Weitz: Interesting.  Which companies hair mineral analysis do you like to use?

Dr. Greenblatt: We’ve been using doctor’s data. Okay. As the lithium,

Dr. Weitz: that one’s been around a long time.

Dr. Greenblatt: Yes.

Dr. Weitz: So what about the herbs? St. John’s Wort?

Dr. Greenblatt: Yeah. [00:30:00] St. John’s Wort, you know, has been shown in research to be helpful in depression.

Dr. Weitz: In fact, a tremendous amount of research.  Right. And yet hardly anybody uses it.

Dr. Greenblatt: Yeah. Yeah. The research is pretty extensive and I think, I think there, there’s still people that use it. As I have done, I used to use it a lot more let’s say 10 or 15 years ago. But as I do more and more testing when we get to root cause, I tend to need it less.  But we do have pretty significant research that it has provided benefit for depression.

Dr. Weitz: Now, some practitioners feel that you should never use St. John’s Wort if patients are on antidepressants.

Dr. Greenblatt: Yeah, I would agree. I wouldn’t use St. John’s Wort if someone’s taking an SSRI. So I agree

Dr. Weitz: now, but isn’t it the case that so many people are taking SSRIs that don’t really work that great?

Dr. Greenblatt: Absolutely. I mean, so,

Dr. Weitz: so theoretically, couldn’t [00:31:00] St. John’s wart be used simultaneously? Especially if you know what you’re doing?

Dr. Greenblatt: Oh, I’m sure it could be. But I think my preference would be to taper someone off the antidepressant and now we can use it to help with the taper. Because again, the antidepressants.

Actually contribute to a serotonin deficiency in the brain, and that’s why it’s hard for some people to come off. So. We use five HCP when we’re tapering someone down. But St. John’s word would serve a similar purpose, just support serotonin and neurotransmitter synthesis. As someone’s coming off the antidepressants,

Dr. Weitz: how long does it typically take to get off one of these antidepressants, like Prozac, for example?

Dr. Greenblatt: Oh just a tremendous variation, people. Can come off it in weeks and other people, it is years, literally years. Some medicines are harder than others. And what, [00:32:00] you know, I found in my research that the difficulty coming off the medicines, you know, are based on a lot of the tests that we’re talking about and some genetic variants.

So, everyone’s different, but many people suffer tremendously trying to taper off these meds.

Dr. Weitz: What about other herbs? Are there other herbs that you use? I know some people talk about and utilize saffron. We have a number of other herbs that can have various benefits for brain health.

Dr. Greenblatt: Yeah, I think the two that I’ve used the most in my practice that.

You know, is Rhodiola. And Saffron now is more, and the literature is very good. So those are the two. I mean, Rhodiola, it just is simple. It’s easy and it’s tremendously beneficial. And sometimes we can use Rhodiola with an antidepressant. Sometimes we use it alone, but it’s can really enhance mood for some individuals.

Dr. Weitz: I think one of [00:33:00] the factors about Rola is how it influences cortisol production.

Dr. Greenblatt: Yeah. As a, as an adaptogen, it can regulate you know, the stress response while kind of supporting mood. So we use, you know, low lower dosages with A DHD and sometimes higher dosages, 400, 500 milligrams in depression.

And, i’ve seen some pretty standing results.

Dr. Weitz: What about NAC? There’s actually some amazing research on NAC for depression, for suicide.

Dr. Greenblatt: Yeah, I mean, I think in the psychiatry literature and the conventional psychiatry literature there’s probably more research on NAC than any other micronutrient. So from, and yet

Dr. Weitz: we tend not to think about NAC for mood disorders because we think it’s for detox or.

Dr. Greenblatt: Correct. And you know, there’s great [00:34:00] research on many psychiatric disorders and I think the you know, inflammation and providing, you know, it does a lot. And I see the list is quite long from stabilizing glutamate to supporting glutathione synthesis, but you’re absolutely right.

It a treatment, you know, adjunct to almost every psychiatric disorder. And it’s one of the few things that we can use words like there’s a double blind placebo controlled trial. And that’s unique in nutritional psychiatry

Dr. Weitz: is this telling us that toxins are probably playing a role in some patients with mood disorders.

Dr. Greenblatt: I think clearly inflammation is a path. There are now pharmaceutical companies that are looking for anti-inflammatories to treat depression. So inflammation, absolutely. And you know, in environmental toxins we just know contribute to mood disorders as well as a host of nutritional deficiencies.

Dr. Weitz: So do you test for toxins? [00:35:00]

Dr. Greenblatt: You know, I don’t on, on round one. I think as you know, we’re kind of. Potential for 300 different tests and a patient struggling. You know, where do you start? Particularly with the psychiatric, absolutely a smaller battery of what we talked about. But then there are people that we’re gonna have to dig deeper because it is, we’re gonna look at environmental toxins, glyphosate, we’re gonna look at mycotoxins.

So after we get the history and after we do this initial workup, then we decide, you know, where we have to dig deeper.

Dr. Weitz: Right? So what are some of the other lifestyle factors that can affect. Mood disorders. We’ve been talking about diet, we’ve been talking about neuro micro, we’ve been talking about nutraceuticals and vitamins and minerals.  What are some of the other lifestyle factors like exercise, sleep, stress reduction?

Dr. Greenblatt: Well, you hit the three. I mean, I think that there, [00:36:00] there’s not, that we don’t have any better antidepressants than exercise. So we know that. And the research. Is there a

Dr. Weitz: particular form of exercise that’s better?

Dr. Greenblatt: Well, I mean, I think the challenge is a psychiatrist is that many of my patients know that exercise would help ’em, but they’re too depressed or not motivated. So we can tell ’em to exercise, but that’s challenging. So we just ask for. Any kind of movement or walking. But eventually as they feel better, that becomes part of their kind of the lifestyle changes that can sustain recovery and sleep, I think, is even more dramatic.

And I think it’s missed because. The research is so overwhelming that sleep deprivation has profound effects on inflammation and brain function. Not only is it associated with depression, but suicide risk. I mean, there many studies looking at suicide attempts and sleep that week, sleep [00:37:00] that month.

And and we know the mechanism. It’s just chronic inflammation. So I’m quite aggressive about supporting sleep hygiene when we can and if we need supplements or even if we need medications for two to four weeks. But regulating sleep is one of the most important things we can do to treat depression.

Dr. Weitz: I, I have noticed that especially as people get older, sleep disorders tend to become more and more common. Do you, what are some of your favorite strategies or supplements for sleep?

Dr. Greenblatt: Yeah, I mean, I think you’re absolutely right. It’s too common and it’s certainly too common when we think about treating depression or anxiety.

I think step one for me is always optimizing magnesium. And oftentimes that’s huge for improving sleep. So optimizing magnesium is usually number one. And then melatonin is kind of number two. And often that’s [00:38:00] sufficient. And then again, as we are looking at the testing, we’re gonna find paths that are interfering with sleep.

I mentioned zinc. So zinc deficiency. Zinc is required to make serotonin, but it’s also well required to make serotonin, but also ser melatonin. So if someone’s deficient in zinc due to a vegan diet or any other cause, then sleep will be affected. So if we can optimize. That zinc, then we’ll be able to improve sleep.

Dr. Weitz: How much think do you think a lot of your patients need? Sometimes it’s hard to know. I find a lot of times with some of these micronutrients, people end up underdosing, you know, they, they get told to take magnesium, so they take one pill. And they assume that’s enough, when in fact they might need eight or 10 pills.

And I find the same thing for vitamin DI, I see a lot of patients, they’ve been to their md, their vitamin D is [00:39:00] 25 and they’re told to take a thousand milligrams and then they never get tested again. And you know, it moves maybe to 27. So a lot of times they’re not taking really a therapeutic dosage.

Dr. Greenblatt: Yeah, no, I think you’re absolutely right about vitamin D and magnesium typically is underdose. ‘Cause we’re trying to get yeah, up there to four or 500 milligrams, and that might be four or five pills. I think zinc is a little easier because we don’t want to overshoot with zinc. You know, I like.

Depending, you know, anywhere between 15 and 60 milligrams, you know, I think 40 is the magic number for maintenance, but too much zinc over a period of time can set up imbalances with copper and other nutrients. So, you know, I use that 30 to 60 milligrams for maybe. You know, four to six months and then cut back to 1530 milligrams.  Oftentimes a dose you can get in a multivitamin.

Dr. Weitz: And [00:40:00] what’s the ratio you like to see on labs between zinc and copper?

Dr. Greenblatt: Well, I mean, I don’t really look at ratios as much as others because. Looking at so many blood tests that I’ve seen that they can change day to day, you know, and I don’t like to base too much on these isolated levels, but you know, it is closer to you know, one-to-one in the serum and then it differs when we look at hair tests and other indices.

Dr. Weitz: Alright. And what about for stress reduction?

Dr. Greenblatt: Yeah, I mean, I think for chronic maintenance and relapse prevention, you know, the ability for individuals to kind of appreciate the role of stress in their life, understanding mindfulness and how powerful. That is in terms of changing both brain structure and function.  So, you know, sometimes we ask patients to just take a few minutes a day while they’re doing other things and then [00:41:00] try to increase it to more and more time where they can really appreciate how. The role of mindfulness and mindfulness training can play for mood disorders. And again, it is an area where we can say there is research, right?

It is not something these alternative doctors just made up.

Dr. Weitz: People use meditation, breathing exercises. Is there a particular strategy you like the best and tools for that?

Dr. Greenblatt: No, I mean, I think that everyone’s different. So I just encourage people to find, you know, the exercise that they enjoy so many different kinds of yoga.  But mindfulness practices are just available everywhere to learn. And it doesn’t have to be complicated. You can be sitting, standing, walking to be able to appreciate some of the core concepts of mindfulness and how it affects brain function

Dr. Weitz: and how does technology affect [00:42:00] depression and anxiety.

Dr. Greenblatt: Well, that’s a great question that I’m not sure I have the answer, but everyone has their own opinion. Okay. So there are plenty of people that are talking about technology, you know, contributing to depression or adolescents higher usage today, technology more depressed.

Dr. Weitz: And we see recently the whole country of Australia has banned social media for kids under 16 partially.  Because of these rising rates of anxiety and depression that we see in kids.

Dr. Greenblatt: Yeah, I’m a huge fan for this pediatric child banning in schools. I mean, absolutely limitations. And it has to take place. And so that is something I’m in favor of. I think there, the only thing to mention though, there’s a tremendous downside.

Some kids get sucked in more than others and become literally addicted. But for other individuals. It is a [00:43:00] community and it is a social interaction that they wouldn’t have otherwise. So I do think balance and moderation, but I certainly, I cannot believe the use of these screens in school are allowed.

So I really do kind of agree. The limitations in schools and these young kids have to be enforced.

Dr. Weitz: It just interferes with the connection kids can have with each other. And our, that human connection has gotta be so important for our overall health as well as our moods.

Dr. Greenblatt: Oh, a absolutely and we know, you know, important part that we don’t talk enough about maybe is that, you know, brain development continues into our twenties, you know, for 21 well actually

Dr. Weitz: continues our entire life, right?

Dr. Greenblatt: Absolutely. We’re always modifying it. But the major structural changes, and if we’re. You know, focused on screens rather than humans. I think it [00:44:00] has profound implications for these developing neurocircuitry. Yes.

Dr. Weitz: Great. So, any other issues that we should talk about that we didn’t mention?

Dr. Greenblatt: Well, I think we hit on a lot of it. I think that. You know, I, my practice, I don’t think medicines are evil. I think they’re overused and psychiatrists are and are in such a rush. They’re just over-prescribing two and three medicines. And I think understanding nutritional medicine can have profound implications for treating depression, which is the most common kind of disability worldwide.

Dr. Weitz: So how often do you try to have patients wean themselves off of medications?

Dr. Greenblatt: Well, I don’t recommend patients weaning themselves off. I think working.

Dr. Weitz: No, I know. How do you, how often do you feel that patients would be better off not being on medication?

Dr. Greenblatt: [00:45:00] Oh I would say the vast majority, if we do our work well as functional psychiatrists, you know, I’m just making a guess, maybe 80% would not need their medications any longer because we Wow.

Supported you know, the synthesis of their neurotransmitters. We decreased inflammation, we optimized hormones. There is a subset that do better. But I think at some point many patients can taper off these medications.

Dr. Weitz: Well great. Thank you so much for joining us and listeners can buy your new book at I’m assuming Barnes and Noble and Amazon and all the places books are sold.

Dr. Greenblatt: Yeah, absolutely. It’s pretty much everywhere. Really appreciate the opportunity, Ben, and thanks for your work. And

Dr. Weitz: And practitioners, where can they go to learn about your courses in functional psychiatry?

Dr. Greenblatt: Sure. There are professional trainings are on psychiatry [00:46:00] redefined.org. So we have courses and a year long fellowship to train on functional psychiatry.  And then my books and my work with consumers. Where we have courses is on jamesgreenblattmd.com.

Dr. Weitz: That’s great. Thank you so much.

Dr. Greenblatt: Thank you.

____________________________________________________________________________________________________________________________________

Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review.  As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 3 1 0 3 9 5 3 1 1 1 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.