The Dr. Hyman Show - Antidepressants Explained: Benefits, Risks, and Alternatives for Depression | Dr. James Greenblatt

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Starting point is 00:00:29 for 30 years to help my patients improve their mental, emotional, and cognitive health. So if you want to feel calmer, clear, and more in control, and stay sharp and protect your brain as you age, check out Brain Shaping Academy at Dr.hyman.com, 4.com slash brain shaping. That's Dr.heimen.com for slash brain shaping. Let's talk about antidepressants, what percent of they affected for, who are they affected for, and where are we failing with these medications? For too many years, it's a psychiatric community completely ignored what happens when you stop these medications. I call it withdrawal. They call it discontinuation syndrome. And it was just

Starting point is 00:01:04 kind of eye-opening when I had two people stopped the same medicine. It was Selexa. And one person did it fine. And the next one had these intractable, you know, brain zaps and suicidal thoughts. And I realized, what's not the medicine, it's what's going on in that individual. And once we do the functional testing, we replete the D and the B-12 or the amino acids, we can safely withdraw someone from these antidepress. If you've been listening to this podcast for a while, you've heard me talk about Seed before. Now, I've reviewed countless of probiotics over the years, and Seed continues to stand out as the microbiome company really pushing the science forward. Their DSO-1 daily symbiotic is the number one digestive health probiotic. It's formulated with 24 clinically studied strains designed to support

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Starting point is 00:03:35 missing something, you're not alone. That's why I created the Brain Shaping Academy, a new program that looks in places most people never think to check, like nutrient deficiencies, the health of your gut, metabolism, your immune system, and lots of more. Dr. Greenblatt, welcome back to the podcast. It's so good to have you. I mean, right now, it's estimated that 18% of Americans suffer depression. One and four people in their life will have a major depressive episode.

Starting point is 00:04:02 So this affects everybody at some level, either you or someone you know. I mean, I know many people who have committed suicide. I know many people who have been depressed. I've had that in my experience myself at different times of my life. And, you know, what we're learning about is really what you wrote about in your book. what you've been studying for the last 30, 40 years, you and I are kind of in the same generation. And, you know, we came up going,

Starting point is 00:04:27 wait a minute, what we learned in medical school and what we learned in residency and what we learned in our conferences and the orthodoxy doesn't actually explain what we're seeing. And we have to come up with a different set of explanations for the phenomena that we see in patients. And so I'm just super excited to diving this topic with you and to help people with depression,

Starting point is 00:04:49 have hope where often they don't. Really have people understand that this is not a often psychiatric problem alone. It's a physiological problem. It's something that is in their system that can be identified and that can then be treated in a way that we don't treat in psychiatry, which is basically diagnosed and Medicaid. And there's a whole realm of interventions and thinking and possibilities of helping people heal that have nothing to do with that.

Starting point is 00:05:16 Now, there's nothing wrong with talk therapy. There's nothing wrong with medication. but they're the last resort when it comes to solving a problem that, you know, is affecting so many people. And we have to get to those root causes. So, Kenon, take us back to the origin story a little bit. We've had you on the podcast before. We just briefly talk about your inspirations because I think it matters. And I think, you know, you and I have very similar inspirations in terms of the leading thinkers and figures in the field of medicine, science, and psychiatry that have kind of helped us see things a little bit differently, starting with Linus Pauling and Abramie.

Starting point is 00:05:48 and Roger Williams. So talk a little bit about how each of those people have helped you think about psychiatry differently. Sure. I think you mentioned my three kind of hero mentors that defined my career. So, you know, Linus Pauling, you mentioned two Nobel Prizes. It's a little frightening when I give talks and I ask people, you know, if anyone knows, no one raises their hand anymore. But Linus Paulin has got a Nobel Prize in chemistry in peace.

Starting point is 00:06:18 and he wrote this article on orthomolecular psychiatry was a title in Science Magazine in the 60s. And basically it was a very scientific, you know, on enzyme kinetics. And all he said is that perhaps we can think of mental illness as abnormal molecules, you know, in the brain. And maybe we could fix or treat it by optimizing these normal molecules. and he described many micronutrients. And then Abraham Hopper was a psychiatrist that was able to utilize micronutrients for the treatment of those severe schizophrenics.

Starting point is 00:07:01 And I've treated some of his patients that he treated 50 years ago that were old cured of schizophrenia by nutrient therapy. And I think it all starts with biochemical individuality, which was, you mentioned Roger Williams, and that's how I start every one of my presentations,

Starting point is 00:07:24 first chapter in every book, is helping people appreciate that they're different than their neighbor, and particularly with depression, might be 10 individuals walking into your office or friends with depression, and there might be 10 different underlying factors. I think that's absolutely true, and I actually got to meet Abram-Hoffer and also Linus Pauling,

Starting point is 00:07:45 never Roger Williams, died for my time. But, you know, that paper you're talking about in Science magazine, by the way, which is this premier elite magazine. And Linus Pong was a biochemist, and he understood biochemistry in a way that most of us don't. I mean, he won the Nobel Prize for his work in the study of proteins and chemistry. And the title of the paper was orthomolecular psychiatry. Ortho means to straighten, like orthopedics means to straighten bones. It's an ortho to correct molecules, orthomolecular. And he talked about different nutrient needs,

Starting point is 00:08:22 and it was a very, I mean, I read the paper. It's super geeky. I could barely understand half that. It was very deeply scientific. But it really spoke to this idea that maybe our mental health was not simply just an emotional problem, although it often can be if there's trauma and things that are quite serious

Starting point is 00:08:38 that happen when you're younger. Those all influence us. But, you know, we shouldn't sort of assume that that's the problem, and we should start to look for things that are actually treatable. And in your work, you really, you kind of also talked about Roger Williams,

Starting point is 00:08:52 who was the father of biochemical individuality. And, you know, I often say the same thing as you, that if you know the name of your disease, it doesn't mean you know what's wrong with you. Say, I have depression. Well, that's just the definition that medicine has given to people who share a collective set of symptoms. They're hopeless or helpless.

Starting point is 00:09:10 They have no interest in sex. They can't sleep. They have no appetite. Whatever. There's a whole list of these things in the, in the medical categorization book called DSM fiber. It's helpful for grouping people in categories, but it doesn't tell you anything about the why.

Starting point is 00:09:24 And so you spent your life thinking about the why and asking really difficult questions, which is how are these people all different? And like you said, you know, I always say this, you have depression. It's not a Prozac deficiency. It's something that is often treatable. Take us through how you kind of unpack the fundamental root causes,

Starting point is 00:09:44 the drivers, the biological drivers, of depression because most people think it's a chemical imbalance, right? Oh, just it's a serotonin deficiency. So take this drug that makes you have more serotonin in your brain, right? That doesn't work. I mean, the studies for mild and moderate depression, really, these drugs are not much better than placebo. And, you know, they're often come with a lot of side effects.

Starting point is 00:10:06 So take us through these major biological drivers that you talk about in your book. Well, I mean, as you described, there are many possibilities. and, you know, how do we assess where to go? And in the integrative and functional space, sometimes people get carried away with too many tests. But there's often, you know, very low-hanging fruit. And I think the first part of the assessment is a good history and family history, because we do know that depression runs in families.

Starting point is 00:10:34 And that helps us understand some micronutrients that could be deficient and some genetics, like having, variants of, you know, folate, MTHFR variants tend to be genetic. And that for people listening, that's a particular gene that regulates folate metabolism, which is very involved in neurotransmitter function and mood. So even traditional psychiatrists understand that folate can be a treatment for some case of depression. And this is a gene that makes us different.

Starting point is 00:11:03 So that's what that gene was. Working in the inpatient psychiatry role for 30 years, one of the most common presentations that I see for those that are what we call treatment refractory that don't get better with meds and, you know, are those with that kind of genetic variant? So looking at that gene is, to me, a critical component of a depression workup. Then, you know, just simple vitamin deficiencies, as you describe, B12, zinc and magnesium, I think one of the most significant and simplest and could dramatically change the public health implications of depression and suicide globally is just vitamin D deficiency.

Starting point is 00:11:42 The research in 2025. Yeah. I mean, everything you and I have been talking about 30 years, 2025 was a year that just solidified everything. I mean, so I have research articles now on low vitamin D in suicide, low zinc in suicide, low folate in suicide. It just came out this year. And so we can't really argue with the stunning research that's just been blossoming.

Starting point is 00:12:12 And everybody thinks, oh, you know, know people in America have plenty of food, they eat a lot, they're not malnourished. N. Haines data, which is the government survey, the National Health and Nutrition Examination Survey, where they go and test thousands of people every year and they monitor history of their health conditions, they found over 90% of Americans have a deficiency in one or more nutrients at the minimum level to prevent a deficiency disease, like how much vitamin C do need to not get scurvy or vitamin D do not get rickets, right? And so it's, it's omega-3s are probably 90%, 80% lower and efficient vitamin D, 40%. 40% lower and efficient vitamin D, 40,000,

Starting point is 00:12:42 35% magnesium, but the same in zinc, the same in iron. And these really affect your mood and your brain function. And so people think your brain is sort of like disembodied from the rest of your body, like it's just this thing sitting up on top of your shoulders. And, you know, the joke is that psychiatrists pay no attention to the brain and neurologist pay no attention to the mind. But you're a psychiatrist who's paying attention to the brain and how it works and what's needed for it to work. And nutrients are a huge factor. Talk about also sort of the gut brain issue because I think that's a very big one that people don't necessarily understand is how could the gut be related to the brain? And by the way, like, does your psychiatrist ask you for a stool test when you go in with depression?

Starting point is 00:13:22 Probably not, but maybe they should, right? So take us through that whole understanding of how the gut function and the disturbances in the microbiome are linked to potential depression. Yeah, I mean, sometimes, you know, I make a joke that I'm more of a gastroenterologist than a psychiatrist because, I mean, even from from the milk down, like, you know, zinc deficiency is common, and we'll pick that up by someone not having taste. And then the digestive enzymes in hydrochloric acid. So if you don't digest food properly, you don't absorb the micronutrients. So I have a lot of patients who are spending money on very expensive, organic food and these brass-fed, you know, protein. But when we do testing, they have very low levels of amino acids, the building blocks, because they don't have enough digestive enzymes.

Starting point is 00:14:16 And then that sets the whole dysbiosis. And it's clear that now, and again, the research has just supported it, dysbiosis, it's been related to every major psychiatric illness. I mean, Alzheimer's, depression, anxiety, anorexia, it's pretty stunning. It's true. I mean, I've had a lot of patients with, gut issues that when you're an actual psychiatrist, I'm not. I'm a family doctor. I've had some training in psychiatry, but I joking call myself the accident as psychiatrist because I would treat people's gut issues and all these psychiatric problems would go away, whether it was OCD or depression or anxiety or even more serious things. You know, autism would improve and the ADD would improve. And I was like, well, what's going on here, right? You know, and so I think, you know, behavioral issues

Starting point is 00:15:09 it improved. But I saw this over and over, and I just, that's why I wrote the book, Ultra Mind Solution a decade and a half ago, because I was like, oh, wait a minute, there's more of the story than just, you know, these, these psychiatric diagnoses and drugs, and there's something else going on here that's affecting the brain. And a lot of the common pathway of this is inflammation. Even like the gut, we didn't talk about this, but like there's bacterial overgrowth, yeast overgrowth, leaky gut, all that stuff, plus gluten is a big factor. I want you to sort of touch on that because I think even without gut symptoms, you can have gluten sensitivity that creates an inflamed brain. And I want you to sort of unpack the brain

Starting point is 00:15:49 inflammation story when it comes to depression. Because I think it's a central unifying feature of a lot of the things that go wrong. When the pharmaceutical companies get involved, you know it must be important because, you know, there are pharmaceuticals looking for anti-inflammatory drugs to treat depression. So there are many mechanisms and many paths to how inflammation affects depression. And we know the, you know, people are all now familiar with cytokines and all these inflammatory markers. Well, they target the brain and they decrease these neurotransmitters and they affect

Starting point is 00:16:23 depression. And that's been known for many years. And inflammation is a common pathway, but there might be many, many paths to an inflamed brain. And simple ones are like sleep deprivation, inflammation. inflammation, increased risk of depression and suicide. And then we could talk about infections from COVID to Lyme to anything else. But I do want to go back to what you had mentioned about gluten, because gluten sensitivity or particularly celiac disease is one of the most commonly missed

Starting point is 00:16:58 causes of depression and anxiety. I mean, literally complete remission and reversal of symptoms, and there are no GI symptoms when they sit in your office. You're just complaining of fatigue and depression. And you find out they have celiac, which is an autoimmune disorder to gluten. You eliminate gluten, replete those nutrients, and their depression is gone. As you know, I talk a lot about protein, especially as we age, but not all proteins are the same. Collagen is actually the most abundant protein in your body.

Starting point is 00:17:31 It's the glue that holds you together, your skin, your joints, your bones, your connected tissues, and after the age of 20, our bodies start producing less collagen, which contributes to the changes we notice in skin, in joints, and in bones over time. Traditionally, we got collagen from nose to tail foods, things slow-cooked stews, bone broths, and connective tissue, but most modern diets don't include those foods, which is why supplementing with high-quality collagen source can be really helpful. And that's why I like paleovali's 100% grass-fed bone broth protein. It's made from bones of grass-fed and finished cattle raised on American regenerative farms,

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Starting point is 00:19:44 and it's even HSA and FSA eligible. So I head to Bunchar.com slash hymen and use the code, Hyman, for 15% off today. That's B-O-N-C-H-A-R-G-E dot com slash hymen and use the code, Hyman. It's true. I mean, I think gluten creates a linky gut that creates inflammation, inflammation of the brain, but also as other effects. Like there's a little many proteins that get digested from gluten that can create brain inflammation and psychiatric symptoms. They're called gluteomorphins, well described in the literature. And again, most doctors don't check for it. We test for these urinary peptides. We test for gluten sensitivity. But it's not even, it's not even

Starting point is 00:20:21 full celiac. It could be non-celiac gluten sensitivity, which may affect up to 20% of the population. And, you know, I think that's, again, often missed. And, again, you don't go to the psychiatrist and get a gluten sensitivity test, right? So that's part of the problem. Talk a little bit more about this whole sort of inflammatory phenomenon because I've seen a lot of literature and I'm seeing the psychiatrist talk about, like, treating depression with these major biologic drugs that are immune suppressants like the TNAF alpha blockers that cost 50 grand a year and have cancer risk and, you know, increased infection risk.

Starting point is 00:20:56 I just think we're kind of misguided with that, and I think the question should be wiser inflammation. So can you talk more about this sort of neuroinflammatory phenomena and how it's sort of linked to depression and what the root causes of that are? Yeah, no, no, you're absolutely right. It's a little frustrating to me, and partly the reason I read the book is to help people dig deeper

Starting point is 00:21:18 because to just say inflammation is the cause of depression, and you can use a $10,000 drug or curcumin, it's not going to necessarily help. So, yeah, you hit the nail on the head. We've got to find the root cause. And that's why it still takes a psychiatrist an hour to do an evaluation, because that root cause could be early trauma. We know trauma as a child creates chronic inflammation.

Starting point is 00:21:45 It could be those infections. It could be food allergy. We mentioned gluten. It could be sleep deprivation. I mentioned vitamin D, but vitamin D deficient. just kind of sets up the immune system to be hyperactive. So we're always digging deeper. Could be obesity.

Starting point is 00:22:04 Could be ultra-processed foods. I mean, the list is long, but we all know what it is. Stress, I guess, is probably the most overwhelming, direct path to inflammation. So to just tell someone to take a drug or a supplement without having a more personalized path is just not going to be as effective. Let's just touch in a few more things. I want to talk about one of the key themes in your book, which I think is really unusual

Starting point is 00:22:31 when it comes with psychiatry, which is what I would be calling the biomarkers of mental health. Doctors don't think about how do I test for blood tests or other diagnostic tests that tell me what's the root cause of these psychiatric problems or depression? And I think you can't practice medicine or psychiatry without knowing your biomarkers and how they relate to different conditions. And you really dive deep in that. But before we go on to that, I want to sort of touch a little bit more on the hormonal imbalances that relate to depression that are common and also the sort of blood sugar and metabolic story. Because there's a lot of work on Harvard around that with Chris Palmer.

Starting point is 00:23:12 You've had them on the podcast talking about, you know, the mitochondria and insulin resistance in the brain and how that links to depression. But there's also thyroid, cortisol, sex hormones. So can you kind of walk us briefly through how this sort of hormone metabolic phenomena or driving depression. It just adds to that list of, you know, what we want to look for in an assessment for a depressed patient. So clearly, you know, hormones and for many, it could be thyroid, probably the most common. And, you know, when we're in medical school, you know, if we have to take a test, what causes

Starting point is 00:23:47 depression, we have to check a box, low thyroid. So, but then when we get out in training, we don't think, as a, you know, as a lot. mental health professionals, that it's thyroid. But thyroid is probably the most common that we see, but certainly low testosterone and, you know, dysregulation of estrogen and progesterone can all contribute to depression. What I have found most helpful in my practice,

Starting point is 00:24:12 and the simplest, is look at precursors to these hormones, and simple blood tests like Pregnolone and DHA can often be low and really the simplest path to supporting all the hormones. Yeah, so doing a good hormonal assessment is key, looking at thyroid, looking at cortisol, sex hormones, and it varies. I mean, you know, as older men, you can get low testosterone that can affect mood. Women, obviously, menopause can have hormonal issues, PMS, all that can be related to mood issues, pre-mestral dysphoric disorder.

Starting point is 00:24:47 They're actually, they took Prozac and renamed it Seraphaph. famine, called it a drug for PMS, you know, which always made me laugh. But, you know, these things have to get looked at in depth. And the good news is there are ways to look at these things. There are ways to look at all those factors. And I think, you know, one of the biggest things affecting people is the insulin resistance and blood sugar issues. And they have to do with a lot of psychiatric problems, whether it's, you know, I've had people with panic attacks because of blood sugar swings or night sweats, but even more, more mood instability, depression can be a factor. So that's, that's a problem. So that's,

Starting point is 00:25:21 something easy to fix. And again, something often not looked at. Yeah, I mean, I think Chris Palmer's work in Georgia Ead and a number of other people have really kind of put this kind of understanding of insulin resistance as a factor in mood disorders and major psychiatric disorders and also as a treatment path. I think that many of our patients will get better on a kind of diet that's kind of supportive of higher protein and lower carbs. Sometimes it's hard to sustain ketogenic diet long term, but it's a powerful tool for mental health clinicians to support recovery. You've seen pretty dramatic changes. I know. It's powerful. Just those simple changes in diet and lifestyle make a huge difference. And that's got to be the

Starting point is 00:26:08 foundation of any mental health approach. So let's kind of dive into, you know, we've covered a lot of the issues from nutritional deficiencies to gut issues, to inflammation causes, to hormonal balances, the genetic factors, all these are really important to assess. And one of them you didn't talk about it was toxins, which I think is also important. So maybe we can touch on toxins, then we can dive into the, how do we diagnose the root causes through testing? Yeah, it is a frightening door to open, but we have to assess. I mean, I think in a standard psychiatric practice, the two most common things we see

Starting point is 00:26:45 is mercury and copper. And both high and low copper, high copper usually is contributing to irritability associated with depression. And low copper, we see a lot in celiac or people supplementing too much with zinc. Also has been a path to depression. But any of the kind of heavy metals can contribute to brain dysfunction. In kids, we see lead still. It's frightening.

Starting point is 00:27:17 A lot of copper, a lot of mercury are the most common. I know. I mean, I often told the story, but I first got into functional medicine because I had mercury poisoning after living in China and eating a lot of fish and all this stuff. And I was so depressed. I mean, I knew I wasn't emotionally depressed. I knew I was physiologically depressed because I've always been a very happy person. and I'm like, something's wrong, and I don't need Prozac, which is basically what the doctors were telling me to do. And I'm like, no, there's something else.

Starting point is 00:27:48 And I actually figured out that it was mercury. I keelated myself and it went away. So I think people don't realize there's so many roads to Rome, depending on what your issue is. So the question is, how do you figure out what your particular issue is and how do we give people help navigate this complex field? Because what I always say is tests don't guess, right? test don't guess. And that helps you guide precise treatment decisions, track your progress, see how you're doing. Tell us how you start, you know, thinking about the workup of someone diagnostically with depression. And one of the kinds of diagnostic tests we should be looking

Starting point is 00:28:22 at that we're not doing for mental illness. Yeah, no, it's really important. I, you know, I just read an article, the group of people figuring out the DSM-6, the next STEM version. and they commented on, we're still not ready to include biomarkers. So we go 20 more years without a concept of biomarkers. And there's just 20, if not 100, that you and I know contribute to depression, but our colleagues who are kind of controlling this next manual for psychiatry

Starting point is 00:29:02 are still way way out of it. You know, the workup, again, has to include a history because stress and trauma just plays a role in everything. And we have to be sensitive to that history. And family history, because a lot of choice of supplements depend on family histories, even though the patient might not suffer if there's a family history of addiction and helps me fine-tune my treatment. But a basic nutritional workup, nutritional deficiencies, and that would include B-Vitis. in D and hormones, and those precursors to hormones, like pregnant alone and DHA. And then in a functional psychiatry practice, we like to add genetic testing, looking at MTHFR and a few

Starting point is 00:29:52 other genes. We like to add, looking at amino acid levels and fatty acid levels, and a molecule called cryptopyril, which has tremendous implications. So it's a, it's a, urine test. And so we try to have a comprehensive assessment, as we've been talking about for years, to be able to find that personalized treatment plan. Yeah, I think you're talking about things that we do do all the time. We look at all the nutrient levels, you know, homo-sistine, melancholycass, which are B-vitamin markers for B-12, Foley, B-6, and those really are important. You know, we look at zinc. We can look at red-tell magnesium. We can look at, like you said, copper, even, lithium levels in place like the hair, and they can be very helpful. And we look for heavy metals.

Starting point is 00:30:40 We look for toxins. We look for change in the microbiome to stool testing. We can look for inflammatory levels in the body. We can look for insulin resistance through looking at lipids and blood sugar and insulin levels and A1C. So there's so many ways of looking at things. And we can also look at all the hormonal issues, complete thyroid testing and sex hormone testing and cortisol testing or you mentioned pregnant, these are all things that should be standard part of practice, even gluten sensitivity, food sensitivities. These are real things that can drive mental health issues. And most doctors don't think about it. They don't know how to test it. They don't know how to order it. And they don't know how to interpret it. And it's unfortunate. It's not their fault. They just don't

Starting point is 00:31:18 learn about it because the orthodoxy hasn't accepted this yet. But I'm excited about kind of your book because it lays a lot of this out. And I think that for me, it's part of the reason that I co-founded function health, which was to empower people to get this data on themselves and not have to wait for some doctor to hopefully figure out that this is the problem and they can be going on for years. I mean, thyroid issues often go on for years or even a decade before they get diagnosed because people just don't think about it or they don't do right diagnostic tests. So I think that the test not guess message is really important. And now with function health for basically a dollar a day, $365 a year, you can get twice

Starting point is 00:31:59 to your testing, see what's going on, and then you can modify those risks and change things. So I think it's really, really important. And the basic idea here is that, you know, depression and many mental illnesses are not just in your head, they're in your body, and do you need to address those fundamental biological imbalances and test for those things and actually address those more systematically? So can you maybe share a little bit more about some cases and some stories of patients you've had that you've seen, you know, various factors, just as to give you a flavor how you work through some of these problems with patients?

Starting point is 00:32:37 The challenge, I think, for clinicians is all the tests that we've talked about, you know, how do you prioritize and how do you understand, you know, what's part of that depression, you know, some of these abnormal tests might not be affecting the mood. So that's the challenge and that's why it's important to see a mental health professionals who know this work. But I think, you know, over the years, the cases, you know, that kind of most traumatic to me are when I can use words like remission and recovery. The mood is completely gone. So I've seen that in celiac disease, you know, from 7-year-olds to 40-year-olds, just completely eliminating gluten. I had someone in our training program presented a case last night of an autistic kid who was nonverbal,

Starting point is 00:33:36 who just took lithium orate, a nutritional supplement that I talk about in the book and we use all the time and became verbal. So an autistic patient became verbal. And for our, you know, adults, the most common things we see are B12 deficiency. You mentioned homocysteine. I can't tell you how many patients that we've seen in the past year with these dramatically high homocysteine levels, which is a proven marker of deficiencies in B-6, B-12, and folate, and have also been shown, we've known for 20 years, a risk factor for depression as well as dementia. So it's a simple test where we then dig deeper to find out, is it B6, B12, or folate,

Starting point is 00:34:28 and then treat the underlying cause, and the depression completely disappears. You see these miraculous recoveries of things that are, quote, you know, chronic illnesses. And I think, you know, when you look at the biggest burden on our society, we talk about chronic illness and diabetes and so forth and all the cardiometabolic diseases and those are big but when you talk about disability quality of life years lost suffering you know the economic impact globally not not the direct cost but the indirect costs on society from people who are depressed and can't function it far exceeds all the rest of of that and most put together so it's really one of the biggest drains on the whole society and we have such a horrible

Starting point is 00:35:13 mental health system that doesn't really address this, unfortunately. And, you know, you've been doing this for decades and so by. And we've just seen over and over some of these these repeatable patterns that aren't just boo-boodoo or, you know, kind of made up. But if you look at the scientific literature, it's there. And if you put the pieces together, it's really there. And yet it just somehow hasn't gotten into traditional medicine and psychiatry. It's unfortunate. I'm wondering if you have a curious about why psychiatry is so resistant to this, is it just, is it just so far outside the paradigm? Or it just seems like there's some areas where they kind of do this, like they give Deppelin, which is a very high-dose folate, or they'll give, you know, T3 for some patients with

Starting point is 00:35:55 depression, which is a thyroid hormonal. They'll kind of play with the edges of it, but it's like, they don't really even realize what they're doing. It's challenging and, and frustrating for me being, you know, kind of one foot in, one foot out. But I'm hopeful. I mean, last year, the American Psychiatric Association, you know, 10,000 psychiatrists. The theme of the conference was nutrition and lifestyle. So it's pretty dramatic. So there were a lot of lectures on nutritional psych, and certainly lifestyle, sleep and exercise. So, and then there's major psychopharm conferences. Actually, the Harvard PsychoFarm Conference this year, there was a little section on nutritional psychiatry. So I think there were five of us that gave them half our presentations. So things are

Starting point is 00:36:42 changing. So, but not, not significant enough because the pharmaceutical hold is so powerful. And I think it empowers docs to think that they have a cure. And that's medicine is, right, surgery and drugs. I'm just hopeful that the younger generation of doctors and the limitations that's, you know, certainly hit with our just medication approach that things have, I think, changed dramatically in the past two years, and we'll continue to change. Well, let's talk about the medication issue because you write about that in your book,

Starting point is 00:37:21 and you talk about, you know, how these drugs are often difficult to get off of and how they do, you know, once you get on them, you're kind of like in a pickle, one, because if you stop them, who knows if your depression is going to come back, and how do you prevent that? And two, they're just hard to get off of because of the side effects of getting off of them. And so let's talk about antidepressants. And I think, you know, they seem to help some people.

Starting point is 00:37:49 But talk about their efficacy or effectiveness over the broader population. Are they effective? What percent are they affected for? Who are they affected for? And where are we failing with these medications? We're failing on a lot of fronts. I mean, even in traditional psychiatry literature, you know, the word is treatment, refractory, depression, no response to medicines is at least a third.

Starting point is 00:38:13 And those two-thirds that, quote, got better, they still have symptoms. You know, they've only shown improvement. And I think the limitations are, it's just symptomatic-based treatment without looking at the cause. But what has happened for too many years is a psychiatric community completely ignored what happens when you stop these medicines. And, you know, I call it withdrawal. They call it discontinuation syndrome. Either way, it's pretty significant for some individuals. And this is where I think functional medicine can play a unique role in the field of psychiatry. Because I'm quite convinced if we do these functional medicine test before someone stops their medication, we can completely eliminate those withdrawal symptoms.

Starting point is 00:39:06 And it was just kind of eye-opening and probably 10, maybe 15 years ago when I had two people stopped the same medicine. It was Calexa. And one person did it fine. And the next one had these intractable, you know, brain zaps and suicidal thoughts. And I realized, what's not the medicine, it's what's going on in that individual. And once we do the functional testing, we replete the D and the B-12 or the amino acids, we can safely withdraw someone from these antidepressants. So basically what you're saying is get all the fundamental imbalances and dysfunctions sorted, test for them, address them, correct them.

Starting point is 00:39:47 Kind of like the orthomolecular concept of correcting the molecular dysfunctions. And then you'll find an easier way of tapering off the medication. Oh, absolutely. I've just seen a thousand and stuff. What these antidepressants do, you know, they kind of trick the brain, particularly the SSRIs and SNRIs, the Prozac. And the brain adapts to this medication, which means there's a functional serotonin deficiency. So there's less serotonin being produced.

Starting point is 00:40:16 So if you have deficiencies in any of the co-factors in serotonin synthesis, that you pull this drug and your brain just goes crazy and doesn't know what to do. But if you can replete that process, then it becomes much more manageable. and we can eliminate those side effects. Do you try to mostly get people off of these drugs? Most of my work now is people who have struggled with inability to come off their antidepressants. They've been feeling okay or just side effects, whether it's weight gain, sexual side effects. So that's why a big part of what I've been doing is supporting people coming off the medications. And where do you find resistance to the effects of actually working?

Starting point is 00:41:03 with patients with this model. Where are the ones you find, you know, are treatment resistant to using a functional medicine, sort of more holistic psychiatry approach? In terms of the patients? Yeah. Like, you know, some people do better, but some people, you know, don't necessarily.

Starting point is 00:41:20 There are patients who want the quick fix, and that's what they're used to, and they want the medication, and we need to kind of respect that. And then what our role is that these micronutrients will just minimize side effects and support their recovery. You know, other patients, you know, are interested in digging deeper and looking at the root cause, as you describe.

Starting point is 00:41:46 Most of the time I'm looking at the literature, the psychiatrists, you know, do sometimes help people with major depression. But if you look at the literature objectively, at least what I've seen, and there's some big trials that look at this, that for mild to amount of depression, it's not much better than placebo. might work, but so does placebo, right? So does a sugar pill. And so if they're much harder than placebo, then why are we prescribing them, given they have all these side effects? Yeah, no, I used to have a picture of M&Ms, and, you know, because some of the research, you know, the best research may be 60 percent or, you know, and other people coming up with 50 percent. And that's what placebo

Starting point is 00:42:24 will help. I mean, placebo has a powerful effect on depression. And we've known that for years. That's why there was a lag in drug development because they couldn't beat the placebo. So that's why, you know, we haven't given up our skills and training in therapy. And part of the reason, you know, the name of the book is kind of helpful because that therapeutic alliance and our ability to instill hope in our patients is just, you know, the first step. Yeah, I mean, the name of your book is quite good. It's finally hopeful, the personalized whole body plan to find and fix. the root causes of depression. And honestly, James Medicine is really not focused on root causes.

Starting point is 00:43:07 It's focused on describing the disease, the symptoms, and then trying to suppress those symptoms with a medication or modify some downstream pathway rather than dealing with the upstream root cause. And that's really what you've been doing for so long is actually how do we actually think about getting the root causes and treating the body of the system and then looking at the things we can actually measure and test.

Starting point is 00:43:29 We did talk about this a little bit on your last podcast with me, but it might be worth sort of touching base again, because I think you've been to know leaders in nutritional lithium supplementation, low doses of lithium, not the massive doses you get for people with bipolar disorder or manic depressive disorder, but you're saying it's often missing, and there's a lot of kind of research globally

Starting point is 00:43:53 on how it may be linked to suicide and genetics, how they play a role, and talk to us about the role of nutritional lithium and how you use it in clinical practice and how you assess it. I mean, I think lithium orate, nutritional lithium, is one of the most important tools in my toolbox as a psychiatrist. And again, 2025, the year of research, just a stunning paper came out of Harvard published in Nature

Starting point is 00:44:22 where they demonstrated that, one, lithium was low in the brains of Alzheimer's patients. So it was one of 50 elements tested. Wow. And then two, that lithium orate in these mice models that develop Alzheimer's pathology, lithium orate was able to prevent and reverse the neuropathology of Alzheimer's. So it was one of the most stunning things, and it was, you know, not lithium carbonate. So the other forms of lithium did not reverse the plaques and tangles, but only lithium orotate. And I think you can appreciate this.

Starting point is 00:45:04 I saw that paper. Yeah, we've been talking about lithium orotate, but everyone who commented on the study said, brilliant, great, but we need more research because we've never used lithium orotate. And we've been prescribing it for 30 years. So it just kind of helped us as clinicians. but lithium is an essential element for brain health. And I'm quite convinced there are some individuals that just have a little higher need based on family histories, particularly addiction or bipolar.

Starting point is 00:45:38 And sometimes two to five milligrams of lithium has been some of the most traumatic changes we've seen in depression and other mental health problems. As we head into the busiest stretch of the year, longer days, travel, more on your plate, your immune system is working over time. And that's why now is the time to make sure you're giving it the support it needs. I rely on H-TB immune energy shoes from Big Bold Health. Each serving delivers 1,000 milligrams of sprouted Himalayan tartary buckwheat, a powerful seed packed with over 100 immune-active polyphenols like quercetin and rootin.

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Starting point is 00:46:51 Good question. So symptoms, I look at irritability and impulsivity, so moodiness, irritability, and that could be in an ADHD kid or depressed person. And then family history is important to me as well. So family history of depression, addiction, bipolar, or suicide. And you measure like lithium levels in the hair, or how do you sort of assess? Yeah, yeah. Blood levels won't help because. the blood levels only pick up pharmaceutical lithium. So I do look at a trace mental hair test on everyone. And oftentimes we can see now undetectable lithium.

Starting point is 00:47:31 But even if there's lithium in the hair, sometimes we'd use it as a nutritional supplement. So I think, you know, one of the things that we get into medicine is binary thinking. It's how they're it is for that. It's how they're only, you know, holistic or only medicine or, and truth is we need an approach to integrates all modalities, whether it's, you know, functional medicine, psychiatry, and root cause analysis and addressing the imbalances in the system, combined with talk therapy, combined with other trauma-related therapies, combined with medication. So it's really a spectrum of things that we have to choose from. It's just that there's a whole toolbox that we never addressed,

Starting point is 00:48:08 which is the toolbox that you and I use that gets ignored by traditional medicine. So talk to us about how you think about an more of an integrated approach to mental health. Sure. I think many, both the doctors and patients are struggling with, you know, do I take supplements or do I take medications? And everything that we talk about in the book can be utilized, you know, with medications. And oftentimes looking at these functional tests, utilizing the supplements while someone's on medications, is a path to help someone taper off the medications. But I think depression is complicated for some individuals and, you know, haven't given up my prescription pad if needed, and certainly the role of psychotherapy, whether it's couples therapy,

Starting point is 00:48:58 a family therapy, you know, or trauma therapy can be incorporated into treatment models. So we don't have to pick one or the other, but we have to embrace all. That's right. I mean, I always jokingly say, you know, it's a lot harder to be. you know, happy or enlightened if you're mercury poisoned or your V-12 is low, your thyroid's not working, you have a lot of gut issues, fix those things, and then you see what's left. And then there may be issues that are more from your childhood or more, you know, from development issues or life stresses, but, you know, often people mislabel the problem. And they go, you have depression. It's just totally a mental issue. It's all in your head. So we have to do things that affect

Starting point is 00:49:44 your brain chemistry or your talking, your therapy, which doesn't really address the root causes. So I think root cause medicine is sort of where it's at. I think it's something that's coming up. And also the whole idea of treating the system, not just individual symptoms, which we do in psychiatry. And I think when you're doing is really a more comprehensive approach. And you're doing things that most psychiatrists don't do, which is you're doing blood tests, you're doing stool tests, you're doing, you know, urinary tests for toxin testing, hormonal testing. I mean, these are things that are just so outside the scope of what most psychiatrists actually look at. So, I mean, I think it's impressive. We've been doing this for a long time.

Starting point is 00:50:25 You see these patterns. And I think your book, Finding Hope, is really a great summary of a lot of these things you've learned over your lifetime that help can provide actual hope for people who are struggling with us. So I think anybody listening, anybody struggling with depression, anybody having a hard time for sure, you should get Dr. Reedblatt's book, the personalized whole body plan to find and fix the root cause of depression. It's out now. You can get anywhere you get books. You can find out more about Dr. Greenblatt, James Greenblatt, MD.com.

Starting point is 00:50:53 He's got many courses for professionals, and he's training a lot of doctors and psychiatrists how to do this, thankfully. But you also, you've launched a new online platform, which is a functional psychiatry clinic that's focused on delivering personalized root cause mental health for people of all ages called finally living. Can you talk more about it? that I think it's really kind of an interesting model and I think for people listening and struggling, it might be something that might benefit from. You know, we've been training doctors for a long time,

Starting point is 00:51:23 and I think we wanted to kind of work as a group to provide a consultation model to offer, you know, functional psychiatry to more individuals. So I think in the next month we should have clinicians licensed in all 50 states to not take over treatment, but to really do the testing, provide the consultation and help people get on that path to recovery for those struggling with depression. Thank you for doing this. It's so important. I think it's much needed because people are struggling are out there. So I think for people listening, just realize that if you're depressed or you struggle from mental health issues, you have someone you love who is, that there is a roadmap to thinking about this. There is a systematic way of assessing somebody through deep root cause testing, through

Starting point is 00:52:11 comprehensive, you know, history taking to find out what's going on. And, and through that, we often find the clues that help us really solve these, these patients' problems and relieve a lot of suffering, which is so necessary given the scope of, and the kind of incredible amount of people who are struggling with, with these issues. I think, I mean, the data is sort of staggering, you know, like, when you look at globally, it's, I think, like, over, you know, 300 million people suffer from severe depression. And it's worse than older adults. It's tremendous amounts of suicide,

Starting point is 00:52:47 almost third-leading cause of death in ages 15 to 29. So I think we need to kind of revise our framework, revise our thinking, and actually help people with a new model. And I think you've laid it out so beautifully, and you've been doing this for it for so long. So thank you for keeping out of it. You could be retired and playing golf, you know. So I really appreciate your work.

Starting point is 00:53:09 It's what work to be done. There is 100%. So thanks so much for being on the podcast and helping us understand the deeper level of how to think about mental health, particularly depression, and all the options there are for both assessing and treating these people. Great. Thanks for having me. Nice seeing you, Mark. My pleasure.

Starting point is 00:53:27 If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments. questions. Don't forget to rate, review, and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at

Starting point is 00:53:55 Cleveland Clinic, and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the ultra-wellness center at ultra-wellnesscenter.com and request to become a patient. It's important

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The Dr. Hyman Show - Antidepressants Explained: Benefits, Risks, and Alternatives for Depression | Dr. James Greenblatt

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