The Liz Moody Podcast - The New Science Of Depression & How To Actually Heal (+ SSRIs, Postpartum, Grief, and More)

Episode Date: April 30, 2025

Mental health isn’t one-size-fits-all. Most of us have learned that depression is a chemical imbalance that works like a disease - you either have it or you don’t, and if you do you can seek treatment through psychiatric medication. While this model of depression has helped destigmatize mental illness, it also has its limits. Today, I’m speaking to Ellen Vora, MD, about new approaches to treating depression and mental health tips.  If you want to cut past the noise and finally get to the root cause of your depression, this episode is for you. Ellen and I discuss SSRIs, birth control, inflammation, and more – and as always, we’re giving you tips you can implement now to help with your depression. In this episode, we get into: Is It Normal To Feel Sad All the Time? Genetic Components in Depression How SSRIs Work False Moods SSRI Withdrawal Dealing with Grief Spirituality & Mental Health Postpartum Depression  Physical Root Causes of Depression Finding Your Root Cause Should You Test for Thyroid Problems? Hormonal Birth Control, AKA The Pill Finding Community PMDD Your Gut and Your Brain For more from Ellen Vora, find her on Instagram @ellenvoramd, online at https://ellenvora.com/, and get Ellen’s book The Anatomy of Anxiety here. Ready to uplevel every part of your life? Order Liz’s book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  To join The Liz Moody Podcast Club Facebook group, go to www.facebook.com/groups/thelizmoodypodcast. Connect with Liz on Instagram @lizmoody or online at www.lizmoody.com. Subscribe to the substack by visiting https://lizmoody.substack.com/welcome.  Join Liz Moody in New York City for the Your Best Life Intensive Event on May 11th. Check out the previous episode of The Liz Moody Podcast discussed today: Ask The Doctor: Anxiety Edition—Everything You Need To Know About Treating Anxiety Naturally with Ellen Vora, MD This episode is sponsored by: Maui Nui: head to mauinuivenison.com/LIZ to secure your access to a limited collection of Liz’s favorite nutrient-dense wildly delicious meat cuts and products. The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. The Liz Moody Podcast Episode 325. Learn more about your ad choices. Visit megaphone.fm/adchoices

Is it normal to feel a little bit sad all the time, or is that depression? A lot of us, I'm convinced, are in a state of chronic low-grade depression because we're in a state of chronic low-grade inflammation. Anything unwell or imbalanced in the brain colors the very lens through which we see our lives. We have millions of people taking medications that are based on a narrative that these are correcting that serotonin imbalance. And if the serotonin imbalance doesn't exist, are these medications in effect? your depression is not the verdict. This is a symptom. Let's roll up our sleeves and figure out what's out of balance. We will have had this journey of self-efficacy of recognizing our agency and all of this is really helpful preparation for making big sweeping changes in our lives. Hello, friends, and welcome

back to the Liz Moody podcast. Today we're diving into a topic that so many of us struggle with, but we do not talk about nearly enough, depression. This episode is going to cover both what we think of as clinical depression, but also that more general feeling of melancholy, of wondering if life should be more than this. We're getting into all of the hard topics, including SSRIs, PMDD, postpartum, why it feels like so many of us are depressed these days, the surprising actual cause of depression that no one is talking about, and so much more. And of course, as always, we're getting into tons of action steps. This episode is packed with unlocks and ahas that will change your life starting today. My guest is Dr. Ellen Vora, a board-certified Columbia and Yale-trained

psychiatrist, and the best-selling author of The Anatomy of Anxiety. Ellen is known for taking a truly root cause, holistic approach to mental health that blends functional medicine with the latest science, and you're going to get a lot of mechanism of action science in this, a lot of great explainers, but also a lot of heart and just a really different perspective. Ellen is a dear friend of mine and a gem of a human being. And I'm so excited for you guys to get to experience a taste of the magic that is her. There's a lot of powerful information in this episode. So if you want key takeaways and practical tools, when you were done listening, head over to lizmoody.com and send up for our free newsletter. You're going to get science-backed action steps for every episode.

You're going to get full transcripts. You're going to get bonus content like our attention restoration challenge, our five-day gut reset that actually works, which actually goes along with some stuff that we talk about in this episode and so much more. Dr. Ellen Forer, welcome to the podcast. Thanks, Liz. It's good to be here. I'm so excited to have you back. We were just talking about how the last time you were on, we were sitting on your floor of your New York City apartment and you were comforting me that COVID wasn't going to be a very big deal. That's an age well. But it's a great episode and it has tons of strategies for anxiety. So I highly encourage everybody to go listen to that. You've been a guiding light in my anxiety journey personally. And today

we're going to talk about depression. And we're going to talk about this sort of general sense of and we and sadness that I think a lot of us are feeling right now. So let's just start with that. Is it normal to feel a little bit sad all the time or is that depression? Okay. We're going to deconstruct the whole concept. First of all, I don't think it's, though it's common, I don't think it's normal to feel sad all of the time. But I think what goes into why many people are feeling that sense of enwi and that low motivation, low vitality, low mood feeling, there's so much that goes into that. And there's like a Krishna-Merti quote that's like it's no indication of health to be well-adjusted to a sick society. And I think that there's a lot of ways that we are appropriately saying

something does not feel right here. And that's an indication of our surroundings and late stage capitalism in all the ways that we're not living in alignment with our values. But I think there's even so much more that goes into why we're chronically sad, low mood, low vitality. So we're going to break it all down. Here's where I think we need to philosophically shift around mental health. Because you know this Alan Watts quote of a problem that remains persistently insoluble should always be suspected as a question asked in the wrong way. And we've had a particular narrative about mental health for the last, like since about the 1980s, 90s. And it started from a good place. We were like, let's stop with the whole Freudian thing about it's just about your relationship

with your mother. And there was so much stigma and shame and mental health. So we move toward a more biologic basis for mental health, this disease model understanding that says, depression isn't a moral failing. Depression isn't because you have a weird relationship with your mother, though they're still a validity to all of that. But they're saying depression is a genetic chemical imbalance. And it took away the stigma. It says, why would you feel shame for taking medication? It's like diabetes. You have a disease. And now some, I guess, 40 years later, we're realizing that that's actually not a perfect explanation either. And it's been helping us in certain ways and getting us stuck in other ways. So there's some people for whom that model really works.

It implies you have this genetic chemical imbalance, but no big deal it can be corrected with a pill. And when that process works for someone, hallelujah. Like I'm not dogmatically opposed to that journey. I am in the business of alleviating human suffering. And when that works, that's a victory. I'm also now 13 or so years into practice. And I'm aware of the millions of people for whom that system doesn't bring them adequate relief. So we just need a new way of thinking about it.

And I think that we need to move away from what do you have and moving more toward what's going on. What do you have harkens back to the glory days of conventional Western medicine where we realized, oh, you can have a bacterial infection. That's your diagnosis. And that implies a particular antibiotic. And that allows you to achieve a cure. And like we want to get back to that so desperately. and psychiatry really wants to legitimize itself as a science. But with chronic diseases, with amorphous problems with mental health,

it doesn't work so smoothly because depression isn't necessarily an entity the way a bacterial pneumonia is. It isn't necessarily a serotonin deficiency or like a Prozac deficiency the way we've been taught. And so we have to grapple with the fact that it's not what do you have. Like saying you meet criteria for depression. that's what you have. That's actually not the final verdict. That's the beginning of the inquiry. That tells us how are you manifesting imbalance? What symptoms you get? You get depressed. Okay. So we know how it manifests in you. Naming that can be very grounding, but it does not tell us the ideology.

It doesn't tell us what's going on, what's causing those symptoms. When I realize that someone's meeting criteria for depression, then we roll up our sleeves and say, what's causing this, what's going on in their body. And it's usually two types of imbalance. There's physical imbalance or there's psychospiritual imbalance. Physical imbalance with depression, it's some lack of vitality. It's usually happening on the level of mitochondrial function, on the level of this is a brain that is missing some kind of fuel that it requires to have full optimal function. blood flow, fuel source, not being bombarded with inflammation, maybe not being chronically exhausted. It's a brain that's not getting its needs met. It's showing up as a lack of vitality.

And then a psychospiritual imbalance can look like unresolved trauma, ongoing socioeconomic stressors, living out of alignment with our values. That's that Krishna-Murti idea. And then also unmet needs because we are human beings and we have certain fundamental needs, need for community, need to feel that our lives have meaning and purpose, need to feel that we're being of service and making a contribution. I think we have a need for play and need for pleasure. We have a need to make our unique art. And I think that the last piece of psychospiritual imbalance is that we have so much unmetabolized grief. So when someone's depressed, I'm not thinking the end, I know what this is, this is a Zolaoft deficiency, I'm going to cure them with a pill. I've been down that road too many

times and seen how people still struggle. They might get help a little bit initially, sort of shrug. Like, I think it's helping. I'm crying less. We can talk about what's mechanistically happening there. But then over time, someone's right back to feeling no motivation, no pleasure, no hope, no joy. And I don't want to leave someone high and dry. I want to roll up my sleeves and say, we don't just accept that you're feeling this bad. There's something contributing to this. Let's investigate, get to the bottom of that, address it at that level. Okay, there's a lot to unpack there. Let's start with some of the things that you said. What does research show is the genetic component to depression as we understand it right now? Some and it's not everything. There's certainly a genetic

predisposition. It's not helpful to deny that. It's there. It's nuanced and complicated. Like there's a genetic predisposition that can or cannot be activated by things like childhood stressors and trauma. There's still an epigenetic component to this, that idea that we have the gene, the predisposition, but it's always the environment that pulls the trigger. And when the environmental insult is happening is also meaningful. So childhood trauma is a pretty potent environmental insult. And that can influence the expression of a gene and make it more likely for someone to manifest or express this genetic predisposition. We see that with serotonin transporter, genetic profiles, that you can have two copies of a particular short serotonin transporter gene, but without childhood trauma, in adulthood,

you look no different than someone who has no copies of that short gene. And the hybrid, like if your heterozygous have one copy of the short, one of the long, that's intermediate. But it all hinges on whether or not you have this insult in childhood. That's helpful from a research standpoint to understand. but let's say you're the person who's had the childhood trauma and then you hear this, that feels very damning and then we feel stuck. And I think if nothing else, my interest in all conversations around mental health is to point to the place where we're not stuck. Because what good is it to say, like, okay, so I'm just stuck? So I think that even if you have that gene, even if you have that environmental insult, that childhood trauma, even then we're never stuck. It's to me a

more helpful narrative to focus on, here's the ways that we can influence genetic expression. Here's the way that we can overrule a genetic predisposition. Here are the ways that there's reason for hope. It's so interesting how the two ideas kind of butt up against each other. This, it's a chemical imbalance. It's genetic. It's not my fault. And I want to be able to take action that will make me feel better. But if you can take action that will make you feel better, there's a certain amount of agency that you're saying, oh, I could do something about it. this and those really grind against each other. That tension is everything. And I think that, A, when you're depressed and you don't have motivation, you don't have vitality, the idea that you have

agency is overwhelming because you're like, okay, so you're telling me that it's not just as easy as taking a pill, that it comes down to my behaviors, my choices, that I can make myself less depressed if I do this. I say this and I'm like, shouldn't that make you feel hopeful and empowered? and someone who's depressed is like, no, that makes me feel overwhelmed. It makes me feel hopeless. And like I don't even want to get out of bed now. I feel just completely overwhelmed by that calculus of like, now I have to do all this stuff, but I don't even have enough energy to take a shower. It's kind of critical to recognize that we start in the most microscopic changes and you just need to start turning the ship around. Because with each little microscopic change,

you get a little bit of incremental progress. They become keystone habits. We witness. ourselves, doing something for ourselves. There's self-efficacy in that. But more importantly, we start creating the physical reserves to make the next change. Even if the first step is just you crawl into bed a little bit earlier at night, or the first step is you go outside for a four-minute walk, or you just put on Whitney Houston and see if you feel like dancing in your living room and your underwear in the dark with the curtains pulled. It's whatever is actually doable. And maybe you only do that for days, weeks, months. It doesn't matter. And if that starts to, shift the momentum, then the next step is possible. There's another piece of this, that tension of

agency is exhausting and overwhelming, which is that I think it feels insulting and invalidating and trivializing. I come up against this all the time where someone says, that's all nice, like that you have these holistic diet and lifestyle strategies for depression. But surely, you must mean that's only for someone who's like in a funk, a little like low key, and that's where I think we need a complete philosophical overhaul because what this is about is addressing the problem at the root. And the difference between you're a little bit stressed, you're a little bit in a funk, or your true blue clinical depression, in my opinion, that's a difference in degree, not in kind. I don't think that those are two different things.

I think that one is certainly a stronger expression of the same underlying problems like mitochondrial dysfunction, inflammation, chronic sleep deprivation, macronutrient deficiency, hormonal imbalance, gut health issues, all of that, those are the root causes of both. And so you still start with those holistic approaches. And oftentimes the person who felt like this is true blue clinical depression, that's still what actually addresses the problem. And anytime we think that it's something different, we're just going to keep barking up the wrong tree for a long time. I think we feel insulted when it's like, wait, so the diet and lifestyle strategies, which I could have done at any point in this, they work, were insulted by it.

It's the same thing when someone's like, I thought I had major depression. And then it became April and the sun came out and I realized I'm just an elaborate house plant. And we don't like that feeling of it was something so accessible. It was there all along. We almost need to believe I've been stuck for months or for years because this is refractory treatment resistant depression. Because if we start to realize like this came down to diet, lifestyle changes, things, like that, then it feels like it's too uncomfortable to grapple with the fact that we could have changed that months or years ago. So that's, I think, kind of triggering. And so then it becomes

harder to like want to believe that that might be the path out. So what do we do about that? I would say like we're going to get into so many of these strategies. We're also going to unpack SSRIs. We're going to unpack the chemical imbalance hypothesis, all these things. But I don't think we can get into any of that until we give people advice on how to grapple with the, it's my fault. of it all. Like if it was curable by these things and you didn't do them, then like how do we deal with that? This kind of goes back to what we said at the top of hour when we were like deep in the philosophy. This is the inner work. Inner work, shadow work, ultimately is very de-shaming because we can take a look at the good, the bad, the ugly, the everything that makes us us, our good

behaviors, our bad behaviors, the times when our good behaviors are really just a performance of virtue because we're trying to be liked, because we're trying not to be abandoned in the world. So it really is often a process of integrating and giving ourselves grace for our bad behaviors. And I think if we realized we had a mindset that was getting us stuck, but it was because it was too hard to look at the truth straight on, that's where the inner work really helps us. We reckon with the painful and difficult truths. And then we say, okay, I can move on from here. Can you talk to me about the idea that there's a chemical imbalance and that is why we are depressed?

What is the science show about that as of right now? It was originally this sort of derivative reasoning because certain tuberculosis drugs, which were known to modulate serotonin behavior in the brain, seemed to modulate people's moods. And so that's where the whole science comes from is that, oh, okay, so serotonin equals mood. And I think that the spirit behind this pursuit was always like, let's alleviate human suffering. And now we are many decades into a big billion dollar pursuit of pointing to this chemical imbalance. And I think what my field is having a hard time owning right now is that we haven't been able to demonstrate it because it is not actually there. And Mark Horowitz, he's a psychiatrist out of the UK, published an umbrella review.

in molecular psychiatry in 2022, where he examined all studies related to serotonin. He looked at serotonin transporter studies, receptor activity, serotonin levels, tryptophan metabolism, like every angle that you could look at, like cerebral spinal fluid levels of metabolites of serotonin. And he really concluded that basis for a serotonin theory of depression. It isn't there.

I think it's time for us to pivot. And it's an awkward pivot because we have millions of people taking medications that are based on a narrative that these are correcting that serotonin imbalance. And if the serotonin imbalance doesn't exist, are these medications ineffective? And what you'll see when you talk to people who are taking them is like, no, not completely. What the research tells us, like the JAMA meta-analysis in 2010, is that they are maybe not separating from placebo in mild to moderate depression. There's probably even a lot of nuanced unpack there because mild, moderate depression is not a homogenous thing. There's a lot of different reasons someone might have that. So are the medications helpful for some of those cases and not others? They are demonstrably helpful for severe depression.

So that's where we start to say, are they working in a way that has to do with the blunting of affect that we're narrowing the range of how someone's feeling, making the highs a little less high, but also importantly, the low is a little bit less low. And so if you're mild to moderate depression, maybe that's not meaningful improvement, but if you're severely depressed, there probably is meaningful improvement. And so there isn't really a chemical imbalance, but these meds are helping some folks. And I think that what we also have to med is, like, we've never really known how they work, because if it's just more serotonin equals more better, like, then they wouldn't take six to eight weeks to work. They are serotonin selective reuptake inhibitors or SSRIs, medications like Prozac, Zoloft, Lexopro,

Alexa, they are increasing the availability of serotonin in the synapse in the brain. And if it were that simple, like the way a benzodiazepine like Xanax does that for GABA, and that works. Oh yeah. Like right away. Almost too much. We can get into how that can be a problem. That's not the same case with SSRIs. We're putting more serotonin into the synapse. We're limiting the re-uptake or the sort of reabsorption of the serotonin into the pre or post-synaptic neuron, but we're not instantly feeling less depressed. So any impact it's having on mood is some kind of downstream effect. Maybe it's modulating our stress response, modulating the behavior in the amygdala. Maybe there's a placebo expectation impact. Maybe it's that we are neuroplastic afterward. Maybe it's a window of getting

more out of therapy. Maybe it's just the awareness that we're doing something to help ourselves. Maybe it's that we're finally being looked after and cared for and witnessed by a practitioner. There's a lot that can go into why it might be helpful. And we deserve the truth, which is that it's probably not just as straightforward as it's correcting a chemical imbalance, but something's happening there. And if that's helpful for you, great. And if it hasn't brought you adequate relief, also great, because we're starting to realize that that might have been barking up the wrong tree for some folks. And let's start to look at all these other paths up the mountain of healing, because we've had a limited menu. If you do feel like these SSRIs are working for you,

Are there any negative side effects to being on them? And I want to talk about in the short term and then also in the long term, which I think a lot of people have long term concerns about their health. Yeah. In the short term, you kind of know it if you're having them. Did it impact your libido negatively? That's not fun. That, you know, I always sort of grapple with the importance, like the central importance to our happiness of pleasure, of having a sexually fulfilling. experience, like whether that's with a partner, it's with self-pleasure practice, but like,

that's also a source of our happiness and our fulfillment in our lives. So taking that from someone, you know, it's an important take and that figures prominently on the con list. But if you're not experiencing that, great. How common is that? It's very common. Some people have digestive issues. Some people feel that they have waking with it. Some people get headaches. All that sort of regular laundry list have had as a body tolerated medication. Long-term concerns, I'm a little bit not that worried about long-term, like, is this harming you? My long-term worry is almost entirely the lion's share of that is focused on what happens if and when you decide to go off the medication. And I think that journey is something that we're not talking enough about. We're

not giving people strategies. We're not giving practitioner strategies to support their patients with it. And the result is that we don't have upfront informed consent when we're initially prescribing it because we don't say, and should you want to decide to or need to go off of this medication, here's what could happen. And then we're just not supporting people through that process and it can get really harrowing. Let's talk about that then. What happens when you go off these? For some people, nothing. For some people, no big deal. And for some people, an alleviation of whatever side effects they might have been struggling with. For others, and it's hard to predict who will go down which path and it's maybe about a little bit less than half of folks seem to report that they have

discontinuation symptoms. That can be so variable, but some people might experience irritability or increased tearfulness, maybe sleep disturbances, mood swings, mood lability or kind of just looser swinging through different mood states. And then some folks are even going to experience more like acathesia or agitation or they want to kind of jump out of their skin. Some people have dark thoughts and sort of a trigger warning on this, but I think it's so important to talk about that openly. I had a patient who went on an SSRI when he was going through a divorce. This man had never had depression, had never had a suicidal thought in his life, and then he goes on Prozac to get through a stressful time in his life. When he goes off of it, he became suicidal. So to me,

that's a perfect illustration of the fact that this was not a relapse of his prior state. His prior state was not depression. This was a withdrawal state that can have dark thoughts. And that's the thing I want people to recognize and just know is if they're going off medication, they might feel fine at first. Then there might be a bump in symptoms around two weeks out and then again around two months out. It kind of is a mirror image of when we start someone on SSRI and we say, this might take six to eight weeks to work. It seems to also take about six to eight weeks to unwork. And so, So someone might be suddenly feeling more depressed, more tearful, maybe even suicidal. But it's about two, two and a half months after they stop the medication.

So we don't know to attribute it to the withdrawal. Humans don't work well with that time frame. And so people are usually saying it's a relapse or they're saying, this is just my circumstances and they don't think to attribute it to the withdrawal. And that's a misattribution. We're saying relapse for something that's actually withdrawal. And the reason this is important is that there's things we can do. to mitigate that withdrawal. We can go much more slowly, tapering much more slowly, rather than

taking two weeks to go, you know, half the dose and then go off. Sometimes I'm taking six months to a year to get somebody off of a medication. It doesn't mean that they're stuck on this medication. Often it's more like you're not even on a therapeutic dose for those final six months of the process. We're just supporting the brain and building back receptors, building back neurotransmitters, kind of this slow growth process. We're just supporting that and we're just staving off withdrawal. The person's not even really medicated for the second half of that taper. They're just not in withdrawal. I think it's powerful just to be able to call it withdrawal because then when we're tempted to say things are as doom and gloom as they feel, we can remind ourselves or am I seeing the world through the lens of

withdrawal? Is it making things look a little darker right now? Yeah, I mean, that's the tricky thing with all of this is your brain wants to say like, no, this is how it is. This is how it will always be. This is why mental health will never be the same kind of disease as diabetes, is that anything unwell or imbalanced in the brain colors the very lens through which we see our lives. Yeah, I've struggled with that. You've gotten to be on the receiving end of text where I'm struggling with that. And you're like, no, I believe this is a false mood. And I believe you will feel very differently about this thing in a week or two weeks or a month. But it's hard to believe it at the time. It's really, really, really hard to believe it at the time. Impossible. I mean,

anybody who's ever had a period, like, has a firsthand experience with a false mood, right? It's like the day before your period, you feel like unlovable, like nobody likes you. Everyone's mad at you, and everything feels impossible and everything bothers you. And like that's a very perfect illustration of a false mood. That is a hormonally generated mood state. And it feels very real. And I think there's actually beauty in moving through these different outlooks because in a weird way, that follicular phase where we're like, everything's cool, everything's fine, nobody bothers me. That's also a false mood. It's just that that's a false positive mood. You know, that's where we are falsely okay with everything. So I think the truth is in between because the ludial phase, the kind of truth serum of those days before our

where any injustice feels enormous to us. Like, I think that that's not just false irritability and bitchiness. I think that that's that we've lost our tolerance for bullshit. So we, you know, we kind of want to just hold all of it a little lightly. Like, that's the real thing here is that we're so caught up in our stories and our narratives and maybe we want to hold all of it more lightly. But I do want to just double click on what you said, which is that what we are perceiving as this is a sign my SSRIs are working that I feel this terrible when I'm off of them is in fact

often withdrawal from those SSRIs. It's not a sign that the SSRIs were working. I have so many patients over the years who tell me like LexaPro saved my life. And what it always ends up being is that they were in some kind of crisis or stressful time in their life. Or maybe it was like they went on birth control pill. They were in a false mood. They were depressed. They went on Lexapro. Was it helpful at that phase? Shrug, kind of, I don't know. I started crying less. Yes. Okay. So we saw that narrowing of affect. And then a year goes by circumstances change. They're feeling better in their life and they're thinking like maybe I don't need this medication anymore. It'd be nice to not have to go to right aid every week and serve every month. And so then they go off of it, usually without support from a prescriber or very inadequate support from a prescriber. They go off rapidly. Two weeks go by, they think, that's cool. I didn't need that. It turns out I'm fine. Two months go by, they're thrown into a state of withdrawal. They feel really bad. They're in crisis. They realize, oh, I needed

that medication more than I realized. It was actually working. It was actually helping. This is me underneath the medication. And so then they go back on it. They feel often pretty instantly, dramatically better. Not the way SSRI's work, that six to eight week delay. This is the way nothing feels as good as scratching the itch of withdrawal with the withdrawn substance itself. That's treating withdrawal with the withdrawn substance. So that's like a sign in itself that what you are dealing with is withdrawal, not the SSRIs we're working and now they're not. That's right. And so then someone feels better and they think, thank God for that Lexapro that just saved my life. And it turns out like, this is my best friend. This has always been

helping me. I didn't even realize it. And honestly, it gets someone back to a place where they're intact and okay. So we don't, nothing here is broke. We don't need to fix that. But I do think we deserve the full true narrative there, which is that it helped alleviate its own withdrawal. It's saved you from a problem it created. It's like having a headache because you don't have caffeine and then you drink the caffeine and your headache goes away. It's just like that. And we can still decide we prefer a life with coffee. And even if it means it can create a withdrawal that it can alleviate and then we say coffee save my life and save my migrains. But I think that we just deserve the full truth. And maybe a life with the SSRI is the life we choose. Maybe the life with coffee's

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We don't know why that narrowing of affect is happening, though, because that does seem to be the common thing that people point to that's helping them. People report it's like my highs are lower, but my lows are higher. Yeah, which in mild to moderate depression is a little bit of a toss up, whether that's improvement. I'll usually see someone say, I'm crying less often. And then in severe depression, that is a pretty meaningful improvement for most folks. The lows are so low. And so all-consuming. You can decide whether or not to include where I'm about to go with this.

but it creates an interesting counterpoint to psychedelics. Can we go there? Oh, I was going to ask you about psychedelics. Fabulous. So, like, the fact that part of the way SSRIs that we perceive them and experience them as working is that they do blunt affect, so we're crying a little bit less often. That can look like health. But one thing that's been interesting as I support patients through, like, whether they decide to work with ketamine or psilocybin and take a psychedelic path through alleviating their depression, part of how those medications, medications, work is actually through eliciting crying. And it's almost like you have this big therapeutic,

cathartic purge and a very big cry and you feel better afterward. And I think that's such an interesting counterpoint is like to tamp down the crying is what we're calling health, but actually is perhaps eliciting a very big, emotionally cathartic cry resolving something in a more meaningful way. I don't know. It's something I'm just watching, contemplating, but the psychedelics and how they're treating depression, it seems to be when it works and when it's appropriate and indicated, it seems to be more of a fundamental resolution than the way the SSRIs are kind of helping someone maintain a state of euthymia or sort of lifting them up their threshold from not being in a depressed range. It reminds me of something that all the grief books that I've read and people keep saying to me on

my grief journey is like cry. Like don't hold in the tears. The tears are part of the thing that's going to get you to the other side of this. This is it is I think we're due for a cultural rebranding around crying. Because right now when we cry, we think that's the problem. The first thing we do when we start to cry is we apologize. We say, I'm sorry. And then we try to squeeze it back in and make it as brief and small as possible because we think he who crieth the least, like is the strongest person. And so we don't want to be a burden. We don't want to make people uncomfortable. We don't want to mess up our makeup, whatever it is. So we tamp it down. And then we feel good about that stoicism. And it's like we're literally pathologizing crying. Whereas I think we got it wrong. And I think

crying was actually always the medicine. This is the wisdom of our body, giving us a much needed opportunity to have a release to move through our emotions and our feelings. To arrive at an endpoint that's alleviated compared to where we started. Interestingly, a component of our stress response. called acethe or adrenocortocotropic hormone comes out in our tears but only our emotional tears not if we're chopping an onion and crying comes out in our emotional tears it's almost effectively cutting the stress response off at the root so i think that this is a big part of what we're grappling with with our that general low grade on wee low vitality is that we have so much unmetabolized stress so much unmetabolized grief we're not feeling our feelings because we live in an emotionphobic culture

that tells us pinch in your tears the way you'd pinch in a sneeze. And so it's all stuck in us and it's weighing us down and it's not coming to resolution. And I think this is where the role that we have as being the person like supporting someone who's struggling, we have so much that we can do in terms of allowing the person who needs a good cry to really have it. Using our body language, using our facial expression, using those little like humming sounds are like, mm, like it's not even verbal. It's just, it's a nonverbal yes to say like, Like stay right here with where you are. And then I will at this point, I'm so interested in getting my patients, my friends, people

and my family to like push it to 11, like not just accept a middling cry. I want them to have a full process. I've come to appreciate that crying has a false peak to it. Like you can cry for a little bit. You get to a point where you're like, okay, I'm done. And then you can catch your breath and you can start talking again. And like actually, if you're lucky, you just catch a quick breath there and you dive back in. Because if you can dive back in at that point, you go very deep into the cry. And that's where you get into this like grimace that's stuck and you're like accessing that fine line between what feels tragic and what feels transcendent and like the most exquisite poignancy of the human experience. We get to it there in that like deep 11 moment of crying and none of us get there ever. And that's I think part of why psychedelics are such potent medicine is that they get you there.

They permission it, they disinhibit it, they get us to that point. I think we get to a lot more resolution of our trapped emotions after that. Crying softens us. It's not the pathology. It's the medicine. You keep mentioning this grief. Do you mean a societal grief? Do you mean individual grief that we're not allowed to express?

What do you mean by that? I think it's an interesting question. I haven't thought as much about societal grief, though I do think we carry collective grief. Like the pandemic, we still have a lot of them, metabolized grief, a lot of unmetabolized resentments. We just have so much that's like, we're like a family system that's dysfunctional. Like, let's not talk about that, but I think that I'm really talking about individual grief. And grief can certainly be you've lost a loved one, you've lost a pet, you know, it can be all of this, but it also can be other losses. And it can even be things that wouldn't be

typically thought of as losses, but their changes and their transitions. So a divorce, a pregnancy loss, These are big losses that we need to mourn properly, but also a job change or even like having a child and the transition change, the role transition that comes with that. So all of these have mourning to them. And we're just culturally not in the habit and we don't have the skills for how to properly be with that, nor do we have the time and space in our lives to properly be with it because it's inconvenient and nonlinear and who among us has that time. I remember the summer after I lost my mom, and I was pregnant, and I kind of got my dream job, and I was going to take on a project with, like, a hero of mine. And I would sit down to try to work on this project, and then a tsunami of grief would hit me, and I would just find myself on my living room floor, like, writhing and rolling around,

and, like, just pregnant and grieving and crying and pushing it to 11. And I had to email him and be like, I don't think I can. And that was even a privilege to be able to not have that income that summer and to be able to be like, I'm not going to maximize income, career, ambition. I'm not going to maximize anything right now. I'm just going to make space to grieve. And we don't all have that privilege. We don't all have that opportunity. And so I think that there's all these societal factors that are also preventing us from properly moving through our grief.

If somebody's listening and they recognize themselves in that list you gave of things that could be. reasons we're grieving. Can you give them maybe one thing that might help or one little action step they could take to begin to process that? Is it putting on a sad movie and trying to turn the crying up to 11? What should we be doing with that? I think you try a bunch of different things. So Pixar or sad music and having a good big cry and you'll know for yourself if that helped or not. Like you might feel afterward like I feel a little lighter or that might have left you feeling worse. I know that there was a point when I used to go see a therapist in med school where I was like, this is helping me. And then there was a point where I was like, this is hurting. This was digging a

groove deeper. And I was like, I'm not sure I need to keep going in every week to like dig that groove deeper. And so you'll sort of know for yourself which you need. I think that if it feels at all resonant or if you have space for this kind of outlook to open up a dialogue with the person, with whatever you've lost. And for most of us, we bristle and we're like, that feels goofy, that feels weird, it feels awkward, it feels diluted, you know, and if it's not for you, that's completely okay. For me, like sitting on my bed with my hands on my, at that time, like pregnant belly and basically asking my mom to come to me in my dreams, to come to me in my dreams, to come talk to me, to dialogue with me, that was immensely helpful. And, and, you know, and,

And I didn't know that that was something I had access to until I tried. And now it's like a constant, ever-present dialogue in my life, ever-present relationship. And if for anybody who has a strained or complicated relationship with somebody that they've lost, it's my husband who put this best, he's like, I think once they've passed over, like, it's a more fully actualized version of them. All that same baggage and blockages and tensions that we used to have with them, like that falls away. So it's just like this pure cosmic connection that we have with them. So it's not for everyone and there's nothing to force here. But if you feel like you might just be open to giving it a try, having a dialogue,

sitting down and just trying to talk with them, journaling to them, asking for a sign, reading Laura Lynn Jackson's book signs, like any of these I think can bring a lot of comfort. And if it doesn't work for you, that's okay too. And there is no wrong way to grieve. And it's just hard. we should not berate ourselves if we're stuck for a really long time in grief. It's really hard.

Yeah, it's interesting. I was listening to Arthur C. Brooks on a podcast. He's from Harvard. And he talked about how spirituality he believes is one of the four key components of happiness. And it's one of the ones that many, many, many of us are missing. And that does not need to be organized religion. It can be a sense of awe at nature. It can be coming together and singing.

It can be all these things. but that is this core, core, core component of happiness from all of the research that he's done at Harvard. Yes. And Lisa Miller at Columbia has also researched this in a beautiful way, especially around the topic of depression, that basically having any spiritual worldview or practice and, like, agnostic about, like, how spiritual is that spiritual worldview. It could just be like, I like going and sitting among the trees. And it can be anything. My dad. My dad says the high sierras is like that, that's his spiritual commune in place. I mean, that's. And he loves it.

yeah, that's highly sacred. And so basically it's anything where you have a brush with transcendence. You know, that could be singing in a church choir. It could be going to a church or it could be looking at art at a museum. It could be playing with a puppy or a baby. It could be listening to music. It can be time in nature. It can be surfing. It's so many things, a brush with transcendence, but it's protective against depression. And I think that it's not to say we want to force a spiritual outlook on anyone. It's more that we deserve to know it's protective against depression. I know when I was depressed. I thought that I was like smarter and more like I was sort of this like misanthropic, skeptical, angry thing. And I was like, I saw someone with their spirituality that was protective

against depression. I like resented it so much as to judge it. And now I'm like, no, it's actually really helpful. But I think that at the time I could only feel negativity toward it. And now I realize that it doesn't have to look one way, and it's not necessarily a form of delusion. It can really be as simple as giving ourselves permission to ask the questions, wherever we're going to land on that. If we're asking the questions and grappling with those questions, like looking up from our myopic tendency to just be like taxes, mortgage, like day-to-day, mundane material things, and be like, oh, shit, the cosmos.

Just being with those questions is itself, I think, a spiritual practice. And so I think Rilkeh said, like, live the questions, and that's protective. If somebody's listening and they're trying to decide whether or not they should experiment with SSRIs, what questions would you have them ask themselves? I guess that probably will end up segueing us into talking through the physical underpinnings of depression because I think of medication as this useful tool when you're not in a position to address. the fundamental root cause. It can be this outstretched arm that reaches and pulls you out of a very dark hole and says like, hey, like let's create a bridge and get you to solid ground so that

we can begin the investigative process of what is the root cause of your depression. What kind of trauma-focused therapy do we need to do? What kind of psychosperiritual needs do we need to help set your life up to help get that started to be supported. It can be this bridge to help you get to the place where we do identify the root cause and address the root cause. And so usually if someone's in a position to spend some time on diet lifestyle, psychospercial health, I'm always going to want to do that first. And if they're not in a position, then whatever it takes to get them to solid ground. Is that true even in acutely difficult situations like the loss of somebody or postpartum? Well, those can be examples where they're not in a position to do the diet and lifestyle first, right? And so it depends on what degree is this crisis. And increasingly we kind of know, even though we used to say, well, like, antidepressants, it takes 60 weeks to work. If someone has a strong narrative about this is their path to dry land, that expectation is powerful. That expectation is powerful. And witnessing ourselves doing something to support ourselves is powerful. Getting over a stigma that we might have had for ourselves about the choice to take medication is powerful. So like, sometimes,

that's a very therapeutic self-loving choice to do in those moments. We now have things like research on ketamine, like S-Ketamine combined with S-NRIs seems to be maybe a more effective, more neuroplastic-inducing change. And so there's different ways I would approach it with somebody. But I think that postpartum is an interesting example in that there are times when someone's unsafe, their child might be unsafe, this might be such a crisis and they might have no support and there might be no way to have a platform to do diet and lifestyle. But if there is any platform, postpartum, I think, is a great example of how we're getting it wrong. And to me, postpartum depression, in addition to the role transition, in addition to the sleep deprivation, in addition to the

massive hormonal swings happening, there's so much going on to. There's all these challenges. There's all this, you know, lack of support on a societal level and a household level and all these different levels. In addition to all of that, I think we are so damn depleted in the postpartum phase. And again, if we go back to the initial premise, mental health is largely physical health. And good mental health is a reflection of healthy brain function. I think a postpartum brain is really sucked dry of its nutrients. And the name of the game is repletion. And I think some cultures, especially Eastern cultures, have more of a tradition around the mom needs to rest, recover, and she focuses on baby, and then the community focuses on nourishing her.

And we live in such a tension where it's like for you to have nourishing stews and broths and food that repletes your nutrient stores would require you standing in the kitchen for hours cooking. So it's like these don't square because you do not have the time to do that in the postpartum days. So it's like you would deplete yourself even more than you'd replete yourself if you were the one having to prepare all that food. So we just are not culturally set up to replete the postpartum. and brain. But that's my hope is that we start to appreciate by definition. This is somebody who

needs really nourishing food because she just gave all her best nutrients to building a baby, birthing a baby, the blood loss that happens in labor, and then breast milk is itself giving all of our best nutrients. So it's so much depletion and we just need to replete, replete, replete. I think a lot of postpartum depression is a brain screaming, I don't have enough. Okay, so knowing that most people don't have access to this village. Can you give us maybe two or three things we should prioritize postpartum if we don't want to be in that depleted state? I think good quality bone broth is helpful. I think having someone throw some marrow bones in the oven and putting some olive oil, salt, and pepper on it and like just eating bone marrow if you eat animal products. Because it is so nutrient

dense and so fatty and that is a big part of what we're trying to replete. We're repleting B vitamins. we're repleting cholesterol and neural cell membranes. We're repleting DHA, so like a good quality fish oil or eating good wild fish, leaning into healthy fats and protein, but also like not being low carb either, but like starchy tubers, not just reaching for that quick hit of refined carbohydrates because that's usually going to put on us on a blood sugar roller coaster. So these really sustaining foods. And healthy fats means more than avocado and olive oil, right?

It's like healthy fats is I think anything that has always existed, like that humans have always eaten. Are there any supplements that you would recommend for somebody who is coming up on this postpartum period and they're worried about their mental health? I think supplements is always actually kind of a complicated conversation because it is of course so much easier to just take a pill than to eat a nutrient-dense diet. But I think that while it can be helpful in these temporary therapeutic intervention windows to take a good quality multivitamin with methylated B vitamins to take a good fish oil, I think that that's helpful. I don't want it to be an opportunity cost where someone says, I'm doing this, and therefore, I don't have to focus on nutrient-dense foods.

I think that for whatever reason, our bodies always do better with it coming from food. And it's more bioavailable. It's the real thing. I think it repletes us more effectively. But I think it is a phase where it's hard to do the nutritional scavenger hunt effectively at any phase of life, but especially the postpartum phase. So a good quality multivitamin, like continuing your prenatal can be good. And magnesium glycinate is when I'm usually putting most of my patients on,

even though I'm leaning on supplements less. Our food is deficient in minerals because our soil has been depleted of its minerals. So it's hard to get enough magnesium from food. So most of my patients I'm having on magnesium glycinate, or like regular Epsom salt baths. Postpartum or just in general? Always. Okay.

What do you find is the difference between a patient before they take the magnesium glycinate and after? Well, magnesium is involved in about 600 biochemical reactions on the body. So it's helping with better, deeper sleep. It's helping with anxiety. It's helping with migraines and other headaches, menstrual cramps, muscle tension, back pain, digestion, cardiovascular health. It really can help across the board.

The postpartum conversation is interesting because it points to one of the things that I see people talking about the most when it comes to SSRIs generally, which is, yes, if you can do all of these things, it's great. We live in a society that does not allow for us to do all of these things, and then we shame people for taking the medicines that help them. Yeah. The shame conversation, I recognize whenever I am opening up an alternative reflection on medications for states like depression, what that comes across as is shaming and stigma of medication. And that's actually not at all where I stand. I feel like who should have shame for trying to get relief from depression? When I was depressed, I would have taken anything to not feel

the way I was feeling. It's never about like, I have a lot of patients who think, I shouldn't because it would be pressing the easy button. We think it's morally weak to press an easy button. If you're depressed and you're unable to care for your infant and you could press an easy button and feel better, like, do that. I'm never thinking like it's a morally weak choice or it's something we should stigmatize. My concern is much more about does it really work and does it create problems? If it really worked and didn't create problems, let's put it in the water. It doesn't work for everyone and it can create problems and that's why we need informed consent and we need really judicious choices around it, not because there should be stigma, but because we just want to

look at this in all of its truth and complexity and considerations. I also think it can delay someone from getting the actual root cause resolution to their depression. And sometimes it even can be a little bit like putting a sticker over the check engine light. Like if it does narrow the range of affect and your affect was communicating, like your tearfulness, your sadness was communicating, here's an unmet need, here's misalignment, here's a physiologic imbalance. That affect was helping us look at where was there imbalance. And if we mute that, sometimes we are then not driven to actually address it at the root.

And so it can just delay that for some folks. So what do you think from a lifestyle perspective are typically the root causes of depression? So let's talk about the physical root causes. And I think to me that is, if I'm like here to do anything in the conversation about mental health, it is almost exclusively this. It's to help elicit in people, the aha moment that. there might be a physical basis to your mental health issues. And so much of our depression and our anxiety and our panic, this is actually caused by physical imbalance.

It's avoidable. It's unnecessary suffering. We want to identify the physical imbalance and address it at that level and eliminate this unnecessary suffering. It doesn't have to be more complicated than that. Think about anxiety as something has generated a stress response in the body. It can be a blood sugar crash. It can be a hangover. It can be an extra cold brew coffee. It can be sleep deprivation. It's all these things. It's generated stress, which we subjectively experience as anxiety or even panic. It can be mouth breathing. That's like your whole book, the anatomy of anxiety. You go into that. Yes, deeply. It dives deep into all of these false moods and how we can mitigate them that are causing our anxiety. I found it immensely helpful. I share the blood sugar thing like 50 times a day. So everybody should definitely go check that out. Thanks, Liz. Depression is different. Depression's a little bit different. And I haven't written a book about this one. But I don't. did have this one in a way that I actually haven't grappled with anxiety, but I was at a state of

false depression through college and much of med school. I've had that most important credential, which is the first-hand experience of I'm suffering and how do I get out of this. I think with depression at the root is not a stress response. It's actually a lack of proper energy functioning. It's something at the level of brain cells to function properly and to have good vitality and good energy. They need healthy mitochondrial function. They need a good fuel source. They need good blood flow. They need to be rested. When our brain does not have all of that tucked and in place, it can show up as a total lack of vitality. Importantly also, contributors to why it might not have those things are it needs thyroid hormone in appropriate ways. It needs to not be bombarded with inflammatory cytokines.

So a lot of the ways that we are in a state of physical depression, it can have to do with chronic sleep deprivation, which itself can have to do with sleep apnea or mouth breathing or lifestyle habits, which aren't really us being irresponsible. It's us being humans who are being exposed to artificial light after sunset suppressing our melatonin, so we don't even get sleepy. Or us being humans and we're susceptible to being addicted to endless scroll. So we stay up later than we otherwise would. There's also inflammation. And this one's really interesting in that what we just looked at that whole serotonin hypothesis of depression, which is also called the monoamine hypothesis of depression that is not as robustly supported by the evidence as we've been led to

believe. A competing hypothesis that actually has much more robust evidence to support it is called the cytokine or inflammatory hypothesis of depression. And this one effectively says, our depression correlates with the degree to which we have inflammatory molecules circulating in our bloodstream. And we are so chronically inflamed in modern life. And what's so interesting is that the appropriate response to inflammation is called the sick response. You drank the wrong pond water. You got a microbe and now you're acutely inflamed. So you'd want to retreat. You'd want to isolate from the tribe because you might be contagious. You'd want to rest in your dark cave because the immune system works best when we're at rest, when we're in the dark. And you'd basically want appetite changes.

You'd want malaise. You'd want fatigue. You'd want all of these things that. help us heal from an infection. It just happens to look an awful lot like what we call depression. And a lot of us, I'm convinced, are in a state of chronic low-grade depression because we're in a state of chronic low-grade inflammation. And that's because of our modern environment. It is so pro-inflammatory. And that harkens back to our inflammatory exposures from our ultra-processed foods, even to the fact that we decimate our gut flora with courses of antibiotics and the fact that we're not exposed to dirt, and fermented foods and all the microbes from just a less hygienic life, our immune system misses out on that tolerance training that it can develop when we have a diverse ecosystem of bacteria, fungi,

parasites in the gut. And so we are so chronically inflamed, it's contributing to our depression. And we can do something about this. We can eliminate some of the sources of inflammation. we can add in things that soothe inflammation, ginger and onion and garlic and healing the gut. So prebiotics and probiotics, fermented foods and starchy tubers, ghee is helpful, collagen and bone broth are helpful, glutamine is a helpful supplement. But healing the gut lining, colonizing the gut with a diverse ecosystem, and just making sure we're not continuing to provoke the immune system, all of that can help lessen inflammation and improve depression.

Nutrition's a big one. It's like such an unfun topic these days. I've gotten the criticism of my book of like, it's giving diet culture. And I don't know. I think that this is such a delicate balance of we are overwhelmed with the mixed messages and the tribal warfare around how to eat and what's the right or wrong way to eat. And I understand. And yet, I will not stop beating the drum of the fact that sometimes what we think of as heavy duty refractory mental health issues is just vitamin B12 deficiency. And a brain that's deficient in vitamin B12 or foli. or iron or magnesium, all of this can contribute to depression.

And it's sometimes that simple. And somebody can go years, decades, really not thriving, not feeling their best. And it's because they're chronically anemic or chronically deficient in a particular micronutrient. So if somebody's trying to figure out the root cause of their depression, you just named a lot of different things. Yeah. And that can feel really overwhelming. Where should they start? It depends on their capabilities.

capacity and in a way, like, you can start by trying to eat more nutritious food and prioritize better sleep. Like, you don't have to choose one or the other. Often for most of us in modern lives, these are all playing some role. But I think that usually working with a naturopath or a functional medicine internist can be a good place to start where they can evaluate your idiosyncratic imbalances. But that's not always, I mean, sometimes that's prohibitively expensive. I always think, like, the books written by naturopaz and functional medicine docs, these are usually their life's work poured into 250 pages that you can get for $12 or for free at your library, you know. And so if you don't have the ability to see a practitioner in this way, I mean, there's also group models. There are different

ways that people are making the treatments and the information accessible, but they've usually given so much of their life force into making this explained clearly and well in a book. That's a great place to start. And then it's really just, are you somebody who's self-motivated enough to hold yourself accountable to put some of these things into practice? Because there is an initial activation energy required. Once you're in a maintenance mode rhythm with diet and lifestyle strategies to support your mental health, it feels good. But at the beginning, there's so much activation energy. You're just aware of all the ways that you're being asked to change. And that can be overwhelming, especially if you're depressed. So you'd read a book like that as a buffet, not a tasting menu. You

basically think to yourself, okay, they've just laid out a spread of different things to try to alleviate my depression. And I'm not going to try all of these things. I'm going to think for myself, what's the one thing or two things that feels most accessible, resonant? We kind of know inside them, maybe that is me that speaks to something in me. And you just start there and put no pressure on yourself to do the rest. You start in one place because that will buy you incremental progress and then you have a little more capacity, a little more energy, a little more motivation to do the next thing. And people can treat this podcast as the same thing. Like you're going to get a lot of strategies, you're going to get a lot of tools, but you don't need to do everything. You can just try a few

different things. And for you, the important thing is that people have the unlock that there can be physical things at the root of this mental health thing that they're dealing with. That's exactly right. And usually you'll have some symptoms. pointing a little bit of an arrow toward where might you be out of balance. If you have a thyroid condition, that's where you would want to start. And in depressed patients, something like 20% of people with depression, some kind of undiagnosed or subclinical thyroid condition. And thyroid conditions are very common. There's a whole spicy conversation we could have about why that is, but there's a lot about our modern environment that is very uniquely targeting

thyroid tissue. And so then we are having underperforming thyroid, which is a guarantee, guaranteed pathway to mood changes. And in the textbook, they would say, hypothyroid creates depression, hyperthyroid creates anxiety. In my clinical experience, either creates either. And but what you see most commonly is Hashimoto's thyroiditis or hypothyroidism, underperforming thyroid. And it almost seems to me like someone toggles between states of depression and anxiety, but many people are not textbook in how they show up symptomatically. So if you suspect that, the first thing would be to try to address your thyroid things as much as possible. I think that's tricky too. Are there other little signs that it might be like,

oh, there's inflammation at play here, oh, there's microbiome at play here. Yeah. And with thyroid, it feels important to point out that if you go to see a conventional dock and you want to get your thyroid checked because you're like, I'm cold, I'm constipated, my hair's falling out, my skin is dry, I can't lose weight and I'm depressed. That's like textbook. It's like, you might be hypothyroid and they'll be like, okay, sure, fine. And then they will tech your TSA and your T4 and they'll say, you're fine, bye. It's all in your head. You kind of want to push for what I was think of as like this Picasso cubist look at the thyroid. That's a snapshot and it doesn't tell us a lot. It tells us either your thyroid is perfectly healthy or your thyroid is doing a darn good, effortful job

of compensating for the fact that it's being attacked. When you look at T3, reverse T3 and the antibodies that attack the thyroid, thyroid proxidase and thiroglobulin antibodies, then you get a richer picture of what's happening with your thyroid. And I've seen many times over the years, someone whose thyroid is functioning well, but they have very high levels of antibodies. So what we realize in those moments is that we caught it early, that there is an autoimmune attack on their thyroid tissue. But the thyroid tissue is still functioning well, but it will not always be so. So that's a beautiful moment to intervene and say, why is the immune system inappropriately attacking the thyroid? And sometimes it has to do with shoring up a leaky gut lining, recalibrating the immune system, decreasing overall burden of

inflammation, a little bit of detoxification, which is like this controversial term. People are like, you have a liver, you have kidneys. But yeah, and yet we are very burdened by environmental toxins. It's like, it's insane that we can think that the liver and kidney that we evolved with that had the level of exposure it did like 500 years ago is prepared to detox us from like when plastic didn't exist and now we're eating plastic every single day. And it's like, oh yeah, your liver and kidney is just like tuned up to that real quick. It's fine. Like evolution does not work that quickly. Maybe in, you know, another few thousand years our livers and kidneys will be like super sized and we'll be able to detox from our crazy environments. But it's not going to happen that quickly. That probably is what we're evolving

towards is larger organs of detoxification. For now, yes, it's the microplastics themselves. and the endocrine disruptors in our environment and heavy metals and even for some people, gluten intolerance and molecular mimicry, like all of this can be directed at the thyroid. For some people, fluoride exposure, like I have one patient who it was a fluoride intolerance, she was like allergic to fluoride and then created Hashimoto. So really autoimmune is really the immune system responding to damage. And for whatever reason, thyroid tissue is vulnerable to deposition and damage and then the immune system sees it and thinks, uh-oh, like there's inflammation, there's injury here and we need

to address it. And so anything that's creating damage in the thyroid. So we do want to support detoxification. And then that can look like sauna. It can look like dry skin brushing. It can look like jumping on a trampoline. It can look like eating bitter herbs and bitter greens. You know, there's so many different ways to support this, but you'd want to do something. And cultures, traditional cultures often had a fasting practice, a sauna practice, a sweat lot. Like there's different ways that traditional culture is already kind of new. Like once in a while, we need to give the body a rest and support a release in a catharsis. Somebody listening to this just to kind of bring it all home.

If they feel like they might have mental health issues, would you say get your thyroid looked at? Would you say everybody should be getting their thyroid looked at and trying to ask for even more testing than might be conventionally ordered? A great set of labs to get if you want to start to investigate the physical basis for mental health issues would be that Picasso look at the thyroid. You'd want to look at vitamin B12 and folate. It's helpful to look at what's called a complete blood count or a CBC where you're looking at your iron levels. And then sometimes a red blood cell magnesium level, it's a little bit more niche.

CRP, or what's called C reactive protein. That's for inflammation, right? That's for inflammation. Sometimes looking at homocysteine for inflammation. And then everything related to insulin resistance. So you'd want to know your fasting insulin. You'd want to know your hemoglobin A1C. You'd want to know blood sugar because then you're getting a picture of.

of this is something we certainly come by, honestly. Our modern food landscape is refined carbohydrates and coffee drinks that are secretly milkshakes and rosé all day and we are just on a blood sugar roller coaster. It's so much more than our sweet little bodies can handle. And so we are so many of us epidemically in a state of insulin resistance. And that just fatigues the insulin receptors

on every cell of our body, but certainly our brain cells. And then our brain cells are trying to help us. They're trying to function well. They just can't appropriately get the fuel that they need and they poop out. And so then that can look like depression, that can look like dementia, that can look like ADHD, it can look like a brain not functioning optimally. Yes, it's helpful to test that. But even before you have those results back, it's probably helpful to see what you can do

to support insulin sensitivity in your body, which generally looks like less of the added sugars or refined carbohydrates. Easier said than done, I know. But the good news is more protein, more healthy fats, which is the broad. broader list than just avocado and olive oil. This is actually a juicy, nourishing, delicious way to eat. It's just not what we're told is healthy. And then it also looks like activating the muscles in the legs. So whether that means you stand up and do a few squats or you take a 10-minute walk after dinner, but basically any opportunity you have when you're typically sedentary,

typically well-fed, and your body is just in a state of insulin resistance, if in those moments, you can move the muscles in your legs, then those large muscles will put up their insulin receptors and it shifts the whole milieu and the body toward insulin sensitivity. What are three specific things that you think help the most with your own depression? This is not widely generalizable. For me, I had to get off birth control. I had to go gluten-free. I needed community. Birth control was the lion's share of that problem. And this, I'll sort of tell it through the lens of a patient of mine. I had a patient that I treated years ago. She came to see me. She had already been highly therapists, highly medicated for years and years. It tried every cocktail,

every regiment. And I knew that her mental health history had started when she was about 16. She had started birth control pill when she was 16. And then she had become depressed and started antidepressants when she was 16. She never thought to attribute it to the pill. But even if she had, I know, like me, she would have walked into her prescribing practitioner's office. be like, I think I'm crying every day since starting this. Like I literally said those words to my GP and they were like, you seem stressed, sweetie. And so, you know, I bought that. I didn't know I was being gaslit. I was like, that's true. Okay. You know, and so I went back and stayed depressed on the pill for many years. But it's a teaching moment for me now. I never overlook the potential role for exogenous

hormones. And so off the pill, she wasn't depressed anymore. We didn't need all of this other apparatus that was scaffolding her mental health. It really just all hinged on this. This was a effect. It's not true for everyone. I'm not in the business of denying the benefits of contraception. Like, this is liberatory. This is really critical. But we just, we want to have the full conversation about the whole menu, the relative pros and cons of all the different options. And if you suspect that it's affecting your mood, then like, let's just reconsider it as maybe that's not the right formulation for you. That's, to me, a very sobering tale. What I've gone through in my own life, I need to get off birth control in order to be happy.

gluten that's unique to me. I'm the daughter of a celiac. I was chronically inflamed with all these other symptoms of inflammation. Sistic acne, Ibs, I couldn't poop to save my life, polysistic ovary syndrome, ocular migraines. My body was screaming that something was not right. And none of that really corrected until I got off of gluten. And then community. Like I really actually changed my mental health when I finally found the right friends and finally had a life rich with community. That's the one that's harder. That's not actionable. You know, I can say like, get off of seed oils, but to be like, find your people is really hard to do. So that's something where we have to listen for the little microsigns along our path. We have to be able to take that sacred pause and discern.

These people fill my cup. This interaction was life affirming. This one, not so much. And just to keep nudging our path toward the life affirming. And I think sometimes making very proactive choices to orient our lives around community. Like at this point, my life is entirely designed around community. And that comes with sacrifices that to me are more than worth it. I think that's something that people don't talk about is I was talking to somebody recently at this conference that I was at and they had made the choice to live in a city that was maybe not their ideal city in a type of house that was not their ideal house, but they live next door to two of their best friends. So three families had chosen to live side by side in these houses.

And they were like, it was a sacrifice and it was 100% worth it. And I think sometimes we're trying to live in our ideal place, live in our ideal house, and get this community. And we need to prioritize. Yes. And those sacrifices are not even hard to make. And we should be so lucky to be in a position to make those sacrifices. Like if you found the people that fill your cup and make your life work, any amount of sacrifice you can do to design

your life around spending more time with those people, you will never regret. And it just ends up being that life is better. And that's what we know about human health and happiness is that our happiness comes down to the quality of our relationship, full stop. And modern life is increasingly setting us up for more isolation and disconnection. And so it requires very proactive counter mainstream choices to design our lives around building community in. And that's so much more than worth it. And I just want to touch on the birth control thing for a second because I do think it's such a tricky topic. And we have like the rise of the trad wife movement, which everybody knows I'm not very four. And I'm very, I'm a strong, strong feminist. I have strong beliefs in women having power.

And so when people say like, oh, here's some problems with birth control, people say, well, this was the biggest bit of power that women have been given historically was the ability to control their own reproductive health. And I just believe so strongly that one, If we don't talk about it, we don't get anything better, which is denying our own power. Like, it's like, do we not deserve something of a better option here that doesn't cause these problems? And it just like, it both can be true. You can recognize the incredible world changing positive effects of birth control. And you can say this has caused some real problems.

And to not be able to hold both of those things, I think is the core problem. Any time we're up against like the what aboutism of like, but what about, but what about? Yeah. The trouble. It's like that is just to me a clear indication that we are dealing with a both and situation. And it's like this was a central stepping stone towards our liberation. Like to not be just at the mercy of unwanted pregnancies. No one's looking to undo that progress. When I went in and said, I think I'm symptomatic from the birth control. The first time I was gaslit turned away. When I went back with more conviction later, I said, I think I want an IUD. My gynaecologist at the time said, okay, let's go. give you the marina, the progesterone eluding IUD. And I said, no, like, I think I'm symptomatic from taking exogenous hormones. I want the copper IUD. And she wouldn't give it to me, because back then it was associated with, I think, some degree of inflammation that was considered high risk for someone who had not yet had children. And that was the thinking at the time. So I really

had to push, push, push. I eventually got the copper IUD. But that's where I think we're going wrong with this conversation is that there's a menu of options that includes very, very, formulations of exogenous hormones, which can be combinations of estrogen and progesterone or progesterone alone. There are multiple different types of IUDs. There's gondoms. There's fertility awareness method. We need the full conversation. And to say it can only be this one thing, just does us a disservice because it's patronizing. It's basically saying you can't handle these different pro-con conversations. And then also for me, I didn't want an unwanted pregnancy, but it wasn't amazing to be depressed with low libido for more than a decade either.

And so I really wish that I had had the full menu of options up front. Fertility Awareness Method deserves some conversation. And I think that it's, of course, it's not for all situations or all people. It's really only as good as you are meticulous in the execution of it. And it's only as good as your cycle is regular. So there's times where it really can't be perfectly effective. But if you have regular cycles, if you're in a situation where you can be pretty meticulous about it and you understand it, maybe you get supported or coached by a practitioner, so you're really doing it

properly. It's a great method that has this side benefit that it attunes you to your cycle. As a holistic psychiatrist, how do you approach PMDD? If someone wants to take the medication route, it's helpful to recognize that they probably only need to be taking the medication in the ludial phase, not all month long, not continuously. But I usually approach it holistically. And I think that... What do you mean medication? Do you mean birth control? Great question. SSRIs are typically the standard of care for PMDD, and so someone might take an SSRI like Prozac in their ludial phase, those last two weeks of their cycle. Even though it takes six to eight weeks to

ramp. That's what weird is that in PMDD, it's a different mechanism. Okay. Yeah. So it's interesting, right? And that's where we're like, we don't know what's going on here. Exactly. And the neuroplastic weird downstream effects of SSRIs, maybe are even modulating the HPA axis, maybe or even modulating inflammation, maybe they're modulating prostaglandins, which is a big part of like some of the issues with PMDD. So it's something we do not understand but does work. Okay. So taking it like for a week essentially. Yeah, a week or two.

Wow. That said, it usually doesn't come to that in my practice because there's all this other support to do for PMDD. The number one rule of habits is to make the things that you want easier and the things that you don't want harder. Yet so many of us want to eat healthier, but so few of us actually take the steps to make eating healthier easier. That's where Marley Spoon comes in.

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gaslight women and deny that exogenous hormones was affecting their mood, it's sort of now, in retrospect, like, duh. Anyone who's had a period and cried the day before their period, we know that hormones affect our mood. So exogenous hormones can be contributing to depression, but so can hormonal imbalance, which is a huge amorphics topic with a lot of different contributors. But overall, what's true for most of us is that if the ratio of estrogen to progesterone is supposed to be approximately here, and of course that changes every day, every minute, but if it's supposed to be approximately here, in modern life, we are being exposed to a lot of what's called xenoestrogens or environmental toxicans that mimic ester.

in the body. Everything from BPA and plastics to endocrine disruptors in perfumes and personal care products and makeup to pesticides to even like air pollution. And so so much of our environment is mimicking estrogen in our body. That's influencing our estrogen levels. All of our blue light exposure after sunset is suppressing our melatonin, which is also modulating our hormones. So we have kind of an excessively high estrogen. We'll put aside like if we're not having regular bowel movements, we're also not getting rid of the metabolites of estrogen. But then our progesterone is also a little falsely lowered because it requires a really good nutrition, often cholesterol, which we've kind of vilified in our diets. So we're ordering egg white omelets.

We're avoiding saturated fat. We're doing all these nutritional things that we think are to be healthy, but we're actually not giving ourselves the building blocks to make enough progesterone. And then we're chronically stressed. We're not acutely once in a rare while stressed. We are chronically all the time every day stressed. And I'm open to this not being the most current science, I don't know what they're saying today. I know what we said when I was in med school, which is that there's something called Pregnitalone steel, which basically means the precursor pregnant alone that we use to make progesterone is also the precursor that we use to make our stress hormone cortisol. So the body is triaging. It has a certain finite amount of pregnant alone.

And it says, I'd like to use it to make some progesterone today. And the body says, like, not now. We're stressed. We have to use this to make cortisol. And then if we are chronically having to siphon our pregnant alone to making cortisol. We're not making enough progesterone. So it's like if the ratio should be here, our estrogen levels are falsely heightened. Our progesterone levels are falsely lowered. The ratio is off. And I think this is contributing to why our PMS, our sort of symptoms before our period, are exaggerated. And I think we need to do a lot of work around recognizing the truth serum of the lidial phase. So if we're suicidal, if we're having dark thoughts, if we are really severely depressed or anxious in those days, to me,

that's an indication that we're in a state of hormonal imbalance. There's a lot that we can do to support that. So we want to help normalize our hormone levels by dealing with all those environmental exposures and by supporting our nutrition and, of course, stress management, which is easier said than done, but not worth giving up on. So is that your sort of three-pronged approaches? One, we would try to mitigate our external exposures to hormone disruptors, essentially. Yeah. To add in nutrients and three mitigate stress. Yep, exactly.

And that process of decreasing our environmental exposures, like usually we want to approach that not white knuckling and driving ourselves crazy. But, and you've covered this kind of thing, like slowly over time swapping out. Yeah. So when you run out of that perfineer, like that foundation, you swap in a slightly more natural version and you're just gradually over time decreasing your burden without driving yourself crazy or bankrupting yourself. Of the external exposures we have, which things are causing the most damage to our hormones? Would you say it's fragrance? Would you say it's home care products? We wanted to

make the biggest difference quickly because we are having PMDD and we feel miserable for a week a month. What should we start with? You start with the one that you can change right now. If swapping out all of your cleaning products and personal care products just feels daunting and expensive, like maybe hold off on that. Maybe you're not microwaving in plastic. Little changes like that. Wherever you can, start there, know that you're making a difference because I think it's all contributing pretty significantly. Are there nutrients that you found are particularly helpful with PMDD? Magnesium glycinate. I always come back to that. Vitamin B6 can be useful. I like Vitex. The herb is called Chaseberry, which can be good progesterone support. I like that both for PMDD and for

perimenopaus, especially like an earlier phase of perimenopause, when someone's maybe having trouble sleeping in their ludial phase, but they're not yet at the point where they're contemplating hormone replacement therapy. Maybe they're not yet getting hot flashes. That's a good place to start in like nutrient density. So rather than what we are taught to believe is healthy, like a pile of a regula and a chia seed pudding, like really think about what do traditional cultures prize is the most nutritious foods? It's things like that. It's the bone marrow. It's the liver. It's the chicken liver patte. It's the egg yolk. It's that kind of food that's really nutrient dense is usually what builds up those stores of the vitamins that help our body regulate our hormones. As we've talked about,

depression can be really overwhelming. So I would love if you could give us just some really specific things that we can do, whether we feel like we're really overwhelmed by depression, whether we feel tinges of it, that maybe we can experiment with in our own lives. Sure. And then again, this is the buffet, not the tasting menu. Yes, give us the buffet. There was an interesting study a couple years ago now, which was exercise is actually the most effective anti-depressant. more than anything I can prescribe to you. But within that dance in particular, do you need to become a professional dancer or like take an hour long dance class? No. Might you want to consider just putting on Whitney Houston or Carly Ridge-Ubson and like just dancing in your living room for a song,

like great. And get over the leg, but this feels goofy, but there's no way this could work. Like, just try it, allow it. There's a lot of mechanisms for why this would be helping us with our mood. And then, but wait, what are they? So I said that study, when it came out too, and I thought it was really interesting. Yeah. And it is interesting that talking about traditional cultures, almost every traditional culture has some sort of dance practice. Yeah.

Movement practice. So this is me just riffing on why I think dance might be useful. Movement alone is useful. And like the blood flow that comes with that is beneficial. Music seems to have something to do with what is sacred about the human condition. It is uniquely human because our temporal lobe where we're hearing is so tied in with our memory centers and the emotional centers. of our brain. So there's just something about how our mood is so closely connected to like what

we are hearing and taking in through sound. I look at cultures that like dance as a as a community. And I think that this is a way that we're in training with each other. We're syncing up. I think it helps us align and like feel a oneness with the people around us in our community. And it's goofy and it's a release and it's purgative and cathartic. We don't take ourselves so seriously and it's fun. My sister did her part of her PhD work around drumming and it's like mental health benefits, which I think it's really interesting. It can induce a theta wave pattern in the brain. It can induce a trans state. Like all of this can be therapeutic. Okay. So that's one item on the buffet is dancing. So awesome. And I do think it is important to say, I think it's almost like oversight at this point,

but that if exercise wore a pill, every single doctor would be prescribing it for mental health disorders. Yeah. It is so, so powerful. I've experienced this in my own life. It is. It is so powerful. I've experienced this in my own life. so incredibly powerful. It's almost boring now to say it, but it is so true. And I just think that for anyone who's feeling like, yeah, that's nice, that's cute, but it's not going to happen. Like, I'm always interested in how do we get ourselves to successfully change that behavior? And to me, it's always about lowering our standards. Because when we hear exercise, we're pitching ourselves, what, joining a gym, hiring a personal trainer, putting on a sports bra, like absolutely never happening. I think of exercise as lower our standards. It's not all or nothing. It's like the difference

between doing nothing and doing something very small is a more important delta than the difference between doing something small and doing like zone two, three, cardio, whatever it is. So I like- And we often let, am I doing the perfect thing get in the way of doing anything? Exactly. And so a 10-minute walk after dinner, fabulous. Two squats in the middle of the afternoon, amazing. And Whitney Houston, like, you can kill all those birds in one stone and just like have a little dance moment in your life. And like, this can be two and a half minutes and it's still meaningful. So anything small. I think that's helpful for people just here. Here's, here's this doctor, this world-class doctor, and she's saying that it will make a difference. These little things will make a difference. I do. I mean, that's backed

by the evidence, and you also can just feel that for yourself in trying it once. So you can prove it to yourself in two minutes. Give us more of the buffet. Let's go to this quantity-ponty. So, I mean, there's a whole discussion that we've touched on and alluded to around the gut brain connection. I'll say, like, the hot take for today, without belaboring, because you have covered gut health. But I just think we need to appreciate it's a two-way street. We're getting the fact that the brain impacts the gut. We get it. If we're chronically stressed, IBS, if we're anxious, diarrhea. Okay. But it's a two-way street, and the health of the gut is impacting the brain. It is sending information up along the vagus nerve, which is 70% aferent, which is fancy for most of the information connecting the gut

and the brain is information from the gut to the brain, more than the other way. And so it's reporting on the state of affairs. It's either saying, everything's copacetic down here, go have a great day, but like who among us in modern world has a healthy gut? So more often, what it's saying is things are a mess down here. We've decimated the gut floor with that final, like 17th course of antibiotics for acne and our gut lining is decimated from our exposure to round up and ultra-processed foods and alcohol. And so here we are. We are not well in our guts. We come by this honestly. And it's constantly sending information up to the brain that says things are not okay, feel uneasy, feel tired, feel anxious, feel down. And so our unhealthy guts are telling our brain

to feel depressed. There's also the fact that our gut is playing a role in systemic inflammation. So that inflammatory hypothesis we talked about like 24 hours ago, our gut is also playing a role in systemic inflammation. And when we have intestinal permeability, this is seeding inflammation through the whole body, which is then bombarding the brain with cytokines, which we've already established correlate with depressed mood. And then the gut is also where we're manufacturing certain neurotransmitters like serotonin and GABA. We have a lot of talk about the gut is the second brain and 90, 90% of our serotonin is made in the gut. It's not really like the perfect explanation for the gut brain connection though because serotonin is not crossing the blood brain

barrier. We're not making it in the gut and then giving our neurons and our brain serotonin to go be happy. It's more that it's modulating the overall tone of our nervous system and the wellness of our bodies. So we do want to have a healthy get. Where does the squatty potty factor in? We evolved squatting to poop, period, the end. And so we don't now. We sit on thrones. It seems so civilized and comfortable, especially because we don't squat through our lives, so we don't even have that kind of hip flexibility and muscle strength to do it. But it's not anatomically correct position for complete evacuation. So the work around, the harm reduction strategy is to have a little stool at the base of your toilet that you rest your feet on. And that way you can approximate

a proper squatting position, even if you need to be with your body weight sitting and resting. And it helps with everything from IBS and chronic constipation to hemorrhoids. And it's like a $24 thing that has biologic plausibility and it's non-invasive and it's safe and it's inexpensive and it can change your life. And so you think that eliminating properly is going to help our gut be healthier in a way that's going to support our mental health. Absolutely. Yeah. When we're not eliminating properly, this is, it's all. backing up. We are not getting rid of metabolites that our body has decided is waste product and should be

out of our body. It's compromising our digestion. It's creating inflammation. It's leaking into our bloodstream and seeding systemic inflammation. It's compromising our ability to absorb the nutrients that we need. Focusing on the health of the gut is central to depression. And in functional medicine, we'll often say fire in the gut, fire in the brain. If there's inflammation in the gut, there will be inflammation in the brain. I have come to believe that if your gut is not well, it's very hard to be fully mentally well. Top three things for gut. If we say squatty potty is one, give us two more very specific gut things. I always think about gut healing as remove what's irritating the gut, add in what soos the gut, create the conditions for the gut to heal. This is influenced by Chris Cressor, but basically

remove what's irritating the gut. It's a little different for all of us. It's the unfun part of the conversation. Ultra-processed foods, unnecessary courses of antibiotics. ant acids, arguably, and then certain foods like conventional American gluten, for some folks, idiosyncratic random dietary intolerances like egg, add in what soothes the gut, bone broth, collagen, glutamine, ghee, fermented foods, starchy tubers. For some people, prebiotics, probiotics. And then create the conditions for the gut to heal, more than anything that's actually rest.

All of that housekeeping and restoration and repair work only really happens when we're in a state of rest and relaxation. So that one we actually have to take most seriously, even though it's the hardest to do. Squatty potty fits in that. And then vagal tone is really helpful. So anything that we can do to support juicy vagal tone can help us heal the gut. And that can be things like humming, gargling, chanting, certain kinds of massage. For some people, cold showers or cold plunging, which is a whole, you know, is that for everyone? Is that for men and women in the same way? I think probably not. But overall, anything we can do to tone vagal nerve activity can help the gut heal. When you put on your Whitney Houston song, you can sing it while you dance.

And then your two birds, one stone. Exactly. Okay, so we have, although singing Whitney Houston, I'm immediately like, don't help people do that. That's like too hard. It's just. We would throw out our vocal cords. Yeah.

Do like Taylor Swift or something. That's more easier. Here in Whitney's internet, we should not be trying. We have dancing on the buffet. We have squatty potty on the buffet. What else is on the buffet? I think it's overplayed, but nature is on the buffet, which doesn't have to be that you macrodose and, like, go on a nomadic adventure in the high sierras. Like, it really can just be that you go to the park.

But hearing birdsong, seeing green, smelling dirt, hearing wind rustle through leaves, like all of this is ancient primal communication that everything is okay. I remember when I was on safari and they teach you how the trackers are listening to bird song because they're, They know that the birds are communicating all is quiet on the restaurant front or they're communicating there's a predator. And so we have our nervous system is synced up with these unconscious auditory stimuli. And certain bird song is communicating to us. Everything is okay. You're safe. And certain sounds like the absence of bird song can be communicating like there is a predator about.

And so, I mean, I live in New York City and birdsong doesn't come easy. Central Park has a huge bird watching community. Yes, it does. Yes, it does. But when I am working from home, many miles from Central Park, I put birdsong on the radio, which is kind of twisted. Does that work? I mean, I find it really pleasant and soothing. And so it doesn't hurt. And I think it makes me plant happy too. Okay. Do we have two more things that we could put on the buffet? We do. Community is also one of these things that's probably ancestrally tied into our signals of safety. On that proverbial savannah, we weren't the fastest species. We weren't the strongest species. We weren't the strongest species.

were the ones who figured out how to communicate effectively, and that's the only real reason we prevailed. So when we feel connected, a sense of belonging, we feel safe. And when we feel disconnected or isolated or even ostracized, to our DNA, it feels like it's a matter of life or death. As we discussed earlier, this one's less actionable than saying, like, take weeknights off from drinking. But this one is something we need to actually make one of our highest priorities is just to make sure that we are putting shots on goal, building the field of dreams of like, here's the way I would like to socially connect with people. And it's a useful filter because the people who will say no are probably not the right fit. But the people who are like, I also want to watch reruns of sex in the city while

baking gluten-free carrot muffins and sitting around and drinking macho, whatever it is. There's going to be a kindred spirit there. So we want to actually very uniquely prescribe. Here's what would feel good to me and see what sticks. See who shows up to that. This is match theory. Yes. This is my, do you know match theory? You're the queen of this.

And so basically, yeah, the person who like doesn't, you know, you sent the text after the date and then they don't come back. Like, great, you filtered them out early. Amazing. Like, it's such good information to have. So put your whole self out there because that's how you're going to get the community that resonates with your whole self. Exactly.

Yeah. Yeah. Maybe there's one more thing on the buffet, which is just we need to repair our sleep. We need to do that in a realistic way. The definitive solution is probably moving off the grid. raising chickens and making our own sourcrow and defenestrating our phone deep into the ocean. But what we can do is crawl into bed a little bit earlier so that we're not getting over tired, that point when we've pushed past that window when our body wants to go to sleep, and then we secrete

stress hormone. It makes us tired but wired, and then it's hard to fall asleep. We want to go to bed at that sweet spot when our bodies are perfectly tired. It's more or less three hours after sunset, give or take a little bit. And then having a pair of blue blocking glasses is goofy and weird, again, like the squatty potty, safe, non-invasive, biologic plausibility for why it works, and it can change your life. So some kind of good quality blue blocking glasses you put on half an hour, hour before bedtime, maybe you put it on at sunset and wear it until bedtime and not keeping the phone on the bedside table for a million different reasons. But promoting better sleep, dancing, squatty potty, healing the gut, sometime with nature, sometime with community.

That's a pretty good recipe for supporting the physical and some of the psychospiritual dimensions of our depression. And then if you can push your crying to 11, you're on a good path. Are there any other myths that you think we haven't talked about around depression? One myth about depression is this very fixed mindset view of it, that it's how we're wired. We can back up that story. We can say, but my mom was depressed and my maternal aunt is depressed and my sister's depressed and I'm depressed. And yes, what we've brought forth is a lot of seeming, like circumstantial evidence, but really epigenetic phenomena travels and families, habits, traumas, travel and families, it doesn't necessarily tell us that you're stuck. And I think

the problem with that, it's just how I'm wired, belief around depression. It's ultimately not hopeful. It tells me this is who I am. It's the way I am. It's the way I will always be. And that I'm stuck. And when our current menu of offerings, CBT, therapy, medication works for you, then that story about depression is is okay because it's like this is who I am but it can be treated. But when our current limited menu of offerings fails you or it worked for a little while and then it doesn't anymore for whatever reason, then it actually really entrenches this hopelessness. That's where I want to intervene and say like, no, no, no, no, no, no. Like we had the whole narrative wrong. Your depression is not the verdict. It's not your genetic chemical destiny. This is a symptom. This is just a communication from the body.

suggesting something is out of balance underneath. So let's roll up our sleeves and figure out what's out of balance. What's your unmet need? What's your misalignment? What's the unresolved trauma? What's your not having a squatty potty? And so what we really want to do is then figure out how we support someone's depression. And that's where it's a growth mindset understanding. This isn't how you're destined to be. You're not stuck. This is a symptom. It's pointing to imbalance. Let's figure out what that is and address it. And you don't have to be suffering. Do you know how we know if our depression is like a sign that we should make concrete changes in our choices in our lives. Like my depression is a sign I'm not with the right partner. My depression is a sign I'm not in the right city,

not in the right job. How can we suss that out? My algorithm is always to start with the physical basis because it's so much more common that we might confuse unnecessary physical depression for like our true purposeful deep essential depression. And I think that we're always going to believe everything is our true essential like inner compass. We're always going to think that. The brain is a meaning maker. It exists to tell us a story to make sense of these first and foremost physical sensations. So if we are sleep deprived, insulin resistant, macronutrient deficient and inflamed, our brain is in a state of low vitality. It's hypofunctioning and we are depressed. And so then our mind, this meaning maker will say, I know I am depressed. It's because of all of these stressors in my life and the misaligned

here and it'll just really tell us a heavy-duty story about our circumstances. But then what turns out is that if we address all that physical imbalance, often the depression goes away. So it was never really this deep essential inner compass truth. When you address all the physical basis for depression and something remains, whatever is residual there, I do tend to think is our purposeful inner compass depression. And then it's pointing and only really do we know what it's pointing to, but usually we actually have some suspicion. And so then the practice is less about how can I feel less depressed, and it shifts. The question becomes, what is my depression telling me? And the task at hand becomes getting better at slowing down, getting still, paying attention and listening for what's the

call to action baked into that symptom. And it can pertain. to our relationships or our career, our job, or where we live, some way that we are living misaligned with our values. And I think that usually if we slow down and are okay to not shame ourselves, give ourselves lots of grace for maybe something we've known for a decade and haven't acted on, like we need to move out of a space of beating ourselves up for something we've known for a long time because that's what makes it safe to say, okay, I do actually know deep down inside. Here's where I'm out of alignment with my values. And I feel like if I try to get into alignment, it's going to blow up my life. But I probably will suffer more not acting than acting on

it. And we're going to be so much more equipped to have that clarity if we've taken care of all of the other stuff. Equipped and resilient in the face of that challenge and have more clarity and have a more hopeful outlook. And we will have had this journey of self-efficacy of recognizing our agency and all of this is really helpful preparation for making big sweeping changes in our lives. Love that. Well, this was so helpful and wonderful. As always, I could talk to you for like five more hours, but we'll just have to have you come back again. Hopefully it won't predictably be right before a pandemic. Am I bad luck coming on the podcast? We'll have this be the proof that you are not. Can you just highlight where people can find you and anything that you want to shout out? Yeah, I'm pretty active on Instagram. I'm at Ellen Fora, MD. And my first book, The Anatomy of Anxiety, comes. out in paperback on April 29th. And then my second book, The Season of the Witch, is coming out

June of 2026. And everybody should scroll through your Instagram and look for the post that you did not say was inspired by me, but was inspired by me. And they can guess which one was. There's so much that I do in my life that's inspired by you. I think we're kindred spirits and how we, some might say overthank, I think appropriately think about all of the different choices we make in our lives. Yeah, Vimel and Zach might disagree, but that's okay. This is wonderful. Thank you for coming on. Thanks, Liz. If you have a friend or a partner or a parent who has been struggling with their mental health,

who's maybe confused about all of the noise on the internet about depression, who maybe just doesn't feel good and does not know where to start, please, please send them this episode. I really hope that it brings a sense of hope. I hope it brings a sense of calm. And I hope it brings some much-needed clarity and information. Make sure that you're following the Liz Moody podcast on Apple Podcast on Spotify or on YouTube. Following the show means episodes will show up right in your feed so you will never have to

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that at Liz Moody.com. And of course, come say hi on Instagram. I am at Liz Moody. I share tons of behind the scenes of my real life. I share what I do for my mental health, which has been a real struggle, as many of you know, and so much more. Okay, I love you. I really hope this episode was helpful. And I will see you on the next episode of the Liz Moody podcast. Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes. It is not intended as a substitute for the advice of a physician, a psychotherapist, or any other qualified professional.