Given my conviction that the vast majority of psychiatric conditions are caused by inflammation of the brain, most of the recommendations that I make to patients in my practice of holistic psychiatry are designed to support the immune system which decreases inflammation. Depression, anxiety, attentional difficulties, brain fog, and other cognitive changes are all mediated by inflammation.
My healing strategy is multi-modal and holistic. The centerpiece is always an auto-immune type diet like the Paleo Auto-Immune Protocol or the Wahl’s Protocol, as well as often encouraging intermittent fasting. Learning to cook is a priority. In addition, it is essential to identify and treat common causes of systemic inflammation such as environmentally acquired illnesses like mold toxicity and mast cell activation syndrome. It can be helpful to identify deficiencies and excesses of vitamins, minerals, and biogenic amines like histamine, and to prescribe targeted nutrient therapy protocols to rebalance biochemistry. I typically recommend Low Dose Naltrexone to support and modulate the immune system. Therapies to heal the effects of trauma, like Dynamic Neural Retraining System which rewires the limbic system, and Accelerated Resolution System, an eye movement therapy, can be very helpful for many. We always discuss circadian rhythms and sleep, the potential benefit of practices like meditation, yoga and tai chi, the vital importance of incorporating daily movement into one’s day, as well as the necessity of avoiding synthetic hormones, toxic conventional personal care, and household cleaning products. It is crucial to take seriously the biological effects of electromagnetic frequencies emitted by cell phones and other electronic devices. Most patients are unaware that these devices can increase systemic inflammation. We discuss the importance of getting sunlight and communing with nature, developing a sense of belonging to a community, the uplifting effect of service and cultivating nourishing personal relationships. Often an anti-inflammatory treatment includes old fashioned talk therapy and discussion of how to implement a spiritual practice.
A holistic approach requires a great deal of commitment. motivation and hard work on the part of the patient, as it is challenging to adhere to dietary changes, to say no consistently to favorite foods, to exercise regularly, to take many supplements, to put your phone on airplane mode when you are carrying it on your person, to turn off the router at night, etc. It is very different than taking medications, as it involves a whole change of lifestyle and orientation.
One of my very favorite podcasts is Phoenix Helix, which is about healing auto-immune disease. The host, Eileen Laird, is an excellent interviewer and invites wonderful guests. I always recommend this podcast to my patients, as the first four episodes give great advice about how to implement the Paleo Auto-Immune Protocol (AIP) and feature inspiring healing stories. The recipe section contains a treasure trove of AIP friendly recipes.
The newly published book featured at the beginning of this post, The Angel and the Assassin, by science journalist and award-winning author Donna Jackson Nakazawa, is about the connection between the immune system and brain health. Donna Jackson Nakazawa was a recent guest on the Phoenix Helix podcast in a fabulous episode entitled “Autoimmunity and the Brain.”
The episode begins by making the important point that patients with auto-immune illnesses are often told that their depression, anxiety and cognitive changes are a perfectly natural response to the stress and suffering that are part and parcel of living with chronic illness. What is not recognized is that autoimmune illness causes inflammation not only in the body but in the brain as well, and it is the inflammation that is causing symptoms. The protagonist of her book is the microglia cell, an immune cell in the brain, whose role in brain health has only recently begun to be appreciated and understood. Microglia can both support a healthy immune response or become overactive, causing damage to synaptic connections and emitting neurotoxins, which causes brain inflammation. Overactive microglia are seen in many different conditions including anxiety, mood disorders, Alzheimer’s and Parkinson’s disease, to name a few.
We are living through a time of tremendous intensity, uncertainty, grief and change on our planet. The collapse of the biosphere and the ever-increasing toxicity of the environment is creating chronic stress and existential angst, which manifests in our bodies and brains as inflammation. An inflamed person often feels depressed, self-critical, unworthy, anxious, preoccupied, separate and alone. In order to meet these times with resilience, strength, and courage, and to foster well-being, clarity, and hopefulness in the face of such confusion and darkness, it is essential to implement holistic practices that decrease inflammation.
In terms of the larger meaning of all of this suffering and loss, it helps me to keep in mind the quote from the 12-century Persian poet Rumi, ” You have to keep breaking your heart until it opens.” May this heartbreak serve to catalyze the paradigm shift that is needed in order to create what sacred activist Charles Eisenstein called ” The More Beautiful World that our Hearts Know is Possible.”
Here is a link to the audio file of the Phoenix Helix podcast: “Auto-Immunity and the Brain.”
Interestingly, the genes implicated in suicide are also linked to regulation of neuroinflammation, ADHD, long memory formation (like in PTSD), reduced levels of dopamine, Bipolar disorder and schizophrenia. All things associated with Taq 1A.
“At the gene level, our analyses revealed two genes with prior evidence linking them to suicide risk: PER1 and SNAPC1, though specific functional risk variants were not identified in those previous studies. PER1 is a circadian clock gene that plays an essential role in generating circadian rhythms. PER1 has been implicated in long-term memory formation, response to insufficient sleep and regulation of neuroinflammation. Altered expression of PER1 has been found in individuals with schizophrenia and PER1 knock-out mice exhibit ADHD-like symptoms and reduced levels of dopamine. PER1 was significantly downregulated in the prefrontal cortex of individuals who died by suicide and was differentially expressed in suicide attempters compared with controls. Postmortem brain tissue expression results from the psychENCODE sample showed PER1 has increased expression in schizophrenia and bipolar cases”
Studies have shown that suicide attempters and completers have low Vitamin D but nobody talks about that. Instead we are told that if only we had known the signs we could have saved our children…but I’m a nurse, I knew the symptoms and I acted quickly.
Can you please recommend a doctor who is familiar with the subject in the Long Beach, CA area ? I have a daughter.
There is an organization called The International Society for Environmentally Acquired Illness.” Here is a link to a page on their website where you can input your zip code and see if there someone who you would like to work with. The doctors on this list have a more holistic approach.
https://iseai.org/find-a-professional/
Thank you, I’ll pass this info to the other parents.
I lost my son to suicide Sept 2020. It made no sense so I’ve been researching since.
I read your article on MTHFR and would like to point out a different gene polymorphism that does the same thing.. The DRD2 Taq 1A is associated with having 20-30% less dopamine D2 receptors. It is also a Vitamin D receptor gene so it causes LOW VITAMIN D.
When I visited a suicide survivors group I noticed that many of the suicide victims had conditions associated with having Taq1A or had a family history (including ADHD, autism, Bipolar disorder, Borderline Personality, addiction, PTSD and schizophrenia.) and as you know, all involve oxidative stress , low antioxidants, histamine intolerance and low vitamin D. As a matter of fact, ALL the conditions have symptoms that can be caused by low Vit D and the level correlates with symptom severity. Plus a new study showed that Vit D deficiency exacerbates opioid addiction. The lower the level, the more opioids used.
Thanks Dr. Tsafrir —
I started in March 2019, utilizing Functional Medicine protocols (Dr. O’Bryan, Dr. Osborne, Dr. Hyman, Drs. Todd Watts and Jay Davidson, and many others). Within 3 weeks I no longer had anxiety and depression I’ve had for over 40 years. Then I went on to heal many other ailments and symptoms like Chronic Fatigue, Fibromyalgia, insanely high cholesterol and trigliceride levels, pre-diabetes, obesity (I lost 40 pounds), and others.
What you are discussing are what has saved my life.
Lauren O. Thyme
Such a blessing that you finally got appropriate help. Thanks for writing.
Excellent thought-provoking post.
An excellent post that I will recommend to others, thank you Dr. Tsafrir.
A new friend I met recently shared with me the now all too common ‘I’m bipolar’ (not Manic Depressive, but one of the spectrum diagnoses after dealing with depression, also all too common) scenario and that she takes a psychotropic med, etc. etc. And about recent suicides of a friend of hers, and two friends teenage children; so incredible sad and tragic.
I shared a little of my history and we got into a discussion about the chemical imbalance issues – I recommended she read Kelly Brogan, M.D.’s blog who refutes a lot of the lies that get told to patients with clear facts and information and offers much hope like you do by sharing other ways to heal. I always try to get someone to understand simply that yes, their body is imbalanced, but they want to try to figure out why, and find ways to heal.
In addition to causes of systemic inflammation, the other issue that can cause someone to become ill and express mental illness symptoms as part of that illness is ‘undermethylation’ – also called histadelia, yes? For some reason a person does not metabolize certain things (neurotransmitters, amino acids, vitamins, or other) well or at all, and that creates illness issues.
“Many individuals diagnosed with mental illnesses have severe undermethylation which is associated with dangerously low serotonin activity. ”
– quoted from this very brief article that includes a Dr. Bill Walsh video: http://www.mensahmedical.com/common-symptoms-of-undermethylation/.
Anyways, just more thoughts to your excellent article. I’ll recommend to others.
Molly
Thanks, Molly, for your thoughtful comment. Often when a person has undermethylation, then they cannot detoxify effectively, which results in an inflammatory state from the toxins. The two conditions are definitely related.
To add to this, the activated form of folic acid—> MTHFR is a supplement which can be helpful.