Panic Attacks: Biology or Psychology?

When we think about anxiety, we always have to be thinking about what's happening in the gut. And oftentimes people who are anxious will have GI symptomology. They'll have nausea. They'll have loose stools. They'll have been diagnosed with irritable bowel syndrome. And they have anxiety connected to it.

Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman. That's F-A-R-M-A-C-Y. And today is a special episode of House Call with Dr. George Pappas Nicolau from the Ultra Wellness Center and we're gonna talk about panic attacks and anxiety. This is the age of anxiety. I, in the last year, have felt more anxiety and stress than I have felt in a long time given the state of the world and the state of affairs in our environment, with our health, with our economy, with COVID with the political situation, whatever side you're on, it's kind of crazy. And it creates a lot of stress. And on top of that, so many Americans suffer from trauma in their childhood. We call this adverse childhood experiences, growing up in dysfunctional homes, growing up in abusive homes, growing up with alcoholics or drug abuse. Just so much has really caused us to live in this age of anxiety. And it's so common. So, George, tell us a little bit about How common is anxiety and what does it do to people's lives?

As you said, anxiety is extraordinarily common. It's probably one of the most common psychiatric diagnoses that patients will come to an office for. They will sometimes come in with more of a depressive presentation only to uncover that a large part of their depression is driven by anxiety and fear.

Life.

So, it's extraordinary common you can see in all age groups and it's very debilitating. When you have really bad anxiety, it's extraordinary debilitating, particularly if it is associated with panic. Yeah.

And like 40 million Americans walk around with anxiety all the time and I think that's who has an anxiety disorder, not just a normal run-of-the-mill anxiety that we all deal with. And there's a lot of people within that, about 5% who have panic attacks. which is really terrible. So what is a panic attack?

So a panic attack is gonna be that overwhelming, so anxiety, I'll start with anxiety. So anxiety is a general sense of fear, of that something bad is going to happen. It's beyond just stress, it's a general fear a neurotic fear, an unexplainable fear that something bad is going to happen. Panic is when it's overwhelming. It has a physiologic connection where you have this overall sense of doom, you have palpitations, you can actually get it so bad that you may not feel parts of your body. You may begin to fear you're going to die.

So you get anxiety, numbness, tingling, palpitations, shortness of breath, sweating, chest pain, pressure, you're going to die.

All of which, I had in 1987, right before my neuro pathology test in med school.

Wow.

My wife and I were living in Overbrook and I woke up in the middle of the night, I couldn't feel the entire left side of my body. I was sweating, I was short of breath, I was in a complete panic. I said, honey, I'm going to die. You gotta get me to the emergency room. She drove me to the emergency room of my medical school.

Oh my goodness, that was so embarrassing. Well, you know, this is not that uncommon. Dan Harris, who's a really well-known journalist and TV journalist who's on 2020 and Dateline and was on NBC at the Today Show. And he literally on live television in front of five million people had a full-blown panic attack. And he eventually figured it out and learned about meditation. and wrote a book called 10% Happier. And he's got a podcast, 10% Happier. I've been on his podcast and he's been on mine. And it's incredible how powerful these sensations and feelings can be that disrupt your life. But there are ways to fix them, right?

Yes.

And what is a typical doctor do when someone comes in with a panic attack or anxiety disorder? What do we say in medicine to do?

Yeah, so when you have 10 minutes to see a patient and you have a caseload of 28 more patients to see and they say they have anxiety, that to you is a way to catch up. You give them a pill, you tell them to go find a therapist, and you tell them to follow up in three months. That's typically what happens.

So they get a Klonopin.

They'll get an anxiolytic. People commonly know them as Klonopin. Ativan, these are like sedatives.

These are sedatives, essentially.

It's like Valium, right? And Buspar, which is a non-benzodiazepine anxiolytic. Different categories.

But then they also throw at them a lot of antidepressants, right? So the usual like Prozac, Paxil, Effexor, all these things that are treating these symptoms.

Symptoms.

So they're just affecting your brain chemistry without dealing with the cause, right?

Exactly.

And then they have side effects. I mean, the benzodiazepines are highly addictive, like Valium. They can lead to dementia. They cause cognitive impairment. The antidepressants can lead to weight gain and libido issues and all kinds of problems. So, it's not like a free ride.

No, absolutely not. We end up having to deal. The biggest fear I ever have of patients being prescribed those are the side effects, the increased tolerance. Then you have to take more, and then you have to take even more because because you get this increased tolerance in order to control your anxiety. And then, you can't sleep. And now, you're having difficulties because they disrupt your sleep, they disrupt your cognition during the day, and now, you have to come off of those. And they're extraordinarily difficult to wean off of. So, it becomes a real dangerous area.

They don't even work that great, only between 15 and 45% of the time. And, the other thing is, I have a patient last night. seeing yesterday and she's on Ativan, she's on Buspar, she's on the antidepressants and she's still anxious. I mean it's not like it fixes the problem. It's like if you have a broken ankle and you take enough pain medication, you might not feel it as bad but the problem is still there.

Right.

So, I think from a functional medicine perspective, how do we approach this? Because I was going to sort of share a little case study and then we're going to go into how we really think through this. I just remember this patient of mine who was this hard-driving, sort of late 40s, Wall Street executive, and he'd just work hard all day, didn't have time to eat, you know, eat very late at night, drink a lot, go to bed, wake up and do the whole thing again. And every day about four o'clock he'd have this massive panic attack. He thought he was having a heart attack, palpitations, sweating, feeling he was going to die, short of breath, usual. and I just sort of asked him about his lifestyle. I said, what are you doing? He said, well, I do this and the whole thing. And I, you know, I eat so late and I'm like not even hungry in the morning when I wake up, so I just don't eat until four o'clock. And then I get these panic attacks. I'm like, oh, well maybe you're hypoglycemic. Because he was, you know, a little bit overweight, he had this belly fat, and we knew from that he had high and low insulin swings with blood sugar. And these people tend to get high sugar, but they also go crashing low. And when you crash low, it's a life-threatening emergency. You literally think you're going to die, which means you're going to run around trying to find food as fast as possible. And he didn't connect the dots. And he didn't connect the dots. And all I did was have him shift his life a little bit to eat earlier, not drink so much, have.

Some breakfast, eat food throughout the day, his panic attacks went away. So it may be as simple as that. If you've never seen anybody hypoglycemic, they're in a panic.

They're in an outright panic, and they get very confused. And it's a very scary place. It is. I've been there. Like, I want the food now. But I think most of the time, it's not really just that. Although I've had a bunch of patients who it's been really their diet and their sugar. But often it's trauma and other things and other factors. So as a functional medicine doctor, people come to see us at the Ultra Wellness Center, what are the things we're looking at? What are the kinds of things that could drive anxiety? Because clearly there are psychological reasons. You take a history for trauma and other kinds of stresses. But there's a lot of Physiological reasons.

Oh, yeah. Genetic and physiological reasons. Absolutely.

So, it's not maybe a mental issue, it's a physical issue.

Yeah. And one of the most common things that you in a primary care setting, you know, that you'll do is you'll check somebody's thyroid. You know, if they have hyperthyroidism, that would be an obvious reason. So, that's one of the physiologic reasons that you're- Overactive thyroid. Yeah, overactive thyroid that you're alluding to. but there are a whole host of other reasons that people can have them. A woman that might be estrogen dominant. So, estrogen dominance is essentially when you can have normal estrogen and progesterone levels but your estrogen relative to your progesterone is much higher. And that can be there for several reasons. It can be your baseline physiology but it can also be impacted by the foods you eat, the cosmetics you put on your face and the other possible what we call xenoestrogens that you come in contact with in your day-to-day activities because they're everywhere. So women then therefore have too much estrogen. Estrogen impacts your stress hormone cortisol. And so that is the hormone that you really need to have to have a good modulation of your stress. So women who have estrogen dominance can tend to have anxiety and they don't know where it's coming from. So I look for estrogen dominance as a possible cause.

Yeah, so we know hormonal imbalances and I think PMS and other things are well known to cause irritability and anxiety and mood issues.

So it can be hormonal like that. Yeah, and so then I'll also look for other possibilities. There are physiologic things like something called casimorphin and gluteomorphin. So that's how you break down your dairy products like milk and how you break down gluten. You make these peptides, which are small proteins, and these particular peptides can pass your blood-brain barrier and they can actually affect your brain in such a way they can cause depression, anxiety, loss of focus, agitation, and irritability. So, we can look for those other tests that functional medicine doctors do.

Wait, wait, wait. So, you're saying that there are When you're digesting dairy and gluten, it doesn't get completely digested properly and it forms these little psychoactive molecules that go to your brain and mess with your head. Wow. And we can measure those byproducts in the urine to see if you are making those. And you see this a lot in autistic kids, but you can see in other people too.

Absolutely. I see in adults. You know, I see a lot of autistic kids and it's one of my primary tests that I look for. and often addressing those issues are helpful. But I started doing it with adults and I find it very frequently that they have casein morphin and glutamorphin issues. And there's another test that we do called cryptopyrrole test. So when you break down iron in your body, which you need to do when it's done doing its job, you're gonna create a byproduct called cryptopyrrole. Cryptopyrrole in and of itself is benign, but it takes out B6 and zinc. And B6 and zinc are critical to your brain function and managing and metabolizing your neurotransmitters. So if you make too many cryptopyroles, you're going to be deficient in B6 and zinc. And the best way to measure that is intracellularly using RBCs, your red blood cells, not just serum. And so it can be very hard to determine if you're really zinc and B6 deficient. And so that's another reason why a person could be anxious and not even know it. And it's something that's irreversible. That's right.

And I think one of the things that you're sort of hinting at that I want you to speak directly to is a lot of these things cause inflammation. And what we're learning now is that when the brain is not working, whether it's depression, anxiety, ADD, autism, dementia, and I could go on and on. It's usually inflammation. And inflammation in the brain doesn't feel like a sore throat or a swollen ankle. It actually creates all these psychiatric symptoms that we then kind of mislabel as emotional or psychological but are actually physiological.

And when I see it, see it every day in practice, every day, at least one of my patients comes in and they have inflammation in the brain. And how do I know it? Because they have inflammation in their gut. And we know that there's a very strong gut-brain connection. So when we think about anxiety, we always have to be thinking about what's happening in the gut. And oftentimes people who are anxious will have GI symptomology. They'll have nausea, they'll have loose stools, they'll be been diagnosed with irritable bowel syndrome, and they have anxiety connected to it. So if you're anxious and you have GI symptoms, Most certainly, if it's a diarrhea constipation picture where you're rotating between the two, sometimes having irregular bowel movements, it's going to be called IBS and you're just going to be treated very just symptoms only for both of those conditions when they're really connected and by altering the gut microbiome by changing your diet and adding in foods that will enhance a normal balanced functioning non-inflamed gut, we can actually improve your anxiety as well.

Okay, what you just said was pretty radical here, right? That we used to think when we went to medical school, we were taught that people with irritable bowel syndrome, it was caused because they were emotionally unstable.

Yeah.

But they were anxious and they had emotional issues and that's what was causing the irritable bowel. What you're saying is the opposite. What you're saying is that we've learned now, and this is well-documented science, we've learned now that if you have irritable bowel syndrome, meaning you have bad bugs in your gut, you have inflammation in your gut, you have leaky gut, you have food sensitivities, that this causes inflammation in the brain. So that basically an irritable bowel causes an irritable brain. And that is actually the direction of the problem. And yes, of course, if you're stressed, you can have gut issues too because it's a bidirectional system. But it's important to understand that we mislabel a lot of these things that have to be kind of de-stigmatized from being emotional problems to being physiological problems. And that's really why I wrote my book, the UltraMind Solution, How to Fix youx Broken Brain by Fixing youg Body First. Because you don't know if it's emotional until you fix the physical stuff. If you have hypothyroid, if you have mercury poisoning, which by the way can cause anxiety and insomnia and all these other issues. if you have a SIBO or bad bugs growing in your gut, if you have magnesium deficiency, which is a big cause of anxiety, you can treat those things and people will get better. And from a functional medicine perspective, we're looking at all these issues. So when you go to the psychiatrist, they go, let me measure your vitamin D, let me measure your magnesium, let me measure your fish oil, let me look at your poop, let me look at your heavy metal levels, let me look at your hormones. They don't do any of that. They go, no, here's your Ativan. Here's your pro, Zach. We'll see you next week or next year. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Now back to this week's episode.

So when I read that in your book that, you know, brain disorders are really body disorders, that was just transformative in my thinking.

Yeah.

You know, that was, this is transformative. And that's when I really, that was one of the seminal moments of me changing the way I approached the care of my patients and drove me into functional medicine. That's just a huge and important point to make. And I think that all the things that we've talked about are the body issues that we look at that affect the brain. And so, there's so much value in just understanding that simple point.

Yeah, I think it's absolutely true. And all these various things play a role. And, I think some of them are more important than others.

These are genetic components as well. We look at genetics and we know that the genome is huge and we scrape the surface and there are things called single nucleotide polymorphisms that are basically a single peptide variation in your gene blueprint. So your genes are just, as you know, these blueprints and then these blueprints are only used to make proteins. most of those are enzymes that cause all these great reactions to happen in our bodies. And some of those reactions are really important to our neurotransmitters work in our brain and maintain a healthy balance. So we know that there's some snips that we look for in people with neuropsychiatric disorders like depression and anxiety that can have a huge impact on whether they have anxiety or depression. One of those is the CMT gene, When you have a variation in that, you can have a variation such that this gene, as I said before, is a blueprint for an enzyme that breaks down neurotransmitters in your brain. And if this enzyme is working too slow, you're going to have a buildup of your neurotransmitters in your brain. And this particular buildup of dopamine and norepinephrine at baseline helps you stay focused and calm, but the least amount of stress can drive you into anxiety. And if we understand that about a person, there are actually nutritional and lifestyle and targeted supplements that can make a difference. And so that's a key, again, that's one of those root causes that we're looking for in functional medicine that you probably won't get in conventional medicine with the primary care physician?

Not at all. And I think it really is a different thinking that we do with functional medicine that analyzes problems completely differently. And before we assume it's some psychological issue, we're going to rule all these other things out. Absolutely. And we do an extensive evaluation that looks at brain chemistry, amino acids, we look at adrenal function, thyroid function, food sensitivities, heavy metals, which mercury can definitely, I've had mercury poisoning, I know how much it costs caused me to have depression, anxiety, insomnia. We look at nutritional levels like magnesium. Magnesium is so important and we look.

At the gut and it's hormone balance.

In women is hormone balance. So we really do a very comprehensive view and it's amazing. That's actually why I wrote the book, the UltraMind Solution, was I wasn't thinking about all this stuff, but I was treating people with all these issues. I had gut issues or I have this issue, a hormone issue, or I got heavy metals. And then they say, oh God, Dr. Hyman, my panic attacks are gone. my anxiety is gone, my depression is gone, my bipolar disease, I'm like, what? Really? And then I was like, wait a minute, there's something here that the brain is actually responding to all these other things that are happening that we are completely ignoring. And that's the beauty of functional medicine. Magnesium is so important because it's the relaxation mineral. And I think 40 plus percent of Americans are deficient. And if we drink alcohol, if we have coffee, if we don't eat enough Magnesium containing foods.

If we take acid blockers.

Acid blocking drugs for heartburn, nuts and seeds and all these things. We don't greens, we don't get enough of these in our diet and we don't actually get the benefits of this important mineral which we all need a lot of to function well. So that alone can be hugely effective. So let's talk about what you would do with a patient after you sort of got us, what's the general approach that we have with anxiety. And maybe you can talk a little bit about a few cases, but I just would love to sort of get a general sense of what the sort of step-by-step approach is to treating a patient after you sort of see what's going on.

Yeah, so the key part is sorting through. So as I've said before, when you come to my office in functional medicine, you get a very long history and timeline, and then we're going to really look at the underlying root causes and conditions that might be resulting in the anxiety. I always have seen anxiety as a symptom, not a diagnosis. So, I'm going to be looking for the underlying root causes. So, after I do that careful assessment of the history, then I'm looking at basic blood work. So, that will include looking at through thyroid, looking at iron levels, because low iron can lead to anxiety. I'll be looking at blood counts, I'll do, then I'll do some, you know, in functional medicine testing. I'll do genetic testing looking for those SNPs. I'll look for cryptopyrroles, I'll look for the casemorphins. I'll definitely be looking at the gut microbiome. I'll be looking if a person's having GI symptoms and they've been diagnosed with IBS, there's a very, you know, a fair large percentage of the IBS patients who actually have something called small intestinal bacterial overgrowth. And that can be associated with anxiety and depression and fatigue and irritability. So we'll check for SIBO in part of their complete diagnostic stool evaluation and microbiome evaluation. We'll also look at hormone balance and adrenal function.

You look at all that stuff and then you take this patient, you sort through, and you're gonna treat all these things separately. But what's the general place to start in terms of diet, lifestyle, supplements, that seems to sort of help is a basic foundation. Because all those things have to be built on a foundation. Like if you're detoxifying, summoning or balancing their hormones, you're really starting with the foundation of lifestyle. And there's a lot of really simple things that people do that can really work. Oh, yeah. So, I encourage people to listen carefully.

Because there's things you can do without even having to go through all this. Yeah, I think that the first place.

You really look is the diet.

Right. And the diet is medicine. Food is medicine. It's the end of your fork, you know? And, We gotta go there. And I have patients that come in to me and tell me, you know, I eat a great diet. But then we do a real deep dive into their diet and it's not great. They don't realize that, you know, not eating organically or not being paying attention to the fact that you're eating GMO foods that are altering your gut microbiome, that you're getting glyphosate in your, the grains that you're eating. GMOs and glyphosate are microbiome busters. And so right there, I know you're gonna have a broken and imbalanced microbiome that could be impacting your brain. Why? Because 70% to 90% of your serotonin, which is a mood stabilizer in your brain, is actually made by gut bugs. And so we go there. So nutrition is gonna affect your gut microbiome and what kind of nutrition? So we gotta get out the processed foods. We gotta get out the sugars, I mean, as main things. We go after dairy, we go after gluten. Those are really common inflammatory foods that will affect your brain.

And you get rid of all the stimulants, all the things that could cause anxiety.

Caffeine, nicotine, vaping. I mean, those are lifestyle things. I mean, I just went down that path for a second, but yeah, exactly.

So, where do you start out on the nutrition stuff?

So, nutritionally, I really drive people to a vegetable-based diet. with whole foods, fish.

On the supplements.

Supplements?

Yeah. What do you think about nutritional supplements?

So, nutritional supplements, one of the first nutritional supplements I will actually think about using is vitamin D because a lot of people are very low in their vitamin D. And vitamin D is definitely linked to depression and anxiety and you have to make sure their vitamin D levels are high. I like fish oil. Fish oil is very important for the brain. It has EPA, DHA. Both are very vital to neuronal function and maintaining health of your brain. They've been shown to improve people with ADHD, their anxiety and their inattention can improve and they have high doses of fish oil. So, vitamin D, omegas, magnesium is definitely in my top three. So magnesium is very important for relaxation and de-excitation in the brain. I'll use something called GABA. GABA is a neuro relaxant and can help people who have anxiety.

It's like a natural valium.

Yeah, it's a natural valium. Those are some of my top four.

And of course there's things like, like 5-HTP. which is help serotonin, which is a precursor like that's what a tryptophan is sort of made from. I use adrenal adaptogens. And yeah, and of course there's also the herbs like valerian and passionflower. So there's a lot of different things that can be effective. But we also really focus on the other lifestyle issues. We focus on stress and meditation. Exercise is a great way to reduce anxiety. If you burn off all the stress.

Hormones when you go for a jog. Well, recent studies, as you know, I mean recent studies have shown that exercise improves many different disorders, particularly been effective in treating anxiety and ADHD. So, whenever I see a patient with either of those, the first prescription they get from me is 30 minutes of exercise every day.

Yeah, absolutely. And sleep, so the usual stuff. Sleep, exercise, stress reduction.

They're usual stuff.

But now people aren't doing it.

Either, but they're usual, but they're not being done. and people don't realize that, quite honestly, when I address the five lifestyles as the fundamental issues, I get people better just doing that.

Yeah, and that's so true. And, you know, I think all of us experience stress and can experience anxiety, and sometimes I do. And I know I just found ways to change my state. If I go on my bike, if I do a little yoga, if I do a meditation, or even, you know, my favorite is the lazy man's way. I like to take a hot bath with Epsom salt, 'cause that relaxes me, or even a sauna or steam and then an ice bath. That just takes all the stress out of my system. It's amazing. And I can really sometimes feel the stress build up from the day and I just feel a little agitated and wired. And I do one of those things and I literally come back and I'm just completely calm and centered and great. And so there's a lot of ways to access that. I want to end on sort of a conversation about some of the, you know, advances that are there for things that aren't necessarily just physiological. Because we've talked a lot about the physiological, because it's something that gets missed. You know, people talk about therapy and all this stuff, and that can be helpful. But there's really emerging therapies that I think are really worth talking about, CBD and some of the psychedelic-assisted psychotherapies and MDMA therapies. And these are emerging, and a lot of research is being done on these. In fact, there was just a study published recently in the Journal of the American Medical Association of Psychiatry that showed that psilocybin treatment was four times as effective as antidepressants. So can you talk a little bit about these? Because I think they're so critical and they're so ignored and they're, I think, possibly the future of treating mental health disorders. Because a lot of people who experience real trauma, whether it's a war zone experience from a military vet or whether it's someone who's had abuse when they were younger, or who's experienced a real trauma in their life, PTSD can be a real phenomenon. It's not just physiological.

Yeah, I was gonna say one of the things that we didn't have a chance to talk about is, you know, the trauma in people's lives. Trauma is huge. And I think adverse childhood trauma, adverse young adult, adult trauma is very undiscussed topic when it comes to physiologic disease and mental health. And I'm always having my ears attuned to the possibility of an adverse trauma or traumatic event in a person's life that they don't want to talk about or can't talk about. So it's really critical.

I want to say people listening, they can look at how their childhood was and whether or not they really qualify as having adverse childhood experiences by going online and just googling adverse childhood experiences test or ACE test. And you can, the CDC makes this available free. You can take the quiz and you can get a score and you can see, am I someone who's got a high level of adverse childhood experiences? And people who do tend to have more anxiety, more depression, more substance use, more eating disorders, more challenging relationships. I mean, it's just more chronic disease, more autoimmunity. And I think it's really important to understand this because if you have this, then it really is important for you to take control and take initiative to actually deal with this system.

It's really critical and we didn't make that point before we get to the psilocybin and CBD. People need to know that PTSD is different than anxiety and depression. It's treated differently and you have to go to a specialist type of therapist to help you work through that. And there are not drugs that are effective at treating that, but we are going to talk about CBD and particularly psilocybin, but there are other therapeutic interventions like EMDR, which is eye movement dysregulation and hypersensitivity retraining, resensitivity, retraining, which basically is gonna tap into the healing powers of the brain to help a person begin to make connections with their trauma and begin to heal. And DNRS, which is Dynamic Neural Retraining, does the same thing differently. It begins to rewire the neural network of pain and associated with the trauma in the limbic system. system where our emotions and our responses to emotions originate and perpetuate. And so, there are definitely therapeutic interventions beyond the typical that we have now that you wouldn't have had in the past.

So, EMDR can be effective. There's also transcranial magnetic stimulation, which is using magnets to change the frequency of the brain, and that can also seem to help with PTSD.

Right.

So there's a lot of options for people.

But now to the real, the really cool thing that you brought up was the CBD and the psilocybin. And, you know, Michael Pollan's book, How to Change youe Mind, I think you've actually interviewed him here on your podcast. Yeah, how to change your mind.

How to change your mind. Yeah.

Which has been on the podcast.

You can listen more about his approach on that. And, you know, he has a podcast.

In that book, you know, he outlines the history of psilocybin. since it was discovered by Albert Hoffman and in LSD. LSD as LSD. But more recently, you know, it's now being approved for research. It's being approved for use in people with anxiety, post-traumatic stress disorder, and depression. And it's being found that when you people take guided psilocybin trips, they can begin to rewire how their brains work, they can begin to reconcile past trauma, and when they come out of their trip, the studies have shown that their anxiety and their depression, their sense of fulfillment and happiness, has increased and it's maintained over a long period of time after one trip.

It's pretty amazing after one treatment, it's not like you take the drug for the rest of your life like all these other drugs. So, I encourage you to explore this. There's a website called MAPS, which is psychedelic research that is being done around the country and around the world. And I think there's some states that have decriminalized psilocybin. There are some states that have approved it for therapy like Oregon. So, I think we're on the verge of a real breakthrough in psychedelic treatment, particularly for people with real trauma and PTSD. If you've been listening to this podcast, there's a lot of information here about the real causes of anxiety, PTSD, and mental illness in general, things you probably haven't heard about from your doctor. All the variable things that we discussed from hormones to toxins to the gut to nutritional status in our diet and our inflammation in our brain and how all these can be addressed through a very comprehensive functional medicine approach. And how if that really isn't enough, there are all these other options, whether it's transcranial magnetic stimulation, EMDR, psilocybin assisted therapy, or even things like CBD oil, which is safe and it's not illegal. It's a derivative of the marijuana.

I see huge benefits with my patient's anxiety. Yeah.

So, I think this is sort of a new age of psychiatry now, which is very exciting because the old one was pretty bad. And, I'm just so thrilled that at the Ultra Wellness Center here in Lenox Massachusetts, we get to use these advanced approaches to really help so many patients with treatment for problems that they've struggled with for a long time and haven't gotten solutions. So, George, thank you for what you do here. Thank you for your work and caring so well for all our patients. And if you love this podcast, the House Call special edition of the Doctor's Pharmacy, please share with your friends and family. I know a lot of people want to hear this. And also subscribe wherever you get your podcast, leave a comment, how you've maybe had to handle your anxiety issues, what's worked for you, what hasn't, if you have PTSD, what you've learned about it, and we'd love to hear from you. And if you like this podcast, again, keep listening because we're gonna be here next week for another episode of the Doctor's Pharmacy.

Great talk, Mark.