Episode 53: What if it's NOT Depression? With Dr. Achina Stein

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi ladies. Welcome back. So today we are talking about something super, super important. Depression, or is it really depression? I am talking to a certified psychiatrist who's been in practice for a long time and she wrote a really important book, what if It's Not Depression? So when I first read this, I was like, yes, this is so important to my listeners because, right. So many of us are being offered antidepressants for whatever symptom. You know, you're tired, you have brain fog, you're not motivated, you can't sleep, you're going through menopause. I see doctors prescribing antidepressants for a multitude of symptoms and you might really not need it. It might be something deeper than that going on. So I love that she has pulled the sheets back on this one. She's exposing the truth that we give out antidepressants too easily. It's kind of like birth control pills. It's the pill for every ill when it's really not and it shouldn't be. And so this is a really important conversation. So let me just sing her praises real quick. Dr. Chena Stein. She's a board certified psychiatrist for over 25 years. Her osteopathic roots set her apart from her conventional psychiatrist because of her use of osteopathic philosophy and biopsychosocial treatment techniques. However, through her many years of practice, she came to understand the limitations of conventional treatment with medications and she now incorporates a multitude of integrative modalities. This was propelled by her son's health crisis in 2010, which she touches on a little bit. It's a really good story. You need to hear it. And she found functional medicine and it resolved his health problems, his mental health problems, and then she solved her own problems and went on to become certified in functional medicine. And also she's certified by the American Board of Integrative and Holistic Medicine. So she is well overqualified, tons of experience, and she has the insight that you ladies need to hear. So Dr. Stein is a Distinguished fellow of the American Psychiatric Association. She was awarded the Exemplary Psychiatrist Award by the national alliance of Mental Illness of Rhode island in 2008. She's lived in Rhode island since 2000 with her husband and three young children and she's presently in private practice in Rhode Island. She's the co owner of Functional Mind, llc. So this is an exciting time for her because she's recently like in the midst of launching her online health coaching program called Healthy Self Boot Camp. So we're gonna talk about that at the end a little bit. But the links are in my show notes. I want you guys to check her out and her book, what if It's Not Depression? You can get as a free PDF download if you go to her website. So those links are in my show notes. So so much important information because what if it's as simple as a nutrient deficiency or a toxic burden or a stealth infection? Like we're going to talk about reasons that you may not actually have depression. You may have something else going on. So super important topic today you guys. So stay with me through the whole thing. If you have to pause and come back to it, that's the beauty of the podcast, right? And I would love it if you would hit the subscribe button. Tell itunes that you want more of this. That's the only way they'll know. And if you are really enjoying it, you could give me a five star review and shoot me something. Let me read review real quick from Jen J. Excellent resource covering so many relevant health topics for women. Thank you, exclamation point. Thank you, Jen. I love it. It's so good. So shoot me your questions, let me know what you want to listen to. I appreciate everybody's topic ideas. You guys said I need to hear why am I getting put on antidepressants for menopause. I'm not depressed. I will tell you that the conventional medical system has been trained by the pharmaceutical companies that you need that medication to get you threw your hot flashes and night sweats. So, you know, we had this study come out in 2003, I think it was the Women's Health Initiative. And they scared everybody off of their menopausal hormone pills. And so the pharmaceutical companies said, okay, what can we do now to, you know, get people back on some medication? We're losing tons of money here. And they came, they started studying antidepressants as relief for symptoms for hot flashes, night sweats, insomnia, all that type of thing. And the studies, they're pretty pathetic. You know, they showed, like, 1% improvement over placebo or something ridiculous. And so the FDA approved it and said, yep, you can. Those are indicated uses. And so now that is our next go to. We do use hormones. That's a whole other topic. But let me just say that just because a medication has an indication for that or is being used for a symptom doesn't mean that is the best answer for you. I believe deeply down to my core, that our bodies were created to be imbalanced on their own and not require medications to survive and thrive. Medications are a band aid. They help with symptoms, but they also cause more symptoms, new symptoms. I believe with all of my heart that if you remove the impedances, you remove what's causing a lot of the problems. Your body will get back into balance and feel good again. So we need to figure out, why are you not sleeping? Why are you exhausted? Why do you feel so depressed? Why do you want to eat the crap in, you know, the pantry that's calling your name? There are reasons, and it's not your lack of willpower or your lack of motivation or you lacking as a woman. I promise you there's some physiological imbalance. There's bad bacteria growing in your system. There's a stealth infection hiding out in your root canal. There's mold toxicity built up in your cells. There's too much pesticides. There is something that needs to be removed for your body to be able to do the function that it needs to do to get back into balance. So please stay tuned for my conversation with Dr. Achina, because she's super wise, and this is a really important topic. If it doesn't affect you, you probably know somebody who it directly affects. So share this episode with them. Super important. Okay, here we go. Well, welcome, Dr. Gina Stein, to the Functional Gynecologist podcast.

Thank you. Thank you for having me.

Yeah. I'm so excited. This is such an important topic for women to hear about. I mean, I it all day, every day in my practice. You know, people being diagnosed with depression, being put on medications, and oftentimes not feeling better.

Right, right. Yeah. That's usually the only solution for a lot of people, unfortunately.

Yeah. So you are a conventionally trained psychiatrist. So you went through medical school like I did. You had your traditional residency. You learned all the medications. Right. And it might not always be depression. Tell me how you figured that out.

Well, I mean, I practiced in a community mental health center, and there were points where I would come to a point where I had a patient and they were just not getting better. And when I did an evaluation, I would look at the biology, the psychology, the social aspect of their life, kind of broke it down. It's called the biopsychosocial approach in psychiatry. And I did psychotherapy as well, and we had case managers to try to help patients along the way. But there was always something that I felt was missing, something that I didn't know that was missing. And so I thought, you know, I'm going to get more training in terms of looking at the integrative approach, looking at integrative possibilities. Maybe that's what I'm missing, and I just need to know more. And so, you know, I started searching for, you know, other types of training. But in the midst of that, my son had a major psychiatric crisis, so to speak.

Oh, wow.

Yeah. At the age of 14, we were actually in France. My husband is a professor, and we were. He was on sabbatical. So we took all. All three of our kids out of school and basically homeschool them in France. And there was this day where he and his brother had a tiff. And he was suddenly on. Outside of the apartment on a ledge when we were five floors up, wanting to jump.

Oh, my gosh.

Yeah, it was. It was horrific. And it was something that happened literally overnight. There was no sign of this happening. I mean, he had some. Was missing his friends, and, you know, he had a tiff with his brother, which, like, that shouldn't lead to something like that. There was just no sign. So, you know, long story short, when we got home, I had him see a psychiatrist that wasn't me. And, you know, he was put on medications. He was put on three or four medications. He was seeing a psychotherapist, and he was out of the woods, so to speak. But he was not my son. And so he had anxiety, depression, sleep problems, and a lot of trouble with attention. But the thing that really made me think there's something else going on here was the fact that he could no longer read.

Oh, my gosh.

Yeah. So. And nobody can find answers. Like, nobody could tell me answers. I mean, you know, so it was just nobody. They just like, okay, well, he can't read. You know, like, you know, it's just part. They kind of just rolled it all into, well, you know, he's depressed. It's like, no, something's not right here. So I figured, like, okay, I need to do my own research. And I happened to find a functional medicine doctor. And I was so. And this was really more finding a functional medicine Doctor to help with my patients. Little did I know that once I saw the kind of work that he was doing because I was on the search to help my patients, that I was like, oh, my gosh, I have to bring my son here. And so I did. And long story short, he did his thing as a functional medicine doctor, looking for root causes, finding all the sources, bringing the body back into balance, and all of his symptoms remitted completely. And I started shadowing him, this doctor. And I ultimately left my practice as the medical director of Community Mental Health center her, which was literally down the road for me to drive an hour away to work for this practice. Because once you know what you know, you just can't go back. I mean, you just can't. So. So it really. It really was a journey for my son and for me. And then. And then, of course, once you know that stuff, you realize all the things that are wrong with you.

You know?

And I had Hashimoto's and Epstein Barr, and I had hormonal issues, so you could have a field day with me. But all of my own issues had improved as well. And I was actually on an antidepressant for a number of years because I had Hashimoto's thyroiditis and caused lots of mood swings and the Epstein Barr and fatigue and just stress and racing for kids. It all rolled up into this big thing. I ended up having to be on antidepressants, and I actually stopped taking them about a year ago because I got my body back into balance. I needed to prove to myself that I could do that and that it's doable. And in that process, I also helped a lot of other people come off of antidepressants. But I felt like I needed to do this and prove it to myself that I could. And it's been a year, and it's been fine.

That's amazing. I think more doctors need to have their eyes opened.

Right.

I wish every doctor could go on that path and find functional medicine. I think that how most of us find it is our own personal journeys or our family's struggles.

Exactly, exactly. It's always been that way. It really makes you. You get so frustrated with the medical system that you really have to find your own way and do your own research. And there are. And when you're. I shouldn't say desperate, but, you know, when you really keep hitting walls one after the other and not getting anywhere, and I just can't, you know, I just did not want to see my son be there, and I really had to do a lot of soul searching. It's like, oh, my gosh, I've been giving people medications for but 20 years. Right.

Same scenario a lot. A lot of times. Exactly.

Right.

And same thing with birth control pills for women. You know, it's like this pill that just fixes everything magically, you know, like.

Right. Oh, you need.

You're tired. You need an antidepressant. You're an antidepressant. You're sleeping too much. Need an antidepressant. You're menopausal. Oh, you need an antidepressant. It's like, wait a second, what's going on? So, Dr. Achina, I want you to talk about, like, what are the possible reasons to have those symptoms? And it's not actually depression, because you write about this in your book. Right. What if it isn't depression?

Right, right. What if it's not depression?

Yeah.

Oh, it could be a whole slew of things. I mean, first of all, you know, my biggest pet peeve is that there are tons of conventional diagnoses that aren't ruled out. Like, they should be part of the dsm. You know, one of the lines in each diagnosis is that medical cause should be ruled out. So, you know, I don't think we do enough to rule out, really investigate and rule out medical causes of depression or any psychiatric illness. Actually, sometimes it could be as simple. Actually, I was on a call with a patient who initially saw me for attention deficit disorder, and he was on his wife. It's always the case. Right? His wife made him see me. Well, actually made him get treatment. And he did not want to take medications for his attention deficit. He had issues with stimulants. And so I know we're not talking about antidepressants, but it's a similar kind of situation where he learned that if his wife wanted to stay, if he wanted to stay married in this relationship, he had to get help. So that's what forced him to come in. So he was taking. He had a bad reaction to stimulants. He didn't want to do that. So that's why he chose functional medicine. So we're going through the root causes, and we come to find that he has been drinking enough alcohol to cause him to have enough symptoms that he was not able to function in the way that he needed to function on his job. And it was. Some of those symptoms was add, Attention deficit disorder. And he had fatigue and he wasn't sleeping at night. So he had a whole slew of symptoms. But what brought him to treatment was not even the ADD symptoms. It was his wife saying, you better get help. But the thing is, alcohol, I mean, that's a major part of our culture, and lots of people drink tons of alcohol and don't really realize how it's affecting them. And that isn't even investigated in a conventional way enough, you know, to be able to say, I mean, they might ask the question, but not really asked in a way to really get the details and make known to that person, like, hey, you know what? That's a lot of alcohol, you know, and even if it's considered socially normal, it might be a little too much for you in the way that you're experiencing it, you know? So, I mean, so a lot of times people are given a diagnosis of depression without really ruling out substance uses. You know, it's not ruling out other medical conditions like hypothyroidism, like menopause and perimenopause, like vitamin deficiencies, like folate deficiency, B12 deficiency. So I think we need to do more to rule out real conventional medicine causes, which I do do in my practice as well. But then there is the part where functional medicine doctors know that most conventional doctors don't know or don't really pay attention to is the physiology of how the body functions and what we put in our body and how our body deals with it, or we're exposed to our body. So mold. Mold toxicity is a major cause of depression. Major Lyme's disease. Right, Major cause. I've actually diagnosed Lyme's disease because they actually look, there's a certain presentation that I find for people who have major depression due to Lyme disease. And we don't do enough research to even be able to do. But I've seen enough people where I see, say you need to be tested for Lyme disease because of X, Y and Z, you know, so it's a matter of having the time to get the details of a person's history because people don't remember. But it's also really digging and digging and digging. That's what I feel like I'm really good at, especially because I'm trained as a psychiatrist to do that anyway. We spend lots of time with our patients as it is. But most psychiatrists aren't trained to really dig for how things are connected physiologically and in terms of looking at food, whether or not you've had infections, exposure to toxins, and then stress. It's like those four things and then the hormones, right? The whole hormone piece. So those five Areas is what I look at when I take a history.

Yeah. So important. I mean, I need people to understand that what we put in our body does directly affect us. I mean, I always use the simple example of coffee. Like most people drink it because it changes your physiology. It wakes you up, it makes you feel differently.

Right, Right.

That is a direct effect of putting something in your body and getting a result. And it's the same thing with everything else we're putting in our body. We're just not realizing it. I mean, I will tell you, I suffer from Hashimoto's as well. And when I eat gluten, I will be depressed in bed for three days.

Like.

It destroys my mental health. And it took me almost 40 years to figure out that connection.

Right.

But once I did, it changed my life because now in bed for multiple days out of the month wondering like, why am I so depressed? What's going on? Now I know you just can't eat gluten and.

Right. And what, you know what's interesting is that, okay, so we both have Hashimoto's and we both react to gluten, but I react to gluten differently. I get brain fog.

Yeah.

And I have trouble word finding. You know, I have more neurological type of symptoms as opposed to mood symptoms. And I know, and I mean I had mood symptoms from the Hashimoto's, but not necessarily so I was able to even discern how much of it was related to gluten and how much of it was related to the hypothyroidism and Epstein Barr. So it was a combination of things. It's always a combination of things. It's always two to three things, maybe four, maybe five things that come together that create this perfect storm in a person's body.

Oh, I'm glad you pointed that out because that's super important. You know, people always want the answer like, what happened? What's wrong with me? And it's a multitude of things like you're saying. And it's like an accumulation over your lifetime of things that have happened to your body and how your body can function and handle it. And I think so often we have just accumulated so many toxins that like you said, our liver can't even function properly. So you keep adding alcohol to it, your liver's never going to be able to detoxify basic things. And I find that my patients often don't realize that women should only have one drink of alcohol. They're doing two, three, four drinks and thinking that's okay because it's normal, it's common. But really what the research shows is that for women, one drink is our max that our liver can tolerate, and we're headed for trouble. Right, exactly.

Absolutely.

And like you said, doctors aren't telling patients these things, so they're missing easy solutions. Or vitamin D. I don't know about you, but in Michigan, everybody's vitamin D deficient. And simply getting that up to like 60 or 80, all of a sudden, you can feel like a normal human being again.

Right, exactly. You know, getting back to alcohol, a lot of people, I think, know that it can affect your liver. It's common knowledge. People don't understand how much of that. The other thing that people don't realize is it actually is like turpentine to your gut lining. You know, so it shears. It shears the microvilli off of your gut lining. And so then you're not able to absorb a lot of the vitamins that your body needs, particularly the B vitamins. So a lot of times people who are alcoholics have severe B vitamin deficiencies and can have actually dementia to the point of dementia. So, I mean, that's an extreme. But it's important to understand that there's always going to be some deficiency of vitamins as a result of drinking alcohol because of how it affects the gut lining. So it affects other organs as well, but it's not as commonly known as how much it really affects the gut that's so important.

And it also affects your ability to make your feel good. Neurotransmitters.

Right, Right, absolutely. Yeah. Talk about that a little bit. Your neurotransmitters are made in your gut that at some point gets to your brain. Your serotonin, all your neurotransmitters are made in the gut lining, 80% of it, actually. That is where the microbiome is situated. And it's the balance of the microbiome that actually makes serotonin and other neurotransmitters. We don't really know how it gets to the brain. We have this idea. There's some research that shows that it is through the vagus nerve that we have that information brought to our brain. It's that balance of the brain, gut and brain, that occurs through the vagus nerve. That's the simplest explanation I can make. But we're still doing a lot of research and understanding that better. If we can get the gut in balance in terms of making the neurotransmitters, then it usually brings our brain back into balance and that's how I basically approach depression. The treatment of depression is by finding causes of inflammation. That's a major cause of depression, but it's understanding what's causing the inflammation in the brain. So we want to remove what's causing inflammation, what's missing. And so we want to replace the nutrients and the vitamins and the minerals that are missing in the body so that the brain can function optimally. Reinoculating the gut microbiome and repairing that gut lining. It's figuring out what's assaulted all of those different phases or what's disrupted those phases and really addressing each of those. And ultimately it's finding balance in the system so it doesn't happen again. So stress is a major cause of disrupting your gut balance. And so we want to address. I think that's the hardest thing for people to really work on because it's a practice. It's a noticing and being aware of how much stress people are under. Some people are under so much stress and they don't even realize it because it's just so chronic and really downgrading their overdrive. A lot of times they're in overdrive and shifting down slowly over time. So that's a practice that needs to happen. And people have a really tough time putting that on the front burner, really connecting how much stress can affect their gut and other symptoms. So, yeah, that's. It's. There's going back to different causes of depression. You know, food, there's lots of foods besides alcohol and caffeine that can actually cause depression, but there's also foods that can heal your mood as well. So there's many connections in that way. I find that a paleo modified paleo ketogenic, a healthy ketogenic. I know there's lots of people are anti ketogenic, but a healthy ketogenic diet is absolutely fantastic for your mental health. And there's lots of research to support that. So it's understanding what that really means in terms of what healthy ketogenic means.

I remember the first time I put MCT oil on my salad. I had read the book Eat Fat, get thin by Dr. Hyman. I was like, okay, let's do this. I put the MCT oil on my salad and I swear to God, an hour later, I felt like a rock star. Because, you know, that oil, it can go directly into your cells to be able to make energy. And I was so depleted that it was that obvious to my body. You know, that was pretty eye opening for me. Like food really can heal and nourish you like. It's not just a saying. It's true.

It's true.

So I just, I want people to realize that food is information, you know, information.

Right.

Giving our bodies the worst kind of information, like making you feel ill or amazing information, like giving you all this energy and make your feel neurotransmitters and all of that. So I love that preaching. That is so good.

Yeah. It's not just calories in and calories out.

No.

You know, it really is understanding the whole gamut of all the possible foods. And to me, eating as many vegetables, a rainbow variety of vegetables, if anything, even just making that one change can make a huge difference. But when it comes to the brain, healthy fats are probably going to make, I think, the swiftest change. But in the long run, increasing vegetables. So I try to add foods into the diet and as opposed to removing foods. I mean, unless like, I know absolutely gluten and dairy have to come out. You have to be where the person's at, you know, when you're seeing them and starting with where, how much they know and where they're at. What they're willing to do, what they, what they can do, you physically can do. And so it does require a lot of educating. But I think starting with adding as many vegetables and adding healthy fats is a really, really good place to start. And then maybe taking things out and substituting like gluten full with gluten free. It's a journey and it's a process for a lot of people. But I think in the long run, people do benefit. I think very few, at least the people who filter down to our practices, very few people find that being gluten free and dairy free is like, you know, neutral to them. You know, I. Most people do find themselves feeling significantly better. And there's always going to be a few that can put it back in right after healing the gut.

Yeah.

Yeah.

That's awesome. I think it's just so important, like you said, to remember that it's a journey. It's not going to be fixed overnight. It's multiple things that you have to work on. But so eating vegetables is definitely an easy place to start. Just add a new vegetable once a week. That's what I say. Try a new color that you don't eat normally. I mean, blues and purples are like the least eaten color, but they have so many benefits. So start adding some purple in there once a week.

Exactly. Beets. I cannot believe how much I have never eaten a beet. Until I started doing functional medicine. It's like, how did I not know about a beet? They're so delicious.

Yeah. I grew up eating them, like, hot cooked, just sliced up, and they tasted like dirt. But I ate them and my kids, and they're like, are you.

Were they canned? Yes, those are canned. Yeah. The canned beets are, like, gross. But. Yeah.

But even that, I was thankful that I was at least exposed to it as a child, you know, like. But there's so many more better options, like a beet salad. Oh, so good.

Oh, my gosh. Yeah, I love beets. You. You know what's interesting is that your palate changes. Oh, yeah. As you introduce foods. And I always talk about. With kids, like, even if you get a smidgen in, you know, you're still introducing that little piece of broccoli to their microbiome. And then it's the microbiome that wants more, that will tell your brain that we want more broccoli. And that's how you know that your microbiome has changed just because your palate has changed. It's amazing. So I like, then when you start craving things like kale and spinach and carrots and all of these fantastic vegetables, you know that you've done the work.

Exactly. I mean, I try to explain to patients that those sugar cravings, that's just the bacteria and the yeast talking. It's not you. You don't really want that. And you kill them off, those cravings will go away. I mean, I'm living proof. I lived on sugar and donuts and candy. I was awful.

That's not your fault.

To me. And that's how I. When it stopped talking to me, that's how I realized that wasn't me. It was something inside of my body.

And. Right.

You'll start craving good food. People think I'm crazy when I say, you know, oh, I crave a salad or whatever. It's true. You just have your microbiome.

So that's what it is. It really is. Yeah. Keep working on it. Yeah, that's. Yeah, it's. It's definitely been a journey. And so many people have really benefited from our treatment. And it's. For some people, it can be, you know, maybe three months, and others, depending on what their health issues are, it could be a year or two years. So it's, you know, it's a matter of getting started and taking your time going through it and learning as much as you can about foods, you know, toxins, stress. And I think the hardest part is probably really figuring out what chronic infections are on board. People don't quite understand how much that can impact you and that it's a body burden that creates a great deal of stress. And so most people think that, oh, if I have an infection, why, you know, I would have a fever and, you know, I'd have chills and I'd have, or I'd have diarrhea, you know, I'd have these. Or vomiting, would I write, you know, these acute symptoms. So what we're talking about is chronic, chronic infections and.