Beyond Serotonin: Debunking SSRIs for Depression and Mental Health, with Dr. Miles Nichols

People were saying, hey, I came for my gut issue, but my anxiety is completely gone after treatment. There are big connections here, actually, between gut issues, infections, toxins, and mental health onset than there is for neurotransmitter changes in the brain and things like depression.

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Welcome to another episode of the Feel Freaking Amazing podcast with look who's here with us today at Levitan. And we're delighted to be introducing and interviewing Dr. Miles Nichols. He is a functional medicine doctor who specializes in Lyme mold, gut, thyroid autoimmune disease. He's authored two books and founded the Medicine with Heart Functional Medicine clinic in Colorado as well as the Medicine with Heart Institute, which trains other providers and doctors in functional medicine. So, Miles, welcome. We're so happy to have you here today.

Thank you. It's an honor to be here.

Awesome. So you wanted to talk more about mental health issues, right?

And brain health as a whole. Mental health being one reflection or symptom that can be a sign of some other things happening in the body and, or the brain and maybe some other aspects that we can broaden the conversation beyond what I think most people think of as mental health into, into overall psychological well being and emotional spiritual well being with a lens on. Okay. If someone is struggling with depression, with anxiety, yes, we can go there too. And I'd like to not limit us to that kind of place to be able to also speak to how do people function, relationships in their lives, how do they feel in their heart? These kinds of things too. I open to, to discussing.

You've obviously treated a lot of patients and when you say brain imbalances, I mean, you talked briefly that you didn't want to just talk about anxiety or depression. And let's talk a little bit about anxiety depression because everybody, because just about all of us have that. So let, let's. Or we see that very. That's like the most common thing is anxiety. Depression are both, they're a little bit on the spectrum depending on who you ask. So how does that, how do you view that? Where, where does that fall and how does that work with the brain and the mental health? And what are the connections, things for us?

Yeah, yeah, yeah. And the big picture of that is, is that it's on the rise and the stats don't look great for, you know, if you, if you look at sort of the, some of the mental health statistical organizations that are trying to track metrics around this, it's really, you know, more than 1 in 5Americans in a given 12 month period is struggling with a level of a mental health concern that would be diagnosable. And when it comes to anxiety, it's about 19, a little over 19% of Americans with, you know, again, in a year period of diagnosable, you know, anxiety. And diagnosable means it's not just minor, it's not just like kind of, you know, kind of anxious about the day to day. It means it's getting in the way of life. It means it's functionally a problem for the person to either have a quality of life that's not great or to really have disruption in their function in life. And depression's about 8, 9%, so it's a big issue.

So hold on, how much overlap is there? Are we talking essentially 30% of the population at any given time or are we saying that there's a fair amount of overlap and so it's more like only 25% because some of the people with anxiety have depression too. Like that's just like you're like casual, like. Yeah, one out of every five. I'm like one out of every five. Dude. Like we're talking a lot of people.

Well, and, and well, the thing that, the thing that I'll highlight what you were saying is that it's the diagnosable because I know a lot of people that are really, well, that are really anxious but may not be, quote unquote diagnosable but, or diagnosed like, or diagnosed, I guess, but it's still, it may not be getting in the way of their daily life severely, but it's getting in the way of life. It's getting in the way, absolutely.

Yeah.

And I think a lot of people have diagnosed a bull, but without the diagnosis too. So that's another matter. But certainly, I mean, if we're going to look at a spectrum that's, that's beyond the classification that would put someone in the box, then we're dealing with a huge, huge, huge percentage of the population and it's growing too in young adults and adolescents. We see that if we look at a lifetime prevalence for adolescents today, that's more than, that's about half or so. We're really more like 1 and 2 if at some point in their life they would have been able to be classed or categorized in one of the mental health disorders. So that's significant too. And, and it is a grouping. So, you know, the overall for adults is about, you know, it's a little over 20%. But it really is important to emphasize that that's diagnosable. And some subgroups are a lot more so. For example, those who have been diagnosed with irritable bowel syndrome or IBS or have gut problems, let's say things like diarrhea, constipation, bloating, abdominal distension, these kinds of symptoms tend to get, as long as there's not inflammatory bowel disease or another diagnosis, they tend to get lumped into this irritable bowel syndrome diagnosis for these people. There have been studies that look at people diagnosed with IBS and they find that in that population, in that subpopulation, the percentages are much higher. So if we look at anxiety in that subpopulation, we're nearly double. We're really around 40% or so in that population. And when we look at depression, it's nearly triple. The general population, it's about 25%. About a quarter in that population are depressed. So the chicken and egg scenario, what comes first? Is it the IBS that's causing the mental health issue? Is it the mental health issue that's affecting the gut? We know stress can affect the gut, but we also know gut bacteria and the vagus nerve connection and endotoxemia from leaky gut or intestinal permeability all can cause neuroinflammation that might contribute to mental health development. So I think there are many mechanisms by which it would be explainable to understand why we're seeing double, triple the amounts of depression and anxiety in those who are struggling with gut diagnoses like ibs.

Crazy.

That is crazy.

Do we know what's driving the overall increased anxiety, depression outside of ibs?

Well, let's circle back to the history of, like, the ideas of what, what causes depression, because we have to kind of go there if we're going to answer this question. And so if we're going to what causes depression? This goes all the way back to the 1960s. In the 60s, there was some research that was looking at some Brazilian populations that were deficient in an amino acid called tryptophan. And so they were seeing that the depression rates were a little higher in a community, that community's diet was a little more deficient in an amino acid called tryptophan. Than the surrounding communities that didn't have as much depression. And they thought, huh, I wonder, is depression connected with tryptophan? Because tryptophan we know is a precursor for serotonin in the brain. And the brain uses tryptophan as a building block to convert into serotonin. And serotonin is this neurotransmitter that at the time very little was known about, but that the thought or the theory was maybe, maybe that's contributing to depression. There are a few other studies that came along over the years. And then a drug class a couple decades later was created. The selective serotonin reuptake inhibitors, SSRIs that basically take serotonin, that neurotransmitter, and they prevent it from being reuptake or taken out of circulation and keep it in circulation longer in the brain. And what that does is it makes whatever amount of serotonin a person has available for longer. So it's almost like there's more. And what that does is the theory behind the drug company's idea around this was that, okay, that might affect depression. Because we had these studies on these tryptophan deficient populations and depression. So let's study depression. They got through all three phases, phase trials for the medication. They found that they were statistically significantly better than placebo at helping people with depression. Interestingly, an umbrella review just came out year ish ago. Within the past two years, an umbrella review of meta analyses and systematic reviews of all the tryptophan studies, the serotonin studies and depression studies came out and said, you know what, if we look big picture at all these studies, the conclusion of this was there is no connection between serotonin and depression. There's no connection between serotonin deficiency and depression. There is no good statistically significant connection between tryptophan depletion and depression. And this was kind of, it's kind of a landmark study that's been highly controversial. There's a lot of thoughts and opinions floating around. But to me it tells us, have we been looking in the wrong place? And when I see studies like the IBS study that show double, triple, you know, rates, I think, well, maybe, maybe if we look at gut, maybe if we look at also a couple other areas post infection encephalopathy is an area where there's research for chronic infections contributing to brain function or structure changes that may contribute to mental health issues. And there are toxins that we know that also can affect brain and neuroinflammation in the Brain and systemic inflammation that may be impacting people's mental health to significant degrees. And things like mold and mold toxins are one in that category. That if we start to. For me, when I started to open my eyes to this and look at research, and I kind of came to it because I was treating a lot of Lyme and mold and infections and gut issues, and people were saying, hey, I came for my gut issue, but my anxiety is completely gone after treatment. I thought, huh, that's strange. But now I don't think that's strange because I dove into the research and I see, oh, there are big connections here, actually, between. And there's probably a way better research link between gut issues, infections, toxins, and mental health onset than there is for neurotransmitter changes in the brain and things like depression. So that led me to think about, in terms of why are we experiencing so much more depression anxiety in the world today as compared to historically? Well, we have a big onset of. And a lot more gut issues due to things like overuse of antibiotics, things like cesarean section burs, things like the glyphosate sprays and some of the other things. Pesticides, herbicides, fungicides.

Oh, you said it.

The magic.

You're now in trouble. Now you're in trouble.

Glyphosate is my personal hot button word. But it's more in all the toxins, too. Right? Because, you know, we're developing thousands of toxins every year, and we're exposed to thousands more toxins every day, week, month than we were when I was born in 1970. Certainly, like, the. The level of exposure has increased. It's corrosive to the gut. The gut can't deal with it. And then when we know that 80% of our 70 to 90% of your serotonin is produced actually in your gut, not your brain. And your gut is a hot freaking mess. It's not surprising. It's like, oh, this makes sense, actually. And he said the magic word. So you. I want to change subjects a little bit. When you're looking at people, what are you testing them for? What are your favorite tests to look at? What's going on?

Yeah, a lot of times it depends on where they've come in. I get a lot of people who have been to 3, 4, 5, 6 other providers, and many of them have gone really, really deep into gut work and they haven't seen the benefit. They've maybe gotten a sibo diagnosis or they've looked at the stool, or they've looked food sensitivities and food allergies and they've done a lot with their diet and they've done a lot with supplementation and they've done a lot with general blood sugar and metabolic function. But what they haven't done is they haven't gone deeply into testing for and treating infections and toxin issues. So that of course if it hasn't been done, I really like to do tick borne and co infections panel to look for Lyme, Babesia, Bartonella or Lykia, Anaplasma, rickettsia, these kinds of things. And then I really also like to do a neurologic antibodies panel that looks at, there's a panel that looks at 48 different antibodies against the brain structures. So for example, dopamine receptor 1 might have antibodies against that dopamine receptor 1 or dopamine receptor 2 or tubulin or other structures in the brain that impact mood, that impact brain function.

Like who, who's running that? I don't think we have that test.

Let's see, they're Vibrant or Cyrex probably. Right.

There's one called Moleculara that has the Cunningham panel and that's, that's five antibodies. That one's quite good. And then there's the Vibrant Wellness which has many more. So the 48 autoantibodies. And it also looks at a few of the antibodies against some of the viral infections that are known to cross react with brain tissue are in that panel as well. So it also looks at some viral antibodies together with neurologic antibodies. So Vibrant Wellness is the one that I typically run because it has so many more antibodies on it. But the Moleculara Cunningham panel is also quite good. So both of those.

But when you see these antibodies against the brain, where do you go from there? Is it saying, okay, the immune system is completely jacked up so we now need to bring it down. And then you're looking for infections, toxins or what, gut dysfunction, like where do you go from there?

And when it comes to brain antibodies, I'm looking for and theorizing about what the trigger or triggers are. And I say triggers because usually it's not everyone wants one smoking gun, one flaming you sort of cause, but it's usually multiple. But that being said, you know, it becomes an investigation of, okay, we have now a baseline level, let's see if we can identify triggers and treat them and then let's redo and see if they're dropping. And I've started to notice patterns of antibodies that seem to have probable cross reactivities although I haven't. There's not a ton of research on these cross reactivities yet. But what I do notice, for example, is that a pattern of dopamine receptor 1, CAMK2 glycine receptor antibodies often seem to go together with Lyme or Bartonella. And I just, that's just a clinical observation that I've noticed. So there's no research that I know to say that for sure. But I do find that when I treat Lyme or Bartonella that I do often see that pattern of antibodies going down and going the right direction. Whereas certain other ones don't seem to some of the myelin, the demyelination antibodies don't seem to respond as well. And those seem. Maybe there are other triggers, but it just depends. So, so the way I use it, I use it like, almost like a barometer or tracking how on the right track are we to recovering brain function? But it doesn't tell exactly what we need to treat in order to get there. It just tells us if we're on the right track as we retested, if they're going in the right direction versus wrong direction.

I have a dumb question. I'm like a nitty gritty human. I remember in biochem in med school, I was like, where are we in the body? Could we just orient for a moment? And the teachers are like, why do you need to know that? Because I don't understand what's going on here. What's happening? Dummy this down for me. Miles, when you do this brain testing, is 100% of that panel whom you're testing on, do they fall into the anxiety or depression category that hasn't responded to a traditional functional medicine approach or, or is this just kind of all comers? And then you go back to your 20 to 25% of the population have difficult to treat anxiety or depression.

Yeah. So I'll, I'll do neurologic antibody testing on a variety of people even who don't have those kinds of symptoms. Especially, I mean, oftentimes there, there may be a neurologic symptom that's neuropathy, or it's chronic fatigue, or it's chronic pain pattern that isn't structurally explained, or it's significant brain fog, or it's headaches and, or migraines. There are many different manifestations, even things like seizures. And so different manifestations and different autoimmune conditions. Multiple sclerosis relates often to those demyelination antibodies. And so if there's, if there's any autoimmune pattern regardless of if someone has Hashimoto's if someone has any diagnosed autoimmune disease, we know the stats for other antibodies go up significantly. So I will often do neurologic antibody testing on someone who has any antibody whatsoever or any neurologic symptom that's significant whatsoever and not just mental health symptoms. So I will test more than just people who have mental health symptoms.

Well, where can people find you? Because you've got a lot of information, I think it feels like you're just scratching the surface, right?

Yeah.

Yeah.

Best place is My clinic is called Medicine with heart and medicinewithheart.com is the best place where there's a free blog that's available that has a lot of information that comes out. So we'll put out information about some of the topics that we've been talking about today. A variety of things related to mental health, things related to optimization, things related to infections, toxins, gut function, all that goes in there, autoimmunity. So there's lots of free information in the blog there. And if people want to get in touch with the clinic, find out more about what that's like to work in the clinic, they can book a call there with one of my staff members to discuss that. So medicinewithheart.com is the best repository in place for information and from there you can get into the blog and get into some of the other areas that we cover.

Awesome.

No, it's been very educational. Really cool. Yeah.

Miles, thanks you. Thank you for being here and for the listeners, thanks for joining us for another episode of the Feel Freaking Amazing podcast. If you love it, give us a thumbs up and pass it forward so people can transform their health. Because you're meant to feel freaking amazing. So Miles, thanks for being here and we look forward to chatting with you again soon.

Appreciate it. Thank you so much and take care everyone.

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