Reverse Depression-like Symptoms, with Dr. Achina Stein

I feel like many people are inappropriately given a diagnosis of depression and it's often used as a waste basket diagnosis because sometimes people just don't know what else to do. So it must be depression. It's almost like the default thing. That's what you have. And it does take certain amount of training to really look at root causes.

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Welcome to another episode of Five Journeys Live like youe Matter podcast. Today we're so excited. We have Achina Stein, who is an American Board certified psychiatrist with over 25 years of practice experience. She uses functional medicine to help patients find the underlying cause or root causes of illness and the nutritional and biochemical imbalances that might be contributing to them. Since 2016, Dr. Stein has been seeing patients in her private practice called Functional Mind llc. And after writing her book what if it's not depression? In February 2020, she launched a companion program to coach those interested in working with her across state lines. Welcome, Atina.

Welcome. Welcome.

Thank you, thank you for having me.

And we're super delighted to have you because, full disclosure, we work together. Right. And you've been up to a lot since then. So tell us about the book because that's really exciting.

Yeah. Well, you know, a lot of people, the reason I wrote this book and it's called what if It's Not Depression? Is because a lot of times people will come to me and they will explain that they have all of these symptoms and they've been given a diagnosis of depression, either major depression or mild clinical depression. And they're offered only two options, an antidepressant or psychotherapy and. Or psychotherapy. And sometimes people think, you know, like, I don't think I'm depressed. You know, why do they think I'm depressed? And it's usually because they are experiencing symptoms that tend to accompany the feeling of depression. And they might be down, but not, not because anything happened to them where they could say, oh, this happened and because of this, I'm depressed. Right? It's. It's symptoms of fatigue and concentration problems, sleep problems, appetite problems, you know, maybe some difficulty thinking, you know, in their thinking. It's almost like burnout. Sometimes burnout can look like depression. Right. And so it's. I feel like many people are inappropriately given a diagnosis of depression, of clinical depression, a true clinical depression, that they're not necessarily given a good workup to rule out the medical causes of depression. And it's often used as a waste basket diagnosis because sometimes people just don't know what else to do, especially if they're seeing a primary care provider that only gives them 15 minutes of their time and that's all that they have. You know, my book basically unpacks how all the variables that are looked at in terms of that have come together that created this system where people are given this wastebasket diagnosis. So it's not that these are bad doctors. It's really a system that's in place that makes it hard for us to really do a proper evaluation and really look at all of the causes. And maybe an antidepressant is appropriate in many cases because they are life saving. There's nothing wrong with prescribing an antidepressant, but it's important to do it properly. Rule out medical causes, rule out root causes, in my opinion as well. So even if you needed to use an antidepressant, you could potentially come off of those medications in the long run and learn how to take care of yourself because that you've really fixed the problem instead of just putting a band aid on it, so to speak.

I will say I'm so reminded of two things here. One, I remember when my mom got Addison's disease, or really got sick from it. She couldn't get out of bed. She was vomiting all day. She was very bronzed. And she had to go to about eight doctors before someone would actually. She had to be hospitalized because her blood pressure was 60 over 40. It was practically undetectable. But about 5 of those doctors, I'm sorry, they were male, by the way, in the 80s. About five of those doctors said, you're just depressed. And she's like, well, I'm getting depressed because I'm sick. But she wasn't truly depressed. And they said, oh, you're just depressed. Here's a medicine. And she said, I don't need that. I'm vomiting, I have dizziness. So it really is amazing how it's easy to put people in a wastebasket of. You're just depressed.

Yeah, no, I'm actually thinking my first. I'll say what it is in a second. But my patient came in with a. This was when I was starting out, came in with a wheelchair. And I asked her what what's going on? You're a young 40 something year old. Why are you in a wheelchair? Because you're depressed. And depression causes apparently wheelchair boundless. So that was my first patient of true Lyme disease that I found out and discovered afterwards. But it's funny how people, if you don't know anything. Yeah. Depression, like you said, is a wastebasket diagnosis.

Like ask us for the paps, we don't know what it is, you must be depressed. So if someone's listening and they're saying, okay, well I kind of thought I was depressed, but what else could it be for the listeners? What are some of the things that would masquerade as depression and are really some other issue? What are like the top whatever, three to five.

That's a very small list, right?

I know, it's a quickie.

Yeah, yeah, yeah. Well, besides looking at the traditional things, which is the biological, which is, you know, hypothyroid, B12 deficiency, folate deficiency, vitamin D deficiency, there's some nutritional deficiencies, there's a whole host of medical issues, even medication side effects. I mean these are real traditional things that people, traditional doctors should actually rule out. You know, alcohol, you know, drugs, there's a whole list of those just traditionally known. But there's, you know, psychological piece, you know, trauma is a major root cause of, of depression. And sometimes people can't overcome trauma because of these other medical issues. And of course the social reasons, like you know, toxic boyfriend, toxic partner, toxic workplace, these are all issues. And you know, and then there's, you know, spiritual crises. You know, these are all things that can be addressed. And that's typically in a good psychiatric evaluation, these biopsychosocial issues are covered. But then there's the functional piece. And really looking at the physiology of the body and sort of looking at where is the breakdown in terms of the supply chain. So there's foods, right? Foods where foods are turned into amino acids which then are manufactured into neurotransmitters that are then used by your brain. So if there is a breakdown in that chain, then you're going to have a problem. But besides not having the raw materials, there's also an inflammatory component of food and there's, you know, so food's medicine, there's. And which can, and so foods can cause inflammation, but there are also foods that can heal. And there's chronic infections. Chronic infections can burden the immune system and cause it to sort of fall apart, become dysfunctional and even prevent you from absorbing or breaking down those foods causing a DYSBIOSIS and, you know, there's a thing called small intestinal bacterial overgrowth that can cause iron deficiency and B12 deficiency, things like that. So chronic. There's lots of chronic infections. There's foods, infections, toxins. We're surrounded by toxins. And we put toxins in our body, on our body. We breathe in toxins.

We just wrote a book about that, actually.

Yeah, you did, didn't you? And no, stress. Stress is a big one. So stress is huge. And a lot of people don't even realize that they're even under stress. Those energizer bunny moms that are jack of all trades, taking care of the parents, taking care of their kids, working full time, and they don't even know that they're under stress until things kind of fall apart where two or three things come together, causing them to sort of tip. And all of those affect our hormones. Right. So, yeah, hormones, particularly cortisol hormone, can really be destructive over time, especially if it starts young in childhood from the stress caused by any kind of childhood abuse or adverse effects during childhood. So that's that in a nutshell. Right? At least those five things.

I have one comment and one question. One comment is, unless I missed it, you didn't talk about sleep. Because I know I was a raving lunatic when I did not sleep and I was practically clinical.

Top 10 things are better, though.

Top 10 things not to say to your wife. That is one of them. So anyway, sleep is one. And then can you say a little more about infections? Because you mentioned gut infections, But I know a lot of people with Lyme or any of the CO infections will appear anxious or depressed, particularly for children.

And.

And yet the depression isn't the problem. It's the Lyme or the CO infection that's the problem. What other infections are you seeing that mimic or show up as depression?

Well, Candida is a type of yeast. It's a yeast that is part of our normal flora. But it can get out of control due to multiple variables, a combination of multiple rounds of antibiotics. It can be due to taking steroids.

Birth control pills, simply too much sugar, eating too much sugar, too much sugar.

Being sad, a different type of depression, eating a sad diet.

Standard American diet.

Yep. Yeah, the standard American diet is full of processed foods and sugar. And sugar is definitely poison to your body in so many ways, not just your brain. So ultimately, you know, these things cause inflammation. So Candida, there are multiple types of bacteria that can cause, like strep, can cause pans and pandas, and that can be accompanied by depression, that this inflammatory cascade that can affect your brain.

So basically what you're saying is anything that we do in functional medicine basically can come down to anxiety, depression, feeling sad. Basically the whole functional medicine workup.

Yes. I mean, I mean depression is caused by inflammation. I mean, if anyone's ever been sick, they feel depressed because the inflammation is affecting their brain and they're short tempered, irritable, lack of patience. Right. You know, they just feel horrible and they're not, it's hard to engage them. They just want to sleep all the time. They can't think. Right, right. It looks like a depression, It's a sick syndrome. And so a lot of times that's confused with depression. And like I said, someone might say, well, I'm not depressed and I'm just sick. And well, I don't know what it is. So it must be depression. It's almost like the default thing. That's what you have, because they don't know what else it could be. And it does take certain amount of training to really look at root causes. So autoimmune disorders can actually show up, particularly lupus as depression and anxiety. Right. And you brought up like, you know, Lyme and co infections, Babesia, you know, can cause rage and you know, OCD type symptoms. So there's, I think it's important to consider these options, consider what else might be going on, especially if they're not getting better with the course of an antidepressant.

Well, also like you were talking about hormones and I think you were referring to women, but with men, low T, low testosterone definitely causes depression. I've seen it over and over. And you give a man testosterone and feeling much better.

Absolutely. Yep.

Let's talk about the gut a little bit more because I know that a huge, huge percent of the happy hormones, the serotonin, is actually produced in the gut. Can you talk about what happens when there's gut dysfunction and how that impacts serotonin? Because that obviously for people, people think about, oh, my brain, but it's not your brain, it's your. And they call it the second brain. I feel like it should be the first brain is your gut and your second brain is above your neck, like, flip it. So can you talk about that a little bit?

Sure. So serotonin is made from amino acids as well as all of the other neurotransmitters. And all of the neurotransmitters are made in your gut. And it's basically your microbiome, which is the gut bacteria that manufactures the serotonin and basically, you know, constructs them. 70% of the neurotransmitters are made into especially serotonin is made in the microbiome by the microbiome in the gut that your brain needs. And we don't know the exact science, but that information is transmitted to the brain with the vagus nerve, through the vagus nerve. And so that's really important. We don't know exactly how that is whether, because serotonin itself does not actually cross the blood brain barrier, but there's some signaling through the vagus nerve that transmits this information to the brain.

That's so cool. You think about it like your vagus nerve is bathing in. Either you're good or you're not good and you're going to have symptoms as a result. That's really cool.

The vagus nerve is amazing. I mean, it starts in the brainstem and goes all the way down to the tip of your coccyx and basically innervates every single organ in your body. And it's a major nerve that is connected to your autonomic nervous system and regulates so many processes. But particularly well known is the sympathetic and parasympathetic drive. And the sympathetic drive is your fight flight drive. You know, where you know when you're fight flight, freeze and faint, you know when you're being threatened on some level. And the parasympathetic system, it has to do with rest and digest. And so you really need to be at rest to digest, but also to sleep and repair. It's important to be able to be in that state in order to repair, particularly during sleep time.

So where would you start? With someone who feels truly crappy and is having a hard time functioning? Are you starting with the supplements to take the edge off? Are you starting with the food? How long do these things take? I know that was a lot to unpack in that.

Yeah. So, you know, I usually start with food because you can see a huge difference just by changing the diet. Huge difference. Because just by removing sugar and processed foods and adding fats and protein and making sure that digestion is online within a month, you can feel so much better. So I feel like that is the biggest bang for your buck, I guess, for your time. And then if that doesn't work within the first month, then I start adding some supplements. And I usually start with 5 HTP if someone's having trouble sleeping at night, or tryptophan, it depends on the person. GABA is great also for sleep and anxiety. So GABA would be more for anxiety and tryptophan and 5 HTP would be for depression. I like to use inositol for anxiety and OCD type symptoms.

Do you using lithium at all?

Sometimes I do, yeah. I use lithium for, you know, low dose lithium.

Yeah. And let's just stop and make sure we're.

I was just thinking, like, I want to clarify.

We're all talking about the same thing. So lithium carbonate is a medication. We're not talking about that. We're talking about the naturally occurring lithium orotate that's found sometimes in groundwater and has shown to sometimes help stabilize people's mood. Less ups and downs and things like that.

Absolutely. And it's a very low dose. It's like anywhere from 5 to 10 milligrams compared to 150 to 300 milligrams. And that from a medication standpoint, that's an extremely low dose too. So. Yeah, so elemental, you know, the average dose for bipolar disorder, for example, would be anywhere from 900 to 1200 milligrams, sometimes even 1500.

Oh, I didn't realize it was that high. Wow, that's huge.

Yeah, no, it's a big difference. Yeah. So, yeah. So lithium, I have, I have used lithium for those mood swings. Lithium orotate, 5-10mg for those mood swings. But you know, ultimately I, I kind of really try to focus on removing what's causing inflammation, replacing what's missing. The B, all the B vitamins, generally, most people are very deficient in B vitamins. Magnesium, zinc, you know, and it's usually copper is really high. So adding zinc will bring copper down, getting the detox pathways open. So it's, it's. I really focus, deep dive into the root causes and most people feel better within a couple months. So by the time you start an antidepressant, the average SSRI takes six to eight weeks to have an impact. And that's at therapeutic doses. So I feel people can get so much better just by doing the root causes. Like, as I just explained, so much faster than on an antidepressant. So why wait? If you start an antidepressant, that's fine too. But why wait for it to work when you can do these other things? And if it works, it works. And then as you're feeling better and better and you don't change the dosage of the ssri, you can gain the confidence that it's the work that you put into it and it's not the medication. And I think it's a good idea to try, especially if a person's feeling well within six months, to taper and discontinue the medication. So I liken it to the same approach that if you were hit by a car, right, and had multiple broken bones and you had internal bleeding, you're going to want to be airlifted to a hospital, have surgery, have those casts put on. But you know that you're not going to go home for the rest of your life in those casts, right? So, you know, so it's just. And you know, you're going to go to rehab, you're going to go to a rehab, the casts are going to come off and someday you'll be walking and doing the same things that you were doing before that accident. That would be the goal, right? Same thing with antidepressants. I think that our approach should change and that we use antidepressants to save lives, get people functioning, you know, like, you know, getting those casts on and the crutches there and get them functioning and really look for the root causes. Get people back into balance by reversing those root causes as best as possible. And sometimes you're not going to be able to do the whole trick. I mean, sometimes people are in accidents and they have traumatic brain injury, right? There's going to be some long term effects of having an accident. So, you know, same thing with, you know, with depression. You can have long term issues like from child abuse. I mean, it's years of psychotherapy for many people. But getting to the root causes even actually helps with child abuse in terms of therapy, by getting to the root causes and fixing the gut. I have found that people who were stuck in their therapy started moving forward because moving forward in their therapy and getting better. So a lot of the psychosocial issues that they were going around and around and around in their therapy were finally moving, moving forward just because they fix their gut. So you can really fix many things by fixing the gut.

That's pretty awesome.

So if someone's listening and they're thinking, okay, maybe I have depression, I think I'm depressed, but maybe there's something else going on. What's the first step or the one step you would recommend the listeners or someone they know take if they think that they might have this or they might have something else going on, what's the first step?

Well, I think they should be evaluated. You know, first step is get an evaluation. First step is get evaluated.

Functional medicine.

Physician, go see Dr. Stein.

Yeah, so, I mean, so but let's say it's a mild Depression that they're not in danger of harming themselves or others. They're not having problems with reality. It's a mild depression. Most everyone will benefit from taking magnesium as long as they don't have any renal function problems. That's kidney function problems. You know, you don't want to take magnesium if you have any kind of problems with your kidneys. But so magnesium B complex and there are most B vitamins are pretty well tolerated. There's a small percentage of people that can become anxious from a couple B vitamins like B6, vitamin B6P, 5P and some. There's an even smaller percentage that can, that, that become anxious from B12. So they might need a different kind of vitamin B12, omega 3 fatty acids. Practically everybody, I test everyone and every single person that I've, I have not had a single patient who has had a good level of omega 3 fish, you know, omega 3 fatty acids in their system.

So fish oil, that's like part of the triad.

Don't forget about the vitamin D. I.

Know, I remember when you told me about the treatment medicine of 7,000 IUs of vitamin D, that it was a medicine. I was like, well you could just take that over the counter. But I remember you telling me about that. This is years ago. This is what, eight years ago you told me. You may sort of mention it in offhand and it still sticks with me.

Yeah. And so vitamin D, if you have seasonal affective disorder, it's usually because people are deficient in vitamin D. But again, you have to be careful with that because it is a fat soluble vitamin and you want to make sure that you get a blood test to see what your vitamin D level is. And you can get away and you know, average adult can get away with 5000ius without getting toxic, especially if it's a lab low or very low vitamin D level. But it should be, you know, monitored and checked, I would say three maximum six months later to make sure that you're not toxic. So, and I like to reach a vitamin D level of between 60 and 80. And if you have an autoimmune disease and you want to be between 80 and 100. So zinc B complex, omega 3 fatty acids, vitamin D and a probiotic. So most people can tolerate a probiotic pretty well. There's going to be a small percentage that will have bloating and gas from it, which indirectly could mean that you have small intestinal bacterial overgrowth or just dysbiosis.

Yeah. Or overgrowth of bad bacteria.

Yeah, yeah. So then if that happens, just stop it and find someone to help you. But I think you can take, take those five things pretty safely.

Yeah, I think that's great. So I mean, I guess for me it goes comes down to like depression, ibs, irritable bowel syndrome is one of those junk diagnoses or we can't figure it out what it is, and that's what we call it. Is there any movement? I mean, you're awesome, obviously, and there's only one of you and there's a lot of psychiatrists out there. Is there any movement to bring what you're talking about to a broader audience? Like are physicians starting to embrace this?

There are a number of functional psychiatrists. We not call themselves ourselves functional psychiatrists. And believe it or not, the American Psychiatric association does have an integrated psychiatry caucus and we do come together and have lectures every month. In fact, I'm giving a lecture, I think it's In April of 2022, about the root causes of depression and anxiety due to autoimmune disorders specifically.

This is amazing. How can people find you and your work?

So you can go to achinastinedo.com and if anyone wanted to talk about working with me, they can just schedule a free discovery call. I do see patients one on one in my practice and Functional Mind in Riverside.

And you were telling us about the group you also have, which is really pretty, sounds pretty awesome.

Yeah. So IT is a 12 week online group program and that's for people anywhere from the world, you know that wants to join. And it is going really helping you to put on your Sherlock Holmes hat and find all of your root causes of depression. And each week you're going to dismantle them. Every week there's a, you know, homework with videos and live Q and A with me for 90 minutes every week. And to me I find that people actually do so much, get so much farther working in the group than they do with seeing me. Because when you're working one on one with someone, you actually are on your own and you have to figure it out on your own. And people lose motivation and then they, they end up not following through. Because the most important thing about doing this work is that you have to create habits. And the boot camp actually helps you create habits and it motivates you to do the work because you're doing it with everybody else and kind of cheering each other on and giving each other tips and you know, and it keeps you on track. But I think it's really important to create habits that are in alignment with who you are as a person. So sometimes people will see a doctor or other medical professional, and they'll do it because the doctor said so and not because they wanted to do it right. So it's important to figure out, well, okay, if I'm gonna. I need to exercise. And it's really finding the right way to exercise that you know that's right for you, but also that you're gonna sustain over time for the next 10 years, the next 20 years. It's sustaining these habits that are really important. So the boot camp is perfect for that.

That's so awesome. Sounds amazing. Dr. Stein, thank you so much. This has been truly a pleasure. It's our privilege to have you on.

Thanks for listening to another episode of Five Journeys helped Live like youe Matter. Thanks, Achina.

Oh, you're welcome. It was my pleasure.

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