Reverse Depression-like Symptoms, with Dr. Achina Stein

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, Athina.

Oh, thank you, thank you, thank you for having me.

And we're super delighted to have you because we. Full disclosure, we work together, right?

Yeah.

And we loved working together. How long, how long did we work together for?

Since 2012.

Nice.

2012 to 20 end of 2015. Right?

Yeah. So three good years. So yeah, they were great time and had the privilege of working. So that was awesome. Essentially.

It might have been.

You've been up to a lot since then.

Yes, it might have been 2011. I'm forgetting.

Yeah, but you've been up to a lot. And you wrote a book.

Yes, I did.

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 you know, 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 it's not. 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 because anything happened to them where they could say, oh, this happened and because of this I'm depressed. 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 are 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, so 15 minutes, that's pretty good. Yeah, it's a way.

The national average is seven minutes.

Yes. I will say, you know, 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 in the wheelchair they said, I asked her, 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.

Right? Right. Yeah. So, 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, because you could potentially come off of those medications in the long run and learn how to take care of yourself because you've really fixed the problem instead of just putting a bandaid on it, so to speak.

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, what are, like the top, whatever, three.

That's a very small list. Right, I know.

Yeah.

Yeah.

Well, besides looking at the traditional things, which is the biological, which is, you know, hypothyroidism, 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. Alcohol, drugs, there's a whole list of those just traditionally known. But there's psychological causes.

Psychiatrists, as far as I know, don't even check a thyroid or a B12. Is that your experience or do. Some do.

I would say most are trained to do that. So if they're not doing it, they're not really following the standard of care. So. But, you know, I Wonder how many PCPs or pediatricians or internal medicine doctors or, you know, or other medical professionals are actually doing that, because sometimes what happens, and this is part of where people fall through the cracks that the PCP thinks the psychiatrist will do, and the psychiatrist will think that the PCP did it, you know, and not really collaborate and find out for sure. I get a lot of patients after they've seen multiple doctors and no one's done blood work, you know, so, I mean, that happens, but there's, you know, but it is the standard of care. It's to make sure at least the basic panels are done. And so that's the biological and there's the psychological piece. You know, trauma is a major root cause of depression. And sometimes people can't overcome trauma because. Because of these other medical issues and of course, the social reasons, like toxic boyfriend, toxic partner, toxic workplace, These are all issues. And then there's spiritual crises. 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 is 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 from the. 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 so food's medicine, which can. And so foods can cause inflammation, but there are also foods that can heal. Then 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. So all of those things can.

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.

Right.

And you know, 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, our hormones, particularly cortisol hormone, can really be destructive over time, you know, 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 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 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, drugs, just simply too much sugar. Eating too much sugar. Too much sugar.

A different type of depression. Eating a sad diet.

Right, exactly. Eating exact diet. Yes. So 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 these things cause inflammation. So Candida, there are multiple types of bacteria that can cause like strep, can cause pans, you know, I don't know if you're, you know, familiar 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, 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 it's. 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. Yeah.

So I mean, I guess for me it goes comes down to. So like, 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. I was going to ask this later, but it's in my mind so I'm going to ask, 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 do physicians. Are physicians starting to embrace this or is this really. You're so unique.

Well, you know, there are a number of functional psychiatrists. We now call 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, the root causes of depression or an anxiety due to autoimmune disorders specifically. So, so autoimmune disorders can actually show up, particularly lupus, 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 you, 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. 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 microbio, which is the gut bacteria that manufactures the serotonin and basically 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. And so that's in a nutshell.

That's so cool. You know, 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.

Well, it's really. The vagus nerve is. It's amazing. I mean, 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. 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 or. And 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, as you probably know.

Right, yeah. So I was thinking when you were talking about serotonin, so what's let's talk about, or at least I'm curious about, you can talk about. Because I was thinking, okay, this is why we give people sometimes 5 HTP that converts into serotonin and it also sometimes gives you diarrhea because the guts for some people are. It's irritable. Makes people irritable, gut irritable. Is there, let's say, is there between like five htp Gaba, Sammy, all those fun things. If we're going to attack, take a more western approach, I guess, to this as opposed to root cause approach. Is there any favorite things that you use, any supplements or recommendations you have that's before you go on to antidepressants that you can try. That's more. Okay, I have depression and when I say Western, I'm thinking, okay, depression equals these supplements or medications and this disease equals that depression. Now, neither one of us do it that way, but there is sometimes use for that kind of.

There's a role like a linear thought process.

Yeah, there's a role for that.

B2B.

Absolutely. I mean, as you know, to do this approach of lifestyle and dietary changes, you do have to be able to function enough, right. To I mean, if you have someone who's bed bound or can't get out of bed, can't focus, can't concentrate, is exhausted they're not going to be able to do this work. So you have to be almost well enough to do the work, organized enough to do this work. And if they have a history, in particular, of having sensitivity to certain medications, it's much better to use supplements that are a lower volume, so to speak, of addressing neurotransmitters. Balances, you know, to balance, and I hate to use the word balance because, you know, we don't really know, like, there's. It's already been disproven that. That a chemical imbalance in the brain does not exist, you know, but it. Because it changes from day to day based on our thoughts, our feelings, and that that whole hypothesis of a chemical imbalance has been disproven. So I try to. Wait, stay away from those words. But it's kind of hard to describe.

What it is that we're doing that's actually really important, because I still think people have that model very much. It's very much ingrained in society that if I'm depressed, I have a chemical imbalance and I need something. And we know just raising our arms up will change our mood. It's not just chemistry, of course, that's part of it, but it's not the whole thing.

It's not the whole thing. There's so many variables, and it's constantly changing. That doesn't mean to say that, you know, boosting it a little bit. It's just that we don't even know what we're doing when we're doing. We're trying things to see, you know, like when it comes to these antidepressants, we don't really know how they're working. And so that's why people can have reactions and side effects, adverse reactions, because every person has a different, you know, compilation of neurotransmitters in their brain. Like I said, it's constantly changing that, you know, you're not gonna. It's never going to be perfect. And so using the supplements, like five HTP and tyrosine and tryptophan and Gaba, it's like turning down the volume, so to speak. And you can use them based on symptomatology by doing quizzes, but you're still trying it. And it's like, okay, let's see how that goes, as opposed to. So it's helpful to use these supplements to help people feel better so that they can do the work. But it's not necessarily a permanent thing. You know, it's actually better to eat foods that provide these. These very Same, you know, supplements through food. Like, you know, tryptophan is turkey, you know, eating, you know, eating carbs, you know, is serotonin. So there's, there's lots of things that you can do through food to help someone feel better. But then by using the supplements, you can get a little bit more of a boost than compared to food, but not such a big boost as compared to antidepressants.

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 and 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, for your buck, I guess, for your time, you know, and, 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.

Are you using lithium at all?

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

Let's just stop and make sure.

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

We're all talking about the same thing. So there's lithium carbonate, Lithium orotate. Right. So lithium carbonate is a medication. We're not talking about that. We're talking about the naturally occurring lithium orotate that's found in 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, from 900 to 1200 milligrams, sometimes even 50.

I didn't realize it was that high. Wow.

Oh, yeah, yeah.

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 kind of really try to focus on the. 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, magnesium, zinc, you know, and usually copper is really high. So adding zinc will bring copper down, getting the detox pathways open. So 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. You know, 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 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, doing the same things that you were doing before that accident. And that would be the goal, right? Same thing with antidepressants. I think that our, our way, 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, 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, you know, so you can really fix many things by fixing the gut.

That's pretty awesome. I mean, I can definitely say that in my practice at least, I work really hard, first, not to put people on, but second, to solely try to take them off. And there's definitely a population of people that just can't seem to get off or they have too many side effects. And when they taper, even if they taper over 612 months, which is just really ridiculously slow, they still having side effects. And a lot of times those people in a year or two are begging to come back on because they just can't do it. Is there any tricks or any magic that you have for those people that just can't seem to. They've been on antidepressants for a long time and they have too many side effects coming off and they just don't feel right when they come off.

Yeah. So, you know, there might be some people who will just need to be on medications, you know, long term. So there's going to be certain things, like I said, traumatic brain injury, child, you know, child abuse history and that aren't necessarily resolvable in a snap. And it's going to take years of working on those things. So I think it's a matter of allowing that to, if that's the case, if you've worked with them for two, three years and made attempts to come off, sometimes you just have to settle with, you know, maybe this is just the right combination, that I just need to be on medication. And maybe someday down the line, you know, especially if they've been working with someone for years, that there'll be a change where they make a shift, you know, and, and it's, it's different for everyone. It kind of just depends on the person and trying to look for all of those root Causes. I mean there's some long term effects from having Lyme's disease, right. There's long term effects of having an autoimmune disease. So there's going to be certain things that cause inflammation in the body that we're not going to be able to make go away completely. So I have had patients who've come to me on five or six medications, believe it or not, a lot of medications, and I've been able to taper them down to one.

That's a huge win when you look at the relative improvement. Can we talk about expectation management? Because I think that that's a huge what people expect is going to drive their satisfaction with their. Where they wind up. So when you talk about depression, I think there are different categories. So people who you've already alluded to, there's a group of people who, they can't get off medication, but you want to optimize them within that realm. But then for people who are able to get off medication or avoid medication, is the language you're using that you've resolved the depression or simply that it's at a lower simmer and it's no longer like stuck to their face impacting everything they do that it's that it's just like, oh, sometimes my back hurts, sometimes I feel sad. Is it more in that context you'll still have it, just less. How do you language that I.

Well, it, it's, it varies from person to person. So I have had patients where their depression is completely resolved, you know, so, and, but they weren't necessarily, you know, severe depressions, you know, where they were in, in and out of the psych, psychiatric hospitals or needed things like ect. They were mild dep and newly diagnosed. So I mean I've had patients who come to me specifically to come off medication and I've told them, looking at your history and everything that you've been through, I think it would be risk for you to come off of medication, especially if they're elderly. And again, if I don't feel like they have the capacity to do the work that is necessary, which is a lot of work.

Right.

Of lifestyle and dietary changes. They may not have the capacity to be able to do some like some people just can't exercise because of whatever disability that they have, for example. So. I'm forgetting your question now.

How do you manage people's expectations? Do you use the language you're going to cure this or do you use the language you're going to bring it down to a low simmer from a boil.

I don't ever use the word cure, you know, because I've had patients who have. So it's a management. Because I've had patients who have resolved their symptoms of depression but then lost maintenance. Maintenance of their habits. You know, they get busy, they get stressed.

They got human. I say, you got human, forgot to do your own.

I mean, I can even speak for my own son, which is the reason I even went into functional medicine, you know, thank you, Ed. You saw my son and found the root causes of his depression and anxiety and sleep problems and attention problems. And he was able to come off of four medications as a result of working on all of these root causes. But then he went off to college, which is stressful. Yeah. And they're vampires, and they stay up all night and they party and they're stressed out because of the papers they have to write and the exams that they have to take. And so by the time college was over, he was a mess again. Again. But the beauty of functional medicine is that he knew exactly what he needed to do to get back on. He knew. He knew I got to go back to my diet. He knew I have to exercise, I got to get my sleep right, you know, and not. Not drink alcohol like all the other college students, like. So he was able much faster too, you know, get back on track again. And so it does take maintaining those lifestyle changes. So I've had patients who have returned to me. A year later, they feel great. And then a year later, I had cpa. You know, tax season, right? Cpa, tax season comes on, boom. You know, his anxiety came back, the rosacea came back. It's not just mental health symptoms. It's other symptoms too.

Right, sure. It all goes together. It does.

I want to know, Achina, are you using any. I'll call them even more alternative therapies. Are you doing any ketamine or is it psilocybin?

Psilocybin.

Are you doing anything like that?

No, no, no. I refer out. Yeah, I got too many things going on, you know, I gotta stop somewhere. So there's. There are people who are doing ketamine.

Therapies, and I would like TMS do. Are you a proponent of TMS or.

Oh, yeah, sure.

I'm a transmission.

I was gonna say for the listeners.

Right.

Asking for a friend who might not know what TMS is.

Trans magnetic stimulation.

So, you know, I'm in Rhode island, so, you know, Butler Hospital is local, and so they do TMS there. You know, there's a Dr. Linda Carpenter, who does that. And, you know, they also offer ECT if necessary. You know, there's, there's all. There's so many different things that can be done to resolve symptoms of clinical, you know, clinical depressions. And those are generally for severe refractory clinical depression that hasn't been resolved through. And I kind of hate that terminology, treatment resistant. It's like, well, you didn't try functional medicine, so how can you say it's treatment resistant, but it's medication resistant, not treatment resistant. Right. So medications didn't work. And it doesn't mean that, you know, you didn't do a good job. It means the medications failed. Right. So. So it's almost. I don't like that. That term because it almost feels like it's blaming the patient.

No, I feel like that's the same thing. I don't like to say someone's infertile. I like to say they're having difficulties conceiving because they're not infertile. They're simply not pregnant yet.

Right.

It's just the way you think of it.

Absolutely. Gives you more hope. You need hope.

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, if they think that they might have this or they might have something else going on. What's, what's the first step?

What do they take? Well, I think they should be evaluated.

You know, first step is getting evaluated.

First step is get evaluated from a functional medicine physician.

Go see Dr. Stein.

Yeah, 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 for. From a couple B vitamins like B6, vitamin B6, P5P. And there's an even smaller percentage that can. That become anxious from B12. So they might need a different kind of vitamin B12. So what did I say? Magnesium B complex, 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 fatty acids in their system.

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. And this is years ago. This is what 8 years ago you told me. You may sort of mention it in offhand and it still sticks with me. Yeah.

So vitamin D, if you have seasonal affective disorder it's usually because people are deficient in vitamin D. So 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 monitored and checked. I would say three maximum six months later to make sure that you're not toxic. 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 is indirectly could mean that you have small intestinal bacterial overgrowth, so.

Or dysbiosis. Yeah.

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

Yeah, this is, this is amazing. How can people find you and your work?

So you can go to www.achina steindo.com I don't think I have to say www anymore, do I? No, probably not. HTTPs://ford/forward/So@chinastindo.com and yeah, and if anyone wanted to talk about working with me, they can just schedule a free discovery call. And 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 that you work in groups and that seems to be very effective also. So definitely want to put a plug in for that.

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 they are actually taking enrollments now for, I don't know if this is an Evergreen recording, but the next one is starting January 6th. And it actually is going to turn into an Evergreen program, so people can enroll anytime after January 6, 2022. 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 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 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 cheers, 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 going to sustain over time for the next 10 years, next 20 years. Yes. 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 Health Live like you matter. Thanks, Achina.

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