Antidepressants Explained: Benefits, Risks, and Alternatives for Depression | Dr. James Greenblatt

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And that's why I created the Brain Shaping Academy, a new program that looks in places most people never think to check. Like nutrient deficiencies, the health of your gut, metabolism, your immune system, and lots more. Dr. Greenblatt, welcome back to the podcast. It's so good to have you. I'm going to be right now. It's estimated that 18% of Americans suffered depression. One in four people in their life will have a major depressive episode. So this affects everybody at some level. Either you or someone you know. I mean, I know many people have committed suicide. I know many people have been depressed. I've had that in my experience myself at different times of my life. And what we're learning about is really what you wrote about in your book. You've been studying for the last 30, 40 years. You and I are kind of in the same generation. We came up going, "Wait a minute. What we learned in medical school and what we learned in residency and what we learned in our conferences in the orthodoxy doesn't actually explain what we're seeing." And we have to come up with a different set of explanations for the phenomena that we see in patients. And so I'm just super excited to dive in this topic with you and to help people with depression have hope where often they don't really have people understand that this is not a often psychiatric problem alone. It's a physiological problem. It's something that is in their system that can be identified and that can then be treated in a way that we don't treat in psychiatry, which is basically diagnosis and Medicaid. And there's a whole realm of interventions and thinking and possibilities of helping people heal that have nothing to do with that. Now, there's only one we talk therapy, there's only one we talk medication, but they're the last reason or when it comes to solving a problem that is affecting so many people. We have to get to those root causes. So, take us back to the origin story a little bit. We had you on the podcast before, we just briefly talked about your inspirations. Because I think it matters. And I think you and I have a very similar inspirations in terms of the leading thinkers and figures in the field of medicine, science and psychiatry that have kind of helped us see things a little bit differently, starting with Linus Pauling and Abraham Hofer and Roger Williams. To talk a little bit about how each of those people have helped you think about psychiatry differently. Sure. I think you mentioned my three kind of hero mentors that defined my career. So Linus Pauling, you mentioned two Nobel prizes. It's a little frightening when I give talks and I ask people, if anyone raises their hand anymore, Linus Pauling, Nobel Prize in Chemistry and Peace. And he wrote this article on orthomolecular psychiatry. It was a title in Science Magazine in the '60s. And basically it was a very scientific, you know, on enzyme kinetics. And all he said is that perhaps we can think of mental illness as abnormal molecules, you know, in the brain. And maybe we could fix or treat it by optimizing these normal molecules and he described money micronutrients. And then Abraham Hofer was a psychiatrist that was able to utilize micronutrients for the treatment of those severe schizophrenia. And I treated some of his patients that he treated 50 years ago that were old cured of schizophrenia by, you know, nutrient therapy. And I think it all starts with biochemical individuality, which was, you mentioned Roger Williams. And you know, that's how I start every one of my presentations. I think that's absolutely true. And I actually got to be a neighbor of Hofer and also Linus Pauling, never Roger Williams. But I think he died my time. But you know, that paper you're talking about in science magazine, by the way, which is this premier elite magazine. And Linus Pauling was a biochemist. And he understood biochemistry in a way that most of us don't. I mean, he went into normal prize for his work in the study of proteins and biochemistry. And the title of the paper was "Orthomolecular psychology. Ortho means to strain." Like orthopedic means to strain bones. It's an ortho to correct molecules, orthomolecular. And he talked about different nutrient needs. And it was a very, I mean, I read the paper. It's super geeky. I could barely understand half that. It was very deeply scientific. But it really spoke to this idea that maybe our mental health was not simply just an emotional problem, although it often can be if there's trauma and things that are quite serious that happen when you're younger. There's all influence on us. But we shouldn't assume that that's the problem. And we should start to look for things that are actually treatable. And in your work, you're really kind of also talked about Roger Williams, who was the father of biochemical individuality. And I often say this ending as you that if you know the name of your disease, it doesn't mean you know what's wrong with you. Say, I have depression. Well, that's just the definition that medicine has given to people who share a collective set of symptoms or hopeless or helpless. They have no interest in sex. They can't sleep and they're appetite. Whatever. There's a whole list of these things in the medical categorization book called DSM Fiber. It's helpful for grouping people in categories, but it doesn't tell you anything about the why. And so you spend your life thinking about the why and asking really difficult questions, which is how are these people different? And like you said, you know, I always say, you have depression. It's not a pro-sect deficiency. It's something that is often treatable. But take this through how you kind of unpack the fundamental root causes, the drivers, the biological drivers of depression. Because most people think it's a chemical imbalance, right? Oh, just it's a serotonin deficiency. So take this drug that makes you have more serotonin in your brain, right? That doesn't work. I mean, the studies for mild and mild depression. really, these jugs are not much better than placebo and they're often come up a lot of side effects. So take us through these major biological drivers that you talk about in your book. Well, as you described, there are many possibilities. How do we assess where to go? And in the integrated functional space, sometimes people get carried away with too many tests. But there's often very low-hanging fruit. And I think the first part of the assessment is a good history and family history because we do know that depression runs in families. And that helps us understand some micronutrients that could be deficient and some genetics, like having variants of, you know, fully, an MTH of our variants tend to be genetic. I mean, for people listening, that's a particular gene that regulates full-atement tablets, which is very involved in our transmitter function and mood. So even traditional psychiatrists understand that full-at can be a treatment for some case of depression. And this is a gene that makes us different. So that's what that gene was. Working in the inpatient psychiatrists for 30 years, one of the most common presentations that I see for those that are what we call treatment refractory. They don't get better with meds and, you know, are those with that kind of genetic variant? So looking at that gene is, to me, a critical component of a depression worker. Then, you know, just simple vitamin deficiencies, as you describe, B12 zinc and magnesium. I think one of the most significant and simplest and could dramatically change the public health implications of depression as suicide globally is just vitamin D deficiency. The research in 2025, I mean, everything you and I have been talking about 30 years, 2025 was a year that just solidified everything. I mean, so I have research articles now on low vitamin D and suicide, low zinc and suicide, low folate and suicide. That just came out this year. And so we can't really argue with the stunning research that's just been blossoming. And everything though, you know, people in America have plenty of food, they eat a lot, they're not malnourished, nonsense. When you look at the end-hane state, which is the government survey, the National Health and Nutrition Examination Survey where they go and test thousands of people every year and they monitor their history, their health conditions, they found over 90% of Americans have a deficiency in one of my nutrients at the minimum level to prevent a deficiency disease. Like, how much vitamin C do you need? You're not gonna get scurvy or vitamin D to not get rickets, right? And so it's omega-3s are about 90%. 80% lower in the efficient vitamin D, 45% magnesium, but it's not the same in zinc, the same in iron. I mean, it really affects your mood and your brain function. And so people think your brain is sort of like this embodied from the rest of your body, like as just this thing sitting up on the top of your shoulders. And, and you know, the joke is that psychiatrists pay no attention to the brain and neurologists pay no attention to the mind, but you're a psychiatrist who's paying attention to the brain and how it works and what's needed for it to work. And nutrients are a huge factor. Talk about also sort of the gut brain issue because I think that's a very big one that people don't necessarily understand is how could the gut be related to the brain? And by the way, like does your psychiatrist ask you for a stool test when you go in with depression? Probably not, but maybe they should, right? So take us through that. We'll understand how the gut function and the disturbances in the microbiome are linked to potential depression. Yeah, I mean, sometimes, you know, I make a joke that I'm more of a gastroenterologist than a psychiatrist because I mean, even from, from the mouth down, like, you know, zinc deficiencies is common and we'll pick that up by someone not having taste. And then the digestive enzymes and hydrochloric acid. So if you don't digest food properly, you don't absorb the micronutrients. So I have a lot of patients who are spending money on very expensive organic food and these brass fed, you know, protein. But when we do testing, they have very low levels of amino acids, the building blocks because they don't have enough digestive enzymes. And then that sets the whole dysbiosis. And it's clear that now, and again, the research is just supported it. Dysbiosis has been related to every major psychiatric illness. I mean, Alzheimer's, depression, anxiety, anorexia, it's pretty stunning. It's true. I mean, I've had a lot of patients with gut issues that when you're as actual psychiatrist, I'm not. I'm a family doctor. I've had some training in psychiatry, but I definitely call myself the accident psychiatrist because I would treat people's gut issues and all these psychiatric problems in Go-Way, whether it's OCD or depression or anxiety or even more serious things. You know, autism would improve and the ADD would improve. And I was like, well, what's going on here, right? You know, and so I think behavioral issues that improve. And I saw this over and over. And that's why I rode the book, "Ultramine Solution" that didn't happen, though, because I was like, oh, wait a minute, there's more of the story than just, you know, these psychiatric diagnoses and drugs. And there's something else going on here that's affecting the brain. And a lot of the common pathway of this is inflammation. Even like the gut, we didn't talk about this, but like this bacterial overgrowth, yeast overgrowth, leaky gut, all that stuff. Plus gluten is a big factor. I don't want you to sort of touch on that because I think even without gut symptoms, you can have gluten sensitivity that creates an inflamed brain. And I want you to sort of unpack the brain inflammation story when it comes to depression. I think it's a central unifying feature of a lot of the things that go wrong. When the pharmaceutical companies get involved, you know it must be important because, you know, their pharmaceuticals are looking for anti-inflammatory drugs to treat depression. So there are many mechanisms and many paths to how inflammation affects depression. And we know the, you know, people are all now familiar with cytokines and all these inflammatory markers. Well, they target the brain and they decrease these neurotransmitters and they affect depression. And that's been known for many years. And inflammation is a common pathway, but there might be many, many paths to an inflamed brain. And simple ones are like sleep deprivation, inflammation, increased risk of depression and suicide. And then we could talk about infections from COVID to Lyme to anything else. But I do want to go back to what you had mentioned about gluten because gluten sensitivity or particularly silly act disease is one of the most commonly missed causes of depression and anxiety. And literally complete remission and reversal of symptoms. And there are no GI symptoms when they sit in your office. You're just complaining of fatigue and depression. And you find out they have silly act, which is an autoimmune disorder to gluten. You eliminate gluten, replete those nutrients and their depression is gone. As you know, I talk a lot about protein, especially as we age, but not all proteins are the same. Collagen is actually the most abundant protein in your body. It's the glue that holds you together. You're skin, you're joints, your bones, your connective tissues. 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And again, most doctors don't check for it. We test for these urinary peptides. We test for gluten sensitivity, but it's not even full celiac. It could be non-celiac gluten sensitivity, which may affect up to 20% of the population. And I think that's, again, often missed. And again, you don't go to the psychiatrist and get a gluten sensitivity test, right? So that's part of the problem. Talk a little bit more about this whole of inflammatory phenomena, because I've seen a lot of literature and I'm seeing the psychiatrist talk about like treating depression with these major biologic drugs that are immune suppressants like the TNAF alpha blockers, that cost 50 grand a year and have cancer risk and increase infection risk. I just think we're kind of misguided with that. And I think the question should be why is there inflammation? So can you talk more about this sort of neuroinflammatory phenomena and how it sort of linked to depression and what the root causes of that are? - Yeah, no, no, you're absolutely right. The, you know, to a little frustrating to me, and partly the reason I read the book is to help people dig deeper, because to just say inflammation is the cause of depression, and you can use a 10,000 dollar drug or curcumin, it's not gonna necessarily help. So yeah, you hit it, the nail on the head, we're gonna find the root cause. And that's why it still takes the psychiatrist an hour to do an evaluation, 'cause that root cause could be early trauma. We don't trauma as a child, it creates chronic information. It could be those infections, it could be food allergy, we mentioned gluten, it could be sleep deprivation, I mentioned vitamin D, but vitamin D deficiency just kinda sets up the immune system to be hyperactive. So we're always digging deeper, could be obesity, could be ultra-process foods. I mean, the list is long, but we all know what it is. Stress, I guess, is probably the most overwhelming direct path to inflammation. So to just tell someone to take a drug or a supplement without having a more personalized path is just not gonna be as effective. - Let's just touch in a few more things. They wanna talk about one of the key themes in your book, which I think is really unusual when it comes to psychiatry, which is what I would be calling the biomarkers of mental health. Like doctors don't think about, how do I test for blood tests or other diagnostic tests that tell me what's the root cause of these psychiatric problems or depression? And I think you can't practice medicine or psychiatry without knowing your biomarkers and how they relate to different conditions. And you really dive deep into that. And before we go on to that, I wanna sort of touch a little bit more on the hormonal imbalances that relate to depression that are common and also the sort of blood sugar and metabolic story. Because there's a lot of work on Harvard around that with Chris Palmer, you've had him on the podcast talking about the mitochondria and insulin resistance in the brain and how that links to depression. But it's also thyroid, cortisol, sex, hormone. So can you kind of walk us briefly through how this sort of hormonal metabolic phenomena are driving depression? - It just adds to that list of what we wanna look for in an assessment for a depressed patient. So clearly, hormones and for many, it could be thyroid, it's probably the most common. And when we're in medical school, if we have to take a test, what causes depression, we have to check a box, low thyroid. So, but then when we get out in training, we don't think it's mental health professionals that it's thyroid, but thyroid's probably the most common that we see, but certainly low testosterone and, you know, dysregulation of estrogen and progesterone can all contribute to depression. What I have found most helpful in my practice and the simplest is look at precursors to these hormones and simple blood tests like pregnant alone and DHA can often be low and really the simplest path to supporting all the hormones. - Yeah, so doing a good hormonal assessment is key. Looking at thyroid, looking at cortisol, sex hormones. And it varies. And even, you know, as older men, you can get low testosterone like in effect mood, women have seen menopause can have hormonal issues, PMS, all that can be related to mood issues, pre-methyltisphoric disorder. They're actually, and they took pro-Zach and renamed it Sarah Faman called it a drug for PMS, you know, which always made me laugh, but, you know, these things have to get looked at in depth. And the good is there are ways to look at these things, there are ways to look at all those factors. And I think, you know, one of the biggest things affecting people is insulin resistance and blood sugar issues. And they have to do with a lot of psychiatric problems, whether it's, you know, I've had people with panic attacks because of blood sugar swings or night sweats, but even more mood instability depression can be a factor. So that's something easy to fix. I guess something often not looked at. - Yeah, I mean, I think Chris Palmer's work in Georgia Eed and a number of other people have really kind of put this kind of understanding of insulin resistance as a factor in mood disorders and major psychiatric disorders. And also as a treatment path. I think that many of our patients will get better on a kind of diet that's kind of supportive of high-approach and lower carbs. Sometimes it's hard to sustain ketogenic diet long term, but it's a powerful tool for mental health clinicians to support recovery of seeing pretty dramatic changes. - I know, it's powerful. Just those simple changes in diet and lifestyle make a huge difference. And that's gotta be the foundation of any then to help approach. So let's kind of dive into, you know, we've covered a lot of the issues from nutritional deficiencies to gut issues, to inflammation, causes, to hormonal balances, to genetic factors. All these are really important to assess. And one of you didn't talk about it was toxins, which I think is also important. So maybe we can touch on toxins, then we can dive into the, how do we diagnose the root causes to testing? - Yeah, it is a frightening door to open, but we have to assess. I mean, I think in a standard psychiatric practice, we, the two most common things we see is mercury and copper. And both high and low copper, high copper usually is contributing to irritability associated with depression and low copper. We see a lot in Ciliac or people supplementing too much with zinc also has been a path to depression. But any of the kind of heavy metals can contribute to brain dysfunction. One of, you know, in kids we see lead still, it's frightening, a lot of copper, a lot of mercury are the most common. - I know, I mean, I've been told the story, but I first got into functional medicine because I had mercury poisoning after living in China, and eating a lot of fish and all this stuff. And I was so depressed. I mean, I knew I wasn't emotionally depressed. I know I was physiologically depressed because I've always been a very happy person and I'm like, something's wrong. And I don't need pro-zac, which is basically what the doctors were telling me to do. And I'm like, no, there's something else. And I actually figured out that it was mercury, I keylated myself and it went away. So I think people don't realize there's so many roads to wrong depending on what your issue is. So the question is, how do you figure out when your particular issue is and how do we give people help navigate this complex field? Because what I always say is tests don't guess, right? Test don't guess. And that helps you guide precise treatment decisions, track your progress, see how you're doing. Tell us how you start thinking about the workup of someone diagnostically with depression and one of the kinds of diagnostic tests we should be looking at that we're not doing for mental illness. - Yeah, no, it's some really important. I just read an article, the group of people figuring out the DSM-6, the next-time version, they commented on, we're still not ready to include biomarkers. (laughing) We're going one more year without a concept of biomarkers. And there's just 20, if not 100, that you and I know contribute to depression, but the, our colleagues who are kind of controlling this next manual for psychiatry are still way, way out of it. So, you know, the workup, again, has to include a history because stress and trauma just plays a role in everything and we have to be sensitive to that history. And family history, because a lot of choice of supplements depend on family history, even though the patient might not suffer, if there's a family history of addiction and helps me fine tune my treatment. But a basic nutritional workup, nutritional deficiencies, and that would include B vitamins in D and hormones and those precursors to hormones, like pregnant alone in DHA. And then in a functional psychiatry practice, we like to add genetic testing, looking at MTHFR and a few other genes. We like to add, looking at amino acid levels and fatty acid levels and a molecule. called Cryptopyral, which has tremendous implications. So it's a urine test. And so we try to have a comprehensive assessment. As we've been talking about for years, to be able to find that personalized treatment plan. - Yeah, I think you're talking about things that we do all the time. We look at all the nutrient levels, you know, almost sustained mathematics, which are the vitamin markers for B12, fully B6. And those really important. And you know, we look at zinc, we can look at reds, how magnesium we can look at. Like you said, copper, even lithium levels in place like the hair, and they can be very helpful. And we look for heavy metals, we look for toxins, we look for change the microbiome to stool testing, we can look for inflammatory levels in the body, we can look for insulin resistance through looking at lipids and blood sugar and insulin levels in A1C. So there's so many ways of looking at things. And we can also look at all the hormonal issues that are completely thyroid testing and sexual mon-testing and cortisol testing, or you mentioned pregnant alone. These are all things that should be standard part of practice, even gluten sensitivity, food sensitivity. These are real things that can drive mental health issues. And most doctors don't think about it, they don't want to test it, they don't want to order it, they don't want to interpret it. And it's unfortunate, it's not their fault, they just don't learn about it. Because the orthodoxy hasn't accepted this yet. But I'm excited about kind of your book, because it lays a lot of this out. And I think that for me, it's part of the reason that I co-founded Function Health, which was to empower people to get this data on themselves and not have to wait for some doctor to hopefully figure out that this is the problem and they can be going on for years. I mean, thyroid issues often go on for years or even a decade before they get diagnosed because people just don't think about it or they don't do right diagnostic tests. So I think that the test not guess message is really important and now with Function Health for basically a dollar a day, $365 a year, you can get twice to your testing, see what's going on. And then you can modify those risks and change things. So I think it's really, really important. And the basic idea here is that, you know, depression and many mental illnesses are not just in your head, they're in your body. And you need to just those fundamental biological bounces and test for those things and actually address those more systematically. So kind of can you maybe share a little bit more about some cases and some stories of patients you've had that you've seen various factors just to give you a flavor how you work through some of these problems with patients? The challenge, I think, for clinicians is all the tests that we've talked about, you know, how do you prioritize and how do you understand, you know, what's part of that depression, you know, some of these abnormal tests might not be affecting the mood. So that's the challenge and that's why, you know, it's important to see mental health professionals who know this were. But I think, you know, over the years, the cases, you know, that kind of most dramatic to me are when I can use words like remission and recovery. The mood is completely gone. So I've seen that in Celiac disease, you know, from seven year olds to 40 year olds, just completely eliminating gluten. I had someone in our training program presented a case last night of an autistic kid who was nonverbal, who just took lithium orotate, a nutritional supplement that we, I talk about in the book and we use all the time and became verbal. So an autistic patient became verbal. And for our, you know, adults, the most common things we see are B12 deficiency. You mentioned homocysteine. I can't tell you how many patients that we've seen in the past year with these dramatically high homocysteine levels, which is a proven marker of deficiencies in B vitamins, B6, B12 and folate, and have also been shown, you know, for 20 years a risk factor for depression, as well as dementia. So it's a simple test where we then dig deeper to find out is it B6, B12 or folate and then treat the underlying cause and the depression completely disappears. - You see these miraculous recoveries of things that are, quote, you know, chronic illnesses. And I think, you know, when you look at the biggest burden on our society, we talk about chronic illness and diabetes and so forth and all the cardiovascular diseases. And those are big, but when you talk about disability, quality of life, here's lost, suffering, you know, the economic impact globally, not the direct cost, but the indirect costs on society from people who are depressed and can't function, if far exceeds all the rest of that and most put together. So it's really the biggest drains on the whole society. And we have such a horrible mental health system that doesn't really address this, unfortunately. And, you know, you've been doing this for decades in Tobi and we've just seen over and over some of these repeatable patterns that aren't just boo-boo-doo or, you know, kind of made up. But if you look at the scientific literature, it's there. And if you put the pieces together, it's really there. And yet it just somehow hasn't gotten into traditional medicine and psychiatry. It's unfortunate. I mean, I wonder if you have a curious about why psychiatry is so resistant to this, is it just so far outside the paradigm or it just seems like there's some areas where they kind of do this. Like they give deaf lung, which is a very high dose folate or they'll give, you know, T3 for some patients with depression, which is a thyroid hormonal. They'll kind of play with the edges of it, but it's like they don't really even realize what they're doing. It's challenging and frustrating for me being, you know, kind of one foot in, one foot out. But I'm hopeful. I mean, last year, the American Psychiatric Association, you know, 10,000 psychiatrists, the theme of the conference was nutrition and lifestyle. So it's pretty dramatic. So there were a lot of lectures on nutritional site and certainly lifestyle, sleep and exercise. So, and then there's major psychopharm conference. There's actually the Harvard Psychopharm Conference this year. There was a little section on nutritional psychiatry. So I think there were five of us that gave them half our presentations. So things are changing. So, but not significant enough, because the pharmaceutical hold is so powerful. And I think it empowers docs to think that they have a cure. And that's medicine is right, surgery and drugs. I'm just hopeful that the younger generation of doctors and the limitations that's, you know, certainly hit with our just medication approach that things have, I think, changed dramatically in the past two years. And we'll continue to change. - Well, let's talk about the medication issue, because you write about that in your book. And you talk about, you know, how these drugs are often difficult to get off of. And how they do, you know, once you get on them, they're kind of like in a pickle one, 'cause if you stop them, who knows if your depression is gonna come back, and how do you prevent that? And two, you know, they're just hard to get off of, because of the side effects of getting off of them. And so let's talk about any depressants. And I think, you know, they seem to help some people, but talk about their efficacy or effectiveness over the broader population. Are they effective? Are they effective or who they're effective for? And where are we failing with these medications? - We're failing in a lot of fronts. I mean, even in traditional psychiatry literature, you know, the word is treatment, refractory depression, no response to medicines is at least a third. And those two thirds that quote, "got better," they still have symptoms, you know, they're only shown improvement. And I think that the limitations are, it's just symptomatic based treatment without looking at the cause. But what has happened for too many years is a psychiatric community completely ignored what happens when you stop these medications. And, you know, I call it withdrawal, they call it discontinuation syndrome. Either way, it's pretty significant for some individuals. And this is where I think functional medicine can play a unique role in the field of psychiatry. 'Cause I'm quite convinced if we do these functional medicine tests before someone stops their medication, we can completely eliminate those withdrawal symptoms. And it was just kind of eye opening and probably 10, maybe 15 years ago when I had two people stop the same medicine, it was selexa. And one person did it fine. And the next one had these intractable, you know, brain zaps and suicidal thoughts. And I realized what's not the medicine, it's what's going on in that individual. And once we do the functional testing, we replete the D and the B12 or the amino acids, we can safely withdraw someone from these antidepressants. - So basically what you're saying is, is get all the fundamental imbalances and dysfunctions sorted, test for them, address them, correct them, kind of like the orthomolecular concept of correcting the molecular dysfunctions. And then you'll find an easier way of tapering off the medication. - Oh, absolutely. I've just seen a thousand some. What these antidepressants do? you know, they kind of trick the brain, particularly the SSRIs and SNRIs, the prosa. And the brain adapts to this medication, which means there's a functional serotonin deficiency. So there's less serotonin being produced. So if you have deficiencies in any of the cofactors in serotonin synthesis that you pull this drug and your brain just goes crazy and doesn't know what to do. But if you can replete that process, then it becomes much more manageable and we can eliminate those side effects. And you can try to mostly get people off of these drugs. Most of my work now is people who have struggled with inability to come off their antidepressants, they've been feeling okay or just side effects, whether it's weight gain, sexual side effects. So that's why a big part of what I've been doing is some supporting people coming off of medications. And where do you find like resistance to the effects of actually working with patients with this model? Where are the ones you find your treatment resistant to using a functional medicine, sort of more holistic psychiatry approach? In terms of the patients? Yeah, some people do better, but some people don't necessarily. There are patients who want the quick fix and that's what they're used to and they want the medication and we need to kind of respect that. And then what our role is that these micronutrients will just minimize side effects and support their recovery. Other patients are interested in digging deeper and looking at the root cause as you describe. Most of them looking at the literature and the psychiatric use. Do sometimes help people with major depression. But if you look at the literature objectively, at least what I've seen and there's some big trials that look at this, that from mild to moderate depression, it's not much better than placebo. They might work by so does placebo, right? So does a sugar pill. And so they're much better than placebo than why are we prescribing them, given they have all these side effects? Yeah, no, I used to have a picture of M&Ms and you know, you know, cause some of the research, you know, the best research maybe 60% or you know, and other people coming up with 50% and that's what placebo will help. I mean, placebo has a powerful effect on depression and we've known that for years. That's why there was a lag in drug development because they couldn't beat the placebo. So that's why, you know, we haven't given up our skills and training in therapy and part of the reason, you know, the name of the book is kind of helpful because that therapeutic alliance and our ability to instill hope in our patients is just, you know, the first step. Yeah, I mean, the name of your book is quite good. It's finally helpful. The personalized whole body plan to find and fix the root causes of depression. And honestly, James medicine is really not focused on root causes. It's focused on describing the disease, the symptoms and then trying to suppress those symptoms with the medication or modify some downstream pathway rather than dealing with the out of stream root cause. And that's really what you and I've been doing for so long is actually how do we actually think about getting the root causes and treating the body to the system and then looking at the things we can actually measure and test. We did talk about this a little bit on your last podcast with me, but it might be worth sort of touching base out again because I think, you know, you've been two-noted leaders in nutritional lithium, supplementation, low doses of lithium, not the mass of doses you give for people with bipolar disorder or manic depressive disorder. But you're seeing it's often missing and it's a lot of research globally on how it may be linked to suicide and genetics, how they play a role and talk to us about the role of nutritional lithium and how you use it in clinical practice and how you assess it. I mean, I think lithium orate, nutritional lithium is one of the most important tools in my toolbox as a psychiatrist. And again, 2025, the year of research, just a stunning paper came out of Harvard, published in Nature where they demonstrated that one lithium was low in the brains of Alzheimer's patients. So it was one of 50 elements tested. Wow. And then two, that lithium orate in these mice models that develop Alzheimer's pathology, lithium orate was able to prevent and reverse the neuropathology of Alzheimer's. So it was one of the most stunning things and it was, you know, not lithium carbonate. So the other forms of lithium did not reverse the plaques and tangles, but only lithium orate. And I think you can appreciate this. I saw that paper. Yeah, we've been talking about lithium orate, but everyone who commented on the study said, it's really great, but we need more research because we've never used lithium orate. And we've been prescribing it for 30 years. So it just kind of helped us as clinicians, but lithium is an essential element for brain help. And I'm quite convinced there are some individuals that just have a little higher need based on family histories, particularly addiction or bipolar. And sometimes two to five milligrams of lithium has been some of the most traumatic changes we've seen in depression and other mental health problems. As we head into the busiest stretch of the year, longer days, travel, more on your plate, your immune system is working over time. And that's why now is a time to make sure you're giving it the support it needs. 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So symptoms I look at irritability and impulsivity, so moodiness, irritability, and that could be an ADHD kid or depressed person. And then family history is important to me as well. So family history of depression, addiction, bipolar or suicide. And you measure like lithium levels in the hair or how do you sort of assess? Yeah, yeah. Blood levels won't help because the blood levels only pick up pharmaceutical lithium. So I do look at a trace metal hair test on everyone. And oftentimes we can see now undetectable lithium, but even if there's lithium in the hair, sometimes we'd use it as a nutritional supplement. So I think one of the things that we get into medicine is binary think it's how it is for that. It's how they're only holistic or only medicine or in truth is we need to approach to integrates all modalities, whether it's functional medicine psychiatry, root cause analysis, and addressing the imbalances in the system combined with talk therapy, combined with other trauma-related therapies, combined with medication. So it's really a spectrum of things that we have to choose from. It's just that there's a whole toolbox that we never addressed, which is the toolbox that you and I use that gets ignored by traditional medicine. Talk to us about how you think about more of an integrated approach to mental health. Sure. Many, both the doctors and patients are struggling with, do I take supplements or do I take medications? And everything that we talk about in the book can be utilized with medications. And oftentimes looking at these functional tests, utilizing the supplements while someone's on medications is a path to help someone taper off the medications. But I think depression is complicated for some individuals and having given up my prescription pad if needed and certainly the role of psychotherapy, whether it's couples therapy, family therapy, or trauma therapy can be incorporated into treatment models. So we don't have to pick one or the other, but we have to embrace all. That's right. I was jokingly saying, it's a lot harder to be happy or enlightened if you're mercury poisoned or your B12 is low or your thyroid is not working. I have a lot of gut issues, fix those things and then you see what's left. And then there may be issues that are more from your childhood or more from development issues or life stresses. But often people mislabel the problem and they go, you have depression. It's just a totally a mental issue. It's all in your head. So we have to do things that affect your brain chemistry or your talking therapy, which doesn't really address the root causes. So I think root cause medicine is sort of where it's at. I think it's something that's coming up. And also the whole idea of treating the system, not just individual symptoms. which we do in psychiatry. And I think when you're doing is really a more comprehensive approach, and you're doing things that most psychiatrists don't do, which is your doing blood tests, your doing stool tests, your doing urinary tests, for toxin testing, hormonal testing. I mean, these are things that are just outside the scope of what most psychiatrists actually look at. So I mean, I think it's impressive. We've been doing this for a long time. You see these patterns. And I think your book, Finding Home, is really a great summary of a lot of these things you've learned over your lifetime that help you can provide actual hope for people who are struggling with this. So I think anybody listening, anybody struggling with depression, anybody having hard time, for sure, you should get Dr. Reed Blatt's book, the personalized whole body plan to find and fix the root cause of depression. It's out now. You can get anywhere you get books. You can find out more about Dr. Reed Blatt's James Greenblatt, MD.com. He's got many courses for professionals and he's training a lot of doctors and psychiatrists how to do this thing thankfully. But also, you've launched a new online platform, which is a functional psychiatry clinic. It's folks under the personalized root cause, mental help for people of all ages called "Finding the Libbing." And you talk more about that. I think it's really kind of an interesting model. And I think people listening and struggling might be something that might benefit from. We've been training doctors for a long time and I think we wanted to kind of work as a group to provide a consultation model to offer functional psychiatry to more individuals. So I think in the next month, we should have clinicians licensed in all 50 states to not take over treatment, but to really do the testing, provide the consultation and help people get on that path to recovery for those struggling with depression. Thank you for doing this. It's so important. I think it's much needed because people are struggling out there. So I think we're going to be listening, just realize that if you're depressed, you struggle home that the health issues you have. Someone you love who is, that there is a roadmap to thinking about this. There is a systematic way of assessing somebody through a deep root cause testing, through comprehensive history taking to find out what's going on. And through that, we often find the clues that help us really solve these patients problems and really leave a lot of suffering, which is so necessary given the scope of them and the kind of incredible amount of people who are struggling with these issues. I think probably, I mean, the data is sort of staggering. You know, like when you look at the globally, it's I think like over 300 million people suffer from severe depression. It's worse than older adults. You know, tremendous amounts of suicide, almost a third leading cause of death in ages 15, 29. So I think we need to kind of revise our framework, revise our thinking and actually help people with a new model. And I think you've laid it out so beautifully and you've been doing this for a first of a while. So thank you for keeping out of you. You could be retired and playing golf. You know, so I really appreciate your work. It's more work to be done. There is 100%. So thank so much for being on the podcast and helping us understand the deeper level of how to think about mental health, particularly depression and all options are up for both assessing and treating these people. Great. Thanks for having me. Nice seeing you, Mark. I'm pleasure. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. 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