Holistic Psychiatry, What is it?

A comparison between conventional psychiatry and holistic psychiatry will help you clearly understand what holistic psychiatry is, and how it works.

Conventional psychiatry treats the biological component of psychiatric disorders as a disturbance of the neurotransmitters located in the brain.  The hallmark of conventional treatment is medication. 

Holistic psychiatry treats the biological aspect of psychiatric disorders as an imbalance of the neuro-endocrine-immune-gut system.  The approach of holistic psychiatry is to support the body's inherent systems from within. By removing barriers to proper function and providing the necessary nutrients to optimize function we can go a long way to improve the quality of life of many patients.  The hallmark of holistic psychiatry is nutrients.

Instead of looking at the neurotransmitters exclusively, we consider the neuro-endocrine-immune system as one system.  Additionally, we look at the neurotransmitters of the gut as well as the brain.  The majority of serotonin is made in the gut, not in the brain.

A psychiatric problem may be the result of an imbalance in any aspect of the neuro-endocrine-immune-gut system.  For example a psychiatric problem could be the result of an imbalance of neurotransmitters due to nutritional deficiencies resulting from a diet high in sugar and processed food; or the result of the imbalance of the endocrine system due to hormonal deficiencies; or the result of the immune system in the form of allergies or environmental toxins; or due to a gut dysfunction of digestion and absorption of necessary nutrients.  The proper functions of the neurotransmitters of the brain require nutritional co-factors such as minerals and vitamins.  If these co-factors are missing or deficient the proper function of the brain is impaired, creating symptoms.

Some simple examples will help illustrate what this all means.  Pre-menstrual (PMS) is a well known experience that many women have.  Men know all too well the intense irritability that a woman can experience prior to her menstrual cycle.  PMS may be secondary to a hormonal imbalance. Once the hormonal balance is regained the PMS may resolve.  Some women who experience depression may be able to stop their anti-depressant medication when their hormones are balanced.  Some intense anxiety can improve with the balancing of the hormone, progesterone.

A less well known, but none the less important possible cause of psychiatric symptoms is disturbed digestion.  Food allergies, gluten sensitivity, casein (milk) sensitivity, intestinal permeability (leaky gut) and chronic yeast infections can all lead to significant psychiatric complaints ranging from anxiety to profound depression.  The majority of serotonin is produced in the gut.  If the gut is inflamed or not functioning optimally than the production of serotonin will be impaired and the end result is depression.

Some people complain of fatigue and a lack of energy for life.  They lose interest in sex, feel overwhelmed by life's responsibilities and have difficulty coping even with small things. These people may be suffering from adrenal fatigue.  Adrenal fatigue is a condition in which the stress hormones of the body, produced by the adrenal gland, are not sufficient to help us manage the demands of our lives.  This condition is treatable and can improve the quality of life for a great many people.  With the proper supplementation someone with adrenal fatigue will go from feeling like they are profoundly tired, dragging themselves around, to just feeling tired.  When properly treated, the fatigue becomes appropriate to life circumstance.

There are also nutritional aspects to psychiatric conditions.  Some foods are "feel good" foods and some foods are "feel bad" foods.  Foods high in sugar and simple carbohydrates, will invariably make you tired, irritable and unhappy.  Avoiding high-glycemic index foods will often quickly improve one's mood and energy level.  Eating according to your metabolic type will leave you feeling satisfied and content with plenty of energy.

The conventional method of treating psychiatric disorders, utilizing medication, limits treatment to the brain neurotransmitter system and misses the rest of the neuro-endocrine-immune-gut components altogether.  Additionally, the psychiatric medications carry significant side effects, cause vitamin deficiencies and other neurotransmitter imbalances. 

By contrast, treatment with a supplement which is an amino acid precursor to serotonin which allows your body to make its own serotonin, does not cause the nutrient deficiencies seen by medication.  Since the repletion approach is more physiological, working with the body's inherent mechanism, it is generally better tolerated with fewer side effects. 

Another pit fall in the use of medication is that all the neurotransmitters are not accounted for so imbalances form.  For example, the "I don't care about anything" syndrome that some people experience while taking anti-depressants is the result of a relative decline of dopamine.  Unless the dopamine deficiency caused by the anti-depressant is addressed, the feeling of disinterest will remain.

While I believe that psychiatric medications have their place in the acute treatment of psychiatric disorders there are many down sides to using them exclusively.  The holistic approach is broader and much more supportive to the whole body and the whole person.

A brief case history will illustrate some of the principles.  M is a middle aged man who has been on anti-depressants for many years.  He has had many years of psychotherapy for the depression.  When he came to me, he was taking high doses of Lexapro, an anti-depressant.  He wanted to discontinue the Lexapro. 

As we lowered the dose he began to describe the feeling that he did not have the interest to do anything.  He rested his head on the toilet paper roll in the morning and did not even want to get up from the John.  I thought his lack of interest might be an imbalance of the thyroid.

Conventional psychiatry tests only the TSH, the hormone that tells your thyroid to make more thyroid. Holistic psychiatry tests the thyroid more broadly and includes antibody tests. I re-tested his thyroid, including antibody testing.  I found that, although the thyroid levels were normal, he had antibodies to his thyroid.  He had Hashimoto's thyroiditis.  We corrected that with Armour thyroid supplementation.  His interest in life improved and the feeling of not wanting to get off the John resolved.

He also complained that his depression was always associated with a stomach ache.  This had been true throughout life.  As a child he was always the one with the tummy ache.  I suggested he stop all gluten products (wheat contains gluten as do many other products) as 10% of patients with Hashimoto's thyroiditis are also gluten intolerant.  He improved immediately.  Now we have to see if there is sensitivity to casein (milk products) as well and if there is a yeast overgrowth.

M is an excellent example of how the physical dysfunction of the neuro (depression)-endocrine (thyroid)-immune (allergy) can affect mood and interest in life.

If you are interested, or someone you know may be interested, in a more holistic approach to their psychiatric well being, please call The Center for Holistic Psychiatry and Pain Management at 703-734-1774 and set up an appointment with Dr. Somner.