31.1 Functional Psychiatry with James Greenblatt, MD

[00:00:00] It's just enraging that these experts are, you know, working on a model that has only shown dramatic increases in suicide rates with more medicines, more therapy, more hotlines. And there's more research to support some of the work that we're talking about. This DSM, I don't know how many thousands of pages, it's just a list of diagnosis based on symptoms. There's no concept of etiology.

[00:00:28] And when you think about it, it's just absurd. We learned in medical school 10 causes of anxiety, right? From a cancer to elevated thyroid to hiatal hernias to stress or trauma. But once we get out of medical school, it just goes down to a deficiency of a drug. That's what anxiety is. So we give you that medicine. Somebody get this guy some help.

[00:01:05] Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis, or treatment. All listeners should consult with a medical professional, licensed mental health provider, or other healthcare provider if seeking medical advice, diagnosis, or treatment. Or, put more simply...

[00:01:34] If you need help like this guy, call your own doctor. All right. So today, I have James Greenblatt, MD and psychiatrist, who is a pioneer in the field of functional and nutritional psychiatry with several decades of clinical experience. And along with myself, a huge proponent of utilizing low-dose lithium to improve mental health problems and outcomes. He's a licensed and duly board-certified adult and child clinical psychiatrist.

[00:02:02] After receiving his medical degree and completing a residency at George Washington University, Dr. Greenblatt's completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. He serves as a member of the clinical psychiatry faculty at Tufts University School of Medicine and Dartmouth School of Medicine. Also provides training to psychiatry residents at Harvard, Tufts, Dartmouth, and UMass.

[00:02:27] Dr. Greenblatt is the author of at least eight books, including the best-selling Finally Focus, the Breakthrough Natural Treatment Plan for ADHD, as well as Answers to Anorexia. And my personal favorite and most relevant to aspects of our discussion today, nutritional lithium, a Cinderella story, the untold story of the mineral that transforms lives and heals the brain.

[00:02:52] Dr. Greenblatt, you also offer continuing medical education via an online educational program at psychiatryredefined.org, which I think has been around since 2018 or 19, for psychiatrists pursuing an integrative model for mental health, as well as more recently, themindrefined.com, which seems to be more directly tailored towards patients and families.

[00:03:17] You also supervise psychiatrists in a one-year online fellowship program, trying to educate them on an aspect of our own training, which we get very little training on in functional psychiatry. You have a special focus on mood disorders, ADHD, eating disorders, and depression, offer innovative solutions that address underlying biochemical imbalances.

[00:03:42] One of my favorite aspects of just kind of following you and your work peripherally is it really seems like you work to address the root causes of what I call patients' internal pollution by going upstream to cut off the source of that pollution, which I might add doesn't usually result in a clean waterway right away.

[00:04:06] As an educator and an author, Dr. Greenblatt has written extensively on the role of nutrition, genetics, and brain chemistry in mental health, helping clinicians and patients alike understand the power of integrative treatments. You're a very sought-after speaker and what I would say is an actual thought leader as opposed to an industry-sponsored thought leader.

[00:04:28] And you continue to shape the future of mental health care by advocating for a more comprehensive and individualized approach to healing. More recently, some of your work has been emphasizing the benefits of low-dose lithium as a preventive treatment for conditions so pervasive like dementia and Alzheimer's disease, reflecting your commitment to integrating innovative and evidence-based approaches into mental health care.

[00:04:57] I am just so grateful for you and for other practitioners like you and being able to, at least in part following your footsteps, review your work. As a young psychiatrist, it is so important for me to have additional clinical role models outside of just my training program. So I'm very, very appreciative of you. I know there's a little bit of a long-winded introduction, but how are you doing today? I'm doing very well.

[00:05:26] I'm so pleased that you are interested in kind of rethinking the model that you and I were trained on that has its clear limitations and there's so much we can do. Unfortunately, there seems to be a lot of information that I received and that I'm sure that you received in your training that seemed to be somewhat sponsored information.

[00:05:49] And unfortunately, I hate that I have to ask, but do you have any disclosures that are relevant to our conversation today? Wow, interesting question. You know, I think that my books, obviously we give royalties from my books and my educational platform is a business I own. You know, I used to work for different supplement companies. I no longer do. So no, I think we're pretty clean here.

[00:06:15] So the huge market of big lithium isn't paying you to promote this oldest, most natural treatment that we have in psychiatry. Big lithium, is it paying you? No, no. But speaking of lithium, it's a very inexpensive medication, as you know, and it's also an inexpensive supplement. And the fact that you understand how powerful this can be, there are now pharmaceutical companies.

[00:06:43] There's one in France and two in the States packaging low-dose lithium in a new way so they can get approval and charge hundreds of dollars for a pill. I think one was for mood disorders, one is for Alzheimer's and other disorders. So yes, Big Pharma has seen the light and is now looking at a way of packaging lithium.

[00:07:07] I mean, it's pretty clear that too much of psychiatry, mental health treatment over the last 50 years have been kind of molded by the pharmaceutical companies, the training and the education, and too much of the research is driven by the pharmaceutical companies. So whether it's a psychedelic or a new way of packaging, you know, ketamine, there's, you know, financial interests that often cloud the information.

[00:07:33] Yeah, absolutely. And none is more relevant than with very cheap and natural element lithium. First, I'm always intrigued to hear a little bit more about you, about your early life, as well as how you came to pursue medicine and psychiatry. Well, medicine was probably there since first grade. So I always wanted to be a physician. Psychiatry was never on the list.

[00:08:03] I started off in pediatrics. My internship was in pediatrics. And I just got so horribly bored with them. At the time, we were giving antibiotics for every earache. So it just seemed not very either genuine or what I wanted to do. So I switched from pediatrics to the goal was child psychiatry. So adult and then child psychiatry. So I kind of came upon it, you know, through wanting to work with kids.

[00:08:30] And then, you know, coming out child psychiatrist, you just start prescribing Ritalin. And I just realized there had to be a better approach to treating ADHD and other childhood illnesses. And really then got back to why I went to medical school and looked more closely at nutrition and brain function and all the what we now call functional medicine. Yeah, I had on Nicholas Rosenlicht a couple of weeks ago.

[00:08:58] You know, it's amazing how many different specific examples there are of the field being manipulated, whether it be research or whether it be psychiatrists who don't think it's relevant to disclose how much money they've been paid by the makers of, you know, Ritalin and Concerta. And I'm referring to, you know, Nimeroff and Biederman, I believe, that received millions of dollars

[00:09:23] over several years and were at the same time promoting that Ritalin and Concerta were these super ultra effective and safe treatments for ADHD, which not to say that they may not have a role, but, you know, that just seems very dirty and not very trustworthy when it's kind of like if a referee was being paid by a team and that team ends up winning, you may not have obvious or overt

[00:09:48] evidence, but it certainly seems like enough circumstantial proof or evidence to make you question heavily the effectiveness and safety of those things. You've been appropriately critical of how we treat mental illness pharmacologically throughout your career. Can you outline some of your most scathing critiques of the U.S. either healthcare system or more specifically mental healthcare system and how you escape the kind of guideline driven

[00:10:17] system into the space where you are now of integrative psychiatry? Sure. I mean, I think it's really important to set the foundation that, you know, I call myself a functional psychiatrist, but it doesn't mean I've given up my prescription pad or psychotherapy or any other tools that we might've learned. I'm just kind of trying to raise my voice a bit about adding tools to our toolkit.

[00:10:46] I think the biggest critique is just this big picture concept of our current model in psychiatry is just symptomatic based medicine. This DSM, I don't know how many thousands of pages. It's just a list of diagnosis based on symptoms. There's no concept of etiology. And when you think about it, it's just absurd. We learn in medical school, 10 causes of anxiety, right?

[00:11:13] From a cancer to elevated thyroid to hiatal hernias to stress or trauma. But once we get out of medical school, it just goes down to a deficiency of a drug. That's what anxiety is. So we give you that medicine. And so it really has to just be seen as my only criticism is this kind of overarching symptomatic based model.

[00:11:39] And I'm just trying to help people look at, as you described, root cause and objective tests, just like we do in every other part of medicine. You wouldn't do surgery or operate without lab tests and MRIs. And I'm just asking psychiatrists and mental health clinicians to look and to look at blood work and to understand what might be contributing. There's far too many psychiatrists, especially in my position, that are young in their career

[00:12:08] who may not even prioritize basic lab work before they start to muddle with somebody's chemistry in their brain and prescribe different drugs, not necessarily knowing if there's a simpler solution to the problem. In reviewing some of your tests, I'm curious if you found yourself on a deserted island with a clinic of a thousand new patients and you can only bring the capabilities for three different

[00:12:38] lab tests other than kind of the routine or basic what I would call basic psychiatric labs of CBC, CMP, thyroid function tests, and then just the kind of basic vitamin and mineral deficiencies, folate, vitamin B12, vitamin D. What else would you consider to be those three most high yield or important other lab tests that generally are not ordered?

[00:13:07] Well, I think I have to just start. It's a good question. But, you know, I talked to colleagues around the country or actually around the globe now in our training. And there are individual psychiatrists and nurse practitioners in community mental health clinics and practices where they're not allowed to order a vitamin D test. They can't order any lab work, either one because of the cost or for some of these clinics, they don't even pay for them.

[00:13:36] But we don't have time for that. So I'm glad that in your training, you had at least someone thinking and these routine labs, because I believe just vitamin D and B12, two inexpensive tests could dramatically shift the landscape of mental health in our country, if not the globe. So it's really important that those basics are done. And then I think the three what might call functional tests that I would add probably would

[00:14:05] be a genetic test looking at a genetic variant of folate metabolism, the MTHFR. It is common in the patients that don't get better with our traditional training. Another test that's not discussed enough is something called a cryptopyrrole test. It's a urine test that measures a molecule that just leaches out B6 and zinc, which is critical.

[00:14:29] And then maybe the third one might be something that's not routinely done in psychiatry, but very common in my practice to look at fasting amino acid levels. So the amino acids are the building blocks of protein. They're the building blocks of almost every neurotransmitter in the brain. And what we're able to determine if someone has very low levels of amino acids unrelated to diet

[00:14:56] can predict a treatment model for depression, anxiety, fatigue in particular. Tell me a little bit more about the cryptopyrrole urine test and how you utilize that to kind of drive your patient care. Sure. I mean, it's a unique test and it's probably one of the only things that we teach and talk about in our fellowship where I don't have a lot of evidence-based research to back it up.

[00:15:25] But for an inexpensive $100 test that I've been doing for 20, almost 30 years and colleagues around the country that elevations of this marker and there's normals and there's elevation when it's elevated, it just binding B6 and zinc and it leaches them out of the body. And we see anxiety, depression.

[00:15:50] I've seen psychosis, paranoia, a whole range of psychiatric symptoms because of this chronic B6 and zinc deficiency. So we pick it up and you just replete and it's high doses of B6. So it's beyond what you would get in a B complex. So with those high doses of B6 and zinc, you can see some of these debilitating psychiatric symptoms completely disappear.

[00:16:15] If I was to order all of these tests, not just the ones that you mentioned, but also celiac disease rule out antibodies and other markers of inflammation, sex steroids, other hormones, what do you think the cost would be just out of pocket for all of these tests? I don't know. I mean, I think the list from the routine labs, and I would include celiac screening in that.

[00:16:41] I don't think about the cost because insurance would cover it, even Medicare or Medicaid. And then for the functional markers, these tests that insurance might not cover, that could be anywhere from $500 to $1,000 of additional tests that would complete what I would call an adequate functional psychiatry workup.

[00:17:06] What has been the most relevant, I guess, lab test or marker that maybe you were not looking at towards the early part of your career that you've seen so many aberrant results and been able to help people by correcting those deficiencies? I mean, I think all the routine tests I'm doing, you know, I've been using for 25 years.

[00:17:32] And so that's why I can help clinicians understand what's relevant and what's not. Too much of the functional medicine world are people that just treating tests, not patients. And that's a problem. But a newer test, since you use the word new, is something that I used to do years ago, and then I just started doing is looking at a folate receptor antibody. And this is significant in the autism community.

[00:17:59] And we've seen it now in a couple of schizophrenic patients. So that is a new test that has just tremendous implications. So it's looking at this antibody that blocks the binding of folate to get across the blood brain barrier. So essentially, it's creating a folate deficiency in the brain. And there's paths of treating that with a form of folate, which is a medication.

[00:18:27] And that's been quite dramatic over the last couple of years. Can you just treat that similarly to a MTHFR with a L-methylfolate? Not as good as using folinic acid seems to be. And that's a prescription medicine, Leucovarin, where both young kids and adults have seen some pretty tremendous progress. There was just a very recent major news release on that.

[00:18:54] I believe it was Leucovarin for a young nonverbal autism patient that very quickly started to accelerate in their verbal learning and social cognition measures. So that's very, very interesting. Okay. So I've had you give a couple of lab tests. So same situation. You're still on the island. Let us assume that there are some natural substances or treatments that are available on the island.

[00:19:21] What three other medications or pharmacologic agents would you bring with you? I mean, lithium would be number one. It's been around for a billion years. We don't know what the lithium in the water supply of the island is. So lithium, absolutely both the microdoses, nutrients. Magnesium is probably one of the most common nutritional deficiencies we see in a psychiatric practice.

[00:19:49] And third one will be a little more challenging. There's so many. But I've been a huge fan of a class of phytonutrients called OPCs, oligomeric pro-encyanidins is the name. You know, the blue and blueberries and the grapeseed and the green tea and the chocolate. It's one molecule in all of these micronutrients that we've used for mood disorders, ADHD, and

[00:20:16] a whole host of other psychological and psychiatric problems. Something very relevant within what you just said there is, can you tell us a little bit more about where just getting a magnesium blood level may fall short? Sure. I mean, you know, testing is the path towards developing this personalized treatment plan. And that's a core of the work that we teach. But there's some micronutrients, magnesium in particular, that testing is not helpful because

[00:20:44] I don't know if it's 98 or 99, but some high percentage of all the magnesium is in our bones and our cells. So if we do a blood test, if you're deficient in magnesium, and I occasionally have seen it with patients with anorexia nervosa or patients in a hospital, but it's rare, again, because everything is in the cells and the bones. So it's hard to assess magnesium stores. And that's why, to me, it's a clinical diagnosis.

[00:21:14] And there are symptoms of magnesium deficiency that can help guide whether you need magnesium. Let's move on to lithium. In my limited experience, it has been the absolute best drug, most effective, and also, especially when you use lower doses, I would say the safest drug in the long term. And part of me utilizing it, I have to credit you for, because even some of the most well-versed

[00:21:44] psychiatrists, I would say nationally, internationally, spoke to Janis Rybikowski, who did some of the early work on some of the antiviral and immunomodulatory effects of lithium. He was not aware at all of any real positive impact psychiatrically of the low doses, and especially of the supplemental doses. I have to credit some of my early lithium use in my career to you.

[00:22:11] When I read, I think it was a 2017 article or blog titled Lithium, the untold story of the magic mineral. And to me, lithium offers a benefit to risk ratio that dwarfs the benefit to risk ratio of so many other, especially pharmacologic agents that I am taught to use. But I'm curious, how did you discover its potential?

[00:22:38] Or at what point in your career did you realize that this specific drug was extremely underutilized, especially in the United States? Yeah. When I was in college, you know, I was reading Jonathan Wright, who was a physician, kind of the grandfather of all of integrative medicine. And he wrote about lithium orotate. And I had no idea what it was, but he presented cases.

[00:23:04] So I was interested in lithium before I got to medical school. And then you go through psychiatry training and you see lithium as a miracle drug for a month. And then you see patients coming in who need kidney transplants and severe thyroid disorder. So in my traditional training, I was always hung up with people pushing doses for blood levels. Because as I started practicing, I just kept getting the same results with much lower blood levels and no side effects.

[00:23:34] And then I started prescribing lithium orotate, which is the nutraceutical. We're talking about a milligram. Then I've just spent 30 years diving into the research. And it's just incredible how tiny doses, micrograms of this mineral has been shown to prevent suicide, Alzheimer's, aggression in kids. And the literature just keeps exploding. And our colleagues keep ignoring the implications of low-dose lithium.

[00:24:04] I'm a relatively simple-minded guy. I really am. But when I kept being pushed with this narrative to give SSRIs a drug class that I think it was revealing more and more throughout the 2000s and 2010s that could lead to an increase in suicidal behavior, especially in young people.

[00:24:27] And then you add the fact that there's this natural salt, this mineral that is everywhere around us and that we're ingesting through our water supply every day that has proven efficacy even at really low doses. If you want to use a clinical dose, you can still use a dose that's a sixth to a tenth lower than what you maybe would use as an anti-manic dose that reduce the risk of suicide.

[00:24:54] That in and of itself never made sense to me and really kind of launched me down this very skeptical approach to what I was reading and what I was learning. Now, I will talk in a minute about some of the super responders certainly had some of those immediate responses. But the more typical response and what I've seen in some of your articles that you've written is that a lot of these take time.

[00:25:20] Because if you have a deficiency in something or you have something that is working kind of behind the scenes on changing the expression of your genetics or changing the way that interacts inside of your body and system with other ions, it takes a little bit of time. But like most patients I think would prefer, the benefits seem to build progressively over multiple, really even years.

[00:25:48] Getting the patient to stay on board sometimes is one of the more difficult parts for me, even utilizing low doses. How do you counsel patients on how long the effects will take, whether it be a prescription dose, a supplemental dose, or even a micro dose? Sure. I mean, I think education is really the only path where our patients are going to be more compliant and can appreciate the role.

[00:26:15] For the prevention of dementia and Alzheimer's, I think it's clear that someone has to be on it for long term. With the prescription medicine, lithium carbonate, in the prevention of dementia, it only helped if they were on it for a year or more. So I do think we know so much now about Alzheimer's and we know it doesn't happen overnight. We know there's a 30-year progression of this neuropathology.

[00:26:42] So it just makes sense that we have time for these modifiable interventions to treat some of the risk factors. So for the prevention of dementia, lithium should be done long term. When we're talking about some of the symptoms, which usually focus around impulsivity, irritability, and mood, you know, sometimes we see difference in a few weeks and it just motivates patients to continue it.

[00:27:10] But as you said, it's a gradual accumulation of a low dose lithium where people can notice the most significant improvement. There are very few psychiatrists and especially psychiatrists in a position like yourself at a prestigious university in academia who are talking about low doses of lithium in autism.

[00:27:33] My first real kind of mind-changing or professional clinical changing experience with 150 milligrams of lithium carbonate in a high-functioning autism patient was their parent called me a couple of days later and they gave the example of their son, you know, a young adult at this point,

[00:28:01] coming out of the basement, which he would spend most of his time and spontaneously asking them how their days went and how they were. This is something that this individual had not done before. And this was within days of starting this low dose of lithium.

[00:28:22] I've seen other results where the patient doesn't notice, but their family starts to notice this lifting in their mood or it's almost like a lifting of an overly rigid or concrete thought process. When I tried to start looking up online and in the textbook lithium or low-dose lithium in autism, there is very little information out there.

[00:28:48] I've gotten more information from you utilizing low doses or supplemental or micro doses in autism. So tell me about your experience in this population. Where did this first start for you? And yeah, tell me everything you know about lithium and autism spectrum disorder. You know, I mean, as a child psychiatrist, that's what I was seeing early on. Lots of developmental disabilities, autism and ADHD.

[00:29:14] You know, currently I see less autism, but it was just, as you described, kind of mind-boggling and eye-opening to see some of the results. I mean, it doesn't reverse or cure autism, but for many, it can make a huge dent. And again, the symptoms that I found most responsive were things like impulsivity, irritability. I like your word rigidity.

[00:29:39] You know, during my career, I got to see an antipsychotic get approved for the irritability associated with autism. So Risperdal. And it's dished out like candy to individuals with autism. And then they have side effects. They gain weight, binge eating problems.

[00:29:57] And it's just really very sad that going to an antipsychotic for symptomatic-based treatment rather than trying this low-dose lithium. So I've used everything from 400 micrograms on a child once who got kicked out of preschool, you know, to higher dosages depending on the age. And we always start low and titrate up.

[00:30:24] But as you described that case, one thing that I share all the time in my talks is I get more thank yous. I've gotten more thank yous over my career from spouses and parents and teachers and colleagues from their utilization of low-dose lithium. The reality, and I realize this with every patient, they want to get better. Most patients want to get better. I want them to get better.

[00:30:53] And I think that can be somewhat dangerous in drawing conclusions that something works too early on. I am very, very hyper-aware of the placebo effect and maybe even to a fault educating and asking my patients to make sure in the long term that this treatment is effective.

[00:31:14] What do you think are the best ways to measure the progress of such a minute change in exposure to an element over time that can reveal? You know, the reality is we want things to affect us immediately. And when we say that something is effective, or at least as a patient, what I find is patients will typically find stimulants effective because they feel a response relatively quickly.

[00:31:44] It doesn't mean they're effective and safe in the long term. But again, long-winded, what's the best way of measuring progress in, I guess, any individual taking a low dose of lithium like that? Sure. I remember when I was seeing lots of patients in private practice, I would start every conversation by saying, if I do my job well, you know, you don't need to see me, you know, after 46 months.

[00:32:09] I mean, it's not our traditional model of holding on to someone for medication management or psychotherapy for years. My job is to get you to a point where you don't need to come back. For most of psychiatry, as you described, it's a feeling. Someone's sad, they feel depressed, and then when they feel better, they'll be able to articulate that. For some of the disorders we treat, like ADHD, it's not a feeling problem. You know, it's kind of behavior and people can observe it.

[00:32:37] So sometimes we need others' input. But, you know, I think the goal is really helping individuals understand the symptoms that are getting in the way of some aspect of their life and being able to monitor those. I think it's always hard to answer what one nutrient is because it's usually not just one. Sometimes I've used lithium with a dramatic change.

[00:33:06] And if the patient or family, you know, doesn't look deeper at some of the other kinds of tests, then sometimes those symptoms kind of creep back. So we have to make sure we're always doing what you described as the basic foundation, the B12 and the D and other kind of variables. Because when you do the full workup, then I'm much more confident we're going to sustain those recovery and those symptoms will disappear.

[00:33:35] I have gotten some absolutely asinine looks from patients. And part of it is probably because of my age and the recommendation. But when I see somebody who is coming for an ADHD evaluation and I say, look, this drug, lithium, it performs just as well in a randomized controlled trial as, you know, one of the top drugs in the ADHD market, Ritalin.

[00:34:01] People look at me like I'm crazy sometimes recommending lithium for ADHD. You've spoken a lot on this. Can you tell us about how and why you think lithium may be effective in managing the symptoms of ADHD or getting to the root? Sure. And it's not every ADHD individual. I think one of the important things is family history.

[00:34:23] So I found the most kids responsive to lithium are those with a family history of addiction and maybe other mood disorders, even things like aggression or impulsivity. So if, you know, Aunt Anne was in prison or Uncle Johnny, you know, kept getting in fights or anyone had addiction. It doesn't have to be the immediate family. But that genetic kind of lineage, those are the kids that respond pretty well.

[00:34:50] And then when you think of the symptoms, the core symptom for too many of our kids and adolescents and adults with ADHD is impulsivity. Right. The inability to inhibit the thought, the feeling, the behavior. And that's the meltdown. And, you know, I've been to a lecture where doctors spend the entire time talking about the neurochemistry of impulsivity and how lithium can turn that switch.

[00:35:16] And the next kind of, you know, common thing is irritability. That mood changes and irritability and lithium is kind of incredibly helpful there. So when you have the moodiness, the irritability and impulsivity, I mean, it's hard not to think lithium. And, you know, I just make sure parents and patients understand it is not that prescription lithium at the dosage as we might treat bipolar illness.

[00:35:45] These are very low dosages, sometimes as low as what people might get in their drinking water. And you reassure them that will check levels and monitor, but it can be incredibly helpful. Absolutely. In my brief career, I've already lost a job working in inpatient addiction because I was utilizing so much low dose lithium.

[00:36:09] I mean, I had so many patients coming in on five, six, seven, 10 different psychiatric medications. And I was trying to use more really low dose lithium. I don't think risk management understood that there's a huge difference in the use of, you know, really, I would say anything below 600 milligrams of, say, lithium carbonate versus the higher dosages, 900, 1200,

[00:36:34] that you would tend to use more for somebody who is acutely manic or had a more severe form of bipolarity or bipolar disorder. But I love that you've talked about the impulsivity. I mean, that is an overarching feature of lithium is that it helps to reduce impulsivity. And you mentioned one aspect that I think gets overlooked all the time, that there's an impulsivity in our thought processes.

[00:37:02] You know, we have this automatic part of our brain that spits out thoughts that I don't think is very easy to inhibit. But then that message gets transmitted to, for simplicity's sake, to our frontal lobe for processing and the checkpoint to say, no, I'm not going to do that or I'm not going to say that. But what you mentioned, I think is so important, or I'm not going to believe that thought is absolutely true.

[00:37:27] There's an impulsivity if I'm sitting with a patient and I have a thought, oh, I'm young in my career and I don't know what I'm doing. I'm an imposter. There's a certain amount of impulsivity that goes with taking that thought and making it a absolute truth as opposed to what it is, just a thought. And pairing that with the way that some of my patients describe their experience with lithium, and I've had multiple unprovoked to say this.

[00:37:57] It's not that my thoughts or my emotions are any different. It's that I have a different willingness to engage with them, process them, and move beyond them. Can you speak to that at all? Yeah, no, absolutely. I mean, two thoughts. That's one I just want to say about the addiction. You know, I mean, there was a study in a New York psychiatric addiction residential using the low-dose lithium, 150 to 300, and dramatic improvement in compliance, less medications, more completion.

[00:38:27] So just better outcomes with addiction. So it's really important that people understand the role of low-dose lithium for the treatment of addiction. And I think when we think about, you know, impulsivity, you know, it cuts across kind of our normal life, as well as so many of the psychiatric disorders that we treat or individuals struggle with.

[00:38:51] And that's why the low-dose lithium can be such a huge kind of component, you know, of a treatment model, whether it's a nutritional recommendations or pharmaceutical, the low-dose lithium as an augmentation strategy just provides often, you know, incredible amount of strength to the patient. I had one physician, a patient, history of alcohol, coming in for depression, trying to get off the antidepressant.

[00:39:22] And usually I wait for all the testing to come back before I prescribe supplements, but for some it was so clear. So I gave her lithium, low-dose, five milligrams. And when I saw her, you know, back with six weeks, we had all the tests and asked her how she was doing, she just started crying.

[00:39:37] And I thought something was wrong, but it was just really joy because she didn't realize until she took the lithium how irritable and angry she had been to her husband and to her teenage daughter at the time. Because she just always, she thought that was who she was. And the lithium just completely dissipated that. And, you know, she was just moved to tears.

[00:40:03] Kind of a personal question, but when something like that happens with a patient, you know, I've always said, you know, I'm not altruistic by any means. But how do you feel when you get that response and you have that experience? How does that make you feel as a clinician?

[00:40:23] Well, I think the whole world of nutritional and functional medicine has really kind of anchored me as a psychiatrist, knowing that I'm providing information that's not just Band-Aid. You know, I mean, I had some great results as a psychopharmacologist and someone with a, you know, severe mood disorder and people feel better. But I know it's this kind of temporary fix.

[00:40:47] But this work of nutritional and functional psychiatry, it's just much more gratifying because it's really addressing root cause. And people can experience concepts like recovery and remission, things we don't really talk about in psychiatry. Certainly changed my risk of burning out of my profession by having those responses. So as much as I love to see my patients doing well, it really moves me to be able to be part of that.

[00:41:17] There have been times where I've honestly, I've gotten like tearful in those discussions because like you mentioned, you see so many of the responses that fade over time. And the person comes back three, four months later, and it just seems like they're right back at square zero. One other specific to low-dose lithium, I've talked about its role in, you know, the symptom of anxiety and mood disorders. Anybody who is suicidal, even if you're just using a supplemental dose.

[00:41:46] One of the oddest response that I've now seen, I'm going to say one and a half because I'm still holding out a sense of disbelief in the other case. But there was one case where I had a patient come in and her husband drove her from about an hour away because she was worried that she couldn't drive herself due to suicidality, that she might run off the road. And we started her on just for the suicidal thoughts.

[00:42:13] I said, okay, let's start you on 150 milligrams of lithium carbonate and see where you're at in a couple of weeks. Certainly let me know if anything changes in the interim. And she comes back a couple of weeks later and she says, yeah, I feel a lot better. She said, you know, it was the weirdest thing. We hadn't talked about this at her intake. She said, it was the weirdest thing every month since I have been 13 years old, 14 years old.

[00:42:41] I have had just extreme swings of irritability, crying spells. And her words, not mine. She said, I was a complete bitch to my mom, to my husband during that timeframe leading up to when she would start her period. What we used to call PMS or premenstrual syndrome. And now we call PMDD or premenstrual dysphoric disorder. Of course, you know, I thought, well, this is a red herring.

[00:43:10] It's not, you know, maybe she just had one month off. Several months later, she has not come back to see me. And I assume because of my imposter syndrome that she's not come back to see me because I've not helped her and she's gone elsewhere. So I emailed her and I said, hey, I'm just curious. Have you had the resurgence of, you know, PMDD symptoms? She said, I haven't had any of that.

[00:43:36] I've now had five or six months of absolutely no change in my mood with my menstrual period. What do you know about that or what have you seen? Can you tell me how or why that happens? Well, I think, you know, if we just go back to the word irritability and I have a chart where, you know, I just list 10 or 15 diagnoses. And I'm going to add a third.

[00:44:02] But it just, you know, from road rage to borderline personality disorder to people coming off alcohol who are not drinking and irritable to depression, anxiety to we talked about irritability associated with autism. So if you just think of irritability and if you want to add slash impulsivity, it is tremendously helpful.

[00:44:26] And so what you described is someone who was, you know, during other hormonal and neurotransmitter changes was irritable. And lithium can really be that magic mineral to support that. I want to come back to what you originally think about the suicidality.

[00:44:41] The patient you mentioned was struggling with suicide and this micronutrient lithium from the amount in the water to prescription lithium has been demonstrated since the 70s to have anti-suicide properties. I mean, it is, you know, indisputable. The research is clear and the research is across the globe.

[00:45:05] So we've looked at drinking water from Japan and Greece and England and different parts of the United States. And all the studies come back the exact same thing, that the amount of lithium in the drinking water predicts suicide. And then we have the pharmacological studies. So it is just really upsetting to me that this is ignored where suicide rates continue to just increase.

[00:45:32] And there's so many things that we could be looking at as a nutritional and a functional psychiatrist. But just this low dose lithium by itself could help individuals. So I think it's really important that that information, you know, is discussed and people understand it. So that's probably the number one reason why I'm sitting here. Or if you had to tell me to give you one example of why it was important for me to start this podcast.

[00:46:03] And I was afraid of being a little bit more vocal and critical being young in my career. But I just don't know what other way there is to do it. I think that we have to bring this message directly to the consumer. Essentially what I call it is DTCE, direct-to-consumer education, as opposed to the pharmaceutical industry loves direct-to-consumer advertising. But it really is one of the biggest passions of mine.

[00:46:30] As somebody who lives in an area affected by the throes of the addiction crisis, probably worse than any region of the world, as well as losing several friends and, you know, classmates from high school to suicide. It's just amazing to me. And not in a good way.

[00:46:50] It's amazingly atrocious to me that we do not utilize in the ER for somebody who is suicidal just to start them on a low dose right then and there. So that's, again, I thank you so much for maybe taking a more directed approach, especially over the last, I guess, what's it been, seven or eight years? That you've been really trying to get the message more directly out to people.

[00:47:17] Yeah, and the organized educational platform, you know, I've been talking for many years. But, you know, it's still an uphill battle for some things. I just share a story. An academic publisher reached out and wanted me to update a book on depression. And I said, well, I'd like to get this information out on suicide prevention. You know, a functional medicine model looking at some biomarkers like lithium that have clearly been associated with increased suicide risk.

[00:47:46] And so she took the book proposal and she sent it to some experts in suicide. Right. And they said there's no research to support any of this. So they didn't want to publish the book. It's just enraging that these experts are, you know, working on a model that has only shown dramatic increases in suicide rates with more medicines, more therapy, more hotlines.

[00:48:11] And there's more research to support some of the work that we're talking about. Lithium. I mean, vitamin D and suicide is just incredibly a rich area of research. But it's still an uphill battle. But I really appreciate your jumping in and both learning and teaching and practicing. A lot of money that will be siphoned away from other drugs and other companies by lithium if we use it more frequently.

[00:48:39] The prime example currently is the new Alzheimer's monoclonal antibodies that, you know, when they came out are running $50,000 a year when you could get the same amount of a daily nutritional dose of lithium for about $50 a year.

[00:48:57] And, you know, my very skeptical, skeptically focused brain kind of goes to that place often in terms of being very curious about some of the motivations of industry to demonize lithium as well or to not promote. You know, you go up the ranks of academia and it seems like if you're not willing to play ball at some point in terms of towing the company line that you may not rise up the ranks.

[00:49:24] And that seems to be an inherent issue with the system, which is why I'm here talking to you and nobody can stop me. Great. Well, keep up the work. Absolutely. I just have one other question for you. You've been extremely important in the field of psychiatry, aside from the use of lithium, in terms of really emphasizing that we need to do a better job of medically ruling out.

[00:49:52] You may even go as far to say that we could medically find a cause for any psychiatric condition. I think that is so important. I saw some of your earlier work. I think it was on pandas, the neuropsychiatric manifestations of essentially a flawed immune response.

[00:50:13] But I'm curious because, you know, I'm sure you understand and you kind of alluded to this, that the pendulum can swing too far in both directions. It certainly from the academic perspective swung way too far into the biologic. Everything can be treated by, you know, affecting your chemicals in your brain. But tell me where could functional or integrative practitioners maybe go a little too far?

[00:50:40] Well, I mean, I just vividly remember a case where I was treating the daughter, a young adolescent for ADHD and did very well on a nutritional approach and got her off medicines. And then the mother started sharing about her depression and wanted to get treatment. And she was really struggling and did a vitamin B12 level. And it was very low. I mean, dramatically low. So I feel good.

[00:51:08] And this woman's going to be mood is going to be improved. And I think we gave her B12 shots. And she comes back and she's still depressed and very upset. Didn't make sense because your B12 is 200. But, you know, I don't know if it was that visit or the next one. I mean, what she failed to tell me is she was in a horrific, abusive relationship, you know. And I was too quick for the B12s. She did not want to share, you know, that.

[00:51:38] She didn't trust me at that time because I knew of her husband because he came in with the daughter. So we can't forget our skills as therapists and our ability to ask questions and understand and empathize. And that therapeutic alliance, I think, is the most important part of our job as mental health clinicians. So I do worry about the functional medicine movement where now everyone's just selling tests.

[00:52:06] You can just order your own tests and you're going to cure mental illness by, you know, in my case, I thought a B12 was going to do it or whatever other test is being sold. So I really caution clinicians and patients that, as I said earlier, we don't treat tests. We treat people and individuals. We still need to dig deep to find out what's going on with our individual patients. Absolutely love it. Anything that you want to plug that you're working on now?

[00:52:35] Anything related to your websites you want to promote to my listeners, viewers? Well, we're always training clinicians and we have courses now looking at how we can help parents. So we have courses on ADHD for parents and courses on anorexia. And I just completed a book, Functional Medicine for Depression, that should be out at the end of the year. Well, thank you so much for your time.

[00:53:00] I will read your materials and try to incorporate what you're doing into my own practice and hopefully grow in what I'm doing. And maybe be able to come back to you one day and have something that you weren't aware of. No promises, though. I'm sure. I'm looking forward to working with you. Thanks, Dr. Trump. Absolutely. You have a good rest of your day. Thank you. Somebody get this guy some help.

[00:53:36] Thanks again for watching and or listening. If you're passionate about the subjects that I discuss on the channel, do me a favor and like, comment, subscribe. Do whatever you can to make your voice heard that these are problems that must be addressed in our society. If you have any questions, comments or concerns, I want to hear them.

[00:54:02] Feel free to reach out on social media or email us at renegadesyke at gmail dot com. And if you'd like to be a guest of the show or you have a connection to somebody that you think would be a good guest, let us know. Thanks again for listening.

[00:54:55] If you need help like this guy, call your own doctor.