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A Functional Medicine Approach to Perinatal Mental Health – Part One

 In a two part post this week, regular contributor Kathy Morelli shares information about and an interview with Kelly Brogan, MD on her nontraditional approach to working with women who are dealing with perinatal mental health issues.  Dr. Brogan shares information on incorporating a whole body Functional Medicine approach alongside traditional Western medicine to help and support women dealing with postpartum mood and anxiety disorders. Part two of this short blog series runs on Thursday. – Sharon Muza, Community Manager, Science & Sensibility.

Creative Commons Image: Pamela Machado

Creative Commons Image: Pamela Machado

I’ve been interested in Integrative medicine for many years. I’ve gotten a lot of feedback from Science & Sensibility readers and my psychotherapy clients that they are very interested in holistic approaches to their health.

On a personal level, I struggled with depression at different times in my life. Nineteen years ago, I suffered a long postpartum depression. I didn’t want to take any psychotropic drugs as I was breastfeeding; there wasn’t much research available then about medication and breastfeeding. I looked for other ways to heal. In the short term, homeopathy is what healed my severe depression. On a longer term basis, I studied many forms of mindbody healing: diet, exercise, bodywork and professional counseling techniques have been my holistic program for mental and physical health. I’ve been fortunate that I haven’t had depression in 17 years.

On a professional level, in my clinical practice, I’ve seen the whole gamut of results in my clients’ levels of anxiety and depression when using psycho-trophic drugs: successful, lackluster and very poor results. So, I’m always searching for complementary and gentle therapies to add to my own toolbox and referral list to improve my clients’ mental health.

Disclosure: I want to clarify that I’m not a doctor and I’m not licensed to prescribe medication, but in my role as a licensed counselor, I often share clients with psychiatrists, who do prescribe medications.

Medication Taper: I want to clarify that this article does not suggest that women should discontinue their medication.

In some ways, what is old is new again! Conceptually, functional medicine (FM) mirrors the approach of Traditional Chinese Medicine (TCM), which approaches the patient from a holistic level. However, functional medicine is an evolutionary development in the practice of modern conventional medicine. FM is a systems biology approach. FM uses all the tools now available to the modern medical doctor: current assessment and diagnostic technology, cutting edge research into the interaction of the endocrine, gastrointestinal, and immune systems with our environment and treatment with a range of integrative and pharmaceutical medical therapies.

A doctor trained in this sophisticated approach performs a personal and careful assessment of an individual in order to find and then correct the underlying imbalances in the body, rather than treat separate symptoms. This is a departure from the conventional “organ based” practice of medicine, whereby the focus of diagnosis and treatment of a person is set up in silo-like medical specialties.

Dr. Kelly Brogan practices Holistic Women’s Psychiatry in this manner. She has impressive academic credentials, having studied cognitive neuroscience at the Massachusetts Institute of Technology and medicine at Cornell University Medical College. She is Board Certified in both Reproductive Psychiatry and Integrative Medicine and certified in Endocrinology. She is a leader in Functional Medicine. For her clinical work in Holistic Women’s Health Psychiatry, she analyzes and combines the research from the intersection of these three fields. She has appeared at many conferences, including the recent 2013 Postpartum Support International conference, the 2013 Lamaze International conference, is the Medical Director at Fearless Parent, blogs for Green Medical Information and has blogged for Postpartum Progress.

At her private practice in New York City, she offers a supervised lifestyle and food-based approach for women to manage perinatal mood disorders without psychotropic drugs.

This article is meant as an introduction to a different medical approach to women’s mental health. The functional medicine approach integrates the emergent research of the past three decades that suggests that a modern diet high in processed food, carbohydrates and sugar not only impacts the body with such chronic diseases as diabetes and heart disease, but also impacts brain health and contribute to the rising rates of mental illnesses such as depression and postpartum depression, postpartum psychosis and more severe mental illnesses such as schizophrenia.

Kathy Morelli (KM): Dr. Brogan, I was excited to discover your work via the Fearless Parent website, where you’re the Medical Director. You’re also active on the Green Medical Information website, where you regularly blog and present webinars. I admit, I was at first skeptical. However, after attending your webinar, and finding the information to be so very detailed and well-researched, I’m very intrigued. How did you become interested in your particular niche, Reproductive Psychiatry and Maternal Mental Health?

Dr. Kelly Brogan (KB): My post-residency fellowship training was in medical psychiatry, which is looking at how bodily problems like infection or liver disease can cause psychiatric symptoms. I specifically focused on reproductive psychiatry and the treatment of mood and anxiety disorders related to menses, pregnancy, and postpartum.

Despite my extensive training in helping women to navigate the risks and benefits of medication treatment during this vulnerable time period, I found that many women chose to discontinue medication.

Because of this and also because I wanted to help the women in my care optimize their health for anticipated or current pregnancy, I decided to investigate some common body-based drivers of psychiatric symptoms. I focused on these areas of the body: thyroid and adrenal dysfunction, food intolerances and gut infections, and sugar imbalances, rather than solely looking at the neurochemistry of the brain.

I also began to research what evidence there was to support mood-enhancing treatments that were also beneficial to the baby (given maternal deficiency) such as vitamin D, fatty acids, magnesium, and b vitamins.

Now I focus on inflammatory models of depression and anxiety and look at environmental exposures first and supporting the immune system and minimizing inflammation second. I haven’t started a patient on an antidepressant in some time.

KM: Dr. Brogan, as I understand it, you approach your work by focusing on the underlying human physiology of depression and anxiety, which is impacted by such factors as a sedentary lifestyle and a nutrient-poor diet which, in turn, causes inflammation. The inflammation in the body negatively impacts hormonal and neurotransmitter production and balance, which causes mindbody ailments, such as thyroid dysfunction and depression and anxiety. How would a woman coming to your office experience her visit with you differently than she would in a conventional psychiatric visit?

KB: The backbone of my clinical interventions is a sophisticated diagnostic assessment which includes a large battery of blood work, stool samples, salivary hormonal assessments, and urinary organic acids. In this way, I can personalize interventions rather than just empirically suppress symptoms. All of my patients require expert nutritional guidance, which I support them through, as well as personally tailored exercise and relaxation response interventions.

I’ve developed deep concern for the excessive, and what I believe to be irresponsible, use of medications to manage chronic disease. We have lost touch with our body’s native ability to heal itself and to correct, through elaborate checks and balances, any disturbances.

We’ve lost touch with this because we look to doctors when we should first be looking to our homes, our plates, and our minds to see how we can better facilitate that healing process, as you have done, Kathy. I believe that psychiatric medications, but also common medications prescribed for pain, acid reflux, and high cholesterol are wreaking havoc on the body’s ability to function optimally.

Here is an example of how I work with a simpler case: A lovely woman comes in to see me. She says she has debilitating melancholic depression, no energy and brain fog. I even note some instability when she walks. When I take her history, she tells me she was put on an acid blocking medication 2 years ago for her heartburn. I ask about her diet, which is high in sugar and fried foods, which is most likely causing her stomach discomfort. It’s well known clinically and in the research literature that long-term suppression of stomach acid blocks the absorption of the essential B12 vitamin.

Did you know B12 is one of the building blocks of life? A B12 deficiency is a silent condition that disrupts the myelination process, which leads to depression, confusion and eventually, to brain shrinkage. B12 protects your brain and nervous system, regulates rest and mood cycles and also keeps the immune system functioning properly. In fact, in persons over 65, B12 deficiency is linked to memory decline, brain shrinkage and a greater risk of age-related dementia, as the production of hydrochloric acid slows down with age.

In addition, because my patient is of childbearing age, it is very important to help her maintain her proper B12 levels, in order to help maintain her baby’s health. An infant born to a woman deficient in B12 is at serious risk for negative neurological symptoms, such as lethargy, developmental delays and delayed cognitive and motor development.

So, back to my patient. I’ll run a simple blood test to determine B12 levels to see if this lovely woman has either a suboptimal B12 level and/or a secondary marker of B12 deficiency. If so, I treat her with non-invasive B12, which can resolve all of her symptoms.

I do this because there are cases in the research literature describing patients receiving electroshock and antipsychotic medications before someone bothered to check their B12 levels and then successfully treat them to remission with this vitamin!

I work overtime to uncover what might be driving symptoms and driving inflammation. I don’t believe that the answer lies in a psychiatric medication, and I do believe that these medications can cause significant short and long-term side effects. Some have posited that, in addition to often containing synthetic preservatives, titanium, and gluten, medications such as Prozac contain fluoridated molecules which may impact the body as fluoride – a neuroendocrine toxin – does.

If they were seeing someone else, they might be started on an antidepressant after a 45 minute clinical contact. They can expect to take that antidepressant for the rest of their lives because few prescribers are experienced in medication discontinuation.

On Thursday, Kathy continues her interview with Dr. Brogan, sharing more information about the role of diet on the childbearing woman’s mental health and how the functional medicine approach can help to improve perinatal mental health and provide help to those who need it. – SM

References

Bergink V. et al. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. British Journal of Psychiatry, 2011;198:264-8. Epub February 22, 2011.

Black, M.M. (2008). Effects of B12 and folate deficiency on brain development in children. Food and Nutrition Bulletin, June (29), 126-131.

Brogan K. (2013). Putting theory into preliminary practice: Neuroinflammatory models of postpartum depression. OA Alternative Medicine, May 01;1(2):12.

Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Alaedini A, Yolken R. Markers of gluten sensitivity and celiac disease in bipolar disorder. Bipolar Disorder. 2011 Feb;13(1):52-8. doi: 10.1111/j.1399-5618.2011.00894.x.

Fasano, A. and colleagues at the Celiac Center, numerous medical research articles.

Jackson, J., Eaton, W., Cascella, N., Fasano, A., Kelly, D. (2012). Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity.Psychiatric Quarterly, 83(1), 91-102, http://dx.doi.org/10.1007/s11126-011-9186-y

Li J, Harris RA, Cheung SW, Coarfa C, Jeong M, et al. (2012) Genomic Hypomethylation in the Human Germline Associates with Selective Structural Mutability in the Human Genome. PLoS Genet 8(5): e1002692. doi:10.1371/journal.pgen.1002692

Niebuhr DW, Li Y, Cowan DN, Weber NS, Fisher JA, Ford GM, Yolken R. Association between casein bovine antibody and new onset schizophrenia among US military personnel. Schizophrenia Research, 2011 May;128(1-3):51-5. doi: 10.1016/j.schres.2011.02.005. Epub 2011 Mar 4.

Oberland, TF, Weinberg, J, Papsdorf, M, Grunau, R, Misri, S, & Devlin, AM (2008). Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics, Mar-Apr,3(2), 97-106.

Severance EG, Dupont D, Dickerson FB, Stallings CR, Origoni AE, Krivogorsky B, Yang S, Haasnoot W, Yolken RH. Immune activation by casein dietary antigens in bipolar disorder. Bipolar Disorder. 2010 Dec;12(8):834-42. doi: 10.1111/j.1399-5618.2010.00879.x.

Perlmutter, D. (2011). Grain brain: The surprising truth about wheat, carbs, and sugar – Your brain’s silent killers. New York: Little, Brown & Company.

Depression, Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression , , , , , , , ,

  1. avatar
    b
    February 18th, 2014 at 11:42 | #1

    Very interesting. I look forward to the second half of the piece. Is there a central place one can look to find a functional medicine specialist in mental health?

  2. February 18th, 2014 at 11:57 | #2

    Hi – Thanks for your interest. As it;s a new field, there isn’t a centralized database for practitioners. There are doctors whoa re certified in functional medicine, but its takes a detailed search in your local area. There are some drs who identify themselves as functional medicine drs, if you search with google. Sorry I can’t help you more. Good luck!

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