The Mental Health Revolution: Why Natural Healing is Taking Over!

[00:00:00] Welcome to Take On Healthcare. I'm Mary Sheehan, pharmacist and natural health advocate. And I'm Dr. Ted Suzelis, a naturopathic doctor. Here we explore holistic science-based solutions to the biggest challenges in health and wellness. In today's episode, we're thrilled to be joined by two extraordinary guests who are transforming the way we think about mental health. That's right, Mary. First, we have Dr. Sarah Hoong, a naturopathic doctor and licensed acupuncturist.

[00:00:29] She'll share her insights into using adaptogens, nutrition, and acupuncture to support mental health naturally and effectively. And also joining us is Dr. Amit Dhingra, a pharmacist and author of the book, Happy Science. Dr. Dhingra has developed an integrative program that helps people safely navigate the challenges of discontinuing their antidepressant medications while supporting their mental and physical well-being.

[00:00:56] This episode is packed with practical advice and expert knowledge. Dr. Hoong will highlight the fascinating gut-brain connections, herbal therapies, and lifestyle changes that can transform mental wellness. Meanwhile, Dr. Dhingra will dive deep into the science and strategies behind medication withdrawal and how to approach it safely.

[00:01:17] If you've ever felt stuck between conventional treatments and natural approaches, or if you're exploring ways to support your mental health more holistically, then this episode is for you. Dr. Dhingra So whether you're looking for improving mental well-being or seeking guidance on tapering medications safely, our guests have the insights to help you take charge of your health.

[00:01:40] Dr. Dhingra Stay tuned as we explore how naturopathic and integrative care can change the way you think about healing. Dr. Dhingra Let's get started. Dr. Dhingra You're listening to Take On Healthcare with Ted Suzelis and Mary Sheehan. It seems that almost each one of us has been touched by mental unwellness. From seasonal affective disorder to the role the gut plays in anxiety and depression, we are taking it on.

[00:02:09] Our special guests, Sarah Hoong, naturopathic doctor, and Amit Dhingra, doctor of pharmacy, offer simple practical solutions to this big complex problem. Dr. Dhingra Okay, so during the unprecedented times when I was working many, many hours behind the pharmacy counter and at the drive-thru window, I started to notice something with the public.

[00:02:35] Dr. Dhingra And that is my patients who were on one antidepressant were suddenly on two. If they were on two, they were on three. And this could be anti-anxiety meds as well, like everything in that category. Four, then they were on five. Like I noticed this, I became alarmed. Like this trend where people are on more and more antidepressants.

[00:02:58] And then I started looking at other trends in society, like increased use of alcohol and other just markers of a society, a culture that is suffering with their mental well-being. Dr. Dhingra And I just, again, became aware that perhaps not every, this problem cannot be solved behind the pharmacy counter.

[00:03:26] Dr. Dhingra Perhaps there's a different perspective that is right for some, not all. Like some people are just doing great. Some of my patients actually were doing really great. And you know, like that, that's not what we're talking about. We're talking about like kind of big picture and the mental health crisis in America and alternatives for people. So my perspective, it has been, or how I've been taught, it's not my personal perspective that there is kind of a pill for every problem.

[00:03:55] And there's, you just have to find the right chemical and you can be free of any kind of mental anguish that you might experience. Dr. Dhingra So that has been my perspective or what's been taught to me. And so, Dr. Sarah, I'd like to start with you and talk about then what's the naturopathic perspective on mental health?

[00:04:21] Dr. Sarah Well, it's a, it's a little bit different than the conventional approach. Dr. Sarah Well, it's a little bit more multifaceted. And so we're looking at every aspect of a person.

[00:04:44] We're looking at underlying factors such as diet and lifestyle, which I know we'll talk about more in depth later on in our conversation. Dr. Sarah Well, it's a great question. Dr. Sarah Well, it's a little bit more about the conversation. Dr. Sarah Well, it's a great question. Dr. Sarah Well, it's a great question.

[00:05:09] We're looking at the whole person and trying to break down what are the many different factors that play a role in our mood, not just one factor. I would say that's the main difference between the two approaches. Dr. Sarah Well, along with that, I would say that it's not just about the internal influences. It's about, so much about the external influences, our lifestyle factors. Dr. Sarah Yes.

[00:05:36] Dr. Sarah Well, about our relationships, about our diet, our exercise, all of our coping skills. All of these different pieces are, especially with mental health, I would say are even more important often than the internal systems. Good. And we're going to get to all of that, especially the liver. I'm very excited about this. The unsung hero of this, I think, of the last 15 years, 10 years has been the liver.

[00:06:02] But before we do that, just to get a little bit more specific about the conventional approach to what's going on, the mechanism of depression, Amit, as a pharmacist like me, could you go over what we're kind of taught to believe?

[00:06:21] Yeah. What you were alluding to is that a drug, when it's considered quote-unquote successful, is designed to bind to one specific receptor site and do something at that point. And that's in stark contrast to nature, which, as I'm alluding to, is designed to do many things all at the same time.

[00:06:44] And so that medication, that drug, by just binding to that one site can create some limitations where it's only able to do one thing or not do one thing, whereas nature is able to do many things with just one compound. And in addition to that, there's a synergistic effect where one compound in nature might work very well with a second compound in nature and work very well with a third compound in nature.

[00:07:12] And when those are combined together, at least physiologically speaking, we might get a synergistic effect. But in addition to that, you know, what Ted was alluding to where we also have to think about how we interact with society, how we manage our thoughts, you know, things that are just outside of just chemicals and compounds and how we just cope with our universe and nature in general.

[00:07:38] And then why doesn't the traditional system, why can't we include that? I mean, there's no reason why, well, there is, and you can go into it, a doctor can't write a prescription for an SSRI and then have a discussion about these things that Ted was talking about. Why is that not happening? Yeah, we are seeing, and Mary, I know you can see this as well, that the conventional model is being asked to do more and more with less time.

[00:08:06] So now doctors and physician assistants and nurse practitioners are having to see 20, 30, 40 patients at a time in the emotional mental health space. A lot of this is happening remotely. So they're given about five or six minutes to kind of reassess, re-diagnose, and then quickly just make modifications to their drug regimen, whether that's a new drug or tweaking the current drug. And then that's the end of that appointment. And then they go on to the next patient and the next patient.

[00:08:35] And that's how the day goes for the rest of the week. How is it possible to have a conversation about maybe getting more applied into nature, getting access to more sunlight when it's applicable and appropriate? You know, how do you have those conversations, especially when nobody's really funding that and there's really no financial help to do so? Well, speaking of funding then, I think, well, I know that the, or they wouldn't spend so much money on it.

[00:09:04] The direct-to-consumer advertising that drug companies do impact us. It's an external influence, right, Ted? Oh, yeah. Impact the patients, but also impact the doctors, right? Right. So who would like to speak just a little bit about our good friends at the drug companies? Yeah. So it is sort of a weird marriage between the drug companies and the doctors and the marketing and everything, too.

[00:09:33] Some of that has to do with, I mean, that direct-to-consumer advertising, I feel like it should be banned. It is totally inappropriate. Ted. Ted, okay, so Ted is suggesting shutting down America, but go on. Right, right, right. Well, we may be able to reduce the drug prices by 10% by cutting out the advertising. But, you know, I mean, it's one of those things where with that direct-to-consumer advertising,

[00:10:04] we're taking the doctor's role partially out of the whole thing. Yes. We're having patients that say, I need this drug. And so if my doctor doesn't, you know, doesn't prescribe that, then I'm going to go to three, four, five, six other doctors until I find the doctor that is going to give me this drug that's going to make me feel like that commercial makes me feel. Wow. That was very well said. Yeah, that's what's happening.

[00:10:34] Sarah? I'd like to add a couple other things to that. Actually, direct-to-consumer advertising is banned in every single country in the world. I've lived in China. I travel to Spain often to visit my in-laws. I've visited India. I've never once seen direct-to-consumer advertising in any of those other countries. The only other country that has direct-to-consumer advertising is New Zealand. Right. And it's very, very regulated.

[00:11:00] You're not seeing happy families running around with smiles on their face and then disclaimers about all the side effects at the end of the commercial that include suicide and death, infections, things of that nature.

[00:11:13] But that brings up another point is the interesting fact that you do have to have those disclaimers at the end of those direct-to-consumer commercials that indicate that even though this medication may help your symptom, there are – and you can look also at the inlets by reading the inserts for various pharmaceutical drugs that there are a high amount of adverse effects.

[00:11:41] And so many patients that come to me in my practice are seeking naturopathic medicine because they're either experiencing some of those side effects or they would like to avoid them. But that's just sort of a formality because that's why they run through those side effects at, what, two or three times a speed because you don't really need to listen to that. It's not really important, is it? Right. Right. Just ignore the insert. Exactly. Ignore it. Pay no attention to that man behind the curtain. Okay. Okay. Okay.

[00:12:10] That's a good point. Right? And I'm going to go back to Amit for this too. How a drug works. I think the word side effect is like a marketing term. It's like – it's a side effect. It is an effect. Right. The drugs do what the drugs do. That is what they do. It's not on the side. It is what they do. It may happen with some people. It may not happen with other people. But same with the benefits, right? Somebody might get a benefit. Somebody might not.

[00:12:38] So on that note, Amit, like talk about like why – what drugs actually do. Like the receptors, like what they're doing and why are there even side effects? Yeah. They're really designed to bind to – ideally in their world, if it's a good drug, not a dirty drug, it's designed to bind to one receptor site.

[00:13:05] And it either blocks some kind of action or it kind of promotes some kind of action. And in the process of doing so, if you're blocking the normal physiological homeostasis of the body, then is there going to be a side effect as you alluded to? Most likely there will be, right? Because you're changing the balance, the homeostasis of what the human body is supposed to do, a glocking something.

[00:13:34] And so a side effect is going to pop up to the surface. And if you're actually pushing something more than what it's supposed to do, then again, a side effect or multiple side effects will be possible. In addition to that, because of – we were talking about the liver, all these pharmaceutical agents, many of them, probably 90%, Mary, you can correct me if I'm wrong, but they're all metabolized by the liver. Yeah.

[00:13:59] So if you're having one drug do one thing and you have a second drug doing a second thing and a third drug doing a third thing, then of course there's going to be a possibility that there's some metabolic issues going on where there's the same liver enzyme competing to break down both drugs. And when they're both trying to be broken down by the same enzyme, we're going to have some challenges there as well.

[00:14:24] So what you just said then specifically, break down like let's say the most dominant, the SSRIs, like what they are and what they're doing in the brain and then what the brain does in response to that and why you might need another one or another one. Yeah. So again, SSRIs generally are thought to bind to the serotonin receptor.

[00:14:49] In the process of doing that, they prevent – they're a blocker, so they're a selective serotonin reuptake inhibitor. So they keep that serotonin bound to that receptor site, which in theory should help us feel better. And in some cases it does, especially early on when we first start a medication.

[00:15:11] It takes about six weeks to kick in, but then for a period of a few months we may start to feel better or in some cases we may not to feel as negative. We may feel more numb. But over time that receptor site becomes desensitized and now we need either two things. Either we need more of that drug to get that same effect or we need to add new drugs or more drugs to still feel the same way.

[00:15:39] And that's where we run into challenges where we get into polypharmacy and prescribers are now having to add two or three or four medications to try to address the same condition. And make the person feel like the same way. And all very well-intentioned, right? Like we could also add that. Like of course as a doctor, a provider, whatever you're doing, you want your patients to feel better. Like we're all in it for the same reasons I feel like to help people.

[00:16:06] It's just sometimes our perspective and the system makes it impossible to kind of see beyond that. I want to add one other thing to what Dr. Amit was mentioning. And with long-term use of medications like SSRIs or SNRIs,

[00:16:27] those medications over time can also deplete micronutrients that act as co-factors for the production of neurotransmitters like serotonin, dopamine, and norepinephrine in our bodies as well. So one of the major micronutrients that's depleted with long-term use of those medications is vitamin B6,

[00:16:50] which is needed to convert, for example, tryptophan 5-HTP, as well as help convert serotonin to melatonin. And also it's needed for the production of GABA, which is an inhibitory transmitter in the brain, which helps with the relaxatory response in the body.

[00:17:12] And so a lot of times you can also see that because there's less raw tools, if you would, or raw ingredients for the body to make those neurotransmitters, that could also be leading to the depletion as well. Yeah, that's such a good point. Drug nutrient depletion just started to become a thing, I think, right around, oh gosh, I was a little baby pharmacist, so like in the 90s. So I'm curious if you guys could each take a turn,

[00:17:42] how much is drug nutrient depletion a part of your practice? Like Ahmed, as a pharmacist, why don't you start? How much is it a part of what you look at? Well, Mary, I think you mentioned, do you work in a compounding pharmacy? I do now. Yeah. But for many years I spent, well, I started my career clinically and then landed in community pharmacy and then after the unprecedented times left and ended up in another pharmacy and now compounding,

[00:18:12] which is, I had some years in compounding actually, initially too. Okay. So, yeah, so I also work in, I also am affiliated with a compounding pharmacy or compounding pharmacies and, you know, unfortunately the drug nutrient depletion issue, I wish it would come up a lot more. You know, it requires two things. One, for the patient to be engaged and interested in learning about that.

[00:18:39] And number two, you need your team within that pharmacy setting to be willing to be on board with that. Because, you know, we have to set out, allocate a certain number of minutes to have that conversation with the patient. But, you know, it comes up, you know, when they're on a proton pump inhibitor or an antibiotic or many other types of classes of medications.

[00:19:05] If that conversation is happening and you feel like they're wanting to have that conversation or to learn more about it, then, yeah, we'll certainly bring it up. You know, magnesium, she was mentioning that the cofactors to make VibHTP, B6 is that. Magnesium is also required. In fact, proton pump inhibitors will reduce magnesium levels. So all of a sudden, is it possible that long-term use of proton pump inhibitors for our stomach issues can affect our mood? I think so.

[00:19:35] Yeah. So what about you, Ted? How much time do you spend if someone approaches you, they've been on a certain prescription medication to help with their anxiety and depression, and now they want either as an adjunct, a natural approach from you, or they want to do something totally different. How much time do you spend on that? Well, I mean, I spend a great deal of time with patients focused on those micronutrients. When we look for, so going back to that whole SSRI model,

[00:20:06] those drugs bind serotonin to those receptors and hold it in the receptors more, but it doesn't actually help you to make more serotonin. So I think that's one of those things that people don't understand, that those drugs don't actually help you to make more serotonin. You're right. They don't. I think we make a lot of assumptions. We either make assumptions about what people think or, yeah, I never thought about that quite that way, but you're right. They do. Yeah.

[00:20:34] And other micronutrients we didn't talk about yet, niacin. So if you are depleted in niacin, the L-tryptophan, which then gets converted into the 5-hydroxy tryptophan, which gets converted into serotonin. If you don't have enough niacin, your L-tryptophan will get converted into niacin so that you can have that nutrient and you'll have less to make serotonin.

[00:21:01] So that's part of that mix too, where we have to make sure we have enough of these nutrients. Another piece is people's genetics. So like, for instance, there's a good portion of the population that have some type of MTHFR gene mutation.

[00:21:21] And there are definitely studies showing that people that don't respond to SSRIs actually can have a much better response if you add in a high dose of methylfolate. So I don't really know what the true mechanism there is, but obviously that folate is important for your mood.

[00:21:45] And so I focus on all those micronutrients more to help build the system and help the body to feel better. And I do use more specific compounds to actually support, like say, using 5-HTP to boost serotonin levels. But that's still not, you know, we still have to work on all those other nutrients to help the body to feel better.

[00:22:13] And, you know, sometimes we need to look at those nutrients, not just because when we look at, say you look at a multivitamin and you see vitamin B12. And especially if you look at a good clinical, you know, a naturopathic multivitamin, you might see that the RDA says 5,600%.

[00:22:37] And that's because those vitamins, the RDA is made to be, tells us how the minimum that needs to be there in the system to be ingested to be able to actually not have a major deficiency disease. So like, for instance, vitamin C, you need 60 milligrams of vitamin C a day so you don't get scurvy.

[00:23:07] Obviously, we don't get scurvy in our country. We get enough. But that doesn't mean that 60 milligrams of vitamin C is optimal for your body. So that's where we have to look at. Sometimes we need a lot higher doses. Some of it is just because we do need a lot more than what has been identified. But also we can have different genetic susceptibilities where our body doesn't process those nutrients properly.

[00:23:36] And if we have a much higher dose, it sometimes is even working more as a drug effect to be able to help the body to heal. Yeah. And Sarah, I want you to weigh in too. But it's interesting. Like, I asked the question from somebody who obviously, like, works in the medical system, writes a straight line. Okay, so you take this drug, it depletes this, you give this. And your answer is, like, so comprehensive because it's the way you think. So, Sarah, what would you add to that? Yeah, absolutely.

[00:24:06] Another point I would like to touch on, as well as mentioning a few other important micronutrients and macronutrients too, is the way that our diet has changed over time. And so in the last few centuries or so, we've removed the bran from most of our grain products. And we may have had, you know, brown rice, millet, amaranth.

[00:24:31] Those may have been grains that we consumed in the past, all very high in micronutrients, even protein, iron, things of that nature. But now we've stripped our grains of those nutrients. There are also many of them are high in magnesium as well. So magnesium is one of the most common micronutrient deficiencies found in the United States.

[00:24:56] Even if it's tested in the blood and it sounds to be normal, usually there is some sort of magnesium deficiency. It hasn't. Also, the reduction of eating foods that are rich in phytonutrients, polyphenols. Obviously, a lot of dark leafy greens are very high in both magnesium, folic acid, which Ted was mentioning MTHFR polymorphisms.

[00:25:25] But everyone does need sufficient levels of folate. And in the standard American diet, we're really not seeing that, unfortunately. In terms of macronutrients, also healthy fats is a very, very common macronutrient deficiency that I encounter. Omega-3s are very important for the inflammatory response of the body. It also helps with the fluidity of cells throughout the body, including neurons.

[00:25:54] So allowing for nutrients to enter into those neurons. Omega-3s play a very important role in that. And in my practice, I usually also do micronutrient testing. It's not a be-all, end-all. But I do find that looking at levels of micronutrients and macronutrients, such as the omega-3 to omega-6 ratio,

[00:26:21] can give some information about what is the level of those nutrients, both in the serum and also in red blood cells or white blood cells. So I don't think it's a be-all, end-all. But it does provide some helpful information. And I often see patterns of, again, higher levels of vitamin B12, for example, unless the patients are plant-based and don't supplement with B12.

[00:26:49] But usually borderline or low levels of B1, B2, B6, and sometimes an imbalance between the zinc and copper ratios. And then just to one other thing I wanted to bring up is vitamin D3, which I know we're going to talk about much more in depth later, especially when we talk about seasonal affective disorder.

[00:27:16] But there was a really interesting study about vitamin D3 that showed that vitamin D3 was only effective in reducing depressive symptoms when the levels in the blood of vitamin D3 were 50 nanograms per milliliter or higher to begin with.

[00:27:36] So needing to have a good baseline of vitamin D3 levels within the serum before vitamin D3 was effective for treating a mood disorder. So, again, that shows that just monitoring with testing with vitamin D3 levels and ensuring that it's at least 50 nanograms per milliliter is really important when supporting the mood.

[00:28:05] So I have a question for you with that, Sarah, about you had touched on the B12 when you're doing the micronutrient testing. And I think you said something about high B12. And so what was your point with that? Well, B12, it's interesting. Maybe it's just the particular clients that I see, and I'll be very curious to hear everyone else's perspective.

[00:28:30] Most patients that I see are already taking vitamin B12 when they come to see me because they've heard that it helps with energy production and they want to feel better. But usually they're not taking a B complex. And even when they are, it tends to be a vitamin B complex that's higher in B12 and folic acid, but very low, sometimes even lower than six milligrams of, for example, B1, B2, and B6.

[00:28:59] And so I think that's why I typically tend to see that imbalance with my patients. And then if they're on any medications that, for example, if they're on birth control or any acid-carb, methyl diazom, usually that will tweet vitamin B level further. Yeah.

[00:29:19] And so one of those things that I see that, too, with the B12, well, both B12 and folate in the blood is when we have high levels, obviously supplementing is going to give you high levels regardless. But you'll have some patients that aren't supplementing or supplementing of a small amount, maybe just in their multivitamin, and they have high levels.

[00:29:45] And I find that this is more because they're supplementing with, like, the cyanocobalamin, the cheap, you know, inactive form, and their body can't convert it into the methyl and the methylcobalamin or the adenosocobalamin. And so they have a functional deficiency. They might have high levels, but yet they're still deficient of the actual active B vitamins. Same with folate.

[00:30:12] I see people that have MTHFR gene defects. They might have a high level, folate level, but that's almost always indicative of they're taking lots of folic acid. Their body can't break it down, can't make the methylfolate or the folinic acid. And so they have a lot of inactive folate floating around in their system that's not being able to be used. Wow, that's a great point.

[00:30:39] And probably diet plays a role, too. Oh, definitely. If they're not eating dark leafy greens or foods that are high in the natural sources of folate, then that would be difficult to convert as well. Right. And same with, like, not having enough vitamin B2, riboflavin, that helps convert that folate. Great point. Yeah.

[00:31:04] So, anything else anyone wanted to say about, like, the micronutrients and depletion? Anything else, Amit? Like, how about vitamin D? Do you counsel your patients? Kind of like the nutrient deficiency question, do you talk to them about D3 levels? I do now. I mean, I started to 20 years ago and everyone's like, what are you talking about? But now the doctors kind of know about it. Don't you find that they, everyone's kind of onto that, that we need adequate levels of vitamin D?

[00:31:33] Yeah, finally they are. Finally. And it's a conversation that's easier to have now because, like you said, the doctors are discussing it with the patients. So, when you have that conversation, it's not like brand new for them. Especially since we are, you know, in the colder months, we have a darker sky. So, we could definitely benefit from the vitamin D3. It's so important for mental health. It's so important for anti-inflammatory processes.

[00:32:02] We have a plague of autoimmune conditions. So, vitamin D is so important for that. Yeah. And coming back to, you know, antidepressants, if we're looking to help them slowly, you know, if they've had that conversation with their doctor and they're wanting to slowly taper off, getting the body ready, sort of tending to the garden, so to speak, with addressing micronutrients and macronutrients and vitamin D.

[00:32:32] And maybe even, you know, getting all that into a better place and then trying to slowly taper off of their antidepressant would be the right approach. And that's why the naturopathic component could be so, so helpful for this process. Okay. Yeah, those are really, really good points. And it does sound like a lot, right? Because somebody just, you know, like, I just got a prescription filled.

[00:33:01] And I didn't know I have to worry about all this stuff. And you don't have to worry about it, but it's just really important to know that there are other things going on in your body that contribute to what you might think is just a simple thing, like a pill for a problem. So, on that note, also, when I was a little baby pharmacist and started to get interested in an alternative approach, I was looking at alternatives to anxiety and depression. And in those days, it was all about St. John's work.

[00:33:29] So, my colleagues would just say, well, Mary, it just acts on the same receptor. So, you've solved no problem. Plus, you have the standardization issue and it's not, you know, approved by the FDA. So, it's ridiculous. And just drop it right here. So, herbs for anxiety and depression and mental health issues. Sarah? All right. I guess I'll start it off and then everyone else can take it from there.

[00:33:59] But there are a couple of main herbs I'd like to mention as well as I can touch a little bit on TCM. Ted can give his insights as well. But some of the main adapted, well, herbs that I've looked into and researched and utilized in clinical practice, we already mentioned Siafron. You had mentioned St. John's wort, which is an interesting one. We can definitely talk more in depth about that.

[00:34:27] Rodeova is also one that can be helpful for depression. It's considered an adaptogenic herb. And another one, too, is ashwagandha. So, that's more in the category of herbs that help support a positive mood. So, they might impact serotonin in some way or form. Or they may also act on other mechanisms of the brain outside of simply just serotonin.

[00:34:57] Such is the case with ashwagandha. In terms of more calming herbs that are known as nervine, that's going to be more herbs that are relaxatory in nature. So, that's going to include things such as, again, ashwagandha can help with both anxiety and depression, which is pretty awesome.

[00:35:16] It's also going to include herbs such as passionflower, lemon balm, and valerian root, which act on GABA receptors, just as benzodiazepines do. However, they have far less adverse reactions and are not habit-forming as benzodiazepines are. But I guess, first and foremost, since you brought up St. John's Wort, I will touch on that a little bit.

[00:35:44] St. John's Wort does actually unspecifically act on, again, those nerve endings, as Dr. Amit alluded to earlier, in helping keep various neurotransmitters within that nerve ending, within that neuronal synapse. It doesn't necessarily help with the production of any neurotransmitters.

[00:36:07] But it unspecifically inhibits the reuptake of serotonin, dopamine, and norepinephrine. So, in some ways, I like to think of it as a natural alternative to MSNRIs because it also acts on dopamine and norepinephrine. So, a patient that might feel both depressed and experiencing a lot of fatigue, as you might see with dyspnea,

[00:36:35] that might be an option for them to consider. Now, St. John's Wort is an interesting herb, as you'd mentioned, Yuri, because it has a lot of interactions. It can definitely potentiate SSRIs, SNRIs, as well as tricyclic antidepressants. But also, it can interact with any type of immune-suppressing drugs.

[00:36:59] So, if patients are on any type of medicines for autoimmune conditions, they do have to be careful about that. And it also interacts with warfarin. So, it does have a considerable higher amount of interactions as compared to some of the other botanicals.

[00:37:19] It's kind of an herb that, if interactions are a concern, rhodiola might be another option for patients to consider if they do feel kind of depressed as well as fatigued. Because rhodiola is actually a tonic herb. It's been used for centuries, not only in Chinese medicine, but also in Russia.

[00:37:43] As a matter of fact, it has been used in athletic performance to help with endurance and strength in the Soviet Union. So, that's one interesting fact about rhodiola. And it does actually modulate serotonin and dopamine and norepinephrine. So, that's one interesting fact about rhodiola. The only thing with rhodiola, it also helps modulate cortisol.

[00:38:12] But you just want to be cautious if a patient has a history of insomnia. In some cases, it may actually help insomnia. But in rare cases, it may make insomnia worse. And you do have to be cautious with bipolar disorder. Ashwagandha is a very interesting and promising adaptogenic herb. It has not been found to actually interact or impact serotonin or dopamine or norepinephrine.

[00:38:41] However, it does inhibit cortisol production. We can talk about cortisol at length later if you guys all want. But that's a stress hormone that has been shown to have an impact on anxiety and depression. In particular, worsen those symptoms. But ashwagandha has actually been shown to impact neuroplasticity within the brain.

[00:39:07] And therefore, that's the mechanism at which it's believed to benefit both anxiety and depression. And it, again, is a tonic herb in Ayurvedic medicine. And then, in terms of the relaxatory herbs, ashwagandha is going to be more relaxatory, again, because of its ability to inhibit cortisol, which is that stress hormone.

[00:39:33] Passion flower and valerian, they do modulate GABA, again, which is that relaxatory neurotransmitter within the brain. However, interestingly, passion flower has also been shown to help benefit serotonin as well. So, again, speaking to the fact that these herbs, they don't just have one mechanism of action. They modulate rather than lock receptors, and they have multiple benefits throughout the body.

[00:40:04] Yeah, that's a lot. Ted, what do you use a lot of or add to that? And then we'll go to Dr. Amit about the herbs. Yeah. So, like we've talked about a lot on the podcast in the past, one of my favorites is ashwagandha. I use so much of that with patients. And I just find, you know, Sarah, you're talking so much about, you know, the adaptogenic properties,

[00:40:32] but I just find it so interesting, especially with ashwagandha, more than any other herb that I've seen, that it has both such, you know, such calming inhibitory effects when people need that to calm the cortisol, to help with sleep, to calm anxiety, but yet build the body, help to build energy, build endurance.

[00:40:57] In fact, I've seen studies in the past looking at mice in a pool and their endurance to swim and save themselves. And so with ashwagandha, it actually helps that exercise endurance too. So I just find it so interesting that, you know, when we look at the natural therapies, it's not just about suppressing or building up. It's, you know, something like ashwagandha is going to help with all of that.

[00:41:26] So it's kind of like, to personify the ashwagandha, it like knows. Right. But again, like I used to say too, it's not all about the pill, it's about the person. Right. Right? Right. Like you, I have seen patients that are on a lot of medications that would like knock me on my butt for a week and who they are is coming through. Like it comes through the drug, which goes to their effect of either pushing you down or trying to push you up.

[00:41:56] And it's, that's why I love ashwagandha because it seems to work like with your own chemistry. Yeah. And so talking about some of the other ones that we already covered, the Hypericum or the St. John's Ward, I rarely use that. I'll occasionally use that with a patient, but just because of all of those other drug interactions and things on that end,

[00:42:20] you know, it's suppressing, what is it, the P450-34A, which is so common in so many drugs to where even I've seen studies showing it could make birth control pills ineffective. Yeah. Because if you're taking enough of it. So you have to be really careful with that one when somebody is on any kind of medications,

[00:42:44] because you may have some unwanted side effects that you, sometimes you don't even expect. And I'll definitely use some of the rhodiola in formulas more. As far as the herbs, I don't tend to use as many. I mean, I'll, once in a while, I'll use some kava.

[00:43:06] I wish that that hadn't, you know, gone out of favor so much because of a couple of rare, most, probably most likely contamination effects where it was affecting the liver. But, you know, a couple of cases and now that wonderful herb isn't really used. You can't hardly get it. I only have a couple of manufacturers that I can get a tincture from.

[00:43:34] Um, and then I would say that's probably the majority of the herbs. I might use like an Eleutherococcus, Siberian ginseng, a little bit in formulas. Um, but I tend to, if I'm using, I would say that's probably the majority of the herbs.

[00:43:55] I will use an awful lot of 5-HTP and along with L-theanine, both of those to help balance, balance things out while we're working on the rest of the system as we talked about. Um, and interesting, it might be just my patient population. Uh, but I've heard a couple of other NDs talk about this with like the omega-3s with like fish oil.

[00:44:20] It's like I could give fish oil till somebody's swimming in it and I very rarely see, you know, have the patient notice any benefits. So I've gotten out of the habit of doing too awful much of that because it's an extra expense and we're always trying to, uh, trying to minimize all the different pills so we can help with compliance. And so that's one that I don't use nearly as much in my practice.

[00:44:47] But like I said, it's, you know, different practices are going to be different as far as your patient population. Um, so that's, you know, one of those interesting things. Um, I've never really used the saffron. I need to look into that more and, um, you know, look at that because I find that so interesting. Everything you've been saying, Sarah, about that.

[00:45:11] And I really want to, you know, get a little more interested in really understanding that better. The saffron. What do you think, Dr. Rommet? What's your, what's your favorite herb for this kind of situation? Mood, stability. What do you love about the herbal world and why? Well, I was thinking in the context of COVID and post-COVID.

[00:45:37] And so many of you are dealing with, um, long COVID symptoms now. And so their cognitive, uh, it's having a cognitive impact where their memory might be compromised. And in addition to that, we have an aging population. So I know for me personally, if, if I feel like my brain is working better that day, my mood will also be impacted in a positive way. Oh, interesting. You know, you mentioned ginseng.

[00:46:05] Uh, you know, I might add ginkgo to there or anything that helps to improve blood flow or reduce inflammation in the brain is going to definitely have a positive impact on our mood health. Uh, so, so I would add ginkgo, uh, to that. Um, but everything else that you said, and of course turmeric sometimes, um, but everything else that you mentioned, you know, those are all amazing, amazing herbs. Um, but we do have to monitor for, uh, drug interactions, drug herbal interactions.

[00:46:35] And especially with benzodiazepines, um, you know, with kava and valerian. But, uh, you know, if I can, if, if I feel like, um, the cognitive impact can improve, then, uh, I feel like the mood also can improve as well. So I think that's so insightful and I haven't, I really hadn't thought of it that way.

[00:46:56] And now I think about myself and as a thinking person, I rely so much on my, my, my mind and I'm, it's one of my strengths. So if I feel like that kind of thing, like there's something about my mind that's not working, that really does affect my mood. And I hadn't thought about it that way. That's so interesting. I don't know what your, you know, your morning routine is.

[00:47:22] I presume that dietary supplements are something that everybody on this talk, uh, incorporate into their daily routine. I pop a whole bunch in the morning. And if I don't, um, it's usually cause it's my day off, but if I need to work or I need to function, I, I gotta, I gotta take them. Um, what's that one Ted that we were taking before the podcast to help our mental acuity? I still take those someday. What's the one that? Oh, that's Avopaxin.

[00:47:50] So it's a combination of acetyl L-carnitine, uh, huperzine and trying to think of a third ingredient there. Um, oh, um. But that's good stuff. Yeah. I do feel like my superpowers are working and then I feel like confident and maybe that makes me happy. Anyway, that, that's just very fascinating to me.

[00:48:19] And I am the adaptogens are fascinating to me just because they work on other systems of the body. And we are tend, we tend to think it's just about here. Right. So on that note, I think we should go to the other systems. Like we want to talk about how the other systems of the body affect our mental wellbeing. And we can start anywhere. Um, either Sarah or Ted wants to start. Don't like Sarah. We could start at the gut, whatever.

[00:48:50] Sure. Um, well, I guess we were talking earlier about how, um, gut health over the past two decades or so, there's been a lot of research showing that gut health can impact brain health. And there are a couple of mechanisms that are kind of believed to be behind this. Of course, we're still learning more and more, but the microbiome has several functions throughout our body.

[00:49:19] Uh, the microbiome. So I guess I should ask, how much does their audience know about the microbiome to begin with? That's like a whole other podcast, isn't it, Ted? Right, right. But, well, I don't know, like how much do we, because there is so much to say about that. Like we can just say there's a gut brain connection and we all get it. Right. Because we've, I've been saying that for a long time and you guys I'm sure have too.

[00:49:45] And now, like I used to have to sneak around at a back alley to buy acidophilus and now it's like everywhere. Right? Right. But I guess it's important, I think, to lay some sort of foundation. Like what do we mean when we say there's a connection? So what is connecting the what? Are they with little cell phones down there? Like what's happening?

[00:50:10] Okay, so yes, there's no antennas, unfortunately, as much as that would be an interesting situation. There would. But so in short, the microbiome is the bacteria, the living organisms that live within our intestines, mainly the large intestine. There are millions and millions. It's believed that our microbiome weighs about between three to five pounds, if you can imagine that.

[00:50:37] And so that includes beneficial bacteria, as well as if there's any type of imbalance, there can also be overgrowth of hardball or kind of opportunistic bacteria. So the beneficial bacteria, many of them are strains that are in the lactobacillus or the phytobacterium family. These bacteria have a wide amount of benefits for our body.

[00:51:07] They produce B vitamins, vitamin K. They've also been shown to impact immunity through cellular signaling. And what's really, really interesting about the bacteria in regards to the brain is that they, over the years, have been shown to actually communicate to the brain via a nerve called the vagus nerve.

[00:51:33] There was a researcher in, I believe, either 1990s or 2000s that actually did a wide variety of studies on mites looking at the relationship between the gut and the brain. And in addition to the vagus nerve, because he found that when he cut the vagus nerve, any communication between the gut and the brain would be severed.

[00:52:00] However, the bacteria of the bacteria of the gut are believed to also be able to impact brain health via the bacteria's ability to impact immune cells. And immune cells, therefore, impacting inflammation in other parts of our body, including the brain. Wow. And then there's, this is, you know, still being researched quite a bit.

[00:52:29] And Ted and Amit, you may have some additional insights. But there is a wide, a huge percentage of neurotransmitters that are produced by the microbiota in our guts. And it's debated whether or not it's more that that can directly influence our brain or indirectly impact it. So I'm curious to hear what everyone else has to say about that. Yeah, Mary.

[00:52:58] So to answer your question about the cell phones. So it's actually more of a wired connection. So, you know, that vagus nerve, you know, we don't have a wireless connection with the cell phones. It's, you know, a wired from that vagus nerve. So the vagus nerve. Okay. Just to refresh. It's part of the parasympathetic nervous system, which is the nervous system that kind of calms everything down.

[00:53:23] Which is interesting that that's the pathway of communication, I think. That's interesting. Okay. And did you? Yeah. And so, I mean, I think Sarah covered a lot of, you know, the main information there. I mean, as far as that, those neurotransmitters being produced in the gut, I feel that, I mean, obviously they're, they, they don't cross the blood brain barrier.

[00:53:51] You can't have serotonin from the gut cross the blood brain barrier. So it's produced in the gut to where we, you know, we talk about the second brain and we don't really understand that fully. But there is some, you know, there's something to that at this point where when we're producing more serotonin in the gut to regulate the gut than we do in the brain, there's a purpose there.

[00:54:21] And that's why that when we have, like say IBS, irritable bowel syndrome. So people's anxiety and stress will cause either diarrhea or constipation in that irritable bowel issue because of that connection between the two. Oh, that's interesting.

[00:54:48] Dr. Ahmed, what would you like to say about the gut and the second brain and what is all those, what are all those neurotransmitters doing there? Yeah. I think the last five years have just seen a huge push and research on gut health and impact on this, you know, systemically.

[00:55:10] And, you know, as he was alluding to, Tab was alluding to with the, you know, the chronic inflammatory bowel conditions, when anxiety flares up, it makes the gut flare up. And when the gut flare up, it makes the anxiety flare up. Yeah. One way or another, there's this channel that's connecting both. So if you're having an issue in the gut, it's creating an issue in the brain. If we're having an issue in our mental health or emotional health, it's having an impact on the gut.

[00:55:42] You know, another thing that we could probably talk about for a long time is sugar, the impact of sugar that can impact our gut. You know, something called lipopolysaccharides is produced by our gut flora when there's some imbalance and those lipopolysaccharides just tend to be inflammatory in nature. So getting that gut regulated and making it our friend is really important just for our overall systemic health.

[00:56:10] And we have some challenges to do that. Our food system, of course, the incorporation of pesticides, glyphosate, many things can reduce the diversity of our gut health. And we have a lot. So we have a lot of challenges to address that in our food system. But somehow we have to, you know, with the help of our integrative medical community, we got to figure out ways to address that. So there's some things that there are a lot of toxins everywhere that we have like no control over.

[00:56:39] And that gets me very anxious, gets my balls in upper, all the things I don't have control over. But sugar is an interesting thing. If you could talk a little bit about that, because some of us, me, I like sugar calms me down. So if I'm feeling anxious, I will have some sugar and then I feel better. And I would like to know then that what it's doing to my gut.

[00:57:09] So one of the issues there could be that, I mean, it has you could be having a low blood sugar moment. If you're having some hypoglycemia, you're, you know, one of the symptoms is that you'll be more anxious because your blood sugar is dropped too low. Good point. That's signaling your brain saying, alert, alert, we need to fix something. So you eat that sugar, raises that blood sugar and helps you to feel better because that crisis has been averted.

[00:57:38] But on the other hand, too, people with diabetes that have high blood sugar is going to affect their their mental health and their anxiety and depression also. But what can I make one other point? Yeah, go ahead. Go ahead. Oh, sorry. I just wanted to add to that. As Ted was mentioning with elevated blood sugar, it can also elevate levels of cortisol.

[00:58:04] And so a lot of patients that have, you know, dysregulation of blood sugar, you can see kind of that. It's difficult to lose fat in the midsection. And therefore, with the elevated cortisol levels, that can really impact anxiety and depression as well.

[00:58:21] And then one other potential result of sugar, just for gut health in general, is that dysbiotic bacteria and fungi such as candida or E. coli and salmonella, they tend to actually, well, if you remember in microbiology class, a lot of times sugar is added as an agent to help bacteria to grow.

[00:58:45] And so many of those organisms will increase when there's a high sugar diet and you also find carbohydrates. Yeah, I used to run around as a 20 something year old worried about feeding my yeast. Like, don't feed your yeast. Right. That's what we used to say when we were trying to cut down on sugar. OK, that's it. Yeah, I mean, it's something that we can control. But to your point, Ted, sometimes it's a natural response. And again, once again, we got to go underneath. Right. And see. Right. Well, why?

[00:59:14] Why are you craving sugar? Because that is not a normal thing. Right. Right. Yeah. And so, yeah, that whole cortisol piece is interesting, too, because, Sarah, like you had said, cortisol can be raised because of your blood sugars being elevated. But also, cortisol is also the mechanism for hypoglycemia to raise your blood sugar.

[00:59:37] When your blood sugar drops, and I'd like to talk about this when people have trouble sleeping, they wake up and say 2, 3, 4 o'clock in the morning, wide awake, sometimes hungry. Their blood sugar is dropping, and the body's way of protecting us, we produce more cortisol, which then elicits to pull more sugar out of the cells to raise the blood sugar so that you can feel better.

[01:00:05] But on the other hand, that cortisol stimulation might make it harder to fall back to sleep. Yeah. I've experienced that. So many patients. Yes. Yeah. I personally go into these phases where, you know, I'll just go at it with the sugar, you know, during the holidays, of course. And then for whatever reason, I'm able to kind of work my way out of it. But for a little while, I'll just, you know, I'll just go for it. Yeah.

[01:00:36] Everybody dies. Yeah. I would say that sugar is one of my favorite drugs. Sugar and caffeine. Those are my favorite drugs. Yes. I don't know what I would do without either one of them. How about, is there some sort of connection with caffeine and anxiety and depression? Because some people say caffeine really makes their anxiety a lot worse.

[01:01:05] And it's such a struggle, too, because they enjoy the coffee. It's a ritual. We like our rituals, right? Right. And they get, like, that nice central nervous system effect from it. But then also they feel much more anxious. 100%. And as Ted was mentioning before with MTHFR, there can be other genetic polymorphisms that can make certain patients more susceptible to anxiety.

[01:01:35] If they have too much caffeine, I think I might be one of them as a matter of fact. If I have more than two cups of coffee, I'll have a racing heart rate and I'll be speeding like I was speeding in solids. But in regards to coffee, it can also, well, one thing is it can increase energy temporarily but lead to crashes later on throughout the day. That's one concern. You just have more coffee.

[01:02:04] Sarah, let me, I'll help you with this. You just have another cup. Okay. Yeah. That's kind of interesting. But for patients that are very sensitive to caffeine, one thing that we'll do in our practice is kind of draft them more to adaptogenic approaches.

[01:02:24] So either mushroom coffee that consists of things like reishi and cordyceps, which also have adaptogenic properties and can help with more balancing the mood. Mushroom coffee. Okay. Who here has tried mushroom coffee and liked it? Me. All right. Ted and I really love our coffee. Have you tried mushroom coffee and do you like it?

[01:02:54] Okay. I love mushrooms. I'm fascinated by mushrooms in general. Oh, we could maybe talk about that. Ted. Is it going to be espresso? You know, is it going to give me that espresso? No. I don't know. All right. Fine. Ted, do you like mushroom coffee? To be honest, I really have not tried it. Okay. I've tried some of the older coffee subsuits.

[01:03:21] I'm trying to think of what kind of herbs they're even made of. Like chicory. I've tried the chicory for coffee substitute. I've tried several. Yeah. I haven't tried anything more recently because I'll have my one mug of coffee in the morning and I'm good because I am caffeine sensitive too. I won't get the racing heart rate or anything. But if I have a second cup, like I make sure to have a second cup before we do this podcast so I can be at my top.

[01:03:49] But chances are it's going to affect me tomorrow morning. Right. I will probably wake up at 5 o'clock tomorrow morning and not be able to fall back to sleep. Ted is taking one for the team. That's right. Anything else about that, Sarah, about caffeine and the connection that you wanted to say? Just that for some patients that have any type of issues with cortisol, it can lead to further elevations in cortisol. So that would be another.

[01:04:19] And it might worsen anxiety for those who are sensitive. I do know some patients that can have a cup of Turkish coffee at 8 o'clock at night and sleep great. So I think it really is an individual response. One other thing I wanted to mention, some patients that are sensitive to coffee, if they switch to green tea, green tea is actually a natural source of L-theanine. Not as much as supplementing with it, of course.

[01:04:47] But they do find that they are often able to tolerate green tea better. Well, it has a lot less caffeine too. True. And it has a more mellow effect, I found, green tea. Like, it's a little bit milder. It's a nice energy boost, but it's not like the real jolt that I get from caffeine. See, now I'm wondering, and I blame Amit, do we go off script because he mentioned mushrooms?

[01:05:16] And I feel like I do we dare approach the new, because it's like a little bridge, right? Psilocybin that people are doing. I have friends that go on these retreats and they're doing the psilocybin. What's the other one Amit that people are doing? That's the one that you, that the rainforest that has all those different components in it. Are we referring to ayahuasca? We are. Yes. Okay.

[01:05:43] So, and there's also for depression, low dose. Oh my gosh. What else are people dosing with? Like kind of on the down low. A lot of ketamine these days. Oh, there's ketamine. Gosh. Yeah. We used ketamine in the compounding lab topically though. And I'm sure you're familiar. So what? And we don't have to keep this in, but what do we think about this? To me, it feels like, okay, people are gonna, they still want the quick fix, right?

[01:06:12] Mm-hmm. But they're doing it naturally, right? We're gonna go and get the right dose of whatever we're doing, ashwagandha or psilocybin. I'm simplifying, of course. And not that these things don't have a place and there's not amazing things to be said about them. But I don't know about mass consumption, I guess. Amit, I would love to get your thoughts on that. Yeah. Yeah.

[01:06:38] I love the idea of incorporating psilocybin into the world on a massive scale. Wow. I hope that day comes. You know, it'll be the job of society to figure out how that's regulated. Mm-hmm. And if we work with a practitioner on that process or if we just do low dose, like microdosing. Mm-hmm.

[01:07:03] And there's literature out there that suggests it could impact the heart if you're microdosing on a regular basis. So there's a lot there. But yeah, I think it's needed. And I hope that day comes. You think it's needed. Why?

[01:07:23] You know, these quote-unquote psychedelics are, I think the terminology is enanthogens where, you know, there's something about them that increases your level of self-introspection or consciousness. You know, that'll be a whole other talk to talk about what that means. Mm-hmm. To raise a level of consciousness at the level of the individual as well as just the collective consciousness, I think.

[01:07:52] Mm-hmm. I think that these are bridges or catalysts that could help that process along. I think that's an interesting point because I think from that perspective, it's a chemical or an idea or a concept whose time has come.

[01:08:09] Because certainly the culture, the society has pulled us so far away, right, from ourselves and each other, which also, you know, just from some social studies have shown lack of community, lack of a meaningful purpose in life. Things like that really do contribute to anxiety and depression. So from that perspective, having a substance that can increase our awareness of, like, some purpose within ourselves, like, why are we here?

[01:08:39] Mm-hmm. And how we're connected to our fellow mankind. Yeah, we may have to have a whole other show on that if we dare. Oh, definitely. Oh, Ted's down for it. I'm terrified. I am terrified of the topic, but Ted's down. I don't really know. I really don't know a ton about psilocybin, but I just find it interesting talking to people that are a lot more educated about it,

[01:09:06] how there's this thought that our different levels of human evolution over the centuries, we've, you know, that may have, that some of these mushrooms may have contributed to a big increase in our development as a society. Right, Amit? Isn't there some, like, speculation on that?

[01:09:30] Like, the Age of Enlightenment and maybe the boon in our philosophy or maybe art that came from that? You think that's true? Yeah, I've also, you know, I've also read that, you know, I've also read about it in terms of theology and, yeah. I mean, who knows? Oh, yeah, that's a whole lot. Yeah, that's, I didn't know about the theology.

[01:09:59] That's take on health care going really big. But so just to clarify for everybody, these things are not something that naturopathic doctors prescribe. Correct. Correct? Right. Well, I think that there may be one or two states, maybe Oregon. Really? Maybe Oregon, Washington, that have psilocybin that are starting to get prescription rights. Wow.

[01:10:30] Wow. I didn't know that. And then what do you think is the general medical community's perspective on it? I know no pharmacists who know anything about it. We're just like starting to catch up with like medicinal cannabis, you know? Yeah. Yeah. I think if it becomes available, I mean, there's certain channels where you can get access to it.

[01:10:54] But I think if it becomes available in a way that's accessible to people, you know, then maybe the more conventional world will start to embrace it. But until then, yeah, I think, you know, I think there was a study that said that if some of the new research comes out, it takes Main Street like 10 years to start to incorporate it, you know, on a regular scale. And so that might be where we are with that. Well, and I do think things move faster, though, because of the Internet, right?

[01:11:23] Like think about like before the Internet, how things would move slower just to get the information from place to place. And now we have access to theoretically all information all the time. I mean, I know there's other things besides information that slow things down, like culture, your opinions, you know, and ethics, all of that. But things like other than that.

[01:11:47] But with that, with that, the research has been, you know, it's just we're just starting to get more research again because nobody could do research on these, you know, on psilocybin for such a long time. Just like cannabis, too. I was thinking about LSD so we can research psilocybin. But research on low dose LSD isn't even possible, correct? In this country. I don't know. Microdosing of LSD. Do you know about microdosing of LSD, Amit?

[01:12:18] I think maybe there's some federal. There are some studies, you know, where the federal government is involved where it is being done. But you're right. It probably is really hard to try to get some kind of a grant or to get access to the product to do a study just on. Right. Yeah. Right. Quick point about the caffeine.

[01:12:40] If that 20 or 30 percent that's having a hard time tapering off of their antidepressant are needing support, unfortunately, sometimes they have to reduce their caffeine consumption either by 50 percent or just reduce it all the way. Wow. So coming off of that medication becomes much more difficult. Well, should we talk about then tapering? Because that's a big part of your practice, Amit. Let's talk about tapering of antidepressants.

[01:13:07] Because I remember, again, early on in my career, I think there was even like a big controversy over Prozac and increased risk of suicide. And that was just happening. And a lot of debate. And people were getting afraid and stopping these things or the doctors were afraid and taking the patients off of them. And we would do and then eventually we do it like a taper. But it was such a short taper.

[01:13:36] And not everybody can just do a three week taper. Right. Amit, tell me why. Why should people taper? Does everybody taper off if they want to get off? Yeah. And, you know, not everybody wants to. And so it's just for that group that maybe felt like they had some kind of acute incident that required them to want to get on a medication. And now that has subsided. It's now they're ready to get off.

[01:14:05] So like the population tapering off of the medication isn't that all that difficult. And they can just work with their prescriber and come off of it. But for maybe 25 or 30%, it can be extremely difficult. Now, if they're on a, let's say they're on a Fexor and they're on like 150 milligrams a day. When they initially start to taper, coming from 150 to 100 or to 75 isn't all that difficult or challenging.

[01:14:31] But when they get to those lower doses, I've just seen, you know, in the practice that it just becomes a little bit of a grind for that 30%. And all of a sudden, just getting from like 15 milligrams down to 12 milligrams or 10 milligrams takes weeks, if not months. Wow. So that's kind of where the conventional model hasn't really been able to help all that much. Because, you know, how do you do that?

[01:15:01] I mean, what can you do to help speed that process up? But at the same time, not push the person into a wall saying that you have to do this quickly. Like just helping them understand that it's okay that it's taking time. It's not a race, but helping them along that way. And so that's kind of what the book was about. And so in why the integrative model can be so, so important for this process.

[01:15:30] Well, you made a good point, though, about like the lower doses isn't partly the lower doses getting to the lower doses harder to taper because they're not available in the lower doses. So then what do you do? Okay. Now I'm going from 20 to 15 to 10 to seven to eight to seven to six. They're not available. What's someone supposed to do? Yeah, and that is one of the challenges is, first of all, anti-discontillation syndrome was not really a thing until just a few years.

[01:15:58] I think it was only brought into the DSM-5 just recently. And so it hasn't even received acknowledgement from the national community. And like you said, because there's no drug company that's making these specific doses, what do people do? Sometimes they go on the Internet and they go into these, you know, these chat communities and they figure out what other people have been doing.

[01:16:26] And so on the side, they might do something called blade cutting or, you know, they might just cut little, little small pieces of their tablet. They try to kind of do a one-off of a few milligrams here and milligrams there. That's one way. Another way, if their budget allows, is to utilize the services of a compounding pharmacy where they can work with their prescriber and have the compounding pharmacy make the medication in a specific dose. And they can kind of continue that process over a course of many months.

[01:16:55] You know, that costs money, but that's one way that people are doing it. And another way is they just get a weighing machine at home. They crush up the tablet. Maybe they mix it into a certain volume of water. Yeah. And then they just take less and less of the water over the course of days. I think they call that micro. Yeah, I've had one patient do that. I just helped her with it because I knew she could handle it.

[01:17:20] But, um, and then when you talk about when we get to that, like, crisis point where it's really tough, those lower doses, and you said that's when we would incorporate an integrative model. Like, I assume that that's a good place that you and Dr. Sarah would work together. So, like, just so we have a picture, like, what would that look like? Or if you could think of a particular patient that was tapering off and having a hard time, and then you brought something else in, just so we can have an example.

[01:17:50] Yeah, just some of the things that you've already discussed, uh, you know, looking at micronutrients, uh, looking at macronutrients. And one thing I've noticed is, you know, sometimes we want to bring in all these different herbs and dietary supplements into the equation. But when they're, uh, tapering and they're having a hard time, it means that their body is relatively sensitive in general.

[01:18:14] And so sometimes a large incorporation or a large influx of many things all at the same time can actually be counterproductive. Ah. You really have to be very careful. We, we might just want to bring in one thing at a time and just kind of keep it very basic, you know, for the time being, maybe a good multivitamin, you know, a methylated form as Ted and Ted and Sarah alluded to. Maybe just, um, looking at macronutrients and micronutrients, maybe adding magnesium or certain cofactors that might help with neurotransmitter production.

[01:18:42] Uh, but before we just bring in the whole, the whole tool belt into it, I just want to do one thing at a time. And these are just unfortunately things that the conventional medical community is just not trained on. And right. And so that's one limitation. And then what limitation number two is again, the thing that we discussed earlier, which is the time. Yeah. Yeah.

[01:19:06] And I think one of the things that's really important when you're tapering is, uh, making sure that they know the process, they have the right mindset because fear is such a, you know, such a potent destroyer of all of our good intentions. Uh, where, and just letting people, you know, sometimes it's a matter of them just knowing that.

[01:19:34] If I taper down to the next dosage and I start having side effects, that's okay. It just means that maybe I need to back back up to the next, that previous dosage and give it a little longer. Um, but I think that when people are, you know, that, that fear and anxiety about tapering off their medication, if, if they're not given the right tools, that that can really sabotage things.

[01:20:02] That's a really interesting point, Ted, that I think that the, um, the current dominating system doesn't do a good job with managing expectations. Right. And I, I tried to do that behind the counter in the 30 seconds I had at the drive-thru window. Cause you're right. That's, that's a big, I, it's, but like we said before, there's really not enough time, I guess, to do all of that.

[01:20:28] Well, and, and that managing expectations is a double-edged sword too, because if you do, if, if you look at it, if you give them the wrong expectations, they might be expecting that they're going to feel horrible. And that's going to bring on, they're going to bring on an Acebo effect where they're actually going to experience that too. Good point. Yeah.

[01:20:55] Placebos are also one of my favorite antidepressants. The research actually shows that they're quite effective for depression. Yes. I love my placebo antidepressants. I use them a lot. I love them. Yeah. We, we did a, an episode last summer on the placebo effect and found, and there was a research study showing 70% of antidepressants effect is placebo. So. Right. And, and that doesn't make it wrong or bad. Right.

[01:21:25] Yeah. And the medical community, I think would acknowledge that too, or that exercise. Talk about that one there, about the role of exercise, since we're kind of like in, kind of segueing into the lifestyle piece and exercise and anxiety and depression. What, what do we know? Yeah, absolutely.

[01:21:45] Well, interestingly, I was just looking at a study recently done looking again at the effectiveness of SSRIs and SNRIs for depression and anxiety.

[01:21:57] And actually exercise in particular, short, intense bursts of exercise was shown to be more beneficial for mild and moderate depression than SSRI or SNRIs for, which is really incredible if you think about it.

[01:22:17] And again, it goes back to what we were just explaining about a large part of, of that placebo can play a very strong role, especially in depression. Uh, but exercise, it, it releases endorphins in the body. It can help reduce cortisol, which therefore can indirectly impact our neurotransmitters. It can help stimulate gut motility.

[01:22:43] So if there's any issues with constipation that can help with, um, also hormone, uh, imbalances, which can also affect the mood indirectly as well. Yeah. And then another thing too, is, uh, not only when we look at those short, high intensity, uh, exercises and how that can impact depression, anxiety.

[01:23:06] There are also kind of slower types of exercise that can, again, help with inhibiting cortisol response. So things such as yoga or Tai Chi have been shown to be very beneficial in reducing anxiety and depression symptoms. Uh, and so there's, there's a lot that can be done in Clums that adjusts in regard to movement. Yes. And I, I just like the human body was designed to move, right? Right. Right. Yeah.

[01:23:34] I mean, you look at research, you can find research for exercise having a major positive role in helping just about any health condition. I mean, whether it's, you know, from just about anything, including improving outcomes for cancer treatments.

[01:23:53] I mean, it's just crazy how much we can see from these lifestyle factors, but yet it's not focused on in medicine. What do you think about that, Amit? You want to weigh in on the exercise? Yeah. Yeah. And, and, um, and recently I've, you know, I think another thing is breathing. Um, oh, we don't know how to breathe in this country.

[01:24:20] Um, and, um, and so there's holotropic breathing, um, you know, in the Eastern tradition, they call, you know, there's something called pranayama. Mm-hmm. I know when I tried, I feel instantaneously much better, much more grounded. Um, so, so that's another thing that, um, in addition to the height, the exercise, if, if our, if our physical body allows it, can be something that can be done. Uh, and it doesn't cost anything.

[01:24:47] Um, do you teach people the breathing or do you refer them to a YouTube video? Yeah, I would just refer them to certain YouTube videos. Yeah. I wish, I wish I could, I wish I had the training and the expertise to, to treat, to treat, uh, to, to, uh, educate them myself, but I would refer them to a video. Yeah. Yeah. That's a, that's a really good point about breath, breath work for anxiety and depression and just overall, like calming the parasympathetic or,

[01:25:16] calming the sympathetic nervous system. I mean, so often I feel since the unprecedented times I am in fight or flight. And in fact, one of the reasons I quit my job without another job is because I was in fight or flight for so long that I knew I had to choose. It was either, it was me or them. I choose me. And, um, it took, I don't know, two years, years.

[01:25:46] To calm my nervous system down. Hmm. And I mean, I don't, I guess maybe, uh, an adaptogenic herb could have helped with that, but just overall. And I just realized that healing just takes time. You were able to escape that back alley pharmacy. I was, I was, I would barely, barely my, my adrenal glands were like hanging on by a thread.

[01:26:15] They would speak to me. Like, could you please do something? My liver was not happy either. So did we talk about the liver? I feel like I always want to talk about the liver. Cause what I, what I was telling people, like a little segue before I got into compounding, I was with a pharmacy that did a lot of derm. And I realized that people don't understand that their skin is a large organ, right?

[01:26:40] Their largest organ, just like they don't understand what goes on in their gut and how it can impact other things. And I would say to them, well, but you can see it. Like it's the organ you can see. Like what if we could see each other's livers? Oh my God. Right. Can you imagine how things would change? Yeah. I would, I would love to hear about what, what our, what our experts here would say about the liver.

[01:27:07] I mean, it's so, it's such a big organ in terms of background. Chalk experts. Tell us about our livers. Well, Ted, would you like to start? No, I think you need to start. Yeah. Yes, Sarah, please. Okay. Well, I guess when we look at the liver, we can look at it from, you know, a biomedical Western perspective, but we can also look at it from some of the more traditional ways of looking at the liver. So let's look at it at always. Yeah.

[01:27:37] Always. Exactly. So looking at kind of the biomedical approach, obviously taking many of these medications, whether they're benzodiazepines, SSRIs, antipsychotics, they are going to impact our liver enzymes in some way, shape, or form. So anyone who's taking any type of medication, as both Amit and Mary had alluded to earlier, it's going to be processed by our liver.

[01:28:05] And in today's modern society, it's not just medications that we have to process in our liver. We are experiencing all types of toxins in our environment. And of course, there are metabolites from our own hormones and biochemical processes that have to be processed as well. And again, going back to high blood sugar, high cholesterol, those things are quite common in our society.

[01:28:33] And so all those things can greatly increase our risk of an enlarged liver or fatty liver. So many patients that I see, for example, that come in, again, with high blood sugar, high cholesterol, they will also present with elevated liver enzymes and have signs and symptoms of fatty liver. So from that perspective, we do need to consider the liver, whether with mental health as well,

[01:29:03] if they're on medications and if the mood is more hormonally induced. Say, for example, patients have severe PMS or PMDD, then the liver, especially in naturopathic medicine, can be a big focus as well. Now, I do want to kind of segue into kind of more traditional aspects of looking at the liver.

[01:29:26] I'm a licensed acupuncturist and herbalist in the traditional Chinese medicine tradition. And in traditional Chinese medicine, the liver plays a very, very interesting role. And if anyone here has any expertise on Ayurveda, I would be very, very interested to hear that perspective as well. But actually, in traditional Chinese medicine, the liver, as well as many of the other organs in our body,

[01:29:56] are associated with very specific emotions. So, for example, the liver is associated with anger. And if you think about it from a biomedical perspective, liver does help metabolize cortisol, which is that stress hormone anticortisone. So, it still does – there is an emotional component of the liver even from a biomedical perspective.

[01:30:25] But if you look at the liver from a TCM perspective, it is believed that if the liver is not functioning properly, if there's any type of stagnation in the liver, that can lead to increased inflammation in the body, increased agitation and irritability and anger, or even kind of holding on to the past. So, you think of a depression or a dysphymia, constantly thinking about the past,

[01:30:53] regretting – in traditional Chinese medicine, we might look to the liver for free coursing that. Likewise, other organs of the body are associated with other emotions. So, for example, the spleen, which has a very different function in Chinese medicine as compared to Western medicine. It is actually believed to be associated with digestion in traditional Chinese medicine. That's going to be associated with worry.

[01:31:21] So, you might think of a patient that has irritable bowel syndrome and is also experiencing anxiety. The kidneys, which kind of have a similar function to the adrenal glands, in Western medicine are associated with fear, and the heart is associated actually with joy, which joy can be a good thing. But obviously, if you were joyful constantly and overexcited,

[01:31:50] that would not be good for your health either. So, that's just a little bit more about different perspectives on the liver, if you would. Ted, what do you think about supporting the liver with your patients with anxiety and depression? Well, I mean, there are lots of different pieces to that too. In that more Western thought process,

[01:32:18] say if somebody – with the anger, when you're talking about the liver stagnation, in a Western perspective, if you don't have proper Phase II liver detoxification, you're going to have chemicals that your body can't get rid of in higher amounts, and it's going to affect your brain. In some people, it can cause a lot more anxiety and depression and other issues too

[01:32:46] that could impact that. So, the Eastern and the Western isn't – there's always – the Eastern is interesting because it's looked at more as an observation and a causation of things. And in the Western, it's about trying to understand how that fits together with physiology. Yeah. And back to, like, you were talking –

[01:33:13] Sarah, you were talking about the fatty liver and things on that end. I came across a study – it was just released probably about a year or so ago – going back to the B vitamin deficiency, showing that there's successful treatment of non-alcoholic fatty liver from B vitamins, from B vitamin supplementation. So, it's not just about losing weight. It could be B vitamin deficiencies,

[01:33:43] which, of course, some of those B vitamins could affect your metabolism and also help you to put on more weight or make it harder to lose weight too. And also impact our mental health too since there are cofactors for neurotransmitters. Yeah. Yeah. Yeah. It's amazing. Speaking of liver, how about the role of alcohol in anxiety and depression?

[01:34:11] I think I read one piece of data that alcohol consumption in this country is up like 30% over the past couple years. I don't know if it was because of lockdown and we had nothing to do but watch Netflix and drink wine. What about that? Yeah. So, I mean, there's – I'm not sure about all the specifics there, but if we think about it logically,

[01:34:40] there's a lot of different things that the alcohol will do. Definitely, alcohol affects our quality of sleep, so we're not getting as much deep and REM sleep. So, that is going to make us more tired and cause more mental unrest and anxiety and depression because of that piece. Also, alcohol is going to deplete some of your B vitamins, especially vitamin B1. There we go. Because that's an important vitamin

[01:35:10] as far as detoxing alcohol in the body. So, that's another piece that can be effective, you know, affecting things there. And part of it, too, is just why are you drinking the alcohol? And, you know, it goes back to that lifestyle part about just – and some with taking an SSRI antidepressant where we're just trying to suppress our emotions and not really deal with them. Yeah. Well, it is. I mean, if it gets overwhelming,

[01:35:39] that's easier if you've had a long day in the pharmacy. Sometimes you just want some wine versus, oh, I don't know, taking a few jogs around the block. And it gets to be a habit. What do you think about – what would you say about alcohol and anxiety and depression, Amit? Just a couple more points about alcohol. I was just thinking, you know, how it can impact anxiety and depression. I presume it – I mean, not in small consumption, but in larger consumption,

[01:36:08] I presume it can negatively impact the microbiome. So now we're having issues with that. And that's, of course, impacting our brain through the parasympathetic pathways to the vagus nerve. So that's the other thing. And then, again, not in small amounts, but dehydration. If it's causing dehydration, then that could also impact that part as well. You know, we've known for many years that potentially in small amounts,

[01:36:38] red wine is supposed to be good for us. And I presume that – I'm sorry about that. I presume that, you know, sometimes a little bit of alcohol, for whatever reason, can be good for social connection, for community. So you could potentially say that there are some benefits from that perspective. Yeah, fair point. I was, you know, just thinking about

[01:37:06] on top of everything else, and the things that our livers are – I think they're tired. Our livers are just tired. Wow. Absolutely. Now, I do want to mention that there is, in the naturopathic community, when we use things like herbal tinctures, there can be alcohol used to help extract the constituents from the herbs and certain formulas. But the amount of alcohol

[01:37:35] that is – that our body actually processes from those tinctures is very small. Some studies show it is no – when you look at the actual dosage, and especially if you're mixing it with water, it may be equivalent to about the amount of ripe bananas. And going back to what Amit was saying about sometimes alcohol having benefits, when you look at some of the blue zones, which are areas of the globe that have the highest amounts

[01:38:05] of – I always say this wrong – centrarians, people that live for more than 100 years, you do see that in some of those societies there is some alcohol consumption, but the wine is very, very fresh. It's organic. It's usually without sulfites. And the alcohol content tends to be lower. Oh, the alcohol content is actually lower. I didn't know that. And they're probably drinking it communally. They're probably not drinking it alone

[01:38:35] watching Netflix. Right. I'm just speaking from experience. Yeah. I'm speaking from experience. And I'm not judging anyone, including myself. But, yeah, that's really interesting. I didn't know about the alcohol content, but I guess that makes sense because even our wines that we buy, they have different alcohol content. Right. The whites and the reds and the – should we then go into one thing we didn't touch on yet is seasonal affective disorder.

[01:39:05] It's very dark and sad here in Ohio. I don't know. You guys are both in Illinois. What's it like there? It's actually very sunny today, but it's very cold. And, of course, we do have the shortened days still, which is always not very fun. Yeah. So, what's the naturopathic approach? I think the – just the allopathic approach to seasonal affective disorder is I would have a few patients that just took SSRIs in the winter.

[01:39:36] And they would just discontinue in the spring again? Very few could do that and some just didn't because you know what? The winter's coming. And in Ohio, it's 10 months long. So, there we go. That was a slippery slope, actually, for them. Yeah. So, what's the naturopathic approach to SAD, which can be really horrible? Like, there's people that not only the actual seasonal affective disorder, but the dread that leads up to it. Like, oh my God, here we go. The winter's coming. I'm going to start

[01:40:06] to feel like crap. Right. Exactly. Well, that's kind of interesting because the mechanism of action behind seasonal affective disorder, it's essentially a disorder of changes in light and circadian rhythm. So, there's some and the mechanism of action is still not fully understood, but there's, you know, a couple different theories out there. So, one theory or one, I suppose,

[01:40:36] hypothesis behind seasonal affective disorder is that it has to do with decreased reception of light from the retina, which therefore sends signals to our brain to produce certain neurotransmitters such as serotonin and dopamine. And also, it's believed to increase the conversion of serotonin to melatonin. So, therefore, some patients with seasonal affective disorder will experience

[01:41:05] increased sleeping nets, for example. and so, the most important thing from a naturopathic perspective is first and foremost focusing on the light and the circadian rhythms as well as vitamin D, which is another important aspect of sunlight. There have been multiple studies that show that patients that are in the northern hemisphere and go to the southern hemisphere, their SAD symptoms actually go away.

[01:41:34] And then, in those same studies, some of them were treated with bright light boxes and did find that over a course of two weeks or so, their SAD symptoms would greatly diminish, which is really, really wonderful. So, and then vitamin D, we talked about, again, the importance of measuring vitamin D, the serum levels of vitamin D. Really, the clinical effectiveness level is 50 nanograms per milliliter or higher.

[01:42:04] so that's higher than the medical, what's considered medically accessible, which is about 30 nanograms per milliliter. But in terms of preventing depression, you would want it at least 20 nanograms per milliliter higher than that as a baseline. And then, you could even supplement on top of that or take natural supplements such as cod liver oil, things of that nature, or mushroom-derived

[01:42:33] vitamin D3. There are some also supplements that can just help kind of more from a biochemical perspective that might be of consideration. 5-HTP is something I've found clinical effectiveness with. And then, for supporting serotonin production with medicinal foods, usually I look to foods that are higher in tryptophan, and then also increasing

[01:43:03] complex carbohydrates. So things, again, like we were mentioning the different whole grains, ancient grains, quinoa, half-meelets, sweet potatoes and yams, closer to the evening usually to help with serotonin production. That's a good one. What about you, Ted? What do you think helps with seasonal affective disorder? So overall, I tend to focus with my patients very similar to if they're

[01:43:33] having depression all the time. I definitely use a lot of 5-HTP in my practice. As far as the lights, though, and before we were doing the podcast, I was looking for some research, but I can't really find any, but I tend to, in my household and our offices, and I recommend for a lot of patients to use full-spectrum lighting throughout the house. So something that has 5,000 plus Kelvin,

[01:44:04] you know, which is then more like sunlight, so it stimulates the body more similar so that it's less, you know, your body has more of that effect without feeling, you know, like you're not getting the sunlight. Yeah, that's a good point. Good point. Amit, you want to weigh in on seasonal affective disorder? Yeah, you know, again, you mentioned it early on that things are complicated,

[01:44:34] but sometimes the solutions can be quite simple, and, you know, getting more of those sunlights or sun lamps or one of those lights that bring more light into your living room could be, it could just be a simple fix. Not to say not to downplay it by any means, but every little bit helps, and sometimes eating more light into the home during those darker winter months could be helpful. I think that's a good takeaway too, like that every little bit helps. I think

[01:45:04] there's also this mythology that there is just one thing, and there's like hardly ever one thing, right? Like people should do a lot of things, because I used to do a lot of things to try to help myself, and people would say, well, how will you know what's working? As if that's my end goal. Right? No, my end goal is to help myself to heal and to feel better. I don't need to be a beacon of like, here's what works, right? But it's part of the mythology, I started to realize that

[01:45:35] to have more than one thing somehow makes things worse or muddies the water, it's just how it is. We're mind, body, and spirit, so you kind of have to approach it from many angles, I think. Any problem. Yeah, you don't have to be just a human experiment all the time. Thank you, right? And I'm glad I did not succumb to that in my 20s, that I'm not here to prove anything to anyone. Yeah. Is there anything else, Ted, that we wanted to

[01:46:05] cover with our two guests that we did not? I feel like we covered so much and stuff that's not, we went off script, Ted, we never do that. Oh, no, no, we never go off script. No, yeah, no, I think we really covered a lot of good information here. I think that at this point, you know, wrapping things up a bit, having both Sarah and Amit

[01:46:35] just share some things that are coming up, you know, what things to look at for their practices and, you know, what's going on in their lives at this point. Yeah, yeah, what are you guys excited about with your practice and moving forward? That's a great idea, Ted. Who would like to start? Sarah, what are you excited about with your practice and what are you guys together or separately like what is the future

[01:47:04] of your practice? The near future? Oh, well, I'd say one thing that I've been really excited about recently is in August, I moved practice spaces to a bigger space with other practitioners as well. There is a holistic occupational therapist that focuses on emotional relief there. We have a red light therapy room. Nicole, who's kind of the overseer of the

[01:47:34] space, the owner of the space. She does a lot of massage and reiki, lymphatic drainage. There's also group classes there for yoga. So that's something I'm definitely very excited. I'm very excited and grateful to be working with Amit. The way I met Amit was about, I want to say, five or six years ago. At that time, he actually had an integrative pharmacy, and I was an employee of his for, I would say, between four to

[01:48:04] five months or so. So I'm very grateful to know Amit. And just, you know, I've learned a lot from him and I really enjoy working collaboratively with him. Lovely. Amit? Yeah, you know, I've been at Dr. Sarah's practice. They've created a lovely space. I have worked there a few times. I have seen some patients there. It's a great place to be. It's a great healing environment. So I hope to collaborate

[01:48:34] more with Dr. Sarah on that. We are working on Happy Science 2. We're probably about 90% complete there. We expect that to be done by April 1st. So we're looking forward to that. And that's just, you know, that's just getting a lot of what we discussed on paper and in electronic format and then just giving it out to the world and letting them take it for what it is. And if they just get one piece of information that's useful and nothing else, that's wonderful.

[01:49:04] That's great for us. So that's something that we're looking forward to. So if you could explain the book a little bit better because we had talked about it, all of us, before we actually started recording. So for the listeners, describe more what the book's actually about. Yeah, your first book. Start with your first book that's called Happy Science and what that is. You're the author of that and then the evolution into your current book that you're working on collaboratively. So Happy Science, the first

[01:49:34] one was published and written around the time or actually published around the time of COVID. So we saw a lot of stress and anxiety throughout the whole world and and we also saw a lot of things in the conventional world that we might have been critical of. So a lot of that was put into the book about how people can use science to push a financial

[01:50:03] agenda or agenda of control. So some of that was in there, but Happy Science was less about herbs and about nutrients and about tapering suggestions and ideas and more just about how do you get your mind right? What are some practices and techniques to realize and remind ourselves that our thoughts aren't really who we are, they're just kind of floating clouds in the sky that come and go and just a reminder of different techniques to

[01:50:33] suggest that it's not really a part of us, it's not an arm or an appendage, it's just a thought. And if we take that thought and make it a part of us and that thought becomes negative, it can really take us into dark places. So that was what Happy Science 1 was about Happy Science 2 is a little bit more getting into the nitty-gritty and into the science and providing some tapering guidelines, some tapering schedules as samples to use that they can share with their doctor or nurse practitioner or physician assistant

[01:51:03] and just takeaways that we've learned throughout the process about how to taper their medication a little bit better. which to me is like a whole other animal. For sure. Right? You know, I've seen tapering of benzodiazepines in the compounding pharmacy where it's literally just like 0.05 milligrams over a course of a month.

[01:51:32] So that can be another discussion. But there are some parallels there, but this specific book was about antidepressants in general. Wow. Well, we are, Ted and are both excited about the expansion of your practice, Sarah, and your first book, Amit, I'll definitely read that. It's, congratulations, it's amazing you're a published author as a pharmacist and the collaborative book sounds amazing and I think Ted and I now are inspired

[01:52:02] to write our own book, aren't we, Ted? Sure, yeah. We should so do that. You guys have been great guests. You're our first, this is our first episode of 2025. And it was great. We just appreciate the time and the love and the energy and the intention that you guys brought today. Grateful for the talk and again, just a reminder of how much information that naturopathic doctors have and

[01:52:32] they're just a walking encyclopedia. I took a few classes at the naturopathic college in Lombard and it's not a joke, it's very intense and I have a true respect and admiration for how much information that they learn and incorporate into the world. Yeah, amen. Ted? Vice for pharmacists. Oh, thank you. Ted, any final thoughts? I don't know. I just am so

[01:53:01] happy that we were able to have Sarah and Amit on for this and I think it was just an amazing discussion that will really resonate with all of our listeners. Yes. So thank you to our guests, Amit and Sarah and Dr. Ted and for everyone who supports and listens to our podcast. Thank you so much for the invite, for the honor of being on the show. It was great fun and very informative and I personally learned a whole lot. Thank you so much.

[01:53:31] Thank you so much to Ted and Mary again. It was such a pleasure having such an exciting conversation. Always great to talk to you, Amit. And thank you to our listeners. Yeah, thank you to all our listeners for this. I hope you really enjoyed it and we'll see you next time. Take on Healthcare was created and is hosted by Ted Zuzelis and Mary Sheehan. The information contained in this podcast is provided for informational purposes only and is not intended for the purpose of

[01:54:01] diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider, carefully read all labels, and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast including Mary Sheehan and Ted Zuzelis disclaim responsibility for any possible

[01:54:30] adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations for warranties about guest qualifications or credibility.