Mitochondrial Psychiatry: The End of "Chemical Imbalances"

Hey, today on Cell to Systems, we're talking about metabolic psychology.

All right, welcome back to Cell to Systems episode 17. This is an absolutely fascinating episode, one we're really excited to talk about. In 2022, there were a number of studies that were consolidated down into 17. The outcome, the conclusion was that serotonin may not actually play a role in depression, which was very interesting considering, we're going to get really into this, how many antidepressant medications are prescribed per year. At the same time, lots of people are talking about how exercise, nutrition, supplementation play a major role in how people feel in their mental health. And I think this is a great opportunity to talk to a very unique panel of people who are seeing patients with these conditions and a pharmacist who's probably filled more of these types of medications than we ever could imagine. So moving on, we talk about things beyond depression. We're talking about PTSD, bipolar disorder, and you know, generalized anxiety disorder, a whole host of other mental health issues.

I think it's great to start on the pharmacy side with you, Dr. Pastana. Leonard, if you could take us through and kind of give us an idea. We've had millions of these prescribed per year. I think it's like 30 million people are prescribed anti-depressants. And somewhere around it's 14.3% of the population. 38 million people take anti-anxiety medication. Give us a lay of the land from the pharmacy side.

Yeah, it's it's funny. We I've said this a couple times, but when I did spend some time working in retail pharmacy, there is that what they call the fast mover track, right? And it's that those couple shelves in front of you where you don't have to walk down the aisle to look for a medication because they're prescribed so much that they just they have them literally right in front of you. So, you can just you can grab them. And I would say just about every SSRI or related medication like that was in front of us outside of the fact especially if they had a generic unless there was some new extended release version that just came out, right? And so the amount of probably overprescribing that happened in the past couple decades of SSRIs is is is crazy. And then I think this is why that this study that came out was kind of so explosive because so many people millions of people were told, you know, you have you have an issue with serotonin and we know how to fix that. And so not that these medications weren't didn't work, but the the foundation that they were explained didn't work.

And so, as a as a pharmacist during that period, you you get out of pharmacy school and, you know, you're kind of naive to what's going on really in the world. You you've just been studying for a long time. And, you so you I accepted a lot of things that I no longer accept now that I have some experience, right? And and it was a lot of the overprescribing, right, where we we thought we were doing the the right thing for people. But we didn't realize the influence that you know pharmaceutical industry had on on on all of all of medicine even the way that we thought even the way that we were taught you know in school and so later on I realized there was you know differences between situational depression you know where something's happening in the moment versus actual real clinical depression or the fact that these drugs can be used short term during hard times and maybe you know not used in in the future. And so I think about it completely different now than when I was when I was there before. And so yeah, unfortunately there we always swing from one extreme to the next where now we might have, you know, I think they're kind of swinging in the opposite direction saying that these these drugs never had any impact. And I don't think that's true either. I just think that they were described wrong. And I'm glad this study came out because it it's making everybody have a conversation we probably should have had a decade ago.

Mhm. It's so interesting that you say that, Leonard, because I remember being I was probably, let me say I was like 22 or three. I went on birth control pills for I think it was acne or irregular periods or something and I started to become depressed like so painfully. I was in I guess I was in medical school at the time. Remember going to my doctor at the time and saying, "What can we do to treat my depression?" and they put me on an SSRI which helped a little bit like I wasn't so bad but that one caused a lot of like sexual dysfunction and so that's no fun. So then you go and get on another one that treats the sexual dysfunction. So now I'm on birth control plus two other medications to take care of the side effects of the side effects. And I was that way until I was 38 years old.

When I finally went, okay, this is when all this stuff when I started learning all this stuff that we're learning, we're talking about here. And I went, I got to come off of all this medicine. So, I stopped all of it cold turkey. And I haven't had to be on anything. I haven't had any depression since then. It was really crazy. Really crazy. And of course at the same time I started doing all these lifestyle things like I started exercising and training regularly. I changed the way I ate. Um I started sleeping better at night. I mean all the things that go on. But for me I'd pretty much put myself in menopause right by being on birth control pills. And so with that really heavy like high estrogen and and synthetic estrogen and then the progesterines that are in birth control pills. So that was a huge contributor to all of that time for me. That's almost 20 years of my life where I was depressed really badly. It's pretty crazy.

I had this exact conversation with a patient yesterday. She's 22 years old. She has been on Yas and she is utterly depressed. She's been through, you know, all the doses. You know, she reports a subtle improvement, modest improvement for a period of time in her symptoms and then ultimately reverts back to just, you know, feeling really pretty lousy mentally. And you know, I brought her mom into the visit yesterday. Because I just wanted to reiterate to the both of them, listen, I think step one, she's doing everything else correctly. I mean, she's trying to work out. She's eating a healthy Mediterranean diet. She's getting adequate sleep. In fact, she's probably getting too much sleep at this point in time. But, I had to reiterate to them, I think step one is allowing your body to do what it wants to naturally do and have cycles and ovulate and, you know, get off of the birth control. If you need some sort of contraceptive, you can explore, you know, Paraguard, which is the copper non hormonal IUD. But yeah, I I think that these are real problematic medications for a lot of people. Not to say that they don't have utility in some situations, but 100% agree. Major area that needs to be addressed.

If you think about this, Christie, they're taking this to you now, but I want to go back to something that Suzanne said and Craig kind of furthered. Like Dr. Pastana said if this is something that's on the fast track that we're just prescribing at this volume, you got to wonder like hey isn't that a little scary that we're kind of like it's sort of like we're trying to figure out what your brain chemistry is, so how do you approach that Christie? What do you do with a patient, how does a patient approach you, how do you handle this?

Well I guess I mean I I kind of go backwards. I mean just like how Leonard that I mean for decades mental health has largely been looked at as a neurotransmitter problem, right? If someone was depressed we just assumed just like Dr. Faria was saying we were taught okay it's low serotonin and you know if they were anxious we focused on neurotransmitters and and the symptom management. However like in my opinion the science is is pushing providers like us to a much bigger question for patients and and how we treat and and look at mental health. I mean, you know, what if depression is not primarily a neurotransmitter disorder? I mean, asking those, and then what if it's actually an energy disorder of the brain? I mean it's it's fascinating to me. Maybe one of these days I'll tell you guys personal story of what happened with when I was a cyclist with my wreck. But it's I mean I've lived this firsthand as far as it's fascinating to me that I mean the brain only represents about 2% of our body weight yet consumes roughly I mean like at least 20% of the energy, right? So every thought, emotion, memory, behavior depends on this healthy mitochondria being produced for adequate ATP, right, for energy. And when brain cells can't produce energy efficiently, neurotransmitters become kind of secondary casualties to a much deeper metabolic dysfunction.

You know, and today thankfully we we understand that inflammation, insulin resistance, mitochondrial dysfunction, the oxidative stress, and then nutrient deficiencies. And you know I think the big one, the circadian disruptions, and then the chronic stress can all influence this, you know, these mental health outcomes. And serotonin may influence mood, but mitochondria power the entire system. I mean the brain is not a chemistry set, it's an energy demanding organ. We can't fix all anxiety and depression with GLP1s through addressing the insulin resistance alone. But for so many patients, you know, we've all seen it. It's been a major piece of the puzzle through this GLP-1 journey that we've been on for the last, you know, five, six years. And insulin resistance doesn't just stop at the waistline. It, you know, it reaches the brain. When neurons become, you know, metabolically inflexible and glucose utilization declines, inflammation increases, right? And and energy production falls. And in clinical practice, we've we've all seen the improvement in moods, motivation, the brain fog, and anxiety when blood sugar regulation improves. For patients that I've seen, when so many patients are so surprised to discover that the same metabolic dysfunction that was driving the weight gain was maybe also driving that emotional symptom, and you know for me before asking what medication someone needs I want to ask whether the brain has enough fuel by addressing you know the food intake, their exercise, the sleep and and stress management.

It's so interesting because I could go back to about five different things here already. It goes back to what this show really stands for, cell to systems, and that it's all interrelated and at the foundational level, we have to be operating in a certain way to achieve the outcomes that we're after. You know, we were talking before the show got started about ketones, and I think that's really interesting. BHB having such a calming effect or helping with GABA. Anybody want to jump in on that?

You know, what I tell my patients is that ketones, you know, from a from an energy standpoint, right? I mean, when you're using any number of different substrates, whether it's carbohydrate, fatty acid, what have you, for energy production, you're always shooting off as a part of that process naturally free radicals, you know, and those reactive oxygen species have to be contended with in one way or another.

I do want to ask you when you say reactive oxygen species, everybody here knows what that means, but you know, the general person that's listening to us today that's like trying to keep up, I don't think they know what that means. So, what does that mean? reactive oxygen species.

Yeah. So, you know, in simple terms, reactive oxygen species is otherwise colloquially known as a free radical. It's going to be something that is potentiating inflammation. It's precipitating you know, cellular damage or an inflammatory cascade in the environment of the cell. And anytime, I mean, it's a natural process. We're naturally creating these all the time when we you know are generating energy. But you know they got to be dealt with. And this goes back to that whole idea of redox balance. And ketones as an energy source are going to naturally produce less of those free radicals than you know other things that we would utilize like glucose or fatty acids and so on and so forth. So it puts less stress on the body to you know support those antioxidant pathways number one and becomes a little bit more efficient from the standpoint of like you know per actual ATP generation and ATP output per unit of oxygen that would feed into you know the Krebs cycle and whatnot for actual energy generation you're going to generate you know you're going to generate ATP fuel more efficiently when you use ketones.

So I I mean I think that the evidence is strong. We've seen it, you know, all throughout these conferences that we've attended and research and whatnot supports improvements in brain network stability. Improvements in how we're able to sleep at night and have more restorative sleep. Improvements in muscle energy stores overnight. Improvements in how our body is able to process lactate and things of that nature. So I I feel like ketones are a strong place for somebody who's dealing with overall you know low energy state whether that's you know physical fatigue, cognitive fatigue. Always a good jumping off point and we're talking about exogenous ketones. So we're not talking about entering ketosis through a diet approach right Dr. Faria. Is that is that fair assessment?

Correct. You certainly can get that benefit from from going into ketosis. It's just a lot more difficult than taking ketones by mouth. One of the things that's really important for me to think about when someone presents with what might be stress or anxiety is what are all their nutrients? And this is sort of going back to what Christy was saying a minute ago. So if their mitochondria aren't working, we have to think about the fact that tryptophan, which usually goes to making serotonin and melatonin, let's just say that for purpose some purposes that the serotonin is somewhat involved in mood disorder. Tryptophan is required to make serotonin and that requires a co-factor called vitamin B6 and we can be deficient in vitamin B6 which would make it more difficult to make serotonin and melatonin. Therefore, you're not sleeping as well, etc.

But what's curious is when your body is under stress from any a lot of reasons including infectious reasons. We've recently been through a big viral illness for the whole world. And when that sort of thing happens or when we are dealing with the long-term effects of that viral illness, we can become depleted not only of B6 but depleted of energy in general because the immune system is one of the biggest drivers of energy requirement. So if our immune system is busy using up all of the energy, think about when you get the flu, what's the first thing you do? You go to sleep. You can't function. You're too sleepy to go. And it's on purpose. Your body's trying to take all that energy and use it for the immune system. And so if that happens, you in order, one of the cool things that the body does is it takes that same tryptophan that you get from food and shunts it over to being used directly to make energy. So instead of making serotonin and melatonin, it goes over to make energy. On the way, some of the sort of middle products that it makes before it becomes energy are kynurenine and quinolinic acid. And those two can be inflammatory for the brain.

And so when you're dealing with an inflammatory process such as some sort of infectious disease and we all a lot of us a lot of us carry chronic viruses, you know, if you've ever had cold sores on your mouth, you carry chronic viruses. And so your immune system is constantly being required to drive that to get that energy going. The other thing that happens is the nerve cells in your brain require that myelin sheath. So the nerve cell is this big octopus on one end with one long arm that goes out to the side. That long arm is wrapped in this beautiful fatty layer that's that's real slick and is the way that this the the neuron communicates with the next neuron. And so that sheath can get broken down. So the transmissions don't occur as efficiently when there isn't enough energy. When the nerve cell is trying to communicate down the other end, it requires this sort of peristaltic action to push things down, mitochondria to make energy for the other end to allow the removal of neurotransmitters from the neuron. When that's not happening efficiently that's we'll see that a lot of times with things with a lot of diseases neurodegenerative diseases but also I consider anxiety depression those sort of things part of the neurodegenerative profile PTSD for example part of the neurodegenerative profile and so we're looking at these cells not functioning optimally and if we can bring into those cells the nutrients that they need and you know there's lots ways to do that. You can use oral medications which are like fatty acids and phospholipids, but those phospholipids are required to make that.

So, if you're depleted of phospholipids, for example, you're taking a GLP-1 and you're not eating properly, or let's say you're eating, but you're cooking your fats at super high temperature, whatever you're frying, whatever you're making your egg. So now your protein is damaged, your fat is damaged, and you're taking that damaged protein and fat into your body, which is getting accumulated into all of your cell walls. So now those cell walls like that myelin sheath are not being made properly. So the brain, all the areas of the brain don't communicate efficiently. And it's it's often just because of what we're eating.

I mean, it's so fascinating to hear you talk about that. I mean, we've all fried an egg maybe in olive oil where it was too hot and it, you know, went past the smoke point and you can even you can just taste it. But that's that's fascinating. I there's so much in what you just shared. Hey Christie, you know what? I've got this weird thing where I can't wait to the next time we have an opportunity to talk about the cycling thing.

So, it happened. I was when I was trying to enter the professional cycling world and had a I was caught up in the peloton, had a wreck and broke my shoulder, concussion. Don't remember I remember starting the race, the roads were wet. That's all I remember to this day and it's been about two and a half years. And but woke up and I couldn't walk for a week. I mean literally was I'm like I mean I just kind of this out-of-body experience and Barry, my current provider, she had just started with me so I mean she didn't know what to do at that point but we all know I know my very great friend Maryanne Butler, you know Barry called her and she was like, "Maryanne, what do I do with Christie? She's not normal." I mean something you know kind of what Suzanne was talking about as far as with the I mean there was several things and that really saved me. And but I think for me mine was just I had no clue the energy suck that this head concussion was going to take. Like I mean it just I mean cuz I I broke my my helmet.

And you know, I think for me that was that was my biggest longest. I mean, it to this day, I mean, I'm, you know, if I'm going to have a symptom, it's it's it's low energy. And that's something that I really pay attention and go back to these points we were talking about as far as, you know, looking at my stress, looking at my sleep cycle. Making sure I'm I'm doing my part as far as with the exercise, but maybe making sure I'm not overexercising because I don't want to get in that stress state again. But I mean, just like we've talked about that the the ketones, Maryanne even consulted with I don't know if it was Leonard or Franc. I mean, I know we had several people involved in this cuz I wasn't normal. And then I got back to work way too early in typical fashion and you know, I paid for it. I kind of had a setback. But through that experience has kind of been my my passion for this cognitive health and then you know going back to the very first time Barry and I heard Dr. Faria talk about the neurotherapy what was it 2 3 years ago at a conference, you know, it's like okay we're doing like you know I I understood that there was so many you know it's it's a web I mean there's so many integral parts to this process as far as making sure that our our brain is optimized and the good thing that's come out of it I think is my daughter says I'm easier to tolerate that I'm a lot more chilled personality now that I'm not nearly as intense as I used to be, which she's probably right.

But I I just think it's, you know, when when we've all had those kind of experiences where you wake up and you're like, "Oh my gosh, did I, you know, I mean, I knew I was still alive. But I didn't know if I would ever get back to my baseline." And it was terrifying for me. You know, and I was I'm I was kind of embarrassed like to actually admit it around like my colleague friends. I I'll never It was too bad Franc's not here because he can't. He asked me at a conference. It was probably about four months after the event and he's like, "Christie, like..." he he even knew I was kind of a little different and and I was I was embarrassed about it. I mean I'm not going to lie. You know, that I didn't want people to think that I was stupid or I didn't have my brain anymore cuz I had this dramatic event.

Christy, I can't imagine what you must have gone through and what is there anything that you still experience today?

I get headaches and then like I said, there's just the fatigue and um I'm still riding my bike. I mean, it it was a good wakeup call, but I do not I I must have been in my drops when the accident happened cuz as the minute I get into my drops, I mean, my knees I I mean, I have PTSD. I'll admit it. You know, it's just that it's that nervous system that gets um that just gets activated and you still cycle.

I do not competitive. I mean, I just I don't have the time anymore to do it. I mean, I was a crazy I mean, like before work, I was I was at 3:00 in the morning with my headlights cycling down some freaking road and you know, cuz you know, you have to you have to get the miles. That's dedication for sure.

Yeah. So, we've talked a lot about that's that's a crazy experience and well, at least you're back riding your bike, right, Christie? It's really impressive that you're riding your bike again. You're like, "Yeah, you know what? Screw you. Still riding this bike."

I blame my husband cuz he he was adamant of he was like, "Christie, you you've got to overcome this." And I was like, "Overcome?" Like, I didn't even know what I was overcoming at that point in time. And I was like, "What's..." And you know, about a month after the accident and we were just like on a trail and I actually fell over cuz like I I had no concept of balance. But I honestly have to thank my husband for pushing me to get back on that bike. And you know, I joke about it, but I I didn't even understand what I was overcoming because my my brain was just still so so activated. And like I I that's why I will forever owe my life to I mean Leonard knows how special Maryanne is to me, but you know I I forever and not to say that Barry wasn't doing a great job. She just she didn't know what she was doing yet. And I will forever owe my life to Maryanne because of it.

There it is. I hope Maryanne sees this episode. Moving over to Leonard, there's this product that you guys make at New BioAge called AKG and I take it preworkout to kind of get some energy. The other day I thought about just putting it in my water just to have it and drink it during the day. Is that a bad idea?

Uh, no. Um, I put it in my water sometimes also. I guess it just depends on how fast you're you're drinking your water, you know. I think that it's the dose is specific, right? Most AKG supplements, it's alpha ketoglutarate, it's this key intermediate in the Krebs cycle, we've been talking about the mitochondria. Basically, it's you know, one of the the mechanisms or one of the machines within the mitochondria that are responsible for the end product, which is ATP, which is energy, which is what we what we want. And so getting three 3 to 10 grams is what you need. And so I would I would I would drink it, you know, in 8 ounces of water right away, but I don't see a problem in drinking it slowly throughout the day. You just want to make sure you're not getting small doses, which is what some supplements have. You know, couple hundred milligrams or 500 milligrams. You need needs to be in grams.

Yep. I take it in the in the way that you and Christie have said it should be taken. So pretty interesting stuff. I mean, I I I can just tell you from when I take it preworkout. Oo, it's good stuff, man. That stuff will will get you going. I kind of want to bring this back for the general consumer back to, you know, hey, if I'm depressed and I'm not getting results and like like Dr. S said, I think this is maybe more prevalent than and maybe I think Christy, I just think I can't thank you enough for your honesty around this and Dr. S, your honesty around this stuff. You guys share things that are so personal. I love this part of the show where you guys really lead the way by example. Dstigmatizing these things and helping people understand that mental health is important and we tend to hide that stuff. We try to like go inward. If I'm a patient today and just like we talked about with thyroid, I'm saying the tests are saying normal or whatever. I don't know how you guys test for depression. I guess there there's that pH whatever you know scale that you use but there isn't like a chemical test is there is there a chemical test that you can use for depression?

Well, they have those, you know, not I guess a chemical test to maybe measure depressive symptoms. That would be that, you know, PHQ9, but the you know, you can use genetic testing to as we I mean, we're all familiar with the genetic testing that's available to sort of identify what medications people may respond to.

Yeah, we've talked about that previously at Comm. There was that presentation that sounded pretty promising and Franc was really bullish on that. We we talked about it last the notion of the genetic testing and how how that could really be a gamechanger for people. You know one of the things to focus on again is that sort of we're often focused on these downstream markers right and serotonin being sort of the downstream neurotransmitter that may be part of the picture. But is it the causative element within the grand scheme of things? Well, oftentimes, you know, maybe not. I like what what Christy was saying in the beginning of the episode, which is that we have to look at the energy metabolism within the brain. And if every neuron is requiring a certain amount of energy throughput to effectively do its job, then if there's any sort of discrepancy or aberrancy that's present in that system, the regulation of the neurotransmitters is going to falter. So you know again looking at sort of the the upstream drivers as the primary place to intervene you know is is of primary importance and I think that that's that's going to come back to you know circadian alignment and sleep optimization ensuring that we're getting that clearance of metabolic waste with the glymphatic drainage. How are we incorporating things like zone 2 training and resistance training? We've you know mentioned you know the myokines and whatnot in previous episodes you know so all of these things really in conjunction with each other are the primary places to to look and

And one of the things that we haven't talked about is sometimes it's just your life you're not happy with, you know, the people that you're around, the decisions that you might have made, mistakes that you might have made, the fulfillment. I found that a lot of times you talk there's a difference between situational what I mentioned before and like actual like clinical depression. And that's the hard part with you know somebody across from you or a patient across from you is trying to decipher like what type of situation that they're they're in. And this is why I think when we started this podcast there's there's the overprescribing of these SSRIs is because how is somebody going to have that type of conversation with somebody in 15 minutes, which is the is the amount of time that they get? And it's not it's not a bad thing, it's not that it's not that they're looking for the easy way out. They also don't want a patient leaving that might be clinically depressed and them not doing what they could do within that 15 minutes. So, they're trying to do the right thing and just feeling it yourself. Have you ever been in a in a horrible mood or having like a bad week and then all of a sudden you get really good news or, you know, you run into an old friend and all of a sudden you just feel great again and you you thought like, man, what is my problem? Am I am I depressed? You know, so I think it's a lot of it is situational. I think a lot of it is taking a deeper look inside and and thinking like are you are you fulfilled? Are you doing the things that you want to do? Are you working on the things that you want to do? Are you around the people that you want to be? Are you making the decisions that you want to do? Are you keeping the promises that you wanted to keep to yourself? And I think that there's that just takes a lot more time.

That's why this whole longevity thing has a lot to do with you know family and surround like people you surround yourself good really good communities where you can have these discussions because like Christy your story it seems that like Maryanne was a big part of you kind of crawling out of that thing and that that just means that you had a great social network because we can give all the modifications that we that we always we loved it to geek out on when it comes to ketones and peptides and all these things but I think this is like the bigger one. This is the bigger hack is like your your social social environment and if if I say one one lifestyle modification exercise is just a big one because it's just directly stimulating neurotransmitters you know. So yeah that's that's that's the tough thing that's the the transition between this medical system that we're we we see this big transition in medicine from traditional to the medicine that that we're practicing in that you know how are you supposed to help people in in 15 minutes you have to have a deeper conversations. And so and then and then those are the consequences of the overprescribing of certain medications that are like and then you're taking other medications to deal with a with a side effect.

And that's that was retail pharmacy 101, you know, just I worked the overnight shift and it was just everything that was on automatic refills. We had quotas. You had to have a certain amount of patients on automatic refills and if not, you got in trouble. And so we had to harass doctors. Hey, this is a this is a maintenance drug. This SSRI is a maintenance drug. Can we refill this? Can we refill this? Can we put this on automatic refill? Then pharmacists were putting things on automatic refills without even getting permission just so they can meet their quota. And I'm sitting there in the middle of the night just filling as many prescriptions as I can. And now you have someone on seven, eight different medications. They don't even know if they have an actual diagnosis or if it's just a side effect of one of the medications. That's that's kind of like the world that that we're in. That's where everybody's that's why most, you know, physicians I see are trying to get out of that world if they're not already out of it and try to see how they can get involved in more of a longevity medicine. But that's the end of my rant.

Well, you know, that was one of the better rants I've heard in a long time. I mean, holy smokes. You know, it's amazing to think like one of the things I'm so grateful for every single episode on this is I hear something that is really kind of like makes me sort of do stop and think. I've heard a number of them from all of you guys today. But that right there, I think that notion of staying in within that group of people that are positive and keeping toxic people away from you and and making sure that you're trying to focus on the things that you know maybe aren't the obvious. I mean that seems obvious, right? But it it sometimes you can't you're stuck with certain people and it is the way that it is. So that's that is a really phenomenal thing. So, if we were to take if we were to take something and just like distill all this down, I think we could put together a pretty good checklist of things that people could do to keep themselves in check. And we've listed it all out here. You guys have laid it all out in a way. Is there anything else that we're missing?

I just never want to overlook like when someone presents with a mental health as far as anxiety, depression, or wherever it might be that I'm not missing actually just a metabolically sick patient. So I I never want to forget about what just our core our basic labs can can show us as far as a an A1C and a fasting insulin, a CMP, a CRP, the a complete thyroid panel. I mean, we had that last week on thyroid. Same thing. I mean, I think psychiatrists are probably some of the better ones that really dive into thyroid and and understand like why we need those ranges that I know all of us here are going after. And then, you know, looking at the B12 and folate, iron and homocysteine. And then you know if I need to more of a more complete like the prodal scan as far as like looking at the omega indexes. But you know those are just the basic ones cuz I think so and and not to say that there are not patients that truly are serotonin deficient that need medication. But I know for me, so many of our patients, they're just they're metabolically sick that's creating this anxiety and depression for them. That's just this vicious cycle that they get thrown into as far as the, you know, the poor sleep and then the eating and then the self-esteem and then it just you're just you're in a rinse and wash and repeat cycle.

I think it's interesting what you say about that that rinse and repeat cycle. The thing I see so much is and that probably one of the hardest ones to treat is patients with anxiety and there's this desire to not feel anxious like I don't want to feel anxious and so that creates more anxiety, right? So instead of just feeling anxious knowing that it's going to end and I think that was part of what happened for me in my 40s and 50s was, "I know I'm not going to feel this way forever." Has there ever been a time when you didn't stop feeling depressed? Has there ever been a time for you when you didn't stop feeling anxious? Well, no. Actually, it ended at some point.

So, knowing that, can I sit with it and see where it's coming from? Is it coming from a story I'm telling myself? Is it coming from a thing that I'm believing? Is it coming from all the things Leonard was talking about? Is there a a relationship that needs to change? Is there a boundary I need to set? Is there a something I need to say no to that I've not been saying no to? Those are all really important places to look at. And do I need to quit a job that I'm not going to I'm not haven't been willing to quit? Is that what's triggering this? And I'm continuing to feel feel anxious cuz I'm working in this direction but I'm I'm putting all my energy into this career but what I really want to do is be a musician or you know so many so many other things I'm just making things up but you know what I'm saying is like if there are places where you need to be going and you're not doing it it's going to create an emotional charge inside your body so we do a lot of somatic work in our practice and that's one of the things we talk about is where do you feel this in your body tell me what the worry is that's associated with that feeling. And so we make them sit with it, which is really hard. And so giving them something that that can break that temporarily or even or neural therapy can give them that few minutes of break from the feeling so they can begin to process what's happening, what's going on. Wow.

Phenomenal. Anyone else want to take a last pass at this one?

Just kind of going off of that one. We have one multiple bedrooms of the house and at work just in case you ever need that break Dr. Faria's talking about.

Sounds like I got to get some of that. All right. good place. Good news is I know where to go. All right. This has been a phenomenal episode as always. The only thing I would say today I think we all missed a little bit of Frank's wisdom in this one. It's interesting when he's here to show up to talk about these types of things. I think it's really interesting. So, Frank, we missed you today. But we know that these things come up and sometimes we can't all make it to the show. Next week's show is going to be really fun. We're going to have a blast with that one. So, I want to thank all of you once again, everyone for listening, watching Sell the Systems. Please remember to like, share, and subscribe. If you have someone in your family, know anyone that you care about that is suffering from depression, anxiety, or any of the other things we discussed today, please make sure to share this episode with them and help them maybe find the appropriate next steps for them. Until then, we'll see you on the next one.