#131: Kelly Brogan, MD – The Paleo Diet and Depression. Do Antidepressants Even Work?

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About Kelly Brogan, MD

Dr. Kelly Brogan is a Manhattan-based holistic women’s health psychiatrist, author of the book, A Mind of Your Own, and co-editor of the landmark textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. She is board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine, and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms. She is on the board of GreenMedInfo, Functional Medicine University, Pathways to Family Wellness, NYS Perinatal Association, and Fisher Wallace, Medical Director for Fearless Parent, and board member for Health Freedom Action and the peer-reviewed, indexed journal Alternative Therapies in Health and Medicine.

Books Discussed in This Podcast

A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives

Connect with Dr. Brogan

www.kellybroganmd.com

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Interview Overview

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Show Notes

01:58 “Before I stopped prescribing, I never once cured a patient” Dr. Brogan was a traditional psychiatric doctor from a traditional family. The goal of traditional psychiatry is to keep you functioning and to suppress symptoms. Many mental illnesses are not valid illnesses or diseases. They are symptoms. Most outpatient psychiatrists do not run basic blood panels on their patients to rule out known reversible causes, like B12 deficiencies.  She began recommending fish oil, rhodiola, and other supplements to her patients on pharmaceuticals.  Then she read an expose’ by Robert Whitaker called The Anatomy of an Epidemic, which brought her to a lesser known body of science. She stopped using pharmaceuticals and began to cure patients. Her goal is to not only get her patients off of their prescriptions, but to give them the tools to not need to see her.
05:45 Depression Medication Paradox: Practitioners and the lay person (via direct to consumer advertising) are taught that depression is a discrete disease that is likely heritable and is a result of a chemical imbalance, often a serotonin imbalance. There are antidepressant medications that are serotonin reuptake enhancers as well as other that serotonin reuptake inhibitors, and others that have little impact upon serotonin, but impact norepinephrine and dopamine.  Trials show comparable efficacy in non-psychiatric medications like beta blockers or thyroid hormone.

07:51 Do Such Disparate Medications Work? Dr. Brogan says that these medications do not work. The reported efficacy is 30%. There is much unpublished literature. A psychiatry study found that 37 of 38 negative studies used to approve 12 antidepressants were not published because they were negative. When you adjust for active placebo effect, these medications have negligible efficacy.

09:14 Antidepressants: Active Placebo Effect: It is the recruitment of bodily beliefs about your being sick and there being a chemical fix. When you are in a trial, you are told that if you receive the treatment, you may get dry mouth, diarrhea, or headache. The placebo might be a sugar pill. When you start to get the side effects, you tell yourself that you are in the treatment group and you believe that you will get better. A follow up study of people who were successfully treated with Prozac were told that they would be randomized to placebo or continue on the same does that cured them. Both groups became depressed. The power of belief or expectancy is a very important and complex factor.

11:56 Long Term Effects: There is not a single study that suggests that being treated with antidepressants for any psychiatric disorder results in improved long term functioning or improved long term outcomes.  According to the WHO, depression is the number one cause of disability, yet we have more prescribing of treatment than ever before. This should be inversely proportional. What if the treatment is inducing disability and a chronic disorder that might have otherwise been a reversible single episode phenomenon?  It is time to re-examine the theory that depression has anything to do with brain chemicals.

13:07 The Cytokine Theory of Depression: The primary literature is beginning to support the idea that it could be a body-wide, system-wide phenomenon. It comes down to the mismatch of lifestyle with our over 2.5 million years of what our genes have come to expect. This theory asks what we can do to better align our lifestyle with those of our ancestors so the alarm systems in the body, inflammatory systems, and immunological mechanisms, are not on constant high alert. Depression is a Symptom

15:41 Diet vs Prozac: Prozac will not produce clinical effects, just side effects, for 6 to 8 weeks after treatment starts. Diet will produce positive effects within 30 days.

16:04 Cultural Intolerance for Suffering: Every other indigenous or traditional culture the world over appreciates that growth is not always a pleasant experience. Growth comes through walking through a figurative fire.  In our culture, we try to commandeer our bodies and dominate nature, focusing on productivity and ambition at all costs. We have de-spiritualized everything about the American way of life. Suffering has a point, a reason. If you fight it and avoid it, it only makes things worse.  As a practitioner, Dr. Brogan advocates making a safe space for a patient to move and grow through their suffering. They will come to a place where they may learn something about themselves, integrate something, get rid of something, or shed something that needed to go. It is a period of growth.

19:18 Treated vs Untreated Depression: We have been so eager to medicate, that we no longer recognize what the natural course of depression looks like. In earlier decades, studies of untreated depression showed that episodes of depression were self-limiting, with 12 weeks being an average duration. Now, by definition, depression is a chronic, disabling illness. Perhaps our treatment is what renders it a chronic, disabling illness. Dr. Brogan aggressively supports the natural process and finds that 12 weeks is longer than necessary.

21:04 Not Treating Symptoms: Dr. Brogan is excited to help her patients through major transformation. Feeling hopeless disconnected and out of control is an opportunity.  She believes that parts of your psyche are unavailable when you are medicated.

23:56 The Main Component of Transformation: The nutritional pillar of her protocol is an absolute game-changer. During postpartum Hashimoto’s, Dr. Brogan had great success when she shifted from a junk-food diet to an ancestral diet. Over the course of 2 years, it not only changed her body and internal workings of her body, it improved cognitive functioning.  She then turned to a more mind-body-spiritual connection.

25:45 Dr. Brogan’s Protocol: She begins with a simple 30 day clean slate approach to diet. It is simply a shift to whole foods. Most of her patients eventually end up with a moderate carb/paleo diet. A great many psychological issues are impacted by blood sugar instability, chronic inflammatory response, antigenic foods, and nutrient deficiencies. In a psychiatric study, a woman had been a vegetarian for 27 years and developed a psychotic depression. She was admitted to the hospital with catatonia. She was treated with shock treatment and anti-psychotics and yet she did not improve. At another hospital, her B12 serum level was found to be in the 100s and they give her 2 cyanocobalamin injections and she completely remitted of her symptoms, including 14 years of symptoms of malaise which spontaneously resolved. We should know what to eat. Food is one of our deepest connections to the natural world. When Dr. Brogan recommends eating pastured red meat 3 to 5 times a week, her patients are her patients are shocked. The ones who are revolted at the thought of eating meat and if their reaction cannot be changed, Dr. Brogan changes her first 30 days approach.

31:16 How Our Gut Impacts the Brain: Our thoughts and beliefs affect our digestive experience and now we are learning that our digestion affects our brain. With the relevance of the microbiome, we begin to understand the most powerful impact you can have on your microbiome is through your nutrition and sufficiency/efficiency of digestion.  Psychiatric research looking at depression in animals, uses injected LPS (lipopolysaccharides a component of gram negative bacteria wall) to induce a level of depression.  It tells us that there is something about the integrity of the gut wall, which if luminal contents have exposure to the immune system and circulatory system, the symptoms of depression may be induced.

33:10 Evolutionary Purpose for Depression:  Some researchers believe that depression slows the body and isolates us for recovery, possibly of infectious insult. It was found that patients being treated for hepatitis with Interferon developed depression 45% of the time.  Some anti-inflammatory drugs resolve symptoms of depression. Inflammatory markers like interleuken-6 or tnf-alpha have linear tracking to the severity of depression. Markers like CRP can predict the onset of depression in women. Inflammation predates the clinical syndrome in women. The chronic inflammatory alarm signal is nearly always set off in the gut. However, sometimes inflammation can be systemic from psychological stress. In a study released last year, people who were experiencing psychological stress in the study setting had mobilization of macrophages from their bone marrow that fed back into their brains to trigger inflammatory responses in their brains.

35:39 Brain Gut Communication: One of the ways that the gut communicates with the brain is through the vagus nerve. The vagus nerve takes a survey of the gut and translates it to the brain so the brain can perpetuate that message. If there is an inflammatory activation, it persists in the brain itself. We will have identified enzymes like IDO, for example, that impact how the brain can, through its own immune system, microglia, perpetuate a message of inflammation to bring behavior into a place that is adaptive for response. Hypervigilance, anxiety, and insomnia can come with depression. Depression is an agitated phenomenon. These ancient mechanisms were meant to help us.

37:32 Using Ancient Interventions: Dr. Brogan would prefer to use interventions that act with complexity: diet, a type of meditation called kundalini yoga, movement and setting the stage with circadian rhythm preservation and sleep integrity.  The more ancient interventions are effective for many.

39:30 Anti-inflammatory Effects of Antidepressants: There are several studies that suggest that some antidepressants and even an antipsychotic have the potential for anti-inflammatory effects.  In some patients, this may be adaptive. Dr. Brogan doesn’t like the term side effects; because they are all drug based effects. Some we may like and others not so much. Drugs do not address the underlying issue. We have more effective interventions that do not carry the morbid effects that anti-depressants do.

42:04 Dr. Brogan’s Book – A Mind of Your Own: Her book is not meant to provide a complicated mandate. It is a positive message and provides you with simple tools so you do not need to see an integrative professional. It provides tools for transformation. It should be exciting and empowering for you.

45:11 Dr. Brogan’s Morning Routine: Through the years she read the literature promoting the health benefits of meditation, but she did not implement it. She now does Medical Meditation or Kundalini Yoga. It was the entry point for her to be able to change her relationship with her own nervous system. She is interested in the role of the autonomic nervous system as a top down modulator of everything else from endocrine, to immune, to the gut. It is the most powerful intervention for her as far as changing how she experiences herself and how she manages her health. She awakens at 6 a.m. and spends 45 minutes doing kundalini yoga meditation.  She uses non-toxic products and does dry brushing. On the weekends, she does coffee enemas. She does oil pulling in the shower. For breakfast, she keeps it simple, maybe an egg with an avocado, a smoothie, or a turmeric latte. She does a lot of reading before she gets to the office. She finds that she reads exactly what she needed to read that day. She no longer experiences stress, after having been a neurotic type-A person.

49:27 Dr. Brogan’s Favorite Herb or Nutrient: Curcumin supplement is her favorite. She appreciates the informational qualities of basic foods. What this one basic spice can accomplish is near magical. It deals with the body’s networks.

50:56 One Health Tip for America: We are creating a problem and we may not be able to dig ourselves out of as a nation, and maybe a planet, by subsidizing the food industry. If consumers could support agriculture with their choices, we would see a resurgence of health. She might challenge them to a week of not eating any packaged foods to show the impact. If you take packaged foods out of your diet for one week, you will feel like a different person. If you take sugar out of your diet for 4 days, you will feel like a different person.