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Guest Bio:

Achina P. Stein, DO, DFAPA, ABIHM, IFMCP, is an osteopathic physician and board-certified psychiatrist with over 25 years of experience. Dr. Stein practices a blend of conventional and functional medicine at her practice, Functional Mind, in Providence, Rhode Island. Using an in-depth biopsychosocial approach informed by her clinical experience in psychiatry and grounded in the functional medicine model, Dr. Stein works closely with patients to determine the optimal treatment pathway, whether that be conventional care with psychotropic medications or holistic modalities of treatment. Dr. Stein is an expert in guiding patients through diet, lifestyle, and spiritual changes that address distress and disturbances in sense of self, dynamics of relationships, and perceived world view. Over the years, Dr. Stein has received numerous recognitions for her achievements in psychiatry and is the author of the book, What if It’s NOT Depression?

Transcript:

Kalea Wattles, ND:
Mood disorders such as depression and anxiety are multifactorial in nature, resulting from physiological, biochemical, and psychosocial imbalances. The field of functional psychiatry aims to identify the somatic root causes that contribute to mental health disorders. Due to the complexity and sensitivity around how these conditions manifest in each patient, the optimal treatment plan goes beyond a singular treatment modality and focuses on truly bringing the body, mind, and spirit back into balance.

On this episode of Pathways to Well-Being, noted functional medicine psychiatrist Dr. Achina Stein joins us to explore how various body systems affect mental health. We’re so excited to discuss how you blend conventional and functional medicine care for your patients. Welcome, Dr. Stein!

Achina Stein, DO, DFAPA, ABIHM, IFMCP
Oh, thank you. Thank you for having me.

Kalea Wattles:
I think this concept of functional psychiatry may be new to some of us. Can you give us a brief overview of what that means to you? And what are some of the similarities and differences we might notice between functional psychiatry and what we might consider the current standard of care?

Achina Stein:
Sure, sure. I mean, the current standard of care is basically coming up with a diagnosis. I was trained conventionally as looking at the biopsychosocial approach, using the biopsychosocial approach. So it’s looking at the biology, the psychology, and the social-environmental aspects. But it’s generally around the mind and experiences. And we want to, as the standard of care, want to arrive at a diagnosis so that we can match a medication of sorts to the diagnosis. And that generally is medications, and it might be one or more medications, but also psychotherapy. And there’s different types of psychotherapy. There’s supportive psychotherapy, there’s psychodynamic psychotherapy, cognitive behavioral psychotherapy, DBT. So there’s all different types of psychotherapy. But again, they’re generally matched to a particular diagnosis, so it is generally those things. And there will be some practitioners that might have a special interest in something, like meditation or like hypnosis, and they might include that in their treatment, but it’s not something, those are not things that are the standard, necessarily.

So functional medicine is by far different from what we would call integrative medicine, which is adding things to the standard, basically like hypnosis, or meditation, or yoga. And it’s almost complimentary, but not necessarily doing a deep dive. For me, functional medicine is really doing a deep dive in looking for root causes. Like, why did this happen? And generally, most people have multiple root causes, even starting from birth. So it’s almost like if you, to use an example, if you bought a hundred-year-old Victorian home that you were going to remodel, right? That home has a history. Wouldn’t it be wonderful to have a home manual of all the things that were done to the house and all the disasters that happened in the house as well? I mean, you would want to know if there was a cracked foundation, or if there was a fire, or if there was…right? Because it makes a difference to the whole body of the house, essentially. It can really cause a roof to come down if you didn’t know that there was a main beam that was affected, right? It’s the same kind of thing in your body. It’s just that our body has the ability to self-heal in many ways. And so we’re a living organism, whereas a house is not a living organism. And so we really want to find out what are the, all the things that have happened to that body, mind, and spirit, all of those things that impacted you, and perhaps put some barriers in the way of preventing healing. So if we can remove those barriers, and if we can help the healing process, which is the five Rs we want to remove, what’s causing inflammation, we want to replace what’s been missing and really support the microbiome and then repair specifically the gut lining. And so there are a number of things that can be done, and a lot of people don’t even realize what those things are. So, and then I’m happy to talk more about those things.

Kalea Wattles:
That was a very beautiful description. And it got me thinking about our functional medicine matrix, one of our foundational tools in functional medicine that allows us to create this map of all of our body systems, our mental, emotional, spiritual considerations and our modifiable lifestyle factors. And it sounds to me like that’s how we create this manual for our hundred-year-old house, right?

Achina Stein:
Right, right, right. Not that everyone’s a hundred years old, but sometimes people feel a hundred years old. And it’s more than just painting over the house. You can paint the house, make it look nice, but does it really improve the stability of the house? Not necessarily, right? So, yeah, I like to use external examples because it seems to me that people get that. Like, oh yeah, that makes sense. But when we talk about the physiology, if you’re not really familiar with bodily function, then sometimes people don’t understand. But it’s amazing how much is happening external to our bodies that mimic some of our bodily processes. Like, circulation is traffic jams, right? Or the flow of rivers, people get how flow of rivers can get clogged, or how traffic jams impede flow. And so there’s all of these things. Or like, for example, I always use, I don’t know if this is still the case because I haven’t been in New York City for a long time, but I remember when I was young going through New York City, and there were piles of garbage on the corners. Piles and piles and piles, and the smell was incredible. So, like if you have piles of garbage in your colon that you’re not moving along, right? Like, who’s picking up the trash in your body, right? What’s going on from cell to cell? How are you transporting that trash from the cell all the way to the colon? There’s this process in place, just like how we have our sanitation system, all that stuff goes to the landfill, right? So you can use those kinds of examples to get like, wow, this is a real process in our body on a micro level that’s important to support. And, of course, things are going to go wrong. Look how when there’s strikes in the sanitation system, what goes wrong, right? Strikes in the police system, what goes wrong? I mean, I don’t know if they’re allowed to strike, but that would be like our immune system. So there’s a lot of nice external examples to try to explain to people and educate them about the body.

Kalea Wattles:
Right. And that’s the functional medicine model in the real world because it’s so important to us, that retelling of the story. And as you’re retelling, and you’re creating these mental models of how the body is functioning, I think that’s so vital. And it sounds like you’ve really layered the functional medicine model into a system that works for you to honor both the standard of care and to kind of take it to the next level with the functional medicine assessment and treatment. So when you’re in your intake with your patients, how do you approach that assessment piece? Are there some specific tools or techniques that you’re using to understand what type of modality or intervention your patient might benefit from?

Achina Stein:
Well, it depends. Obviously, it’s going to be different from patient to patient. So I individualize my treatment based on what they’ve been through. We do a whole intake process, it’s 37 pages, and yeah, it’s a lot. We gather a lot of information. And it’s important to be able to get even birth history and whether or not you’ve been breastfed, how many antibiotics you had as a child, the number of fillings and root canals, and it’s important to get the full history. And I put all their information on a timeline, the IFM timeline, and really help people to connect the dots. Like, wow, you’ve really been through a lot. You’re not just having fatigue in the last couple years. You’ve actually… A lot of people don’t remember really all of their symptoms and all the things that have happened to them. And then it’s like, “Oh yeah, that’s right. That happened to me. I had a concussion when I was eight years old when I fell off that swing. I completely forgot about that!” Right? And so it is puzzle pieces that you’re gathering in order to create this whole picture of this person’s life.

And so it’s really important to gather all of those puzzle pieces and connect the dots for them. And if… generally what we do is we start with healing the gut. Everything begins with the gut. And so when you drill down to that and start really making a change in supporting the immune system and the microbiome, which is all in the gut, then a lot of things calm down. And we use the MSQ, the multiple symptom toxicity questionnaire, to follow their symptom patterns and to basically bring the MSQ score down from wherever they are when they start down to below 10 as best as possible. So, I mean, that’s the bird’s eye view of it. But the nitty gritty is dependent on what they’ve been through. So some people, if they’re coming in on medication, I generally recommend that they not change medication. It’s because when you do start a gut restoration, let’s say, you can actually make symptoms worse for a short period of time before things get better. I like to use the analogy of like, if you’re going to clean out your basement, you’re pulling things out and it’s creating a lot of dust storm, and people can react to that and there’s garbage everywhere, that taking things out and trying to make things right really can stir the pot, so to speak, on the immune level. And so if someone has tapered themselves off a medication or they want to do that, I really strongly discourage that they do that. That they not do that, I mean. And what’s important to do is to clean up the mess, so to speak, and get things flowing in terms of detox pathways open, and nutrients, make sure the digestion is going. So it’s really important to get digestion fixed. A lot of, like, I find that a lot of functional medicine doctors don’t even really focus and drill down on digestion. Making sure that they’re making enough hydrochloric acid, making sure that their pancreas is working and their gallbladder’s working, that they’re making, and if there are issues with that, that they be addressed. Making sure that people are having regular bowel movements and putting out the trash. So those are the first things that I do before we start stirring the pot, so to speak.

So I know I’m jumping around, but to get back to medications, I think it’s really important to keep those the same during this process. And what I find is that people feel so much better that they realize that it’s not because of the medication, because they hadn’t changed. And so then what that does is it gives them the courage to be able to work towards coming off that medication if that’s something that they want to do, because then they don’t have the fear of reducing the dosage of the medication because they know, we’ve proven, that it had nothing to do with the medication. So I try not to change the medications unless, obviously, they’re so severely depressed that they can’t do the work of functional medicine. I mean, this is work. They have to understand that it’s work. So there are going to be times when the medication has to be increased. There’s going to be times when the medication has to be decreased because if they are coming to me and they’re having severe side effects, then we’ll either have to make a change, but I try not to change them during the whole functional medicine process piece, which is a good six months to a year in the beginning, at least the big, heavy duty work that we do.

Kalea Wattles:
Right. Well, it sounds like you have patients who are coming to you, and they’re at various points in the spectrum of their healing journey, at various points in their stages of change and what they’re able to do as far as their functional medicine treatment plan. And we read a pretty alarming statistic, I was shocked by it, maybe you won’t be so shocked, but we read a recent survey from Mental Health America, and they were looking at the current state of mental health, and they estimated that around 50 million US adults have at least one mental illness. And of those, 55%, they haven’t received any treatment. When you hear those numbers, I just want to get your gut reaction to that.

Achina Stein:
Well, yeah, I’m curious to know if they’ve sought treatment. So are you saying that they haven’t even sought treatment?

Kalea Wattles:
That’s a good question. I’m not sure if they’ve sought treatment, but they’ve not received any treatment. So maybe this is the right candidate to start building that functional medicine treatment plan with.

Achina Stein:
Right, right. So a lot of people, there’s still, even now, even with our sports, people in sports talking about their mental health issues, like the gymnast and the tennis player, I’m blanking on their names right now, but they came out and said, “I’m going to take a break.” And they actually caught a lot of slack for that because of mental health issues. And I think it’s really, it’s great. I really applaud them for the courage of saying that to millions of people about what they’re going through, because I think it kind of normalizes, really, how common depression is. But because of the stigma, it’s very, very hard for people to talk about it, to bring it up and say, “I need help.” So I’m not surprised that they haven’t gotten a mental health treatment because they have not specifically talked about it or asked for help, or if they do talk about it.

Some people are really afraid of the mental health system. There are people who have been admitted to the psychiatric units and been traumatized by it by the people who run them, by the patients who are on the unit, because they basically lump all the different diagnoses together. They have people with schizophrenia, and they have people with bipolar, people with depression, they have people with OCD. There are some units where they might separate the different diagnoses out, where they have specialties, but that’s far and few between. And so I am not surprised that that’s the case. And there aren’t very many psychiatrists as we would like. So if many diagnoses and treatment fall on the family practice, physicians and nurse practitioners, so we have a great need for treatment and a great need to normalize these experiences and to provide treatment more than just medication and psychotherapy. I think it’s really important to say that there are all these other things that you can do on your own at home, which is why I wrote the book I wrote, What if It’s NOT Depression? Your Guide to Finding Answers and Solutions. There’s so many things that you can do on your own to improve your mood.

Kalea Wattles:
Let’s talk about that a little bit because I think you’ve already made the case that mental health conditions are multifactorial in nature, and their root cause is probably not isolated to just a biochemical imbalance in the brain as we once thought. So, from your perspective, you’ve mentioned some issues with the gut. What are some of the other perhaps unexpected root causes of depression and anxiety?

Achina Stein:
So, food. On this podcast, I’m sure it’s not a surprise, I am sure you say it over and over again on this podcast that food is medicine and food is poison. So it’s one of the requirements that I have with my population for the people that I treat that they initially be gluten and dairy free. Gluten is extremely inflammatory for a variety of reasons. Dairy is as well. And so there’s many other foods that can cause food sensitivity that can affect the mood, but it’s different for everyone.

So, for one person, I have one patient who got severely depressed, like to a major depressive level, and I finally got her to become dairy free because she didn’t believe that food could cause so many symptoms for her. And so we did do food sensitivity testing. It’s not something that I do upfront unless people require it, because she just wanted proof on some level. So finally she removed dairy, and she could not believe how much her mood improved. But that might not be the case for another person. It might be anxiety for another person, it might be sleep for another person. So you’re not going to know what it is until you actually do it. And trial off of these, at least the major categories for a period of time, and then reintroduce and really pay attention to how it’s going to affect you, mind and body. Not just one or the other. Mind and body. And take note for, not immediately, but sometimes even days later, you can have a change in your mood. So it’s going to be different for everyone. And there are going to be some people after the treatment phase, some people could probably reintroduce the gluten and dairy, but I don’t find that to be often the case. So most people do react when they do try to reintroduce these types of foods. But there are other foods that are very inflammatory as well. Just recently I figured out for a patient that she’s really allergic to corn. And I don’t really get very many patients that are allergic to corn, but it happens. So it’s just, everybody’s different, and you have to figure out what it is for that particular person. But it’s important to remove gluten, particularly because it is, it is something that can cause increased gut permeability. It’s one of the factors that can cause increased gut permeability. So you don’t necessarily have to have celiac disease or non-celiac disease to have increased gut permeability. So it’s really important during at least the treatment phase to remove gluten, especially.

Kalea Wattles:
Well you mentioned your book, the title of your book is What if It’s NOT Depression? And so many of us in primary care especially, we’ll see patients that have this diagnosis of depression, but they have all these other symptoms going on in their other body systems, things like fatigue, and they have unexplained muscle pains, and they have GI issues. When you’re doing your workup and doing your body systems–based history collection, what clues in that workup are signaling to you, maybe there’s something else going on here? Maybe it’s not just depression?

Achina Stein:
Oh gosh. I mean there’s so many things. First of all, you want to do blood work and rule out the major causes like hypothyroidism, some of the obvious things. B12 deficiency, folate deficiency. I mean, there are certain autoimmune diseases that are connected too, like lupus. And so you want to know if there’s an autoimmune process, so you want to do comprehensive blood work. Vitamin D deficiency can cause depression as well, and anxiety and sleep problems. So iron deficiency can cause problems with attention and fatigue.

So you are going to look for certain patterns. So, for example, here’s a pattern. So if you have someone who is eating meat, and let’s say they’re in menopause, but they’re iron deficient and B12 deficient, so one way people get iron deficient and B12 deficient or especially iron deficient is that they have heavy periods. But if they’re not eating, if they’re not having their period, then they’re not going to lose all that iron through their menses. And if they’re meat eaters, then they should be able to get iron and B12 from the meat. So if they’re deficient in these two things and they’re eating meat, but they’re not losing it in blood, why, right? It’s because they’re not making enough hydrochloric acid, right? So then, so it’s connecting the dots, looking at whatever blood work you have and then connecting the dots.

Sometimes people have a thyroid profile where their free T3 and free T4, they’re on the lower range, but still normal, and their TSH is normal. Well, and that might be okay because they might not necessarily have hypothyroidism, but their body could be downregulating as a way to keep the body in balance, especially if they’re in high stress mode. If their adrenaline is rushing and everything’s being ramped up, the thyroid’s going to automatically balance by downregulating. And so you might have lower numbers, not because you have hypothyroidism, but because it’s actually doing what it needs to do or should do by bringing those numbers lower. So, I find sometimes that people are feeling fatigued, and sometimes those numbers are interpreted as hypothyroidism, but you have to put it in the context of what’s going on in the whole system. I’m trying to think of another example. When you see people who have… let’s say they have high blood sugars, and they have elevated cholesterol, not badly, and they have elevated blood pressure, right? That that’s your body ramping up and it’s like, sending off alarms that something’s wrong. So if they don’t have an elevated hemoglobin A1C, and if their insulin is normal, then they’re not really in metabolic syndrome. So it’s probably something that’s activating the immune system that’s causing these three things to go up all at once. And a lot of times if you can figure out what that is, which is usually something in the gut, and you calm that down, these numbers will come down. So they don’t have hyperlipidemia, they don’t have metabolic syndrome. They don’t have diabetes and high blood pressure. There’s a reason why the body’s responding that way, and it’s just a matter of finding what is causing this fire in the body and what needs to be done in order to calm the body down.

So, and yeah, I mean, so there’s different, you have to sort of look at all of the data in the context of the bigger picture and in the context of their history and what’s happened to them. And it’s like being a Sherlock Holmes, basically, a detective, and putting all the pieces together, and that takes a lot of time. I spend a lot of time with my patients and gathering history, and sometimes if something’s missing or not making sense, I have to go back to the drawing board. It’s like, like what happened here in this time period? And it’s like, “Oh, I completely forgot this happened.” Like, so you have to keep digging sometimes to get more information.

Kalea Wattles:
I think that’s part of the beauty of functional medicine, is a willingness to stay curious and ask those questions and go back and look at the history with a fresh perspective when we need to. And we’re also in the business of connecting those dots for ourselves and for the patients. So I love that you highlighted that. And of course at IFM, one of the ways we do that, we love a mnemonic. If you’ve taken IFM training, you’re familiar with GOTOTIT or DIGIN, and you’ve actually developed a mnemonic that’s specific to functional psychiatry called SHIFT, which stands for stress, hormones, infections, food, and toxins. Will you tell us a little bit about how you’re using this SHIFT mnemonic in your practice?

Achina Stein:
Sure, yeah, I always talk about shifting the paradigm, shifting your perspective. I love the word shift. Shifting into high gear sometimes, right? But yeah, it is important to shift everything, shift your outlook. But yeah, we start in stress, hormones, infections, foods, and toxins. We don’t necessarily address those things in that order. We always start with food. And while we’re working on changing the food plan, and generally the goal is to add as many vegetables as possible. Diversity of vegetables improves the diversity of the microbiome. And then while we’re doing that, we’re doing some testing. I love to get a stool test, a urine test, so like, or organic acid test and some comprehensive blood work.

And then our next phase would be really going, looking at the microbiome and bringing balance in the microbiome and intestinal health. Oh, while we’re doing the food plan, we’re also looking at digestion and changing habits around eating and looking at rhythms in the body, sleep rhythms, eating rhythms, just having a rhythm, having some kind of rhythm, bowel rhythms, really focusing on rhythms. And then, depending on what we find on these tests, we’ll try to make shifts in the microbiome and in the environment that the body is in, the environment that the cell is in. And trying to move pathogens out gently. And again, removing barriers in order to create flow.

And then, that would be looking at toxins. The T is toxins. So foods, infections, the toxins are really supporting the liver and the gallbladder and the pancreas to move. To decongest or cleanse those areas and move the bowels on a regular basis, removing all of these things that can cause inflammation and supporting those processes. And stress is a really big piece of it too. A lot of people don’t realize that they’re even under stress. Those type A Energizer bunnies who go, go, go, go, go. And they don’t feel like they need to rest, and resting is a weakness, resting is bad, resting is wrong, I don’t need it, but their body starts to slow down and their mind is still going, and they get angry at themselves and frustrated. It’s like, “What’s wrong with me?” It’s like, you’re not allowing yourself to rest. It’s really important to have those rest periods. Very, very important. But what is driving that? So it’s really getting underneath that, like, why do you need to push yourself so much? What does this have to do with? Is it approval that you’re looking for? Do you feel worthless if you don’t achieve certain things? Do you feel like you don’t deserve certain things? So then you go, go, go to prove to the world that you deserve it. These are all subconscious ideas or stories, subconscious, unconscious drivers that I usually dig for. It’s really, really important.

And then it’s also looking for how people get in their own way when they’re on this journey. I recently had a patient who said that “What’s coming up in two months is my husband’s surgery and I’m going to need to take care of him. And so I might not be able to do that.” So, well, why does it have to be either or? Why can’t it be both? How can you find a way to take care of yourself and him? Why can’t you ask for others to help you? So, do you see, sometimes people don’t even realize that they put barriers in front of them and don’t even realize that they’re doing that for some reason. “Well, I don’t deserve to get well,” “I don’t wanna get well, because then I might lose the attention that people give me that I’ve gotten all these years because I was depressed,” right? Or “Because I’ve been disabled, “disabled,” on some level.” So it’s important to look at all of those drivers. And this can be stressful if you don’t address these things, and they can continue the behaviors that is dysfunctional over time.

Kalea Wattles:
Right? Well, now we’re really tapping into that mental, emotional, spiritual zone. And when I’ve worked with patients who have anxiety or depression in the past, sometimes it’s very clear to me that there’s multiple body systems involved. But what’s unclear is how I prioritize or create a hierarchy of needs and where to go first. So I think your SHIFT model is really helpful and important for clinicians. Are you using the functional medicine matrix to help you understand where you want to go first? Do you look at infections first? Do you just go right to maybe a detox protocol? How do you choose where to intervene first?

Achina Stein:
I don’t necessarily use the form with patients because I feel like they get too bogged down in it and it confuses them. So I talk about it in terms of energy, or infections, chronic infections, or stress. So I put it in different categories. I do have a functional medicine coach. I have someone who’s graduated from the FMCA, which is the Functional Medicine Coaching Academy, and another person on the team who is a functional diagnostic nutrition practitioner. And they use the DRESS protocol, and people really seem to like that. So it’s diet, rest, exercise, stress, and supplements. And so we lay out our plan using that model, and it just seems, I feel like the lay person seems to connect with that. It feels clear for them, and they know exactly what to do when we lay it out in that way. But when I talk to my patients about their issues, I really sort of repeat back to them their story as opposed to giving them a form that has all these circles on it. So I did use that early on. And I think it’s a great form for practitioners to learn the functional medicine path, and it’s a great learning tool, but I find that patients have a little bit harder time understanding some of the terminology. So, yeah, so we just rewrite it a little differently for them.

Kalea Wattles:
Well, that sounds super approachable and I think probably helps. As you said, sometimes a functional medicine treatment plan really requires for you to invest in your health and your wellness and really be an active participant. And so having that approachable treatment plan is certainly helpful. And you mentioned at the beginning of our episode that removing or tapering medications is not always your first step. Will you talk to us a little bit about how your patients who might be using psychotropic medications are also implementing their, for example, modifiable lifestyle behavior change?

Achina Stein:
I mean, they continue to take their medications as prescribed, and the diet that they are provided, the food plan that they’re provided, I don’t think they have very many issues doing. Some people do. So it is important to make sure that people are willing to make a change. I actually, when I talk to patients before I take them on as a patient, I make sure that they understand that that’s an important part of it, and they have to be willing to change their diet. So I don’t see any contraindication with medications, taking medications and having a specific diet. I’m not sure if that’s the question that you were asking me, if there was a contraindication to the food plan.

Kalea Wattles:
I think it’s just highlighting, you mentioned this DRESS strategy, that often patients are taking their medication and engaging in all of these lifestyle factors, and then maybe at some point into their treatment plan, I would love to hear your perspective. Are you able to kind of revisit their medication after they’ve implemented those treatments and see, maybe now is a good time to taper or discontinue?

Achina Stein:
Oh, absolutely. Yes, absolutely. So some people come to me with this idea that they want to come off medication, they don’t want to be dependent on it. And so we use the MSQ as a guide to know how well they’re doing. And so our goal is always to try to bring it down as close to 10 or below 10 as possible. I’ve actually had patients approach zero, I mean, come down to zero. Not very many, but I have had… So that is the goal. And then if they’re on medication and if that’s what they want to do is to taper off medication, then we certainly then start tapering. And people have less of a problem tapering off medication once they’ve done the entire functional medicine approach and brought their symptoms under a certain point. And so they tolerate the reductions much, much better because I find that a lot of the reason why they have side effects from tapering or withdrawal symptoms from tapering is because their body isn’t able to robustly replace that gap with serotonin. So you really want to make your own serotonin or be able to make your own serotonin more robustly when you’re making those reductions. And so yeah, that’s definitely part of the plan.

Kalea Wattles:
Yeah, priming the body and kind of building our resiliency before we make a change. That makes great sense to me. And speaking of your favorite treatment plans, there’s a real increased interest in our community in autonomic regulation, vagal nerve stimulation, especially in patients with things like complex PTSD. Is this something you’re using in practice? I’d love to hear what types of therapeutics you’re using with patients and if you’re seeing a benefit from this vagal nerve stimulation.

Achina Stein:
Sure. I mean, it depends on the person and their willingness to, to do certain things. I find that the easiest thing to implement, and strangely, I don’t get much resistance, is taking cold showers. So I think that is actually easier for people than singing, or humming, or chanting. Gargling, people hate gargling. So you want to basically do some throat kind of stimulation in order to stimulate the vagus nerve, which is on both sides. It comes down on both sides of the neck. But cold showers is probably the easiest thing to implement. And it’s basically taking a regular shower and starting with the last 30 seconds, to turn it to cold and kind of be under that for 30 seconds and try to bring it up to a minute or even two minutes. But that would be the fastest way. Or cold plunges if they live near the beach or a river. I find that it’s, sometimes, for some people to plunge into a river is easier than taking cold showers. It’s surprising. I guess it’s a mindset kind of thing because rivers are much colder than a shower, I think. So, yeah, those are definitely some things that they can do. There is one thing, well, certainly exercise and massage absolutely can stimulate the vagus nerve and calm the body, but there is something called ASMR. I don’t know if you’re familiar with that. It’s a type of music that actually helps quite a few people, including my husband, to fall asleep. And are you familiar with that?

Kalea Wattles:
I see all the videos on social media of people doing ASMR, and it is very soothing in a strange way.

Achina Stein:
Yeah. I’m trying to remember what it stands for. I’m just looking at… Autonomous Sensory Meridian Response. That’s what it stands for. And it’s like a tingling static-like, or like goosebumps sensation in response to the specific sounds. I think one type of sound that’s really popular is just shaving, the sound of shaving. So, yeah, you might want to check it out, whoever’s listening. It’s kind of interesting and surprising how much it can really help people to relax and even fall asleep. So laughing, watching comedy, and getting your body to laugh is a great way to stimulate the vagus nerve. But ultimately, it comes down to breathing, really spending quite a bit of… breathing, doing breath work really stimulates the vagus nerve. And I like for people to breathe into the energy centers, which are commonly called chakras, the root chakras, sacral chakras, solar plexus, the first three chakras are really important. And using imagery to breathe down into those chakras and expand those energy fields really makes a difference for people too.

Kalea Wattles:
Yeah, it’s just so refreshing to hear all these tools that you have in your toolbox that we can also tap into. And you and I were talking earlier, I know you’ve been channeling this passion you have into a really exciting project that’s upcoming, and I was hoping you could tell our audience a little bit about the Healing Depression Project.

Achina Stein:
Oh, yes. Yeah. I am really excited about it. So I’m collaborating with Silvia Covelli and Kat Toups, who’s a functional medicine psychiatrist on the West coast. I’m going to be the clinical director and Kat will be the research director, but Sylvia is an entrepreneur, and she has this vision of creating a program, a 28 to 30-day program that is a treatment retreat center for healing depression. And it’s using all the modalities that are available to us. There’s not a single place that can treat depression that uses a holistic approach. So it’s including medications. People can arrive and do this program on medication or off medication, but it’s specifically just to treat depression and other co-occurring issues using a functional medicine approach, teaching people how to cook, teaching people lifestyle changes including movement, exercise, meditation, guided imagery, and other even psychotherapy modalities that aren’t as common like psychodrama. And we want to teach people lifestyle changes in order to transfer to, once they leave, be able to make it a specific discharge plan so that they can transfer to their everyday life, so that this already thought in advance that when they get home, when are they going to do it? Like, what’s the schedule that they’re going to keep, because everybody has a different life when they leave, right? But it’s going to be a full functional medicine approach where we’re going to do comprehensive testing as well, and looking for all the root causes, certainly that’s going to take beyond 30 days. So we’ll have functional diagnostic nutrition practitioners to follow them after the program. And it’s going to be wonderful. It’s going to be wonderful, but there is not a single program in the world that provides this. So it’s going to be the standard of care, but also all the functional medicine and all of the other issues that, all the other things like mindset, Sylvia is trained by Dr. Joe Dispenza, she’s an advanced health coach, and has been trained by him and Tony Robbins. And so a lot of mindset will be addressed. There’s going to be lots of things. I can’t even list all the things that we were talking about. Trauma, especially. Trauma will be addressed as well, yeah.

Kalea Wattles:
Well, it sounds like a magical setting. And Dr. Stein, we so admire your work in the field of functional psychiatry, and we’re so grateful to hear all of these clinical insights from you today. Thank you so much for spending time with us and sharing your passion for functional medicine.

Achina Stein:
Oh, thank you. Thank you for having me. It’s been my pleasure.

Kalea Wattles:
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