Interview with Achina Stein, D.O.
We are so lucky to have Dr. Achina Stein here on the blog, and before we get started I want to share some of your impressive credentials. You are a DO, which stands for osteopathic physician. You are also a board-certified psychiatrist with experience in treating trauma, the prison population, chronic community mental health centers, chronic and persistent mental health issues, and geriatric psychiatry. In 2010 you were drawn to functional medicine when your son suffered a health crisis. Functional medicine resolved both his and your own health problems, and it was a transformative experience that influenced your path to practice functional psychiatry.
You have a practice serving Rhode Island and Massachusetts, and you are also the co-owner of Functional Mind, LLC, which provides online health coaching for clients throughout the US. Basically you are a medical doctor, psychiatrist, psychotherapist, nutritionist, and health coach all rolled into one, and you bring a lot of expertise and experience to this equation.
What would you say your primary focus is in functional psychiatry– what types of patients do you see?
I treat men and women 18-78 years of age, but I am most passionate about helping multitasking, busy married women ages 35-55 who have been diagnosed with depression. They often don’t think they are depressed, and wonder if they should start taking prescribed antidepressant medication. Many patients that I see have never taken this type of medicine before and are nervous or anxious about the outcome. They fear that they will suffer severe side effects or anxious they may become suicidal. They fear that taking antidepressants can bring about other types of problems. I enjoy helping these patients thrive and regain their joy, energy, and spirit primarily by making lifestyle changes.
I know I don’t feel well. Am I depressed? Should I be taking anti-depressant medication?
What is the difference between traditional medicine and functional medicine–do you feel that functional medicine offers a better approach to depression and anxiety?
First off, it’s important to understand that both traditional and functional medicine have their place–it’s not one or the other. Traditional medicine is important for acute illness. If you are experiencing worrisome symptoms, you need a quick diagnosis so that these urgent symptoms can be addressed. Functional medicine is excellent for treating chronic issues. Both types of medicine can be used to inform the other to get the best possible outcome.
Many people become frustrated with traditional medicine because they have experienced a doctor seeing them for around fifteen minutes, providing a quick diagnosis and writing a prescription. Functional medicine practitioners spend more time getting to know their patients. I usually spend 30 minutes reviewing patients’ medical histories plus two hours evaluating them in the exam room so that I can solve the puzzle as to why they aren’t feeling well and make a plan to regain health and vitality. During this visit I evaluate them and collect all sorts of data to create a matrix of information so that I can understand the many factors that may be influencing their health.
I then provide a thorough treatment plan that addresses food, movement, sleep, and a variety of issues that can be improved in order to remove the underlying causes of their symptoms. Functional medicine is more about getting to the root causes rather than arriving at a diagnosis. The goal is to remove root causes to achieve resolution.
We look for the root causes of problems to eliminate the symptoms, as opposed to a diagnosis that would only seek to “match a pill to an ill.”
What would you say to those who are fearful about taking antidepressants?
There are times when the benefits of taking antidepressants outweigh the risks. This is true for patients having thoughts about harming themselves or suicidal ideations that they intend to follow through on. I would make sure they are in a safe environment, even a hospital setting if needed, when they first start taking antidepressant medications. That way they can be monitored for any reaction to medications that might place them at a higher risk of following through on their ideations. Usually, in these cases in which the patient has a history of suicide ideations, the benefits of taking antidepressants far outweigh the risks.
Another good reason to start antidepressant medication has to do with a person’s ability to function in their daily life. If a patient isn’t functioning optimally on a day-to-day basis, that doesn’t necessarily mean that they need medication, but it is part of the overall patient-doctor conversation. If other lifestyle adjustments such as food, movement, sleep, and so on are tried first, and do not result in improved ability to function, then it is worth taking antidepressants to help bring about change. Again, this should be carefully monitored, and if worrisome negative reactions occur then the medication can be safely discontinued under a physician’s care.
Antidepressants are not necessarily something you want to avoid at all costs. They can be very helpful and even necessary to restore health, vitality, and joy.
Can depression and anxiety go away without medication?
Sometimes–each patient presents a unique story. If acute illness is present it may warrant swift treatment, and that may include antidepressants, at least for a time. Remember that traditional medicine can inform and work in concert with functional medicine.
Functional psychiatrists and other practitioners are informed by traditional medicine but we evaluate and craft holistic treatment plans based upon the five lifestyle domains emphasized by the Institute of Functional Medicine. Dr. Downey, that typically includes what you call the 5 Ps, which involves changes in mindfulness, sleep, nutrition, movement, and social interactions.
Addressing the 5 Ps typically allows us to get to the root causes of symptoms, and work to eliminate these causes and therefore the symptoms themselves as much as possible. Lifestyle changes such as removing processed foods, gluten, and refined sugar from your diet can have a powerful impact on physical and even mental health within a short time frame. I have seen this time and again in my practice.
Changes in food alone can make an immediate and large impact. I had a patient experiencing panic attacks who could not function at work due to social and generalized anxiety. We made changes in his diet, and his social anxiety went away. A few months later he realized that he wasn’t even depressed anymore. He previously thought he would always be living with depression. He was surprised that changes in diet could bring about such a transformative change. He realized he was experiencing true joy, which had eluded him throughout his life.
I’ve seen people feel significantly better just by changing their diet in 3-4 weeks.
How does inflammation and poor diet prevent antidepressants from working effectively?
The mind-gut connection has been well established. Gut bacteria manufacture most of our serotonin, which is also called the ‘happy chemical.’ Increased levels of serotonin in the brain boosts mood and reduces or eliminates depression.
Some antidepressants function as SSRIs–Selective Serotonin Reuptake Inhibitors. Nerve cells communicate by releasing a chemical messenger called ‘serotonin,’ and resorb any excess serotonin that is released. When nerve cells resorb or reuptake the serotonin that they have released, that lowers the serotonin levels available to the brain, which can be a root cause of depression. SSRIs work by preventing or inhibiting nerve cells from reuptaking serotonin, and this results in higher serotonin levels in the brain.
Imagine what would happen if your gut isn’t healthy. A healthy digestive tract contains trillions of bacteria. If you are eating processed foods and not maintaining a healthy ‘garden’ of bacteria in your gut, then there isn’t enough serotonin available. There wouldn’t be much for your nerve cells to ‘reuptake’ because you are operating with a serotonin deficit. Antidepressants such as SSRIs can’t make much of an impact on your symptoms if you are operating with low levels of serotonin. They might not be helpful until you make lifestyle changes such as improved nutrition.
If you don’t show signs of inflammation, and you are eating a clean diet that supports healthy gut bacteria, then antidepressants may help because your gut will be producing enough serotonin to allow the antidepressants work to boost levels of serotonin in the brain.
Treat the gut to treat the brain – so many symptoms can be addressed by this approach.
Maybe I was just born this way. What if I can’t get rid of my anxiety or depression?
People often have a sense of fatalism and feel that maybe their depression or anxiety is just a part of their lives that they have no control over. It’s important to understand that they are not stuck with these symptoms. The conditions from which these symptoms arise simply haven’t yet been addressed. Patients need to be open to identifying the underlying issues that are causing their symptoms, and know that so much can be resolved when treating the whole person.
No matter the severity or duration of a patient’s symptoms, that doesn’t dictate their path forward. This is great news! Once patients eliminate the root causes of their symptoms their vitality returns. They are more resilient, and more buoyant.
Most people can overcome depression and anxiety with functional medicine because the conditions from which the symptoms arose have not been addressed with traditional medicine.
I can’t see a doctor right now, especially with COVID-19 restrictions. How can I work to identify some of the root causes of my depression and anxiety?
A lot of us work remotely and that can be isolating. With social distancing measures in place due to COVID-19 many people are even more isolated, and it can be difficult to see a doctor in person. I have developed an online client coaching program to help people uncover their own root causes for their symptoms such as anxiety, depression, and inflammation. This online face-to-face platform allows me to extend my ability to help folks all over the country.
Especially during COVID-19 I want to help people identify the root causes of their own depression or anxiety so that they can learn some tools to help make some lifestyle changes. These changes will bring about improvement in some of the underlying causes of their symptoms, which in turn will help resolve certain symptoms. To help folks get started I am offering a free PDF of my book What if it’s not depression? Your guide to finding answers and solutions at www.achinasteindo.com. Anyone who is interested in learning more about the 1:1 coaching that I offer can sign up for a free 30-minute consultation to see if they are a good fit for the program.
If you do end up working with me and complete the coaching program and want even more targeted help or guidance, you can then transition to a provider in your area and seek appropriate treatment. For those who may need more of a maintenance program to keep them mindful about lifestyle choices and maintaining overall health I offer maintenance sessions within a group setting.
My online coaching program can be truly life-changing, especially for those who are isolated.
Will I have to take a lot of supplements?
I find supplements are often necessary in the short-term as a bridge to help patients reach their nutrition and health goals faster. There are few people that need to take supplements long-term. For example, magnesium, zinc, and vitamin B6 are nutrients that are important for brain function. Research has shown that some people’s psychosis and anxiety stems from their higher than usual need for these particular nutrients. This is not true for everyone and I don’t advocate that all patients use these particular supplements, but in cases such as this long-term supplementation may prove necessary.
Most people can boost immunity naturally by eating foods that contain nutrients such as these, and in that case extended supplementation would not be necessary. It’s always best to obtain nutrients from food rather than supplements.
Supplements can provide a jumpstart for reaching nutrition and energy goals faster, but patients rarely need to reply on supplements long-term.
Can you tell me about SHIFT, the acronym that you use in your approach to functional psychiatry?
SHIFT stands for how we are trying to shift people’s physiology using functional medicine, and each letter represents the five pillars or root causes that we look for: Stress, Hormones, Infection, Food, Toxins. By shifting physiology we mean clearing brain fog and moving away from the constant state of stress/distress. One way to effectively address stress is through meditation or promoting awareness of your surroundings. While mindful exercise can be helpful, you have to be careful that your movement activities are not set up to distract you from mindfulness. If traditional meditation or yoga is not for you, then find something that is in alignment with your preferences such as dancing, singing, or drumming. That is better than adopting a practice that feels unnatural that you don’t connect with. You need to periodically evaluate your mindful practices to make sure that they remain effective, and this is an ongoing process. In my book I provide readers with a task called the ‘perfect life’ vision. You are asked to look 10 years ahead into your life in the future and dream about where you would like to be. This provided you with a clear vision of your desired destination. That can actually take some stress away from your life because it allows you to make important life decisions that align with your vision. You can read more about this exercise and SHIFT in the PDF of my free ebook so be sure to download it.
Practice mindfulness and meditation by finding something in alignment with your preferences such as singing or drumming, and use that instead of adopting a practice that feels unnatural.
Thank you, for reading this weeks blog discussing functional psychiatry. You can read others like these here.
Rob Downey, MD
Dr. Rob Downey witnessed his first exceptional clinical outcome in response to functional medicine in 2006 when his natural medicine mentor turned around a severe autoimmunity case via whole food, probiotics and safe, potent anti-inflammatory botanical supplements. When he asked her whether getting Institute for Functional Medicine (IFM) training would allow him to “speak the language” so he could understand what she was doing she responded, “If you get the IFM training, you will help people the way I do.” He never looked back.
Dr. Downey is driven to connect with other people, listen deeply to what they are experiencing and ask, with them, “What’s next, where do we go with our thoughts and actions to be whole and healthy?” It started in childhood talking with friends and family while hiking in the mountains of western Montana and continues part-and-parcel in the IFM-informed therapeutic alliance he endeavors to form with every patient. He finds there is a beauty, transparency and honesty in the doctor-patient relationship when approached this way. His patients report this approach creates a space for them to get over their hurdles and be their best.