Beyond Pills: The Metabolic Truth of Mental Health with Ruth Dottin, Psychiatrist

What if the root of mental illness isn't just in your brain, but in how your entire body processes energy? Dr. Ruth Dottin, a board-certified psychiatrist, takes us on a journey that challenges everything we've been told about psychiatric care.

After years of practicing traditional psychiatry, Dr. Dottin confronted an uncomfortable truth: many of her patients weren't getting better despite medication, and some seemed to be getting worse. This realization led her to explore metabolic psychiatry, a revolutionary approach examining how our body's metabolism directly impacts our mental health.

The conversation dives deep into how our mitochondria—the powerhouses of our cells—play a crucial role in brain function. When disrupted by poor diet, sleep deprivation, chronic stress, or environmental toxins, these tiny cellular components can contribute to depression, anxiety, and other mental health conditions. Dr. Dotton explains how processed foods, sugar, and nutrient deficiencies create the perfect storm for both metabolic dysfunction and mental distress.

Perhaps most shockingly, Dr. Dotton reveals that despite completi

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💊 Ready to Deprescribe Your Psych Meds?

Psych meds have harmed us—and we’re not just survivors, we’re deeply educated in psychopharmacology, psychology, and nutrition. As hosts of The Gaslit Truth Podcast, we guide people safely off psychiatric medications with strategies grounded in science and brain health

🔥 You’ve been harmed. You’ve been dismissed. It’s time to take your brain back—with guidance from people who’ve been there and know their stuff.

Chapters

• 0:00 Mental Health as Metabolic Health
• 5:05 Dr. Ruth's Journey in Psychiatry
• 9:01 Recognizing Medication Limitations
• 15:14 The Challenges of Deprescribing
• 22:04 Understanding Metabolic Psychiatry
• 30:07 GLP-1s and Psychiatric Medications
• 37:25 The Chemical Imbalance Theory Myth
• 42:43 Neurodivergence and Metabolic Approaches
• 47:29 Final Thoughts and Closing

Transcript

TherapistJennschmitz: 0:02

Psychiatry told you pills were the root cause solution. The truth, mental health is largely metabolic, and ignoring that is the biggest gaslight of all. We are your whistleblowing strengths, Dr. Terylyn and therapist Jen, and this is the Gaslet Truth Podcast. Today we are here with Dr. Ruth Dotton, a board-certified adult psychiatrist who focuses on metabolic and lifestyle interventions to target root cause of mental illness. Ruth completed medical school and residency training at the University of Maryland in Baltimore, practicing in a community mental health clinic outside of Baltimore, and then now she's working at a federally qualified health center. Welcome to the show, Ruth. Thank you. I'm so glad to be here.

DrTeralynSell: 0:44

Yeah, we're happy to have you. Yes, I found you on TikTok and I was like, I need to get her on the show, ASAP, because you you're talking about a lot of the things that we discuss here, but you also practice as a traditional psychiatrist, correct? Yeah. Yeah. So if you could share with our listeners your story from traditional psychiatry now into your interest areas, which are the metabolic psychiatry and deprescribing you talk about and whatever else you want to share.

Speaker 03: 1:16

Those lifestyle, those other lifestyle factors. Yeah, yeah, definitely. So yeah, I did my training at University of Maryland Shepherd Pratt residency training program and was very much indoctrinated into the medical model of psychiatry. I think I got really good training there. I have nothing bad to say about them, but but that's just the standard of care in psychiatry. So I I was a I'm a National Health Service Corps scholar. And so I when I started med school, I was already committed to working with medically underserved populations. I thought I was gonna be a primary care doctor actually. I still, like always from the get-go, had like a bio-psychosocial, spiritual approach. But as I went through my med school training, I was on my clinical rotations and they just kept like giving me the hard patients. They were like, Russia's good with those. And then once I hit my psychiatry block, I was like, okay, yeah, this makes sense. This is these are my people. So, and then so I started out working at a standalone mental health practice, but it was primarily working with patients on Medicare, medical assistance. So, and then I moved up here after a couple of years and have been working at my current site for a little over two years. So, you know, I very much practiced traditionally for my first couple of years. And after a little bit of my time up here, I sort of came to the recognition that we just we weren't, I was concerned that one, my patients were generally weren't going getting better despite my best efforts. And two, that in some cases, I was worried that the medications were doing more harm than good. And so I kind of did a deep dive to find out like, is there a better way? Is there a better way to practice? Like, how can we actually treat treat the root causes of mental illness and not just reduce symptoms? Which don't get me wrong, sometimes that's necessary and very important, but it's not healing.

DrTeralynSell: 3:08

So can I just ask you a quick question? When you noticed that your patients were not getting better, what did you notice about them exactly? How did you know they weren't getting better? Do you did you notice they were getting worse? Like what was that like for you as the observer and the psychiatrist?

Speaker 03: 3:28

Well, I think you know, there's kind of two camps of patients. There's your serious mental illness patients who are at risk of psychiatric hospitalization. I've done a lot of work with those. I was on a mobile crisis team. I mean, not mobile crisis, I was doing mobile treatment. So that's, you know, patients who are high risk. Um, and then there's kind of like your anxiety, depression, and then PTSD is everywhere. So yeah, so I think as far as my more acute patients, my higher risk patients, they would continue to have psychiatric hospitalizations. And the goal of care was to reduce the number of psychiatric hospitalizations from multiple times a year to maybe only once or twice a year, right? Which, like, that's an improvement, but it it's kind of a low bar. Um, and then as far as my other patients, just like the expectation that they would keep coming to me forever. Like, I was like, why? Like, I want them to get better. Of course, there were those visits that were like totally straightforward, they're doing well, but it never crossed my mind when I initially started that like maybe this is time to start deprescribing, and that just like wasn't taught to us.

DrTeralynSell: 4:29

Talk more about that. Yes, please, please.

Speaker 01: 4:32

Yeah, not that we can have a uh bias to this, but uh yes.

TherapistJennschmitz: 4:40

People get off psych meds, and yeah, so we we're really wanting you to dive into that just a little bit, please.

Speaker 03: 4:45

Yeah, for sure. So I I mean, in residency and medical training, there is really no formal didactics or information on safe deprescribing. We were very much taught that, you know, obviously the, you know, the what am I trying to say? The the traditional uh traditional model that there's a chemical imbalance and we're correcting those with medications, yada, yada. So, but uh the only time we ever talked about deprescribing was kind of when you're doing a crossta. And so you have to decrease one medication as you increase the other, and maybe a little bit with benzodiazepines, but by and large, there was minimal education on this. And the expectation was that if you've had more than one major depressive episode or psychotic episode or whatever, then essentially you should be on medication for life. I mean, that was really what we were taught, and that's because that's kind of like I said, the standard of care. So, but I think I I definitely I ended, I started with the metabolic psych stuff, and then I also came across Dr. Yosef's work and so kind of have also done a deep dive into that and and also Mark Harwood. So so I have since very much changed my position that like these medications don't need to be prescribed for life. There are cases in which that is needed either because of their symptoms or just because they can't get off of them. Of course, I wouldn't lose hope that they ever could, but but you know, now I I definitely reevaluate each patient. And I'm like, you have to constantly be re-evaluating the risks versus benefits of the medication and of their untreated mental illness. And I just I think that it I was taught it was just like kind of one initial evaluation, which usually the risks of untreated mental illness were greater than the risks of the medication. And so you just kind of start them and and then keep going.

DrTeralynSell: 6:36

Do you think this is a hard conversation, particularly with the the underserved population that you have? Because I I know historically this is no disrespect, but historically, the Medicaid patients and the lower income patients that I have seen have been the most medicated patients. And I think that's because accessibility to pharmaceuticals is uh there. It's easy, it's free. Whereas some of the other stuff is not. So do you find those conversations to be difficult to, I don't know, unwind in that population that you work with? Because that's really the slice of the population that you're working with is the medically underserved, impoverished, that type of thing, right?

Speaker 03: 7:23

Yeah, absolutely. So, I mean, I think that my health center does the best they can within the systems and standard dogma, you know, of typical medical practice. Like I have 30-minute follow-up appointments and an hour for an evaluation. Other places have only 15 or 20 minutes for a follow-up, which is just no time at all. And probably about 40% of my patient panel is not English speaking. And so we have to use an interpreter. So that adds an additional kind of cut to the time. So I think traditionally for patients who are going to, you know, who are dependent on medical medical assistance or Medicare and who are going to these types of centers, there's an expectation, by no fault of them, that like they'll go in with a complaint and they'll walk out with a pill for that complaint. And so, and when you think about it, like with a 30-minute visit, maybe the patient arrives five, five, 10 minutes late, you're using an interpreter, you basically have like 10 to 15 minutes of like quality time with them. So that's just not really enough to go through, talk about their symptoms, how they're doing, about the how the medication is going, and then to also have these, you know, more nuanced conversations about the risks of their medications, what coming off would require, as well as lifestyle interventions. Yeah. So I think, and and like I said, a lot of times the patients are like, I just want a pill for this problem. I either don't want to or I don't have access to, or I just can't. I don't have the bandwidth to do these other things. And so I think it's really about building trust. So, you know, I don't expect to make these big changes in someone's treatment plan if they come to me on their in their own five, six, six trip with medications. Um, I think it's about building trust and and shipping at it a little part, a little bit at a time. And of course, there are there are cases that people have more bandwidth and they have more resources. And it's really, you know, exciting to work with those patients. But I also recognize that working within sort of a traditional framework or you know, treatment plan, it can still be really meaningful with a patient just by treating them as a whole person.

TherapistJennschmitz: 9:35

What have you noticed since you started doing some of that deprescribing work with your patients?

Speaker 03: 10:22

So it's challenging with my patient population because they don't have access to compounding pharmacies, like they can't pay out of pocket for that. And then also just like the frequency with with which I can see them, you know, every two weeks is the most, the closest I would see someone, but usually it's every four weeks. And so if you're doing, if you're trying to de-prescribe, it can be really challenging with having fewer touch points like that. And so I just kind of approach it really slowly. I have a lot of older patients who not, you know, who are immigrants, not from here and uh don't speak English and they're on benzodiazepines, either from their country or for someone from someone here, and so the process to de-prescribe them is you know, it's can be challenging, especially when they don't attend appointments, and not again, not due to their fall, but there's just so many barriers. And so you're like, Well, I guess I should keep prescribing the benzo. Like, I'm assuming they're still taking it. So, yeah, it's definitely a challenge, but at the same time, it's rewarding when a patient is able to successfully decrease their dose. Usually it's decrease their dose and not completely come off, but it almost like medication sparing, right?

DrTeralynSell: 11:27

Like sometimes it's about sparing, like the the smallest amount of dose, the the least amount of meds, right, that are helpful to a person. So it's like a med-sparing approach often too. There there are a lot of barriers, but I did hear you say, like, despite the barriers with benzodiazepines, particularly, because we know that can be a deadly thing if you can't have it. But I have heard other psychiatrists, like if you don't attend to your appointment, they're not gonna give you the prescription putting you in peril, essentially. So yeah, you're like, I can't do that though. In good conscience, I can't do that, you know. I don't think I say that, so that's good. Yeah, yeah.

Speaker 03: 12:08

I think in the past, I've always been like, I think, and I think it's that people are taught in psychiatry that like you can't just stop a benzo, right? It's dangerous, it's gonna be deadly.

DrTeralynSell: 12:16

Yeah, but people do it all the time, they do it, they do it though. Yeah.

Speaker 03: 12:20

And I think before I would have been more read readily like, I'm only gonna give you half the dose. But like now that I understand more, I'm like, I can't just drop their dose like that.

DrTeralynSell: 12:30

Yes. So let's talk about this metabolic psychiatry. Can you give us, well, first of all, what is metabolic psychiatry? Number one, give us a good definition and how how do you work that into your practice? But go ahead with the definition because I think people need to hear this.

Speaker 03: 12:47

Yeah, so metabolic psychiatry, it's a pretty brand new field, probably maybe six years old at this point. And it's a field of psychiatry that looks at the overlap of metabolic health and mental health, recognizing that they in many cases share the same root cause of metabolic dysfunction. And this is caused by things like inflammation, oxidative stress, and insulin resistance.

DrTeralynSell: 13:08

So when you talk about like describe what metabolic means specifically, if you can.

Speaker 03: 13:14

So yeah, sure. Metabolism is essentially your body's ability to take in food, right? Energy, nutrients, and then convert that to energy so that your cells can do all of the different processes and things they need to grow and thrive.

DrTeralynSell: 13:31

Okay. And so when it comes to mental health, what is the body missing metabolically? Often, not all the time, because we know this isn't an all-the-time situation, but when you say that, like this is what the body brings in and uses for energy and fuel, essentially. So it's a brain fuel and body fuel, which is driven in food, right? Food and lifestyle factors. And so, can you explain to people what food does to neurotransmitters and to brain health and things like that? Can you explain that?

Speaker 03: 14:02

Yeah, sure. So it really all comes down to your mitochondrial function, which is, you know, the mitochondria is the powerhouse of the cell. That's how people think of it. That's the part of your cell that converts these nutrients into ATP, which is the energy currency of the cell. And they do a lot more than that, but we'll keep it simple. And so essentially, things that cause metabolic dysfunction are going to be anything that negatively affects the mitochondrial functioning. So diet is a huge component. If you think about it, like every cell in your body is composed of what you have given it, essentially, right? And so, you know, I would say as far as diet, there are things we're consuming that are not good for us, and there are things we're consuming that are or there, and there are things that we are not consuming enough of that we need. So, for example, things like highly processed sugars and carbohydrates, as well as seed oils. I know that's a little controversial, but uh it's all of those things are going to promote things like oxidative stress, inflammation, and insulin resistance, right? And then we're also not getting enough of the micronutrients that we need, things like magnesium, vitamin B12, folate, all these things, they're all in iron, they're all crucial to the cellular processes that our neurons do, and and the rest of our body cells as well, to, you know, to have that effective metabolism. Um, so that's kind of the diet piece, but there's lots of other things that can affect mitochondrial functioning as well. So, like sleep and the regulation of circadian rhythms is really huge. If you're not sleeping, your cortisol levels are really high, you're not getting that rest that your body needs to recover. And so those hormonal issues are gonna also contribute to mitochondrial dysfunction, as well as other hormonal issues beyond. So cortisol is a big one, but of course, if there's thyroid issues and it could sex hormone issues, it's huge. Testosterone, progesterone, estrogen. If those things are dysregulated, like during perimenopause and things like that, that's gonna have a significant effect on your body's metabolism. Other ones, there's a long list. Um, so there's lots of things we can work on. Um, do it, bring it on, yes. There's so there's elimination of toxins, right? That's huge. So this could either be substances of abuse or it could be other environmental toxins, right? So like pesticides or plastics or whatever. And then there's also stress management. Again, that kind of comes down to the cortisol. I would link that with the importance of social connection that, like, in order to have regulated cortisol, you know, those things need to be taken care of. Exercise. That's the last one I'll mention is exercise is also hugely important. Not necessarily for like maintaining a healthy weight or whatever, but it's really important for regulation of blood sugar and for, you know, it promotes BDNF for your brain. It's basically like a little boost for your brain. So exercise is another crucial component as well.

DrTeralynSell: 16:51

Can you can you explain what BDNF is? Because I know a lot of people talk about it, but we don't really know what that is when we have a medical profession. So can you explain that? Yeah. Yeah.

Speaker 03: 16:59

So BDNF is brain-derived neurotrophic factor. It's basically like a growth factor for your brain. So it kind of like it's like a little, I'm just thinking about like Mario Kart, you know, when you get the shell that hits you, and then all of a sudden you start going faster.

TherapistJennschmitz: 17:18

Yeah, it's my contribution here. Carry on.

DrTeralynSell: 17:25

All right. So what impacts BDNF then? So if if it's a brain-derived neuro, what is it, neurotrophic factor? Is that did I say that right? Yeah. Yeah. So what impacts BDN B DM BDNF negatively and positively?

Speaker 03: 17:40

So as far as positive, I mean, exercise is a significant component. Also, if you're able to get in a state of ketosis, so either from changing your diet or from intermittent fasting, that also can promote BDNF. As far as things that are going to negatively affect it, it kind of comes down to those same things like insulin resistance, you know, oxidative stress and uh inflammation.

TherapistJennschmitz: 18:05

So, what kind of conversation do you have with your patients when you're trying to explain to them the idea that the psychiatric medications could actually be causing the metabolic dysfunction that's occurring? And that the psychiatric medications could actually be depleting them of the micronutrients. How how do you try to explain that to people?

Speaker 03: 18:34

And I know that's a big question, but yeah, I mean, I don't know that they necessarily, I mean, some of our medications do negatively impact mitochondrial functioning, and a lot of them can certainly contribute to the development of metabolic syndrome. I don't know that they necessarily have as much effect on like micronutrients, but yeah, I mean, part of it first is sort of like before you get started, right? When you're giving informed consent, you want to be clear that these things can happen. But a lot of patients I receive, they're already on these medications. So of course, we're gonna do routine metabolic screening. And we're I I don't, I don't know that I necessarily get really into the details of the science because it's just a lot of my patients don't have the capacity to really understand that. Or if or you know, there's just like other pressing needs like housing and food, you know, like access to food. So, but yeah, so I think I talk about let's get to the lowest effective and tolerated dose. And then if it comes back that their metabolic labs are off or they're worsening with their uh medications, then we talk about, you know, either lowering the dose if it's safe, switching to a different medication. And of course, I try to talk about how important these factors, right, like diet, exercise, sleep, are to maintaining good metabolic health. And certainly with and but there are a lot of patients that just like don't have the capacity or the executive functioning to implement these. And there have been cases, GLP ones I think are kind of like it could be hit or miss as far as their effect on someone's mental health. But there certainly are cases where I am like, let's talk to your primary care about starting this because you know I can't, it's not working without it. And unfortunately, it would not be safe for you to discontinue your medications given whatever history. So that's kind of how I put you.

DrTeralynSell: 20:13

You mean the GLP one as far as it goes with metabolic issues? Is that what you're saying? Like weight gain and stuff like that. Is that what you're talking about? Right. You find that to be effective. I mean, with someone who's on a psychiatric medication that I mean, I gained like 40 or 50 pounds on a typical SSRI. Yeah. So with someone who has done that, do you find that GLP one to be actually effective in helping?

Speaker 03: 20:37

Oh, it's a it's a very effective medication as far as weight loss. The concerns are I mean, there's multiple concerns, but obviously.

DrTeralynSell: 20:45

Weight loss, what I mean is wait, weight loss due to psychiatric medication. That's what I'm saying. I know it's effective for weight loss, but is that what you mean? The combination of psych meds? Yeah, okay.

Speaker 03: 20:56

Yeah, and there's actually been a few recent studies that have come out showing the use of GLP1s in you know patients with serious mental illness who are on psych uh on antipsychotics. Um, and it's showed that, you know, in those cases it's been safe and that it's it's reduced their you know metabolic risk factors. So I do think it's effective. Is it a perfect medication? No, I think there's multiple issues. Like one is just access, like if your insurance changes, it's like you don't have access to this. Two is we've talked about the importance of uh like maintaining your lean muscle mass. Um, a lot of times that's not discussed when these medications are started. And I frequently talk with the patients about this. I'll give them printouts of like body weight exercises to do, whatever else, so they can and talk about the importance of consuming adequate protein to prevent that loss of lean muscle mass. But a lot of them don't do it, and so the risk is when they stop the psychiatric medication, the GLP one, they're gonna gain weight back and then they're gonna be in a worse metabolic state because they have less lean muscle mass and more fat. So that's an issue. But as far as like GLP1s in psychiatry, I think it's still like kind of a, you know, we don't have enough data to say whether overall they're good or bad. So I mean, in some instances, they I mean they are improving metabolic dysfunction. So metabolic dysfunction being a root cause of mental illness, you can see how they there may be improvement from that end. They also, yeah, go ahead.

TherapistJennschmitz: 22:17

Oh, no, I was just when you're talking, I was just gonna say it's so hard to to like delineate what's causing what. Like, and I don't want to minimize the idea of root cause here because I I think in our fields we say this a lot. Like root cause, root cause is thrown on everything, right? It's the best two marketing pain point words ever when you're trying to say like you know, like rooting with, yeah, like you're struggling with your weight. Let's look at root cause. Like it's just, it's just plastered on everything. I'm starting to like clearly I'm having a reaction to those two words, just kind of like gold standard, right? Like I just can't handle it, right? Okay, but it's hard to know and delineate what causes what. And I think that's the part of this conversation that's important because if you are taking a psychiatric medication and the metabolic syndrome that you have developed could be a result of that psychiatric medication, which with the typical SSRI is extremely common, very statistically relevant throughout research and subjective experience, right? We're actually putting somebody on a medication that the root cause of the metabolic functioning issues they had was either being on the medication or if they're tight trading off of the medication, because that's extremely common as well, or going up and down on doses, right? Like, so so it's it's it's a hard space because if you've got someone who's been on an SSRI for a very, very long time and they have gained a significant amount of weight and all of a sudden now they're having struggles with other metabolic functioning, right? The GLP one can be helpful because we have just been able to assist with what you just said, right there, right? We're talking about fat versus lean muscle mass and things like that, right? But if the root, if the cause of the metabolic dysfunction is coming from the psychiatric medication, it's so difficult, right, to be able to go, well, what came first, the chicken or the egg, right? And sometimes it takes these really crazy dives down some like holistic paths, some functional paths, um, I don't know, figuring out people's story, which y'all are not given enough time in the world to actually get the whole story from somebody to understand what came and when it was introduced and what impacts happen. But I think about that, I think that's the hard part because we're we're talking root cause and it could be well, metabolic dysfunction and the mental health issues you have could be coming from many places. Shit, that the mental health issues you have could be a side effect. Some of them could be exacerbated by the medications that you're taking too, right? So what did life look like first? What did life look like prior to the metabolic dysfunction, right? Do you get it's like you don't have a lot of patients probably that come in that you can sit in and they can have kind of a clean and an easy story in the background, right? Where it's it's a little bit more clear, where it's like, yes, this is definitely lifestyle factors, movement and nutrition, meditation, all these things, sleep, right, that are causing or that ha are the root cause of some of the metabolic issues. Because meds are always a factor in this with your patients.

Speaker 03: 25:15

Yeah, no, I mean definitely. And in general, I I do not recommend giving a medication to treat a side effect of the medication. I'm like, we either need to reduce the dose to something that's not causing side effects, or we need to try something else. It's more so in those cases where uh the patient's the risk of the patient's mental illness is very high, right? Like, so they're they're gonna get aggressive, you know, there's a high likelihood that they're gonna get manic and aggressive or they're gonna attempt suicide. So those are sort of the cases where I don't and I don't have an alternative that I think is safe, you know, then those are the cases that I might recommend AGLP1. But yeah, obviously, if the cause is the medication, the best thing to do would be to get them off, or if that's not safe for them, get them to a better tolerated medication. Yeah, and uh just thoughts about the root cause buzzword. I feel like when I kind of dug into this, the root cause, like it wasn't so much of you know, a politicalized thing, but now it does it just very much feel like everything is politicized right now.

Speaker 01: 26:12

That's the reaction to root cause. Like I I gotta, I clearly gotta get over it because it's everywhere, right? So I just gotta kind of let it go.

TherapistJennschmitz: 26:19

But it's such oh, it just pulls people in, right? Like you, you know, and they they're like, that's it, that's the magic, that's the factor. Somebody's gonna get to root cause. And I I really think like functional medicine and going through the entire story from the start to the end, like that's probably where you're gonna find more of those root cause pieces to things, right? But I it yeah, I have a reaction to it. So I'm sorry about that, Ruth. I'd like just on a tangent with that.

Speaker 03: 26:46

Yeah, well, and I can't say that the root cause of all mental illness is metabolic dysfunction. That's just not true. I think it's like more, it's more likely like an it related, it's more likely involved in like cases of serious mental illness. I certainly can be involved in anxiety and depression as well, for sure. But there can be so many different things contributing. And so that's why I try and look at patients as like a holistic person. I don't just look at like, okay, what's your I do have metabolic syndrome, what's your hemoglobin C and your lipid panel look like? But yeah, I think that it's kind of the root cause has kind of become synonymous with like the wellness sort of sphere, which like those are not my patients, right? Like my patients are not having access to all that stuff. And so, you know, I think it's about making things achievable, digestible, and uh realistic for those people to implement and access. Yeah.

DrTeralynSell: 27:36

Do you think sometimes, because you've mentioned a few times, like they don't have some of your the population that you serve doesn't have the capacity? You've mentioned that word a few times. Do you ever think that some of that capacity is reduced because of the psychiatric medication that they're on? Because I know as a person who has been on it, like my capacity was greatly reduced when I was on psychiatric medication as opposed to not. Do you ever think about it that way?

Speaker 03: 28:04

I mean, sometimes I think, you know, traditionally we've been told, oh, people with schizophrenia, schizopactive disorder, they're like more likely to develop dementia over time. But we also have come to learn that like the effect of these medications on cognition, like if you were to take Haldol, like you'd probably be like, My brain is not working, right? So I definitely think that there's a component there that it can certainly, the medications can certainly affect their cognition. And even with antidepressants, emotional blunting, benzodiazepines, you know, definitely have negative effects on the brain over time. So, I mean, that's definitely a component as well. And so I have lots of patients coming to me with cognitive concerns. So, yeah, I mean, it's definitely something to think about.

DrTeralynSell: 28:45

Yeah. So earlier on in this conversation, you had mentioned you went to traditional med school for psychiatry, and you mentioned the chemical imbalance theory. Now, that is a hot topic for everybody right now. And it's really interesting because there are some. I am going to point to psychiatrists just as, but we all know that MDs prescribe, NPs prescribe, PAs prescribe, like every medical professional that can prescribe prescribes psych meds. Maybe not hardcore ones, but antidepressants particularly, yes. The you said we learned about the chemical imbalance that this was that that's the framework for all of this is a chemical imbalance, which is really fascinating to me because when we share these things, there's people that will come on MDs. No, it's not, it's never been. We always have known that it's not been that simple as a chemical imbalance. But you just said, like, that's pretty much the framework that we were taught in yeah, in med school. She's shaking her head. Go to YouTube, everybody look at the YouTubers like subscribe, people subscribe.

Speaker 03: 30:28

You know, I finished my training four years ago. So maybe, you know, maybe it's different. That's not that long ago. That was like yesterday.

TherapistJennschmitz: 30:36

Nope, nope, nothing has changed.

Speaker 03: 30:40

Yeah. So I mean, I don't know. I would be curious to see what it is now. I mean, I I think there was sort of like it was kind of like we don't really have the, we don't really know how things work exactly, but this is the best proxy that we have. So we're just gonna run with it. Like that, that's kind of how it was communicated.

DrTeralynSell: 30:55

Yeah. So I think I think about that because I didn't, I didn't think critically about anything that I was taught in grad school all the way through my PhD. I didn't really think anything critically about it. I was like, oh, this is what it is. Even in, you know, our clinical trainings. Like I was like, this is what it is, this is what we think, this is what we do. So there was there a time like in your studies that you were like, okay, so I'm dealing with something that we really don't know much about, and we prescribe these things that we don't know much about under the framework of a chemical imbalance, but that doesn't seem maybe quite right. Did you have that then at all? Or did that did that happen later for you? It happened later for me. There's no shame in the game, right? Like it happened later for Jen, you know. Like when did that come? Did that did that start happening there for you, or was it a later experience?

Speaker 03: 31:49

It was a later experience. I mean, I think in med school and residency, you're kind of just in survival mode. You're like, okay, try and keep up with right, like all the expectations that there are of me. Um, and you're honestly like, I don't think I read any extra papers or books during training, then I had to.

DrTeralynSell: 32:07

And then it took the capacity to do it, probably. Like, yeah. Right.

Speaker 03: 32:11

So it probably took me about a year and a half to two years after. And then I was like, oh yeah, I like learning. Like this is why I like went into this field. And so since that, so yeah, that's kind of when it started to like my joy of learning, my love of learning kind of like was reignited, and I had the capacity to sort of ask these questions.

DrTeralynSell: 32:31

I, you know, I think it's interesting because like there's such a division because the research goes back, like the chemical imbalance theory has never been proven since the introduction of these medications. And uh, I'm like, I keep thinking about that. I'm like, how did it get past so many people? How did it get past so many people that four years? Four years is not a long money. Yeah, go back to YouTube, everybody. Watch. Tell us about that. What do you think about that when you did the money signal?

Speaker 03: 33:00

Yeah, I mean, this has happened uh for so many medications, not just in psychiatry and mental health. But if there's something that the pharmaceutical industry can target and monetize, then they're gonna run with it, right? There's gonna be lots of studies, they're gonna pour money into studies that kind of try and prove this, or at least, you know, not necessarily prove, but show the benefits of whatever their medication are for this problem. Um, so we've seen that like with statins, we've seen that, you know, the whole, you know, low fat thing. I mean, was that pharma? Well, I don't know if it was pharma, but it was a thing.

DrTeralynSell: 33:33

I mean, I'm sure it has something to do with pharma in there somewhere because they created some medications with the fat stuff, right? I forgot what are those meds called that that didn't let your body absorb fat. Do you remember that?

Speaker 03: 33:46

Oh, yeah, I know what you're talking about. It's like I know there's like a mnemonic that like it is like diarrhea because that's what it caused, but I can't. Yes, that was a lesson.

TherapistJennschmitz: 33:59

Anybody else remember the old yeah, but that's that wasn't part about shit your pants, but yeah. I know, I know, I know.

Speaker 03: 34:06

Um but yeah, I mean, this is the the problem with you know researching lifestyle intervention, lifestyle interventions and metabolic interventions is like no one's spending that. There's no money for them.

DrTeralynSell: 34:17

Yeah, broccoli doesn't have a marketing budget. There's no marketing budget for broccoli, yeah.

TherapistJennschmitz: 34:21

And it they should and and the studies that have you know looked at dietary interventions are funded by the and so and that's just what I wanted to bring up too is and so were the studies that led to the introduction of a lot of the psychiatric medications. You know, I mean, if we we want to look at at certain ones from the 80s and 90s, and I mean, let's just tip our hats to Eli Lilly because they were geniuses in what they did. Okay. And the research that was out there that was in your curriculums that you studied as a psychiatrist, right, is fraught with conflicts of interest. And, you know, all the way from like the what was supported for med washes and medwashing people, and then they became your control group because of course they got so much better when you put them back on a medication real quickly because they were all going through withdrawal. These are the, these are the studies, like I think this is such a tough space to be in when you're a in the in the helping profession, you know, you're a counselor, you're a therapist, you're a medical doctor, you're a psychiatrist, and you can think critically about the idea that the things I've learned and the basis for what I was taught is actually rooted in things that aren't factual. It's rooted in studies that were quite convoluted because that's what got published. That's what that's what the basis of the whole chemical imbalance theory was. This was created from pharma. And so how I'm just for you, now that you've hit these truths, is how do you reconcile some of that? Like I felt very betrayed when I understood what really started happening and what I learned as a therapist, because we are taught that we that that meds and therapy are are together in a marriage. That's your gold standard. There it is, there's the words, right? Like the best, the best thing for patients. And as I dove down the rabbit hole, which you have started, you know, you've done here for a few years, Ruth. I felt very betrayed in recognizing that the things that I was actually taught and all the science and the research, I'm air quoting this because it's actually not based in clean studies. If you want to call it double blind placebo-controlled studies, right? Like whatever you want, whatever you want to say, a lot of it is not rooted in that, but we were taught that it it is and that this is real and that this is okay. Did do you have any any like spaces that you had to go down, like truths, hard truths that you had to settle, work your way through when it came to this? Because it's like things you learned, some of it is very inaccurate.

Speaker 03: 36:57

Yeah, I mean, I remember like I don't know, a year and a half ago or so, like when I was putting all these pieces together, I I called it I was having like a faith crisis about psychiatry. Yeah, like like what is this? You know, like it was just like is psychiatry even helpful? So I think there was a little bit, I don't know that I felt betrayed. I felt a little bit like what's the word? Just like, what am I even doing here? Like, like, am I helping people at all? But I think since then it sort of has transitioned into like motivation to learn more and to learn how to provide better care and not to kind of spread information about that.

unknown: 37:31

Yeah.

DrTeralynSell: 37:32

So you do you have do you have you ever encountered colleagues that are like, you are insane, lady? Like, have you ever encountered that so far?

Speaker 03: 37:42

I think like the main thing is with like the ketogenic diet. I don't think a lot of the primary care providers are in favor of that, and I don't do that all the time. I have very few patients that you know have the bandwidth to attempt that. But but in general, I I actually give props to my organization. They've been pretty supportive. Like, yeah, I mean, I I've given talks to the groups, you know, to to other medical disciplines, and they've actually been really supportive. And I I train psych and pea residents, and so I definitely incorporate all this into you know their experience as well.

DrTeralynSell: 38:12

Thank you for doing that, by the way. Like, I think that's important because well, I mean, this is my bias about psych and peas. Like, I think they're a huge part of the problem because they are they can be one of the biggest prescribers, and for the most part, more a lot of them prescribe under the basis of chemical imbalance, and that is it. And there isn't further investigation. I'm grossly generalizing right now. I realize I'm doing that, but I I feel like they need a lot more help in with a prescriber, working with a prescriber who thinks a little bit outside of the box. But you're actually not outside of the box, you're inside the right box right now. Well, you know, when you're when you're talking about this. So has has any of the have any of your colleagues, you don't need to have have they come on board and they're like, hey, I'm so interested in what you're doing. Like, can you help can you help me understand this? Yeah, give me more information.

Speaker 03: 39:04

Oh yeah. I've had lots of people reach out like that. Like I I talked about, you know, kind of like where everything began with metabolic psych was reading Dr. Chris Dr. Christopher Palmer's book, Great Energy, which I highly recommend to everyone.

DrTeralynSell: 39:16

And so I've had multiple people be like, I just met the book, like yeah, there's so much good information out there, which by the way, I mean, even if you're talking about ketogenic or any of these things, like I think there is an innate understanding that food is important. You guys talk about food from food scarcity, food poverty, all of those things, and you know that there's a problem with that. Like, why would there not be a problem? People can't get access to good quality food. That is problematic for people's health. Like, that's period. And mental health is health. So it at a very basic fundamental level, we can put those two things together and be like, this isn't mental health, isn't always a you know, a deficiency in a pill, it's a deficiency in good quality nutrients for many, many people, and also notwithstanding the idea of lifestyle and things like that, like chemicals and and such that come into play, which you know is is also another funny and fascinating conversation because there people are either loving that or they're not, they're hating that. Like, what do you mean, chemicals and mold and you know, all these things? Like, listen, anything can impact a body negative negatively. Our skin is our biggest organ, if you think about that. And it, if we don't get curious about even what people do for a living, like for example, I've had historically a couple of clients. One one was had been a swim instructor for like 25 years, so they were always in chlorinated water and struggling, struggling, struggling. I I had someone else who was an embalmer who didn't wear any PPE or anything like that, and struggling, struggling, struggling. And I'm like, these things matter, right? The that that type of chemical input matters a lot to your body. So what even just asking the question, what do you do for a living? Right? And are your hands in chemicals all day? Think about hairstylists, right? Like their hands are in chemicals and they're they're smelling chemicals all day long. So auto mechanics, right? So there's all kinds of people that are impacted by chemicals, and you just have to start asking the right questions. And I think part of the problem with psychiatry in general is the lack of time to be able to do full informed consent, really, and also to, you know, you're inheriting a lot of uh clients from other practitioners, and so you're like, all right, well, here we are. I just have to kind of keep doing the same thing for a while until they trust me, right? To have those crucial conversations about something different, right? Even though they've been on these meds for 20 years and you've just inherited the case, right? So I think that's probably pretty difficult is the inheriting of things that you're like, this doesn't seem right, you know, or there could be something more to this, and not having the full background like Jen was talking about, like, you know, where did this originate? You know, oh, you were 15 years old, you're 55 now. This doesn't seem quite right, you know. Or where have you worked? What have you done? Like, what's your diet? Like, all these things that that all takes time, and that's not a fault of the prescriber, that's a fault of the system. So yeah, unfortunately, but you know, if you're a therapist listening to this, we get a full hour. Like we get a full hour, yeah.

Speaker 01: 42:37

Yeah, take advantage of it.

DrTeralynSell: 42:39

Yep, take advantage of the hours that you get with your clients, and you could be the right hand person for a good psychiatrist if they're if they're willing to listen, right? So that's where the collaboration comes in nice and handy. So I'm guessing in your in your funded thing, you might have some therapists around, right?

Speaker 03: 42:57

Yeah, well, that's another story. Okay, maybe not.

DrTeralynSell: 43:01

Do you want one?

Speaker 03: 43:03

I need my loans repaid, but it's uh yeah, but I would just say, you know, in general, the people I work with are really dedicated to the mission, and you know, they they really want to provide good care, but there are so many systemic issues, and people like don't have the knowledge about you know better ways to do things, or they just don't have the bandwidth to research it. So, I mean, part of my mission is to like, you know, spread the word and make this information more accessible to people, both providers and patients.

DrTeralynSell: 43:32

So yeah. Do you I I do have one? Oh, it's a big question. We don't have a whole lot of time. Yeah, a couple minutes here. I know, but you did mention that you have a special interest in neurodivergence and autism. And I just didn't know, like, from a metabolic standpoint, have you learned anything crucial about that or anything else you'd like to share?

Speaker 03: 43:54

Well, I think that's something I'm definitely still sort of putting the pieces together for myself. There certainly have been plenty of studies showing that a ketogenic diet and other dietary interventions and lifestyle changes are helpful for autism. I think where we have to be careful is about like being clear that the goal is not to cure their autism, but rather to, you know, help them with things that they are struggling with or their and or their comorbid psychiatric conditions. So I think when it comes to that, you just really have to let the patient lead the way as far as identifying what they're struggling with and what their goals are, and being clear that you know the goal is not to cure their autism. Well, I would or ADHD or something.

DrTeralynSell: 44:32

Wait, wait, wait. I just have a curious question. Why would the goal not be to cure something?

Speaker 03: 44:38

Yeah, so I mean, in the field of neurodivergence, you know, I take a neurodivergent-affirming approach, which means that having these conditions like autism and ADHD, they're not disorders or illnesses. It's that trying to live with that neurodivergence in a neurotypical world that has a lot of different expectations for you is what causes all the dysfunction. So they give like an example. There's an example of like, you know, before it was like 1980 or 1990 something, they didn't have like ramps on people for like on sidewalks. So people who, you know, were wheelchair band bound could not like use the sidewalks. And so, but like once you change it, it's like, oh, there's no issue. Not that they're not still disabled, we still consider autism, ADHD in some cases to be disabling. Um, but it's more about how the neurotypical surroundings affect them.

DrTeralynSell: 45:30

Gotcha.

TherapistJennschmitz: 45:31

Okay, so so less of a biological basis of behavior and more about the environmental impact and how that influences the symptomology that somebody's dealing dealing with as more of a okay.

DrTeralynSell: 45:41

That was a mouthful, Jen. Sorry, sorry you're on you're on point on this Friday.

Speaker 01: 45:45

All right, all right, sorry. Okay, okay, we gotta wrap up because we're anything else.

DrTeralynSell: 45:51

Anything else you'd like our listeners to un to know and understand?

Speaker 03: 45:55

Um, I think we've covered a lot. Yes, but I think just in general, don't be afraid to sort of be a trailblazer and to shake it up, you know, like you might get some questions but um and some funny looks. But at the end of the day, you have to do what you feel like is right and what's best for your patient.

DrTeralynSell: 46:13

Love it. All right. Well, thanks for joining us on this episode of the Gaslit Truth Podcast. And if you have hung out with us this far, please make sure you check us out over on YouTube and hit that subscribe and follow, and give us a like, share, and a comment wherever you are. And you can share with us your gaslit truth at the gaslit truth podcast at gmail.com.