Integrative Medicine for Anxiety

Module 1 will begin with an examination of the anxiety crisis: its scope, prevalence, and escalation in recent years.  Current DSM classifications will be reviewed, and a rationale for de-emphasizing formal diagnostic criteria in integrative approaches will be discussed.  Standard pharmacologic interventions will also be objectively reviewed:  their benefits and shortcomings, benzodiazepine overuse and abuse, and the limitations inherent in treatment approaches that do not account for biochemical individuality.   The presentation will then shift to an in-depth introduction to Dr. Greenblatt’s functional medicine approach to the treatment of psychiatric illness: THE ZEEBRA.  The final component of Module 1 will be devoted to key nutrients associated with anxious pathophysiology – magnesium, vitamin B3, and vitamin B12 – and the elucidation of biologic mechanisms through which they influence cognition and behavior.  Guidelines for lab testing and recommendations for the establishment of personalized supplementation protocols will be discussed.

In Module 2, one of the fastest-growing areas of research in functional psychiatry will be explored and related to the pathophysiology and treatment of anxiety disorders: the gut-brain axis.  Fact will be separated from fad as the very latest in gut microbiota research is objectively reviewed, illuminating mechanisms through which commensal microbes influence neuroendocrine systems, cognition, and behavior.  The implications of gut dysbiosis and Clostridia overgrowth will be discussed as they pertain to anxious pathophysiology, and the applications of probiotic therapies substantiated in light of promising empirical evidence.  Next, obsessive-compulsive disorder will be examined from a functional medicine perspective, and research revealing compelling evidence for a biologic model of OCD will be presented.  Discussions will segue into an introduction to PANS/PANDAS, two often-misdiagnosed disorders of infectious origin which can trigger acute-onset psychiatric manifestations inclusive of OCD-type symptoms.  The module will conclude with an immersive look at the role that amino acids play in neurotransmitter synthesis, and how amino acid depletion fits into an orthomolecular model of anxiety disorder etiology.  Factors capable of inducing amino acid deficiencies will be reviewed, and strategies for augmenting neurotransmitter synthesis through free-form amino acid and 5-HTP supplementation will be outlined.

Module 3 will begin with an examination of the many chemical forms and biologic functions of folate. The elucidation of folate’s role in neurotransmitter metabolism and DNA synthesis will highlight the pathologic ramifications of folate deficiency, and dietary, genetic, and metabolic factors capable of hindering folate absorption or conversion will be reviewed as they pertain to the etiology of anxiety disorders.  Next, a closer look at serotonergic signaling will lead to an in-depth discussion of inositol, and the analysis of research evidence supporting the use of inositol in integrative treatment protocols.  The lecture will then shift to a topic at once familiar and under-explored: the association linking diet and mental health, and opioid peptides derived from dairy and wheat that can contribute significantly to psychiatric presentations. Systemic inflammation, intrinsic and exogenous variables that can precipitate inflammation, and the role of inflammation in ‘depressogenic’ and anxiogenic processes will then be discussed, as well as biomarkers that can be quantified through lab testing to hone treatment approaches.  Finally, the mechanisms through which a deficiency of vitamin D can impact neurologic health will be explored.  Recommendations for testing and supplementation in order to achieve vitamin D repletion – a critical prerequisite for the success of integrative anxiety treatment – will be provided.

In this module, integrative and complementary therapies that research has demonstrated to be effective for the treatment of anxiety will be explored through a functional medicine lens, with an emphasis on biologic mechanisms and supporting scientific evidence.  N-acetyl-cysteine (NAC), precursor to the antioxidant glutathione, has emerged as one of the most promising treatments for anxiety and the related body-focused repetitive behaviors.  It’s antioxidant and anti-inflammatory properties will be examined, and case studies supporting its efficacy across a range of anxious disorders will be reviewed.   Guidelines for NAC supplementation will be discussed, as will potential modifiers of NAC response.  Next, the anxiolytic properties and biologic mechanisms of nutritional lithium, l-theanine, GABA, ashwagandha, and cannabidiol will be explored, widening the range of therapeutic options available to today’s integrative practitioners.  The module will conclude with an analysis of “vitamin E” (exercise) and “vitamin Y” (yoga): their long history of use in traditional systems of medicine, their documented effects on neurotrophic factor production and HPA axis stabilization, and strong research support for their efficacy in improving sleep, attenuating stress biomarkers, and reducing anxiety.