Walden Psychiatric Associates Presents to Public on Integrative Treatment for Depression

James Greenblatt
Speaker: James Greenblatt, MD
Author: Answers to Appetite Control,
The Breakthrough Depression Solution,
and Answers to Anorexia

On June 11th, Walden Psychiatric Associates hosted its first event, “Integrative Medicine for the Treatment of Depression; The Hype and the Hope” at the Black Rock Country Club in Hingham, MA. Walden Behavioral Care’s Chief Medical Officer, James Greenblatt, MD presented to an audience of 120 consumers and professionals about the innovative work that Walden Psychiatric Associates is doing at its locations in Waltham and Hingham, MA.

For several years, Dr. Greenblatt has been performing genetic testing for patients seeking treatment with him and his colleagues. These tests check for a broad assortment of genetic markers that have a profound effect on our mood and the way with which our bodies process key neurotransmitters like Serotonin and Dopamine.

The Hype:
Turn on the TV and you will undoubtedly hear commercials advertising various psychiatric medications. Each year, the average American consumer will watch 16 hours of drug ads, far exceeding the amount of time an average American will spend with their physician in a given year. These drug companies are promising improved mood and significant relief in symptoms. What they are neglecting to report on these commercials is the fact that 45-50% of patients with Unipolar Depression will also feel better when given a placebo.

In a study involving 1,829 individuals who were put on an SSRI, 60% felt emotionally numb, 62% reported sexual difficulty, 42% felt a reduction in positive feelings, 39% reported caring less about others and 55% experienced a withdrawal from others.

The pharmaceutical industry is having “profound cultural effects,” Dr. Greenblatt said. “How are we supposed to fall in love or benefit from positive relationships with others if we can’t feel, don’t care about others, have trouble with sexual experiences and would prefer to spend time alone?”

Psychiatry is the only medical discipline that prescribes without clear objective biomarkers to determine treatment course. A patient may trial four or five different drugs and drug combinations over a period of one to two years with little to no improvement—it could even make their symptoms worse.

“We ask a bunch of questions, and with the answers to these questions, we find a diagnosis based on a list of symptoms,” Dr. Greenblatt said. “Everyone with the same list of symptoms gets the same medicine.” If a patient goes to their doctor reporting shortness of breath, a physician wouldn’t prescribe an inhaler without doing several tests that might include an EKG, checking blood pressure or taking a blood sample. If a psychiatric patient comes in to a psychiatrist’s office reporting sadness and fatigue, this psychiatrist will most likely prescribe a mood enhancing SSRI. In treating just the symptoms, rather than the cause (i.e. trauma and/or a nutritional deficit) we are doing a disservice to the patient. “We can do better,” Dr. Greenblatt said.

The Hope:
According to Dr. Ralph Snyderman, “What we have now is a ‘sick care’ system that is reactive to problems. The integrative approach flips the system on its head and puts the patients at the center, addressing not just symptoms, but the real causes of illness. It is care that is preventive, predictive and personalized.”

A New Model
This new integrative approach starts always with a series of laboratory tests that include a urine test, a hair test, a blood test and a saliva test. All of these tests help doctors and nurses to pinpoint specific deficiencies, which allow doctors to detect medical issues that can then be subjectively treated. A few highlights from these tests include checking levels of amino acids, fatty acids, omega-3s, genetics, hormones, zinc, lithium and vitamins. All of these pieces can have great effect on mood and the way that we are able to synthesize neurotransmitters.

Prevent, Predict, and Personalize
With these laboratory tests, Walden Psychiatric Associates staff are able to offer relief to those suffering from depression and other mood disorders, while also able to prevent and predict those who might be more likely to develop any one of these psychiatric disorders. If these tests were part of annual physicals at our doctor’s offices, we would know for example that a patient with deficiencies in B12, folate andthose who carry the short serotonin transporter gene allele would have a greater probability of developing depression, have a poor response to SSRIs and a higher chance of relapse. In replenishing our bodies with whatever we are deficient in, we have a greater probability of being able to prevent these illnesses from happening in the first place.

While we are preventing and predicting, at the very core of integrative medicine is practicing the idea that we are treating the whole person as a unique individual rather than a “textbook” case of symptoms that might match up with a definition in the DSM-5.

After 25 years in the field, Julia Schwartz, LICSW, Director of the Behavioral Medicine Department at Compass Medical and an attendee at the presentation, began to change the way she treated her psychiatric patients several years ago. “I started recognizing that traditional methods of psychotherapy just weren’t working as well as I would have liked,” Schwartz said. “I started looking deeper into the environment and more global issues such as nutrition, sleep and genetic deficiencies and that was when I began seeing the changes in my patients…I would love for the physicians in my practice to begin taking advantage of these genetic tests.”

With the combination of these tests, traditional psychotherapy, a blend of spirituality, mindfulness practice and exercise, Walden Psychiatric Associates hopes to change the way the field of psychiatry is practiced and viewed.

“Here’s the punch line,” Dr. Greenblatt said. “These are simple tests and simple interventions, with the profound ability to improve a patient’s quality of life.”