Mental health illnesses have always been treated on a subjective level, concentrating on the patient’s feelings and thoughts. This may have been a tried and tested procedure in functional psychiatry, but Dr. Donald Raden chose to go beyond the norm and conduct treatments on the objective side. He sits down with Timothy J. Hayes, Psy.D. to share his discoveries in approaching mental health treatments by focusing on biological problems instead of just psychological ones, allowing for a more straightforward designing process of health roadmaps. He explains how this huge leap changes the way medications are provided to patients, helping them get away from antidepressants and common interventions that may cause adverse side effects.
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How To Design An Objective Health Roadmap In Functional Psychiatry With Dr. Donald Raden
Dr. Donald Raden is a Functional Psychiatrist. He blends an expertise in traditional psychiatry with a comprehensive understanding of functional medicine and he offers an unparalleled approach to health that links the mental and the physical. He’s analytical, perceptive and kind. He often succeeds where conventional methods have failed in treating everything from common disorder to diagnoses that may have gone unresolved for years.
Thank you for agreeing to do this and let us and our readers know about your work and how is what you’re doing differently from what most other people do?
I can tell you about my experiences in the world of psychiatry dating back to working in an inpatient setting several years ago. I was working in the inner city with typical children on an inpatient unit and I was unsatisfied with the quality of care they were being offered. What I started doing is rather than speaking about pharmaceuticals, I was looking more at the medical notes and looking at abnormalities in their physiological health to see if there was any correlation between their presenting symptoms and some medical concerns that were never addressed in the psychiatric model.
What I realized is that many of the patients that I have been medicating for an underlying psychiatric issue had multiple medical concerns that were never addressed. I started asking myself, is there a correlation between medical conditions and psychiatric presentations? That’s where my journey began as far as trying to connect the dots between the biological systems that can be the dysfunctional that may present with psychiatric manifestations.
What I started to invest my time in was the analysis of the gut microbiome as an early intervention for psychiatric conditions. I opened up a small outpatient practice where rather than providing pharmaceutical applications, which I would offer to improve symptoms, I was also looking at biological systems that were dysfunctional. The first area of interest was the gut microbiome, given there was a lot of research at the time, several years ago, showing a correlation between dysbiosis or dysfunctional organisms, the GI tract correlating with psychiatric conditions.
What I’ve learned through my own research was that the abnormal gut flora was promoting an inflammatory cascade, which was causing an imbalance of the immune system leading to inflammation in the brain, which was driving neurotransmitter abnormalities. It was a gut immune brain access. When I started delving into the science behind that and focusing mainly on GI microbiome dysfunction to see if there was a clinical change in the world of psychiatry, miraculously, I was finding that by cleaning up one’s GI problems, psychiatric conditions were improving.
That was a steppingstone into the world of psychiatry, which opened my eyes to, is there another approach to psychiatric conditions that isn’t driven by a symptom-based checklist and a pharmaceutical intervention? What I then learned throughout the several years of this journey is that there’s a multitude of insults that go beyond the gut microbiome, which I do in my practice. When someone comes into my office, let’s propose that they’ve been diagnosed with schizophrenia, the last thing I do is talk about the pharmaceuticals. The first thing I do is I get a good analysis through conventional laboratories looking at a roadmap of their anatomy.
I’m looking at hormones, metals, infections, both gut microbiome and systemic organisms, the immune system and autoimmune issues. Miraculously through several years of experience, I’ve been able to give people answers that are objectively defined versus subjectively defined so that they can start looking at another application to improve their psychiatric symptoms that allow the body to heal itself. In the several years of what I’ve been doing, I’ve seen mostly treatment-resistant cases. The reason why they’re treatment resistant in the psychiatric models that no one looked as far as what other systems have been damaged leading to their medical or psychiatric condition.
I get a lot of chronically ill psychiatric cases and I’ve had a wonderful opportunity to help these patients progress in their lives and heal the insult that triggered the condition versus the multitude of pharmaceuticals that led them to an unhealthy life quality. What I’ve learned is many patients have such insult to their biology, that in order for one to heal, you need other applications that mail out. For example, if someone has a nutritional deficiency in vitamins and minerals, you can give them a cocktail of supplementation orally, but you’re making a large assumption that they can absorb what they’re ingesting.
What I learned objectively is that if you’re giving people supplementation to target a certain biochemical pathway for example, but they’re not able to absorb what you’re providing them, is there another avenue that can be used that would allow the proper absorption? That’s where I opened up an IV center. On our IV clinic, we personalize someone’s protocol to their health. If someone comes back with MTHFR abnormality and I want to give them methylfolate or B12, oral supplementation is not going to be absorbed properly so why don’t we go directly through the vein and get 100% absorption?
We delved into the world of IV therapy and we do many applications in that realm because my patients are biologically unstable that oral supplementation didn’t lead to the goal of improving their quality of life. I’ve been able to come up with a medical model of psychiatric care that has evolved over the years. I’ve been able to help many people, not only one feel better as far as their overall mental state but providing them objective data. What is the roadmap to your health? How did you get here?
I’m not a believer that depression is a nutritional deficiency or a pill deficiency. Yes, they help, I provide medications all the time. If you go down deep into the literature, you’ll find that depression is nothing more than inflammation of the brain. If inflammation of the brain is the cause of depression, where’s the inflammation coming from? Is this coming from a nutritional deficiency? Is this coming from a gut biome abnormality? Is this coming from stress chemistry? Is this coming from an infection systemically? Where is the trigger? That is what I’ve been able to accomplish with a lot of my patients that allows them to have another perspective to psychiatric illness.
How do people normally get into your care? What’s the funnel that brings them to you?
It’s interesting because I never did marketing. I never marketed myself. It’s word of mouth at this point. A lot of my patients have had a nice experience and that they’ve finally given some answers to their questions. They may tell their friends. I seem to be finding those that have been struggling in the conventional model are the ones that are seeking me out. How they find me, I’m not quite certain. I wouldn’t say that I’m open to any patient who has been struggling. I would love to take on the challenge of those treatment-resistant cases, because I believe I have another way of looking at psychiatry, which has been helpful for many people, but how they get into my office, I don’t know that answer.
What’s a typical course of treatment once somebody does find their way to you?
When they come to see me, I like to get a subjective story, know what their history is, know what they’ve been through, where they’ve been going, how they’ve been treated so far. I look at their medication and I always want to question if someone’s on 2, 3, 4, 5 medications, for example, what each of the medications are offering them, because lot of times we have polypharmacy, in someone, for example, you have 2 to 3 with stabilizers, I always ask the question, “Is two better than one? Is there a reason why you’re on such agents?” I always look into the medications, and then what I do after we talk about the pharmaceuticals and educate them about what they’re taking, I then look into the biology.With integrative medicine, functional psychiatry can get away from pharmaceuticals and interventions that cause side effects. Click To Tweet
In the general sense, I like to look at the systems-based approach. I look at different systems. I look at the GI system, the immune system, systemic infections, hormones, nutrients and metal toxicity. That’s usually where I start. What I find is that there may be one system that’s broken, there may be two systems, 3, 4, 5, 6, 7, I don’t know, but I’ve done enough analysis with thousands of patients at this time that it’s not a rabbit hole to no man’s land.
It’s directly linear as far as what they’ve been dealing with and what my experience has been. What I’ve learned is the more complex premier resistant cases are most likely infectious triggered autoimmunity. What I mean by that is that many of my patients have an auto-immune condition, it’s driving their psychiatric condition, which was interesting to me. I had been reading a lot of research on the correlation between infectious etiology, meaning our gut biome abnormality, or a systemic infection and how that triggers autoimmune conditions.
We always hear about antithyroid and anti-nuclear antibody. What about things anti-NMDA receptor antibody in the brain or anti-dopamine 1 antibodies? If someone has an underlying auto-immune condition that’s affecting brain structures, that would be important to know. Many of my treatment-resistant cases have that which changes their entire scope of life as far as interventions that can be offered. For example, I had a young lady, she was in her mid-twenties. She was diagnosed with schizophrenia. She came to see me. She was on three anti-psychotic medications and still psychotic.
My first thought was, “This isn’t working. There must be something wrong.” What did I do? I did this overall analysis, conventional laboratories and what I found was she had Lyme disease and Bartonella, which is a co-infection of Lyme disease, triggering an autoimmune condition to her brain. She had an anti-NMDA receptor antibody. Her treatment protocol was not Zyprexa and Geodon, it was treating the infection, modulating the immune system and lowering the antibody burden. I’ve been working with this woman over the past several years because it takes time to heal systems.
At this point in time, she is no longer on psychiatric pharmaceuticals. When I’d seen her originally when she was on the multiple anti-psychotics, she couldn’t even look at me in the face. Now she’s engaged in the world. She’s employed. She’s living her life and she’s content. In me, that was a wonderful case that opened up my eyes to, are there things that we can offer people to give them objective data to provide them a roadmap to their health?
When somebody does find you and you start the assessment and you start looking for these treatment options, is this reimbursed through insurance? Are people having to pay out of pocket and then fight their insurance companies for it? What’s that side of the coin look like?
My practice is out-of-network as far as my time, meaning everything is out-of-network coverage. People have deductibles and they have their insurance coverage. It’s 70% reimbursement or whatever their network coverage is. Laboratories are all done through conventional. As if you went to your general practitioner, laboratories are run through Quest, LabCorp applications, interventions. For this woman, for example, antibiotics, those were covered by insurance, and IVIG was covered through their insurance company. There are other applications we do in the IV center that are reimbursable through network coverage. That is the way our practice runs. Many of my patients are pleasantly surprised to find that there is coverage for the treatments that we offer as an out-of-network provider?
I want to bring up something interesting to me that I’ve come across, it has been a miracle for my treatment-resistant, depressed, anxious clients, is the word ketamine. Ketamine therapy was used originally as an anesthetic at high dosages. If you look at the research on more of a lower dosage, you can see what it’s doing. At the end of the day, it’s promoting a molecule that’s called brain-derived neurotrophic factor. It turns out that’s the antidepressant for your brain and induces neuroplasticity. What happens is when someone takes an antidepressant, it takes about two weeks to get a spike of BDNF and then it goes down.
It’s not the neuro-transmitter concept that we all believe. You take a serotonin agent and then the serotonin goes directly to the brain and you don’t feel better for several weeks. That’s because BDNF is not relevant. You take an oral antidepressant, BDNF goes up and then it goes to this down. It turns out that if you give someone ketamine after one infusion, BDNF is maintained for two weeks, which is a miracle for my patients. This is an IV application that we’ve come across that’s been a breakthrough for my patients. It gets them away from the pharmaceuticals and the interventions that are causing side effects.
I want to bring that up because it’s something that I’ve come across with my research, as far as what is the biochemistry? How is this working? Is this something that’s realistic for my patients? I’ve had some wonderful results with that. The reason why I bring it up is the reimbursement on ketamine is good. I like the idea of trying to push the envelope of psychiatry. I’d to look at the biology of the intervention. No one can argue biochemistry. You can do certain studies and have certain end points and such, but if the biochemistry resonates with me and it makes sense, let’s move forward in that direction.
Another case of mine was someone who had severe ADHD. His ADHD required Adderall at 90 milligrams a day, which is a large dose if you think about it, but then I started redoing research on the mitochondria, which are the energy supply of yourself. Think about it as your cells, if you’re not giving that cell enough energy, they’re not doing the jobs necessary to work. A brain cell, for example. If the mitochondria is insult, you’re not having proper neurotransmitter release. I went back into the literature and I looked at a guy named Abram Hoffer. He did some orthomolecular-type work nutrients. I came across several studies using niacin for improvement of dopamine in neurotransmitters. It has been used for things like ADHD and schizophrenia.
I provided this gentleman NAD because it made sense to me about chemically let’s improve the cell energy to promote proper neurotransmitters. Within two weeks, I was able to get this gentleman down to 10 milligrams of Adderall once a day. He’s doing his NAD, which is a way of improving energy metabolism of the cell. I’ve got him down significantly on the Adderall, which was a wonderful example that this patient’s ADHD wasn’t a deficiency and Adderall was a mitochondrial insult. My mission in life is to try to advance the world of psychiatry. I’ve stumbled along my way and I’ve tried things that haven’t been successful, but I’m starting to come to terms with those applications that are effective and they work. I’m impressed with the outcomes that I’ve seen in my clients.
It is encouraging to hear that there’s more to do than run through the rotation of antidepressants as each one has a bit of an effect and then eventually it doesn’t work anymore and then you go back to the doctor and you get another one or you add one to the 1 or 2 that are already there. That’s been a rather sad part of my work as a psychologist over the years is to have somebody come in the door and they’re on 2, 3, 4, 5medications and they’re still in such a mess that they need somebody to help them try and sort out their life. I’m one therapist, but many times I’ve had people in my caseload, they get fed up with the medication. They go to their doctor and get off all the medications and they’re far better off everything than they were on the cocktail that they were taking and sometimes, for years.
There is the correlation between inflammatory cytokines immune system depression. Depression is nothing more than an inflammatory process. Interleukin 6 goes up, TNF-α, these are inflammatory molecules in the immune system, what’s triggering this? Why are people having depression? If you look at the research, you can look at the gut biome, systemic infections and a bunch of things. The nice thing is that there is an answer to a lot of people’s problems. It’s about looking. If you don’t look, it’s almost malpractice at this point. What I want to encourage other practitioners is to take a leap of faith. Simple laboratories, cortisol for example. A lot of my treatment-resistant cases of depression are low cortisol. Cortisol is a hormone.
Why would cortisol being low? If you look at the research, if you have an anesthetic load like an infectious process the body downregulates cortisol, you want to hinge the immune system to fight off a pathogen. When a patient comes into my office, anxious as can be, depressed as can be and then they have a low cortisol, my next question is what is the anesthetic load that’s suppressing cortisol? You look and you find the answer. It’s interesting that you can take this psychological model and applied medical applications to improve one psychiatric condition. Don’t get me wrong, pharmaceuticals have had its place in my practice. I use them all the time. I don’t want to downplay with pharmaceutical agents I’ve offered my patients. Those that haven’t sought outcomes that were ideal medication, why you wanted it if you’re not feeling better?
Is there a reason why the medication isn’t working? Are there other things that we can be seeking to provide you answers to the treatment resistant condition you’re walking in with? If it isn’t a Prozac deficiency, there’s got to be something wrong in the system that’s causing the problem. I like to say to the patient to make it simple, our job together is to look for triggers of inflammation. We’re going to do everything we can to extinguish the trigger. We’ll look at your diet. Why? Sugar is probably the most inflammatory food you could eat. What happens? Inflammation goes up, cortisol goes up, of cortisol as problems in regard to stress chemistry. That’s one piece.Depression is nothing more than an inflammatory process. Click To Tweet
Is it something more biologically driven? My patients are trying to put forth effort and unfortunately, a lot of them are putting forth without the roadmap. They’re desperately looking for answers. It’s unfortunate that nobody’s has taken the time to invest into analysis. I brought on some wonderful psychiatrists that have been under my wing to try to help these patients, so I think we’re doing a good job at that. It’s about letting go of some of the fears that some practitioners may have about looking for answers and maybe not knowing what to do with the data. I’d be happy to help others be educated in this approach to psychiatry because I think there’s something available that we need to be doing for patients to improve their quality of life.
Most of this that you’re discussing is, these are things you’ve found along the way. They’re not what was part of your medical training? Is that correct?
I learned all of what I do after medical school. What I had to do is to rewrite the book of psychiatry in a functional medicine model. The way I learned this was for an organization called A4M. A4M is a functional medicine platform. There are lectures. As I was driving back and forth in the hospital every day, I was listening to lectures on hormones and toxic metals and immune issues and auto-immunity. I was able to take all these medical applications and apply it to the psychiatric model. It took me a long time to get to where I am now, but I believe it was well worth it because my patients, I hope have a good experience with what I’ve been able to teach them and what I’ve been able to offer. Unfortunately, functional medicine is driven in the world of a medical diagnosis, but they intertwine.
Is cardiovascular disease inflammation in the vessel? Yes. Is hypertension inflammation of the vessel? Yes. Is depression inflammation of the brain? Yes. Is autoimmune disease triggered by inflammation? Yes. They all go together. If you can look at these webs of systems and connect the dots, you can have a better outcome for an individual. For example, you look at the research, it’s 70% of people with depression have IBS. Isn’t that interesting? Why is that? Why are they having irritable bowel syndrome when they have depression? The gut microbiome is a great place to look because it turns out in a published study that shows that organisms that are not healthy release a molecule called lipopolysaccharide. Lipopolysaccharide induces the immune system to activate, which drives depression.
It turns out that LPs also promotes cardiovascular disease. It’s important that once we improve their mental health, we want to look deeper. We’re going to fix the whole system. Why do we only have to deal with psychiatry? What about cardiovascular disease? Once we get people through the complexities of their psychiatric illness, we want to start healing your body and all our other systems. I am a firm believer that the brain is connected to the body and we need to take our time to look.
You remind me of Dr. Jodie Skillicorn, who finished her psychiatric residency and then found the book by Whitaker on the psychiatric diagnosis epidemic. She was shocked to find out that what they were teaching her in school for her medical degree and her psychiatric residency was not helping people. It was loading all of these medications on top of symptoms without understanding the underlying cause. That led her to write the book, Healing Depression Without Medication. You’re not alone in this that you’ve discovered that what you were taught in school is a beginning point.
It’s a beginning point. It’s a good starting point. Medical school offered me an opportunity to work with human beings to be able to communicate effectively, to have that empathy and to understand that relationship is as important as the medication and having empathy is important. I find a lot of physicians have this ego that makes it difficult to communicate with patients. I feel that it is a disservice to the individual walking in the room. In my office, it’s a dialogue. It’s a conversation. I make mistakes along the way, but I’m willing to take accountability for it. There’s a relationship that’s built over the years with my patients about give and take. What the medical school taught me is how to communicate to the patient who’s struggling. I did learn details of things that I don’t remember, because the details are less important than looking at the big picture.
We can get in-depth and get stuck in the woods with, for example, genetic testing and all these unique applications. Don’t get me wrong, they are unique, but if the terrain of the systems is not connecting properly, you have to take a 10,000-foot area of review first. For example, if you do an analysis and find X, Y, and Z nutritional deficiency and plug it into their protocol but their gut biome is not healthy, what they’re absorbing is not going to be helping them. I like to take, “Let’s take it one step at a time. It’s got a 10,000-foot aerial view. Let’s look at the different systems together. Let’s understand the puzzle of the web and we’re going to go deeper and deeper once we unveil the problems.” The practice of psychiatry is medical. I don’t think psychiatry is about the brain. It’s very much medically-driven and my patients have proven it.
When you’re taking that functional medicine approach, that gives you that view of systems within systems, and then you’re not stuck targeting a particular symptom.
Functional medicine has been misinterpreted by those that are not involved. Integrative medicine is a fragile word because people think it may not be driven by science and conventional laboratories. It may be considered fringe medicine to others, but what it is it’s a physician who understands how systems intertwine with each other and how you connect the immune system, with the endocrine system, with the hormonal system, with the gastrointestinal system, with the neurological system and how these interrelate with each other. You don’t have to see six different specialists, you see one individual who can connect the dots between the different systems.The practice of psychiatry is medical. It is not about the brain alone, but very much medically-driven. Click To Tweet
Are you using integrative medicine and functional medicine as interchangeable terms?
I like to use the term precision medicine. Precision medicine is a more individualized approach to one’s condition. It’s a way of allowing us to set the abnormality wide. For example, you come into my office with hypertension, I may not be checking your blood pressure, but I would be looking at insults that drive inflammation. I look at the gut microbiome and metals. I’d be looking at stress chemistry and cortisol because all of these end up with a symptom. It’s a label. The label defines the diagnosis, but that’s only the tip of the iceberg. It’s hard to get there. What functional medicine or precision medicine offers is you tell the interpretation of that symptom you’ve been dealing with.
Because this seems to be a fairly evolving platform and a set of terminology, the functional medicine, the integrative medicine, the holistic, the complimentary, the alternative, the conventional versus traditional, I ask when we have these interviews with people like you, what terms would you look at if you were doing a search for a physician or a specialist to help you? What keywords in labeling or identifying the people you’d want to be working with?
You want to go to the organizations where people are trained. For example, the A4M, A4M.com is where I was trained. You want to look at individuals that have gone through the training and those are the people you want to be working with because they’ve been educated by high-credentialed individuals to give them an understanding of this approach to care. You can go to the website. You can find practitioners in your area that do that type of work. We all have our own niche and our approach to it, but it’s another way of finding that person that fits for you. Unfortunately, many of these people are medically-driven and less psychiatrically-driven, but there are not that many people that I know of that provide the type of psychiatric care that I offer in a functional medicine approach.
The A4M takes you to the American Academy of Anti-Aging Medicine.
That’s why I went through the fellowship, to expand my knowledge in the functional medicine area.
Functional medicine, integrative medicine, integrative psychiatry and functional psychiatry. Are there any other key words that you might recommend for people if they’re not finding something in their area through A4M? If we send them to you, that’s at RadenWellness.com?
Yes. If they are reading this blog and it’s sparking an interest about what they be have been lacking in their treatment, I’d be more than happy to assist them to provide them practitioners in the area or if they wanted to become part of the Raden Wellness Community, we’d be more than happy to help them.
You’re located north of Chicago.
We are currently in Highwood, Illinois, north of Chicago. We are expanding to other areas near term, but for right now, this is our home.
It’s a delight to have more information about what you do. I know that we’ve had some mutual acquaintances that have benefited from your work and I appreciate the fact that you would take the time to share with our readers, your expertise. I look forward to following your work. If you do expand, I like to stay in touch with you and/or Amy and find out where you get those satellites open and do what we can to help more people learn about what you do.
Thank you for your time. I appreciate it.
Dr. Donald Raden is a Functional Psychiatrist. He blends an expertise in traditional psychiatry with a comprehensive understanding of functional medicine, and he offers an unparalleled approach to health that links the mental and the physical. He’s analytical, perceptive and kind, and he often succeeds where conventional methods have failed in treating everything from common disorder to diagnoses that may have gone unresolved for years.He is Board Certified in General Psychiatry and Neurology, Board Eligible in Child and Adolescence Psychiatry and active fellow of the American Academy of Anti-Aging Medicine, a fellow in the American Academy of Ozone Therapy and a member of IALDS. His specialties include Adolescent and child integrative psychiatry, immune system dysregulation, precision medicine, athletic performance/sports medicine, anti-aging medicine, chronic illness, neurodegenerative diseases and environmental medicine. RadenWellness.com
About Donald Raden, MD
Blending expertise in traditional psychiatry with a comprehensive understanding of functional medicine, Dr. Donald Raden offers an unparalleled approach to health that links the mental and physical. Analytical, perceptive, and kind, he often succeeds where conventional methods have failed, treating everything from common disorders to diagnoses that may have gone unresolved for years.
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