Holistic Psychiatry Podcast

In this episode, I discuss:* Mold related illness, with a focus on mold toxicity and mold colonization* The wide range of brain symptoms (and other symptoms associated with mold toxicity* How we can become exposed to toxic mold even when we don’t see mold growth* Why not everyone with the same exposure doesn’t become toxic* How mold toxicity is diagnosed* How we can test our environment for mold* The four core aspects of treatment: removing exposure, using binders to eliminate toxins, addressing fungal colonization if present, and adjusting diet to avoid feeding mold and candida, which often is present in those with mold toxicity* The importance of addressing mast cell activation, limbic system retraining and vagal nerve interventions for those who are highly sensitive to treatment interventions* Practical steps such as air purification, humidity controlIn the next episode, I will be reviewing research exploring the connection between mold and brain related conditions — and address the question, “Does mold enter the brain, in those who are not obviously immunocompromised?”Rarely does mold toxicity occur in isolation. It will often contribute to other root causes, such as mast cell activation, electromagnetic hypersensitivity, multiple chemical sensitivity, increased pyrroles, worsening of copper zinc imbalances, decreased methylation, and an increased risk of other microbial activations or autoimmunity.As always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I explore compulsive caregiving from an attachment perspective. This is a more subtle form of insecure attachment that nonetheless affects one’s ability to thrive and enjoy healthy relationships. Related terms include over-functioning, codependency, and Nice Guy / Good Girl Syndrome.This is the fourth of a four-part series on how our experiences with caregivers in the first three years of life can impact our emotional regulation, beliefs about ourselves, and adult relationships.Here I discuss:* How early attachment experiences shape compulsive caregiving and the “parentified child” dynamic* How over-functioning, people-pleasing, and codependency share a common root in early life and are an attempt to manage attachment anxiety* How physiologic differences, especially of those who are highly sensitive (HSP/Highly Sensitive Person), may make them more vulnerable* The similarities to other addictive and compulsive behaviors* Where this attachment style would fall if placed on the attachment spectrum* The beliefs, emotional states, behaviors, and communication styles that can be present when someone struggles with compulsive caregiving.* The physical and psychological toll of the often-present chronic stress and emotional repression* Tools and interventions that can help one move towards healing and thriving* Specific resources that support awareness and recovery, including The Drama of the Gifted Child, Adult Children of Emotionally Immature Parents, and Codependent No MoreAs always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comLinks to related content:Compulsive Caregiving, Over-functioning, Codependency & Nice Guy/Good Girl SyndromeMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I am happy to share a recent conversation I had with Dr. William Walsh about his new book, “The Essence of Bipolar Disorder,” where he lays out his discovery into the cause of Bipolar Disorder, a condition with fluctuating high and low mood states that has baffled researchers and psychiatrists.Dr. Walsh, the president of the non-profit Walsh Research Institute, is an internationally recognized expert in the field of nutritional medicine. Dr. Walsh’s work in nutrient-based psychiatry began while collaborating with the renowned Carl C. Pfeiffer, MD, PhD (a pioneer in the field of nutritional psychiatry) to develop individualized nutrient protocols, originally focusing on violent and criminal behavior before expanding to ADHD, depression, anxiety, bipolar disorder, autism and schizophrenia. Dr. Walsh went on to study more than 30,000 patients with mental disorders, acquiring an unparalleled database of more than 3 million chemical assays during his clinical and research work. From this database, Dr. Walsh discovered the biotypes of depression, ADHD and Schizophrenia.Dr. Walsh has conducted chemical analysis of more than 25 serial killers. He has assisted medical examiners, Scotland Yard, and the FBI. He has designed nutritional programs for Olympic and professional athletes.In this episode, we discuss:* Bipolar Disorder, how it differs from other psychiatric conditions and why it has been so challenging for psychiatric researchers to understand.* The strong inheritance of Bipolar Disorder (despite a single gene never having been identified).* Dr. Walsh’s journey uncovering the cause of Bipolar Disorder, which started with studying the related neuroscience research, followed by a review of the emerging genetic research, specifically, the GWAS (Gene-Wide Association Study), which identified many genes related to bipolar disorder, to a focus on the ion channel genes, DNA repair genes and finally Bipolar Disorder as a “channelopathy.”* The alignment of genetic vulnerabilities involving ion channel genes and DNA repair genes and oxidative assault.* How the weakness of DNA damage genes can contribute to other health issues, accelerate aging, and lower life expectancy.* How weak ion channel genes can also contribute to high oxidative stress.* Bipolar Disorder as a “channelopathy”, and the explanation for switching from euthymia (normal mood) to mania to depression and back to euthymia (from a neurotransmission standpoint)* How this information impacts treatment and prevention.Related Content:Wash Research InstituteLunch with Dr. William Walsh - His Story, Discoveries & the Future of Nutrient-Based PsychiatryBreakthrough Theory of Bipolar DisorderAs always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I discuss the anxious (ambivalent–preoccupied) attachment style — a pattern marked by intensity, dependence, and a longing for reassurance.I address how this attachment pattern develops, how it can appear in adulthood, and what kinds of therapeutic and holistic supports can help someone move toward a more secure attachment style. Specifically, I discuss:* How inconsistency in early caregiving (and even threats or experiences of abandonment) can lead to an anxious attachment style and problems with emotional regulation.* The key differences between anxious and avoidant attachment patterns* What the infant-toddler attachment research revealed about early caregiving and attachment dynamics* How anxious attachment can manifest as overwhelm, and fear of abandonment in adult relationships* Links between attachment and biochemical factors such as inflammation, methylation, high copper, high pyrroles, mast cell activation, and even biotoxin illness such as mold toxicity.* Psychotherapy approaches that promote regulation and security — including learning about healthy boundaries* The importance of structure, daily routines, and developing a reliable “inner parent”* Mind–body strategies such as guided meditation, goal-focused journaling, and creative learning* How addressing both emotional and biochemical roots can support long-term healing and resilienceWith awareness, compassion, education and support, we can rewire our nervous system toward greater calm, clarity, and self-trust.As always, I welcome your thoughts and questions.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

What do the TV and film characters Don Draper (Mad Men), James Bond, Miranda Priestly (The Devil Wears Prada), and Rick Blaine (Casablanca) have in common? Each is a fairly good illustration of the Avoidant-Dismissive Attachment Style portrayed in film.In the last episode, I discussed how our experiences with caregivers during our first three years of life may continue to impact our ability to regulate emotions and form beliefs about ourselves and others. More deeply, I address how attachment shapes our neurophysiology - specifically our right and left hemisphere differentiation, our limbic system (“lizard brain”) and our autonomic nervous system.In this episode, I will focus more closely on one end of the attachment spectrum - the avoidant-dismissive attachment style. I’ll discuss:* How, in the early research, attachment was measured in toddlers and adults* How avoidant-dismissive attachment appears to develop* What it looks like in relationships* Personality Disorders that, if present, align with this type of attachment style* Similarities with undermethylation and how avoidant-dismissive attachment style may relate to undermethylation* The role of psychotherapy, group work, and supportive relationships in healing* Other tools, practices, and choices that can support healing.* How awareness of these patterns can transform not only personal well-being but also parenting and family dynamics across generationsOne theme I return to often is that growth is always possible. While avoidant attachment may develop early in life, it does not define a person forever. With curiosity, growing compassion, and the willingness to practice new ways of relating to ourselves and to others, we can expand our capacity for connection and begin to feel more whole.In the next episode, I look forward to discussing the other end of the attachment spectrum - the Anxious-Ambivalent (Preoccupied) Attachment Style.As always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comLinks to related content:Methylation & Brain HealthUndermethylation Myths, MTHFR & The Great Folate DebateMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Lately, I've been thinking about the increasing use of the term “dysregulated.” This is an effective term that expresses having difficulty accessing calm in the body and brain after a stressful situation. When we think about nervous system regulation, we often overlook the fact that its foundations are largely built in the first years of life. Though we don’t “remember” this time, it continues to influence us as adults.The good news is that, even if our early experiences weren't ideal, we can still move toward greater attachment security, and thus better emotional regulation, positive beliefs about ourselves and others, and healthier ways of relating.In this episode, I discuss:* What attachment is and why the first three years are so foundational* How our nervous system develops through our early attachment experiences, specifically,* Right and left brain differentiation* Limbic system* Autonomic nervous system, which includes the vagus nerve (that puts us into rest, digest and connect)* The main attachment styles and how they shape our beliefs, emotions, and behaviors* The influence of early stress, high cortisol life-long regulation* Why culture's "left brain dominance" can leave us disconnected from empathy, embodiment, and nuance* Practical ways we can start to nurture secure attachment and grow more self-compassion, even later in lifeFor me, this is not about blaming parents but about understanding the impacts of arguably the most important time in our lives. This is also a reminder that it is never too late for us to learn to become responsive caregivers to ourselves.If you have a specific situation, concern or question that you would like me to react to in a future newsletter/episode, please email that to support@courtneysnydermd.com. Names will never be shared.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comCourtney Snyder, MD This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Lately, I've been thinking about how detrimental the medical field's compartmentalization of our body systems is to understanding what's really going on.Today's episode is for anyone who has seen multiple specialists for various symptoms and still feels unwell, and for anyone interested in connecting the dots between seemingly unrelated health concerns.In this episode, I discuss:* A letter from someone with wide-ranging symptoms who has seen multiple specialists without answers or seeming movement towards healing.* Why the traditional medical system has become compartmentalized into over 130 specialties, and how this model affects diagnosis and treatment* How psychiatry and neurology have diverged, despite both addressing the brain and nervous system* The limitations of the term mental illness and why I prefer to talk about brain symptoms* A comprehensive look at symptoms often considered psychiatric-including emotional, cognitive, behavioral, and sensory ones-and how these may reflect broader systemic issues* How neurotransmitters work, factors that can influence too much and too little neurotransmitter activity, and why biochemical imbalances often underlie both psychiatric and neurological symptoms* My hope for the future of healthcare.If you have a specific situation or concern you would like me to address in a future newsletter/episode, you are welcome to send it to support@courtneysnydermd.com.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I hope you’re enjoying a lovely summer. In recent months, I’ve been taking time away from writing and teaching to help my parents (who are in their late 80's), while continuing my practice, consultations, and mentoring. I find myself learning over and over again that I can’t do everything I want. I have great empathy for those of you caring for family members, tending to your health (and perhaps theirs), working, and still trying to make room for your passion. A big part of my passion is sharing information with you here.To date, I’ve talked about the details of my work and how I approach mental health. Today, I thought I’d take a step back and comment on the broader picture of psychiatry in its evolving forms.In this episode, I discuss:* The education of psychologists versus psychiatrists and child psychiatrists* The decrease in psychiatrists who provide psychotherapy* The difference between Conventional/Allopathic Medicine and Functional Medicine* The difference between Conventional, Functional, Holistic, and Integrative Psychiatry.* The meaning of Nutritional Psychiatry & Environmental PsychiatryLastly, I explain why I prefer the warmer and rounder term, Holistic Psychiatry, and what that means to me.With Gratitude For Your Ongoing Interest,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Previously shared as a paid newsletter in May 2024. In previous newsletters, I’ve addressed many of the more common contributing factors to brain symptoms, including high pyrroles, copper-zinc imbalances, methylation imbalances, candida overgrowth, mast cell activation, mold and other forms of toxicity, and genetic variants, such as COMT and MAOA.Supplements can be needed to address each of these. Medication can also be necessary when treating mold and mast cell activation.But what happens when someone can’t tolerate a supplement or medication because it worsens or creates new brain symptoms? Why, for example, could someone have problems tolerating B6 or SAMe or Methionine. Why might someone have problems with folate, niacinamide, glutathione, certain herbal treatments, antidepressants such as SSRIs, probiotics, antifungal medication or binders such as bentonite clay, activated charcoal, chlorella or cholestyramine?In this newsletter, I’ll discuss:* Five common reasons a supplement or medication may worsen symptoms.* Specific supplements and medications that are more likely to do this.* How reactions may point to root causes.* Treatment steps that can improve tolerance.There can be a wide range of brain symptoms that can occur when someone is having an adverse reaction, such as fatigue, brain fog, depression, anxiety, agitation, and even psychosis or mania. I’ll use “reactivity” to refer to this range of possibilities. While physical side effects can also occur, the focus here will be on brain symptoms.5 Common Reasons Supplements or Meds May Worsen Symptoms1. Immune ReactivityOur immune system is intertwined with our central nervous system. When our body’s immune system reacts to a toxin, microbe, injury, or trauma, we can have inflammatory brain and physical symptoms.“Feel Like I’m Reacting to Everything” - Mast Cell ActivationIf someone is experiencing severe immune reactivity, such as mast cell activation, they may react to many supplements and medications, as well as triggers in their environment and stress. The number of triggers can help point to an exaggerated immune response. In my practice, this high immune reactivity is usually driven by mold toxicity.For many with this obstacle, starting very low and slow can prevent reactions. For others, interventions may be needed to lower immune reactivity and stabilize mast cells. This, however, can require certain supplements. For those who can’t tolerate those treatments, limbic system retraining programs help calm the immune system so people can move forward more easily.Sensitivity & IntoleranceIt is possible to have immune sensitivity (or even allergy) to a supplement, though I find this less common. Herbal supplements, for example, which are high in salicylates, may cause symptoms in those with salicylate sensitivity. Certain probiotics have bacterial strains high in histamine. This is an issue for those with histamine intolerance.2. Too Much or Too Little Neurotransmitter ActivitySome people with brain symptoms have high neurotransmitter (NT) activity, and some have low. Common NT’s include serotonin (5-HT), dopamine (DA), and norepinephrine (NE). I use the term “neurotransmitter activity” because it’s not just about the amount of neurotransmitters present; it’s also about the amount of receptors present that pick up NTs and remove them from the space between nerve cells.High Neurotransmitter ActivityToo much neurotransmitter activity can cause brain symptoms such as mania, psychosis, agitation, anxiety, panic, obsessions, compulsions, and hyperactivity. Reactions can occur if supplements or medications are given that further increase NT activity.Examples include:* Overmethylation* Slow COMT (involved in clearing DA and NE) and/or slow MAOA (involved in clearing 5HT, DA and NE)A variant on COMT and/or MAOA doesn’t mean they are being expressed.What Increases Neurotransmitters?* SSRIs (Selective Serotonin Reuptake Inhibitor) increase serotonin activity* SNRIs (Serotonin and Norepinephrine Reuptake inhibitors) increase serotonin and norepinephrine activity.* Stimulant medications such as Ritalin and Adderall increase dopamine activity* SAMe and methionine increase serotonin and dopamine activityRemember that there can be times when there is a mixed picture, such as when someone is undermethylated and has a slow COMT.Low Neurotransmitter ActivityReactions can occur if supplements or medication decrease the neurotransmitter activity when it is already low. This could look like depression, apathy, fatigue, and brain fog.Examples include:* Undermethylation* Fast COMT (involved in clearing DA and NE) and/or fast MAOA (involved in clearing 5HT, DA and NE). The NTs are getting cleared too fast.What Decreases Neurotransmitters?* Folate, a nutrient that is good for a lot of people happens to be a big problem for many with psychiatric conditions. Most with underemethylation have low serotonin symptoms (depression and/or anxiety). While folate can help methylation, as an unfortunate aside, it can also further lower serotonin activity. Folate is in most multivitamins and B Complex vitamins. To learn more: Undermethylation, MTHFR & The Great Folate Debate.* Niacinamide can lowers DA and NE.Looking closely at someone’s symptoms and traits and assessing methylation through bloodwork can help determine if NTs are too high, low, or mixed and what types of treatment to consider.3. Poor Detoxification or Toxic OverloadZincZinc is one of the most powerful tools I use in my work. Some people can easily tolerate it, while others can struggle. Here are some reasons someone may not tolerate zinc.* High copper—Zinc mobilizes copper. Moving too much copper at once can increase copper symptoms (anxiety, anger, hyperactivity, insomnia).* High toxicity—Zinc is a strong antioxidant. It is needed for the genetic expression of one of the most important antioxidants in our body, metallothionein.It took me 8 months to get my dose up to an optimal range, which is certainly not the norm. I unknowingly had significant mold toxicity at the time.When I start someone on zinc, I slowly build it up over 3-4 weeks. For some (like myself), even this is too fast.GlutathioneThis is the other major antioxidant. If someone is having difficulty tolerating it, they may have problems with detoxification and significant toxicity (metals, biotoxins like mold, and chemicals). These can start to be addressed in several other ways.BindersThese include bentonite clay, chlorella, activated charcoal, and cholestyramine. They bind toxins, especially mold toxins, in the GI tract. If they are started too quickly, the toxins they are supposed to remove get stirred up, which stirs up symptoms. When people say they can’t tolerate certain binders, they usually weren’t started low enough.There are others, but these are the most common in my experience.4. Underlying Microbial or Microbiome IssueB6B6 is very important for brain health. It is needed for making serotonin, dopamine, and GABA. We use it in all the Walsh nutrient protocols to varying degrees. In the last 10 years, we’ve seen a decrease in B6 tolerance. It’s not clear why. I’m including it in this section because the reactivity is suspected to be related to the microbiome. Perhaps in recent years, we have had collective damage to our microbiomes from toxins and rising EMF exposure. We don’t know.The good news is that P5P, the active form of B6, is usually well tolerated. In my practice, I rely heavily on P5P. I will occasionally use it in combination with B6 (if tolerated) for those with especially high pyrroles.Methionine and/or SAMeBoth are used, though usually not together, to help address undermethylation. I suspect candida or mold when someone is having difficulties tolerating either of these. These nutrients are usually better tolerated once candida and/or mold are addressed (or are starting to get addressed).5. Die-OffAnything that kills off microbes, such as candida or mold, can cause a “die off” of those microbes, release toxins, and worsen symptoms. Antifungal supplements, antifungal medication, and probiotics may cause this type of reactivity. Antifungal medications include nystatin, diflucan, itraconazole, and amphotericin B.Herbs and food-based supplements can have antimicrobial effects. Turmeric is one example. There are many others, so it’s always worth checking. Worsening symptoms might point to an underlying fungal or other microbial overgrowth. It may also suggest that appropriate binders may be needed first.Addressing or preventing die-offs could mean supporting detoxification, starting binders if necessary, and, again, starting low and going slow.Antidepressants, interestingly, have been shown in labs to have antifungal effects. This does make me wonder if some people who can’t tolerate them are having die-off.Root CausesKnowing someone's history of reactions can help point to underlying root causes.As you can see, there are typically ways to help someone tolerate and go on to benefit from a needed supplement or medication.As always, I welcome your thoughts and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

We are living in a world that feels increasingly “left-brained.” Though both hemispheres are constantly working together, they have distinct values, traits, and ways of operating the world. In this podcast episode, I discuss:* The different attributes of the left and right hemisphere* How can we recognize which hemisphere is taking the lead in a given moment* The advantages of letting the right brain take the lead* How we strengthen our right hemisphere with the help of neuroplasticity (and specific (enjoyable) activities).* The added benefits of doing this in community.Related to this topic, I look forward to sharing information soon on an upcoming discussion group called “Strengthening the Right Brain in Left Brain Times.” In the meantime, as always, I welcome discussion right here. Please feel free to comment and to help me get the value of the right brain out into the world.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

OCD, or Obsessive Compulsive Disorder, is a debilitating condition that involves intrusive thoughts and time-consuming, repetitive behaviors. It impacts 80 million worldwide, 2-4% of the US population or 1 in 100 people here in the US.It can be difficult to overstate the suffering caused by OCD, not only for those with this condition but also for their family members. In addition to the distress caused by the obsessional thoughts and compulsions, there can be shame and loss - loss of more meaningful, purposeful, or pleasant thoughts and behaviors. and loss of time connecting with others or engaging in purposeful or enjoyable activities.Other conditions associated with obsessive-compulsive disorder include:* Body dysmorphic disorder* Skin picking* Trichotillomania (hair pulling)* Hoarding* Hypochondria* Olfactory reference syndrome (an irrational feeling or belief that one emits a foul smell and often attempts to remove the odor).It´s not unusual for someone with OCD to have other conditions, such as:* Other forms of anxiety* Depression* ADHD* Autism spectrum disorder* Eating disorders* TourettesResearch suggests that having OCD raises one´s vulnerability to developing dementia. Many other brain conditions, however, also appear to increase this vulnerability similarly.Treatment ChallengesOCD is particularly challenging to treat. Of those with OCD, 60% do not respond to typical therapies (often medication in combination with psychotherapy involving gradual exposure to that which is being avoided). Typical medications include:* SSRI´s (Selective Serotonin Reuptake Inhibitors) -e.g., sertraline, fluoxetine, fluvoxamine, citalopram, paroxetine* Tricyclic antidepressant - clomipramine* SNRI - (Serotonin and Norepinephrine Reuptake Inhibitor) - venlafaxine* Atypical antipsychotic medications are sometimes addedMedication is combined with CBT (Cognitive Behavioral Therapy), which involves exposure and response prevention, or CBT is used alone.As you can see, most medication approaches aim to increase serotonin activity. Serotonin, however, is just one of the neurotransmitters involved. What has become increasingly clear from the research is that OCD involves abnormal activity at the NMDA receptor - a glutamate receptor.NMDA & GlutamateThe NMDA receptor is found throughout the brain. Glutamate, the primary excitatory neurotransmitter in the central nervous system, binds to the NMDA receptor. NMDA and glutamate are involved in synaptic plasticity (creating neuronal connections), learning, memory, and motor function.The synapse is the space between communicating neurons. Presynaptic neurons release glutamate, which binds to the NMDA receptor on postsynaptic neurons. This results in a cascade of signaling events that lead to “neuronal excitation.” The problem arises when this receptor has too much (or too little) activity. In the case of OCD, there is too much activity.Implications* Dysregulation at the NMDA receptor appears to play a role in OCD, depression, PTSD, schizophrenia, bipolar disorder, and substance use disorders.* Weak memory extinction can result from high activity at the NMDA receptor. While memory is a good thing, we can have problems with too much memory - or rather, problems putting our memories aside. This can look like thoughts getting stuck, for example:* Intrusive thoughts in OCD* Flashbacks in PTSD* Delusions in psychotic disorders* Cravings in addiction.* Neurodegenerative disorders, such as Alzheimer’s, Parkinson’s, and ALS, have also been linked to NMDA receptor malfunction.Methylation & NMDAThose who are undermethylated, especially those with OCD or addictions, have high activity at the NMDA receptor. To remind you, undermethylation is a biochemical process with many functions, including the breakdown of histamine, support of detoxification, and support of serotonin activity. When someone is undermethylated, they can tend to have allergies (from high histamine), be perfectionistic, competitive, strong-willed, have obsessive-compulsive tendencies, be ritualistic, have dietary inflexibility, and have high accomplishment or have family members with high accomplishment. Undermethylation can contribute to the low serotonin activity seen in OCD. Simply addressing undermethylation, like merely addressing serotonin, will only bring partial benefit. To address undermethylation, those of us trained by the Walsh Research Institute, use SAMe and/or methionine, B12, B6, magnesium, and antioxidants. We address this before starting methylation treatment for those with high homocysteine. But how can we also decrease activity at the NMDA receptor?Blocking NMDA & Normalizing Glutamate ActivityEsketamine or Ketamine, which has been getting much attention in recent years, can impact the brain in various ways; however, its primary mechanism is as an NMDA blocker or antagonist. For some, it can serve as a rapid-acting and highly effective antidepressant. It can also decrease OCD symptoms. Other NMDA-blocking drugs include memantine and dextromethorphan (combined with bupropion). Lamotrigine can decrease glutamate release and has been used as an adjunct medication for OCD.Nutrients, however, play an important role in the NMDA receptor. NAC or N-acetyl cysteine is a precursor to glutathione and, thus, an antioxidant. It is also anti-inflammatory and a binder for a particular toxin made by candida and mold. But, it is also a potent NMDA antagonist (decreases activity at NMDA) and has been shown to reduce obsessions and compulsions of OCD. It has also been studied in alcoholism, opiate addiction, cocaine abuse, gambling disorder, shopping disorder, cigarette addiction, and trichotillomania. It has been used by itself and as an adjunct to medication therapy. NAC has become part of the Walsh undermethylation nutrient protocols for those with OCD and/or addiction.Zinc also plays an important role in regulating functioning at the NMDA receptor. The Walsh Research Institute found that 90% of those with brain symptoms had relatively low zinc. Dosing of zinc is determined after testing plasma zinc levels using a narrow range (the Walsh/Pheiffer range differs from typical lab ranges). Zinc is checked in conjunction with copper. Zinc has been found to improve treatment response in those with OCD treated with SSRIs. Zinc can be depleted because of very high oxidative stress and/or high pyrroles, which also cause low B6. Because B6 is needed to make serotonin, pyrroles are also important to address if elevated.Inositol is a nutrient involved in the serotonin and glutamate signaling systems. It, too, is beneficial for OCD symptoms; however, it can require very high doses.The challenge of research, as you can see, is that these approaches are all looked at in isolation, as opposed to, for example, addressing undermethylation, optimizing zinc, decreasing activity at the NMDA and addressing sources of oxidative stress.Candida & MoldAside from undermethylation, low serotonin activity, and high activity at the NMDA receptor, those with OCD appear to have high oxidative stress, as is the case with most brain-related conditions. One of the more common sources of oxidative stress I see in my practice is candida overgrowth in the GI tract, which often follows antibiotic exposure and /or mold toxicity due to water damage causing seen or unseen toxic mold. Because mold and candida (yeast) thrive on sugar and a high-carb diet, symptoms can fluctuate with sugar or carb intake. How might candida and mold intersect with the NMDA receptor? Mold and yeast can contribute to high histamine states. Histamine can increase activity at the NMDA receptor. EstrogenFor women and teen girls that I see with OCD, there is often a fluctuation in their OCD symptoms with their cycle. Typically, their symptoms worsen during the times of the month when estrogen is the highest. This may be because estrogen can increase activity at the NMDA receptor.PANDAS & PANSWhen a child has an abrupt onset of OCD symptoms, PANDAS and PANS should be considered.* PANDAS = Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections* PANS = Pediatric Acute-Onset Neuropsychiatric SyndromePANDAS and PANS are autoimmune conditions, meaning the immune system is acting on the body, in this case, a part of the brain called the basal ganglia, that involves an acute onset of OCD symptoms. Other symptoms can include restricted eating, mood symptoms, regression in academic or social skills, and motor tics. While triggers are often viral, bacterial (strep in the case of PANDAS), candida,or other microbial source, what is underlying the dysregulated immune response to such microbes, in my experience, is mold toxicity. SummaryBecause OCD can be difficult to treat, my hope in sharing this information is to raise awareness that effective OCD treatments can require a multifaceted approach that includes:* addressing methylation (and high pyrroles if present) to improve serotonin activity* decreasing activity at the NMDA receptor* by optimizing zinc* using supplements or medication* addressing sources of inflammation and high histamine* address sources of oxidative stress - trauma, stress, toxins, inflammation If you find this information helpful and would like to help me get this out into the world, please consider sharing:As always, I welcome your comments, questions, and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to di

This past week, I had the pleasure of attending the Advanced Course for Walsh-Trained Practitioners. To date, 1,200 practitioners from 75 countries have been trained using the Walsh approach.For those unfamiliar, the Walsh Research Institute, founded by Dr. William Walsh, has looked at the nutrient levels of over 30,000 people with brain-related symptoms and found a surprisingly small number of nutrient imbalances (low zinc, high copper, high pyrroles, and methylation imbalances) that repeatedly show up. We address these imbalances in those with depression, anxiety, panic, obsessions, compulsions, inattention, brain fog, hyperactivity, autism, dementia, psychosis, and mood swings with significant and, at times, dramatic results. Bipolar disorder, however, because of its shifting in neurotransmitter states from mania and depression, can be particularly difficult to treat. More than nine million Americans have been diagnosed with bipolar disorder. This severe condition can lead to drug or alcohol use, financial or legal problems, discord in relationships, work and school instability, and/or suicide attempts or suicide. The course typically begins with an acute onset, followed by episodes of mania and depression, which often worsens in severity over time.In this post, after describing bipolar disorder, I will use Dr. Walsh’s Comprehensive Theory of Bipolar Disorder, recently shared at the Society of Neuroscience, to explain:* the cause of bipolar disorder* the reason for the onset, persistence, and increasing severity for many over time* the reason for the increased risk of other health issues* the reason for the switch between manic and depressive states* how this information impacts treatment and preventionBipolar DisorderIt is important to note that the type of bipolar disorder I am referring to here is Bipolar I, a condition in which there are discrete episodes of mania often followed by episodes of depression. Such episodes can occur rarely or even multiple times a year.Manic episodes usually last a week up to several months and include three or more of the following:* increase in activity, energy, or agitation* distorted sense of well-being or self-confidence* needing much less sleep than usual* usually talkative or talking fast* racing thoughts or flight of ideas (jumping from one topic to another)* easily distracted* poor decision-making- e.g., excessive spending, risky sexual behavior* may become psychotic (have a break from reality)Hypomania has less severe symptoms which have less impact on functioning at work, school, social activities, and relationships. Having hypomanic episodes is not sufficient to warrant a diagnosis of Bipolar I.Depressive episodes, which often last a couple of weeks but can vary, include five or more of the below symptoms that are affecting functioning at work, school, social activities, and relationships:* depressed mood (sad, lacking feeling, hopeless, irritable, angry, or tearful)* marked loss of interest or enjoyment of activities* weight loss or weight gain (without dieting or overeating)* too much or too little sleep* behavior slowed down or restless* fatigue - loss of energy* feelings of worthlessness or inappropriate guilt* problems concentrating or making decisions* suicidal thoughts, plans, or attemptsBipolar II Disorder is a different condition. This diagnosis is given when someone has at least one major depressive episode and at least one hypomanic episode. Depressive episodes are often longer here. There is never a manic episode. Despite its name, this is not a milder form of Bipolar I. Biochemically, it is considered a different disorder.Rapid cycling is used to describe bipolar disorder when, in the past year, there have been at least four episodes of switching from mania or hypomania to depression. This can describe either type I or type II (depending on the presence or absence of mania). As with many other diagnoses, the terms came from seemingly related symptoms instead of a root cause or biochemical understanding.Dr. Walsh’s comprehensive theory, which I’ll describe, focuses on Bipolar I, in which there are manic episodes usually followed by depressive episodes. For those who struggle with mood swings changing within a day or a week as opposed to discrete mood episodes of mania or depression, pyrrole disorder should be considered.Genetics or Epigenetics?Having a first-degree relative (parent or sibling) with bipolar disorder raises the risk of developing bipolar disorder. After thirty years of genetic research, however, a gene for bipolar disorder has not been identified. The genetics are more complicated. It appears there are many genes involved.2021 Genome-Wide Association Study (GWAS)These studies compared the genomes of about 5,000 individuals with bipolar disorder and about 8,000 (controls/individuals without bipolar disorder). Over time, more and more “bipolar” genetic variants have been identified. By 2021, there were 64; however, there are expected to be hundreds. Of these 64 genetic variants, 49 are DNA repair genes and antioxidant genes that occur throughout the body (not just the brain). Just as it sounds, DNA repair genes make enzymes that repair DNA. Antioxidant genes make enzymes that support our protective antioxidant systems. Many of these genetic variants are also associated with cancer and other conditions impacted by DNA damage. This would suggest that those with bipolar disorder come into the world with a vulnerability in their ability to repair DNA damage (which translates to cell damage, tissue damage, and, in the case of the brain, neuronal damage. An event, however, is required to shift this vulnerability to illness.Accelerated DNA DamageWhat damages DNA? Free radicals and thus oxidative stress. To remind you, oxidative stress occurs when our body’s inherent antioxidant systems are overwhelmed or depleted by free radicals (due to an insult - a toxic exposure(s), source of inflammation, or trauma). A depletion of our protection leaves our cells and DNA vulnerable to further oxidative stress and damage. If we have variants on protective genes, then we can be even more vulnerable.Numerous studies have found high levels of superoxide, hydroxyl, and ONNO (peroxynitrite)free radicals in those with bipolar disorder.This vulnerability to DNA damage also explains why many with bipolar disorder have a higher risk of other health issues, including heart disease, breast cancer, multiple sclerosis, kidney failure, immune disorders, migraines, gastrointestinal illnesses, and others. But What About the Other 15 Genes? Genetic Weakness on Ion ChannelsThe remaining identified genes are more specific to bipolar disorder and relate to ion channel genes. Ion channels exist on the neuronal membranes, allowing potassium, sodium, and calcium to move in and out of the nerve cell. This movement creates an electrical charge that travels down the cell, releasing a neurotransmitter into the space between that neuron and other neurons to communicate with the next cell(s). OnsetHere again, an epigenetic event (toxic exposure, trauma, significant illness, etc.) leading to oxidative overload impacts the production of the proteins used in these channels, which affects the movement of ions in and out of the cell (more specifically causing flooding of potassium ions (K+) outside the cell) leading to hyperactivity of that nerve. This is why Dr. Walsh’s theory considers bipolar disorder a channelopathy.EuthymiaEuthymia - when the mood is neither manic nor depressed - interestingly, appears to be the first mood state after the onset of the condition. The flooding of K+ outside the cell leads to hyperactivity of neurons for serotonin. However, that doesn’t appear to cause symptoms since serotonin inhibits or keeps the activity of dopamine, norepinephrine, and glutamate in check.ManiaThe onset of mania starts to occur when the serotonin neuron hyperactivity (from the K+ flooding outside the cells) starts to fizzle out. What follows is a reduction in the inhibition of the neurotransmitters (dopamine, norepinephrine, glutamate, and others) that cause widespread neuronal hyperactivity, which causes manic symptoms.Eventually, the declining serotonin activity becomes the dominating force and triggers depression, which may persist for some time. Eventually, the serotonin nerves return to hyperactivity (again keeping things at bay), resulting in a stable mood - euthymia. Progression of Illness It is well known that preventing manic episodes can prevent the severity of the condition from escalating over time. Dr. Walsh’s theory also addresses why.Aside from impacting neurotransmission, the problems occurring at the ion channels are also associated with further DNA damage. This means that each episode can potentially add to the DNA damage. Add to this typical DNA damage (for all of us) that comes with aging. A typically untreated original and often persistent insult (such as a toxic exposure), events occurring at the ion channel, and aging can lead to the progression and increasing severity of illness.TreatmentAs with any theory, the inevitable question becomes, how does this impact treatment? Allopathic or mainstream psychiatry uses medication approaches that aim and usually succeed at stabilizing mood. Again, this is important because of the consequences of mania or depression but also because of the potential physiologic damage caused by ongoing episodes. What isn’t typically addressed in conventional psychiatry are:* Sources of oxidative stress. Does this person have mold toxicity, Lyme, metal toxicity, candida or other microbial overgrowth, chemical exposures, high EMF exposure, trauma, and/or chronic stress that are continuing to deplete protections and contribute to DNA damage? These are the types of issues that those of us who consider ourselves functional and environmental psychiatrists address.* Support for the antioxidant system. As wit

“The journey of a thousand miles begins with a single step.”― Lao TzuIn this episode, I share my journey through illness to health and how this shaped my work as a holistic psychiatrist. My wish for anyone listening is that your pursuit of health, happiness, or whatever you seek leads you to peace and a desire to help others traveling their thousand miles.Until next time,CourtneyCourtneySnyderMD.comMentoring This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Recently, an interview by Christiane Amanpour caught my attention. It was with Coralie Fargiat, the director of “The Substance.” Though I haven’t seen this 2024 body horror movie (nor do I intend to), the story brings up several teaching points about the left brain, undermethylation, neuroplasticity, and our collective obsession with beauty.The movie is about an actress, Elizabeth, who loses her job hosting a fitness television show when she turns fifty. She has “aged out.” While in the hospital after a car accident, someone directs her to a product - the substance - a neon green liquid that will allow her to bud off a younger version of herself - Sue. The rule is that Sue can only go out into the world for one week at a time, alternating each week with Elizabeth while the other lies dormant. Not surprisingly, Sue has more advantages in the world (that Elizabeth inhabits), including replacing Elizabeth on her former TV show. Increasingly, when it’s time to switch, Sue breaks the one-week rule. This results in part of Elizabeth’s body becoming increasingly deformed. The culmination is a grotesque battle of gore between the two, who initially were instructed to remember, “You are one.”In the interview, the director, Coralie Fargeat, discusses her personal experience:“I turned 40 and was more impacted than ever about what it’s like to be a woman, the feeling that if I wasn’t young and pretty and sexy, I would be totally erased from the surface of the earth. So there was this kind of emergency, this vitality to the things I speak about in my film.”Research supports this thinking that beautiful people are treated better and thus have more advantages. With the use of photoshopping, social media filters, and even plastic surgery, many teens and young adults are experiencing neuroplastic changes that are making real people, including themselves, appear increasingly off or even grotesque. Left Brain“The Substance” is a left-brain nightmare. It shows us the self-destructive path the left brain can take us on, especially in a world that tells it exactly how things should look. Elizabeth, the main character in the movie, is rigid in her thinking, addicted to an image of herself, perfectionistic, and highly competitive. In some ways, these left-brain attributes have served her, but unchecked, they destroy her. If the left brain were a person, it would have the following traits and perspective on appearance: (These traits are oversimplified and pulled from Dr. Iain McGilchrist's work) - * Detail-oriented, narrow focus of attention - “That doesn’t look right.”* Prefers what it knows and prioritizes what it expects - “I should look this way.”* Has difficulties disengaging - “I can’t stop thinking about this and how to fix it.”* Sees parts (as opposed to the whole) * Sees the body as a sum of parts * Doesn’t have a whole image of the body (as found in those who have damage to the right hemisphere)* Is competitive - “I need to look better than they do”* Fears of uncertainty and lack of control (As you can imagine, this is a problem for anyone human and thus who will age)The left brain will set its sights on beauty, success, titles, money, objects, or anything else that feeds the “I.” Because the left brain can’t see the “big picture,” it has a hard time pulling back far enough to see how its way of thinking may be getting in the way. The Right BrainOur ability to feel embodied is a job for our brain’s right hemisphere. When the voice in the movie reminds Elizabeth, “You are one,” it may as well be speaking on behalf of the right hemisphere.Our right brain allows us to have compassion, including self-compassion. It honors diversity and differences. It can see the bigger picture of our lives that involve multiple developmental stages. It can sit with uncertainty. It knows that our imperfections and differences promote connection with actual humans.UndermethylationLeft brain tendencies strongly overlap with undermethylation traits. Methylation is a biochemical and cellular phenomenon that serves many important functions. If we “undermethylate,” we can have more difficulties breaking down histamine, more difficulties detoxifying, and lower serotonin activity. Methylation is impacted by a number of genes, the most well-known being MTHFR.Undermethylated traits include perfectionism, obsessive-compulsive tendencies, being highly competitive, having ruminations, and addictive tendencies. The NDMA ReceptorThose of us who are undermethylated can have high activity at the NMDA receptor, resulting in a problem with “memory extinction” or letting go of a thought. This could look like obsessive-compulsive tendencies (including those seen in body dysmorphia) and addictive tendencies. High histamine (again due to undermethylation) can increase activity at this receptor. Low zinc, high estrogen, and low magnesium can also be at play.I suspect Elizabeth is undermethylated and has high activity at the NMDA receptor. Both could be assessed for and treated (in part) using targeted nutrients. I say, in part, because the brain training / neural training that occurs through social media is difficult to override if someone is still “using.” Interestingly, EMF exposure (from phones and wireless technology) can increase histamine, further driving these issues.Neuroplasticity and Images of PerfectionThe more images of beautiful images of people we see, the more those images become the norm in our mind, and the more any deviation from that norm will stand out as problematic. This was already a problem with the photoshopping of celebrities and models. But now, with social media filters, teens and young women aren’t just comparing themselves to celebrities and models; they’re comparing themselves to a filtered image of themself.Filters can create larger eyes, bigger lips, more angular jawlines, whiter teeth, slimmer faces, and smooth and even skin tones. Research into the use of filters:* Millennials are predicted to take 25,000 selfies on average over their lifetimes* About 90% of women aged 18-30 report using beauty filters before posting selfies on social media. * Repeated interactions with filtered images and associated beliefs and worries are increasing the risk of mental health issues such as:* depression* social anxiety* reduced self-esteem* appearance anxiety* body dysmorphia* increase of plastic surgery* 62% of plastic surgeons report that their patients wanted cosmetic procedures because of dissatisfaction with their social media profiles* Snapchat dysmorphia” is what plastic surgeons are calling the act of taking a picture of one’s self and using a filter.* Selfies are the leading cause of plastic surgery among young people* Girls who routinely shared self-images on social media had considerably higher body dissatisfaction relative to those who share selfies less frequently. * Body Dysmorphic Disorder among young women has been linked to social media use.In short, the research shows that investing in one’s self-presentation on social media is often a harmful practice. The more one does it, the more damaging it tends to be. It encourages hyperattention to unrealistic beauty standards and a desire to change one’s physical appearance. This problem of hyperattention to unrealistic beauty standards isn’t just a phenomenon of teenage girls and younger women. I´m 57 and understand these things, and still, I´ve had to be intentional about how much attention and neuronal wiring I put into what increasingly feels like defying the very full and lovely reality of my current age. A SequelIf I could write a sequel to “The Substance,” it would be about how Elizabeth (the main character) gets off screens and finds a group of real women (her age and older) that she comes to trust, finds refuge, and who she is inspired by. Instead of looking through a lens of culturally defined beauty, she is struck by the strength, courage, and peace they never could have embodied at a younger age. These women who inspire and shape her would like Helen Mirin (79), who corrected a podcast interviewer after they said to her, “But you are young at heart.” She tells him that no, she is not….”My spirit is the age that I am. When you say 'youthful', I'm not full of youth. I'm full of the life that I've lived up to this point.As girls and women, we need these women in our lives. We can do our part to become these women - the desperately needed embodiments of the right brain. Wishing you peace and wholeness,CourtneyCourtneySnyderMD.comP.S. This Saturday begins the mentoring group for MDś, NDś, DOś, NP and PAś. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Recently, I was having a conversation with my daughter - who’s 19 - about the mental changes in a family member with memory loss. I commented that it can feel like a long goodbye, as they seem less like themself. Even as I said that, it didn’t ring true. She quickly responded, “When are we ever ourselves? It seems like we’re always changing.'“Her comment, which did ring true, got me thinking a lot this week about the elusive “self.”Who Am I? Who are You?My genes and early life experiences have shaped me. The arrival of hormonal changes around puberty changed me. My friendships changed me. After puberty, hormonal cycles played a role in changing my personality throughout the month. My education changed me. Love, marriage, and motherhood changed me. My work changed the way I make sense of things. For example, I’m sure optimizing my zinc level changed me into someone more comfortable around people. Addressing mold toxicity increased my energy, so everything wasn’t so hard. Addressing methylation lifted an apathy that came with toxicity. When I was in the throes of mast cell activation and inflammation, I was different. For 3 days at a time, feelings of “doom” and head and neck pain colored my world. When the flare passed, “I” was back.Sickness changed me into a more compassionate person. Despite this, I was determined to return to who I was before chronic illness. No one tells you that’s not possible. We may heal, but we don’t going back to a former self. Sickness forced me to let go of certainty and let go of identity so I could approach life with greater ease.Menopause lessened my intensity, possibly because less estrogen would have increased the ability of COMT and MOA-A to better clear catecholamines (which increase tension and, for some, hyperfocus). The need to go - go - go softened.I miss how much I could once do. I don’t miss believing that everything mattered more than the present moment.Even on a given day, our “selves” change. “Morning Me” is calm, has plans, and sticks with a routine. The “3-4:30 pm Me” is slower and less sharp. I’ve come to design my schedule to take care of both. “Me on Too Many Carbs” is self-conscious and judgmental and looks for things to complain about, while “Me on Less Carbs” is more at peace with what is.The challenge, of course, is to accept whatever perceived “self” shows up at a given time of day and not banish the moment with judgments about who we think we are. When we can do this, we can extend that grace to others.Who Is This Person?If you are a parent or have a partner or spouse, you’ve likely noticed the changing personalities of those you love. When my daughter was three, she was struggling with episodic cognitive and mood changes, as well as some developmental regression. Though not apparent to most people, in my mind, she was “herself” only about one out of four days. This was evident in her clear thinking, playfulness, humorous comments, and ability to draw a stick figure. This was who I perceived “her” to be. I felt connected to her.But for three of the four days (for a good part of the year), she was forgetful and didn’t engage in imaginative play. She was irritable and anxious. Her speech was slurred, and she couldn’t draw a circle. It was as if I had repeatedly lost her to an imposter with whom I found connecting more challenging.Ideally, I would have been more present and better connected to all her “selves.” But that’s not often who shows up when we’re in survival mode. I am grateful to my analytical, driven, and detail-oriented left brain, which ultimately found the help and answers that allowed her to return to her developmental path. I did, however, have to let that part of me go (in our relationship), for her and my well-being.There is No Fixed SelfWith these recent thoughts of the elusive “self” came a need to rekindle my relationship with one of my favorite mystics - Leonard Cohen. Though I’ve heard the interview (quoted below) several times, I was surprised at how different it resonates at this stage in my life.After commenting on how he no longer struggles with chronic depression, he explains why that is.“We don’t determine what we are going to see next, or hear next, or taste next, or think next, or feel next. Yet we have the sense that we’re running the show. So if anything has relaxed in my mind, it’s the sense of control, or the quest for meaning. My sense is there is not a fixed self. There is not one whom I can locate as the real me. And, dissolving the search for the real me is relaxation, is the content of peace….But these recognitions are temporary and fleeting, and, you know, …….we go back to thinking we know who we are.”The Right & Left BrainI love how Leonard Cohen unknowingly speaks about the differences between the right and the left brain. His right brain can’t locate a real him; for this, he is glad and at peace. The sense of control he refers to is mainly from the left brain, where the ego resides with its self-focus, striving, and clinging. And though the right brain is ideally the master and where we ultimately find peace, we still reflexively return to the left brain as we “return to thinking we know who we are.”BuddhismIf Leonard Cohen sounds Buddhist, he is. Though Judaism remained integral to his spiritual life, he steeped himself in Eastern spiritual and religious practices. From the ages of 61-65, he was a Buddhist monk.I’m not Buddhist, nor do I promote specific religious beliefs or structures. But, I am beginning to understand why the doctrine of "no-self" - the idea that there is no permanent self - has helped many people worldwide. The doctrine doesn’t claim that we don’t exist, but it does deny ordinary claims about human identity that bring inevitable tension and, for some, anxiety.Instead, according to the doctrine, the self is considered a collection of ever-changing mental, physical, and emotional processes that interconnect with other factors. I can’t help but think that among those other factors are changes in our nutrient levels, microbiome, hormones, epigenetic expression, levels of inflammation, and oxidative stress.Self-Focus & the No-SelfHave you ever noticed the difference in how you think and feel when alone with your “self?” Have you ever stopped and noticed how fleeting your thoughts and feelings are? Who were you in those minute-by-minute moments when you were excited and then when you were frustrated? Who is even doing the noticing? Now, think about how you think and feel when you are in the flow of satisfying work or taking a walk, in friendly conversation, helping someone in need, or petting a dog. In those moments, we don’t need a self to orient ourselves in the world. In those moments, we are in the world.As human isolation increases, we become more self-focused. We are more in our heads and not in the world. Isolation has our left brain taking us on a tedious pursuit of who we think we are or should be. Our left brain wants an identity to hang its hat on as if that will make everything right in our world. And from this identity, we judge ourselves and others, making it more challenging to connect,….if we let it.SufferingBuddhism connects the concept of self to great human suffering.Think about how much of our attention and energy we spend to find ourselves. We strive to be authentic. Many of us have been bucking up against a self we believe we didn’t have much say in creating. And many of us succeed in finding new ways of being in the world that feel more aligned with who we think we are.But many of us will reach a point where we realize the self we’ve been excavating or creating is fleeting. Our perpetual growth has been walking hand in hand with a falling away of self and identity. We find that all we ever had - and have - are our moments.PresenceWiring a brain to be present in such moments takes practice. It is when we practice noticing and paying more attention to the people and the world around us. It’s when we notice what we see, hear, and even smell. It's when we are immersed in a conversation or our work. It is when we are creating anything or listening to music. It is when we experience compassion, which includes self-compassion. It’s not all about good feelings. To be present is to sit with anger, sadness, and fear as they arise. They, too, shall pass, especially if we don’t try to deny or resist them.Being present is the antidote to the self. Being present is an antidote for suffering.Wishing you moments of presence and the ability to hold everything, including your sense of identity, more lightly in the New Year.CourtneyCourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In previous podcasts, I’ve discussed the more common underlying factors that can drive brain-related symptoms. These factors, or “roots,” each have their constellation of symptoms and traits.Because children’s brains and bodies are still developing and because they don’t have the same degree of hormonal influences, some of their symptoms and associated psychiatric diagnoses will differ from adults with the same imbalances. As you’ll see, inattention and hyperactivity and the diagnosis of ADHD can be the manifestation of a number of these root causes.Though I’ll discuss these common imbalances separately, more than one can be present. Below are the most common imbalances I see in my work. Teenagers’ symptoms tend to resemble those of adults.Each of these topics is linked to a more in-depth description if needed.* Undermethylation* High Copper* High Pyrroles* Mast Cell Activation* Candida* Mold Toxicity* Electromagnetic Hypersensitivity* OvermethylationFood sensitivities can be present and result in a range of symptoms; however, one or more imbalances are also usually present and underlying the food sensitivities.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In the last podcast, I discussed sources of toxins and how they can impact the brain and development.In this podcast, I’ll focus on ways to reduce exposure. I say reduce because there is no way to completely eliminate our exposure to toxins. This reality can be liberating for those who struggle with perfectionism.If you’re new at this, feel good about starting. Avoid feeling bad about what you haven’t done yet. (Negative thoughts aren’t great for detoxification;)For me, lowering exposures has been a stepwise process. When I began, I had to avoid overwhelm and resist trying to do everything at once.Though I’ve familiarized myself with the most researched toxins and their specific health impacts, I try to focus more on what I can do to avoid them so I can get on with life and not think about them.Some of the most researched toxins (last I checked) include mercury, lead, arsenic, cadmium, PBDEs, organophosphates, glycerophosphate, BPA, BHA, BHT, PCBs, sodium benzoate, butane, tartrazine dye, potassium bromate, ADA, BVO, yellow food dye number’s 5 and 6, red dye number 40, bovine growth hormone, synthetic hormones, ractopamine, phthalates, parabens, phenylenediamine, oxybenzone, acrylic, DEA, triclosan, PFAS including PFOS, benzene, chlorine, chloramine, ochratoxin, trichothecenes, aflatoxin, chaetoglobosin, gliotoxin, and zearalenone.Electromagnetic fields, though not “toxins,” are considered toxicants, which have similar impacts on our bodies and brains. I’ve previously shared how we can start to assess and lower those.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Recently I saw a humorous reel of a man going through his day. As he does, you hear his inner dialogue. He’s trying to prepare a healthy snack, but at every turn, he’s stopped by his voice pointing out exposure to toxins - in the packaging, the water, the skin of the fruit. Eventually, he sits down and opens a bag of chips.Can we lower our exposure to toxins (and support detoxification) and not live in fear? I think we can. We can all hold this heavy topic lightly and do the best we can, knowing that there’s no perfection here.“If we are going to live so intimately with these chemicals, eating and drinking them, taking them into the very marrow of our bones - we had better know something about their nature and their power.” - Rachel Carson in “Silent Spring” (1962)In this episode, I'd like to help you better know something about the nature and power of the chemicals and heavy metals that we’re exposed to. I’ll discuss* The cumulative effects of our exposures* Sources of toxins* Oxidative stress* How toxins contribute to chronic health conditions, including psychiatric conditions* Impacts on the developing brain* How oxidative stress can be measuredTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Likely you’ve heard about the importance of muscle strengthening in the prevention of bone health. What is less known, however, is the relationship between the health of our muscles and the health of our brain. In this podcast, I’ll address:* Evolution and the types of activity that our bodies were designed for* Causes of sarcopenia or muscle loss* The relationship between sarcopenia, cognitive decline and Alzheimer’s* How role our muscles play in blood sugar regulation and lowering inflammation* Low grip strength as a marker of psychiatric illness and neurodegeneration* Building muscle and address oxidative stressTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

“If the only prayer you said in your whole life was, ‘thank you,’ that would suffice. - Meister EckhartIn recent years, the benefits of practicing gratitude have become more widely known. During this time, my experience has expanded to include two more “radical” forms of gratitude that I’d like to share with you.In this podcast, I’ll address:* The increasing importance of gratitude in these times* Examples of gratitude practices* The many benefits* Children and gratitude* Aspirational gratitude* Radical gratitude* Spiritual bypassingTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe