An Interview with Dr. Kelly Brogan, MD: A New Approach for Depression
Interview by Tina Beaudoin, ND
Kelly Brogan, MD is a Manhattan-based holistic women’s health psychiatrist, author of the New York Times Best Seller A Mind of Your Own and co-editor of the landmark textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. She is board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms. She is a certified KRI Kundalini Yoga teacher and a mother of two.
Dr. Beaudoin: How did you start on the path of integrative medicine?
Dr. Brogan: I went to medical school to become a psychiatrist and have always been interested in women’s health and became one of the first 300 reproductive psychiatrists in the country, which meant medicating pregnant and breast-feeding women. It was my own health experience that tilled the fertile soil for my radical transformation. I was diagnosed with Hashimoto thyroiditis after my first pregnancy. Very uncharacteristically, I pursued treatment with a naturopathic doctor for the first time in my life. Through lifestyle medicine, I put my autoimmune condition into total remission and my career took a left-hand turn that has persisted for the last 10 years.
Dr. Beaudoin: What do you view as one of your primary roles as a clinician?
Dr. Brogan: I’m holding a safe space for women to move through their deepest challenges and confront some of their most deeply felt existential fears. And that is really what illness has come to mean for me. It’s a portal for you to work with and move through a lot of the ways in which perhaps women are uninitiated into themselves, before being delivered a diagnosis or before confronting the limitations of your lifestyle; whether relationship, job or before developing a consciousness of what a gift this human organism is.
Dr. Beaudoin: How do you frame or view mental illness?
Dr. Brogan: There is a lot of pushback as my position on this is a very controversial concept. People feel very indicted in some ways by the notion that the disabling experiences of mental illness could ever be re-packaged as something valuable. We’ve only ever been taught that suffering and pain and symptoms are bad, that discomfort is bad and needs to be eradicated. Mastery and dominance over our bodies and life experiences has not led us to a place of vitality and freedom. We are now struggling in ways that are very complex and we are sicker than we have ever been in history. People are flocking to integrative practitioners because something is not working.
Looking at your illness as an invitation or opportunity, it puts you back in control over your own destiny rather than leaving you a dependent victim of your own bodily experiences, of your genes, bad luck, etc. Anyone who has recovered from a chronic illness and has put it into total remission would never go back and say; “Oh I wish that didn’t happen.” It was essential for that to happen for them to become a more authentic version of themselves. Anyone on the other side of a healing process knows that they needed that to happen.
All indigenous and world cultures understand that initiation is a part of growing up and if we continue to run from this then we will remain infantilized adults who have no in-built capacity to meet challenges and who experience life as this scary, dangerous place until they die. That’s not acceptable and not a goal I want to support.
Psychiatric medications are a means to say that what you are feeling is scary and wrong and needs to stop. Informed consent is about informing patients, up front, about all that science has to say so they can chose what they believe. All of the research around the placebo effect substantiates the notion that our medical outcomes in allopathic medicine ride the placebo effect more consistently than they do a validated mechanism. So our belief in what we are doing is more relevant than actually what we are doing. You have to identify your belief system before you can know what type of medicine is right for you. How can you connect with a belief system if you don’t know it exists? A big part of my activism is video interviews with patients who have completely shed their severe chronic psychiatric illness so that others know that it is possible. Sometimes knowing it is possible can ignite the process of transformation.
Dr. Beaudoin: What do you do in your initial first office visit?
Dr. Brogan: My initial visit is three hours long. During the first two hours we explore their longitudinal narrative. I want to understand the meaning of the presenting illness to the patient. What does it mean that they are having these symptoms and that they are coming in at this point in their trajectory? We start with the in utero experience and march along from there. We explore how they think about health and suffering and symptoms and how much fear are they bringing to the table. Most of my patients have done a lot of work on this already and are not blocked by fear and have a high level of commitment to self-care. I try to assess for what elements of their life experience might be holding them back? Almost always it relates to diet, inadequate relaxation response, toxicant exposures and often also relates to their marital relationships, career, home, etc. These are some of the trappings that are keeping them in a small version of their life. When I’m bold enough, I ask, “What needs to die in your life for you to be reborn?”
Dr. Beaudoin: What labs do you do order?
Dr. Brogan: It’s become much more simplistic over the years. I do almost no functional medicine testing now. I spent many, many years doing lots of functional testing (salivary testing, stool analysis, organic acid testing, etc.) and at this point I focus so much on belief level and totally patient-driven self-care. I don’t find much of a need for lab work. I am interested in autoimmunity and thyroiditis in chronic psychiatric illnesses, so I will always screen for that.
- CBC, Chemistry Panel, ANA
- TSH , Free T3, Free T4, Reverse T3 (especially if on T4 medication) & antibodies
- CRP, homocysteine & serum B12
For the most part, the labs don’t change my initial template because I don’t want too much of a situation of where the healing approach is contingent upon my expertise as a provider. I want to set up the ground conditions for them to take control of this process. My online program, Vital Mind Reset, is a replica of what I do in clinical practice and the outcomes we get from that program are actually more robust than what I get from my own practice. I’m publishing three case reports that I believe have never been replicated in medical history that are so dramatic and only one of them are from my practice. A big part of that online program is community-based online healing. It is a very active community. There is a deeply empowering and healing element to the groups. We need to resolve this separation that we are suffering from and these communities are a compelling part of rapid and radical healing.
Dr. Beaudoin: Can you tell us more about the coffee enemas you prescribe?
Dr. Brogan: I’m passionate about coffees enemas, which I learned about from my mentor Dr. Nicholas Gonzalez. Many patients ask; “Where can I go to get these done?” I reply; “You do this for you as part of your self-care.” They are so effective because they up-regulate phase I and II detox in the liver. There are papers from the 1960s in the New England Journal of Medicine talking about coffee enemas resolving acute onset psychosis and catatonia in the ICU setting. Coffee enemas have the ability to quickly clean things out.
Dr. Beaudoin: What has been your experience with pharmaceutical interventions for mental health?
Dr. Brogan: I read an Anatomy of an Epidemic by Robert Whitaker right around the time when I was healing from Hashimoto’s and this book totally changed the course of my life and career. It essentially makes an unimpeachable argument that the very medications we are using to treat mental illnesses are actually perpetuating the recidivism and chronicity of those illnesses. It is a controversial claim, but Mr. Whitaker backs it up with non-funded research. It was a big part of why I put my prescription pad down and when I did, I offered all my patients (many of whom who I had put on medications) the opportunity to come off. And that is how I learned about the fact that psychiatric medications are the most habit-forming chemicals on the planet. Others pale in comparison when we are looking at the basics, even just even the neurological profile of the withdrawal phenomenon.
Dr. Beaudoin: What is your approach for patients who are already on pharmacological treatment for depression when their goal is to discontinue medication? What is your tapering schedule?
Dr. Brogan: I’m so glad you asked this question. I learned first-hand that even a relatively slow taper at 25% can be disabling to a person. And if you don’t know what you’re doing, you’ll say; “Oh my, you are relapsing, you better stay on this medication, you need it.” When you have more experience and you know the literature that supports this allegation (as mentioned in previous question), then you know this is a complex withdrawal phenomenon and that it can manifest in all manner of strange ways from gastrointestinal bleeding to strange neurologic symptoms to even gait-based phenomenon to flares of autoimmune conditions. And of course it can lead to many different psychiatric symptoms ranging from impulsivity (including homicide and suicide), self-injury, panic attacks and dysautonomia.
Now, I do not touch a medication dosage until my patients have completed my program, Vital Mind Reset, with no exceptions. It is very basic one-month commitment to a nutrition program, daily meditation and coffee enemas. Self-care is a devotional aspect of the entire process.
There is no cheating; with no exceptions and then and only then will we began a taper. Normally, I start with a 10-15% taper test dose decrease where I see how they do for about two weeks. Often there will be some declaration that that is too aggressive or that it is just fine. For example, if they are on 100 mg Zoloft, we will reduce by 12.5 mg. We might proceed at that very same dose decrease and if it goes well, we will do those taper decreases at month intervals. If the 12.5 mg taper wasn’t manageable, then we reduce to 6.25 mg taper and if that is not manageable, then we are looking in the compounding realm. It is not frequent that we need this slow of a taper, but it does happen that I need to go down to a 1% taper per month because it is so medically destabilizing.
It’s a very personalized journey and highly individualized and it important to frame this process as not something just to get through, but as a shift in consciousness that needs to undergird the physiological adaption to life without meds. There was a mindset that brought you to meds and you need to be initiated to a mindset of faith and trust that needs to emerge on the other side because otherwise what has changed in your consciousness.
My goal is resolve all of the root causes that led to medication in the first place. Whether that is a B12 deficiency, hypothyroid, toxicant exposure, etc. and to resolve that on the physiologic level and to work on the mindset shift that is necessary to move forward. We create the space for the spiritual awakening that, in my experience, 100% of the time comes with this process.
Dr. Beaudoin: What type of supplement do you use to support your patients?
Dr. Brogan: I don’t ever start with supplements as we always start with the month-long self-care regimen as described above first. After the first month, I use supplements for taper support, which generally includes combination formulas (amino acid & B vitamins) to support serotonin, dopamine or more generally neurological health or a plain amino acids supplement. I often recommend N-acetyl cysteine\NAC and also occasionally SAMe, but rarely. I use a base of amino acid support as well as fatty acid support. I also use phosphatidylcholine, evening primrose oil and cod liver oil or fish oil (with the full spectrum of fatty acids as my patients are eating a fair amount of saturated fats). Dr. Gonzalez also taught me about digestive enzymes and glandulars (adrenal, thyroid, hypothalamus, pancreas and liver). I often don’t start with a probiotic as my patients are eating a bunch of fermented foods; rather, I view probiotics as a strategic intervention in my taper support approach. For calming agents, I might consider an oral lavender extract, L-theanine or GABA and sometimes adaptogens, like rhodiola, ashwagandha or holy basil as needed.
Dr. Beaudoin: What type of dietary modifications do you prescribe?
Dr. Brogan: The basic protocol is a Paleo-style template with pastured animal foods, eggs, natural fats (olive oil, coconut oil and ghee), nuts and seeds, all vegetables and fruits as well as honey and maple syrup. During the first month, we do eliminate resistant starches (white potatoes and white rice), all grains, dairy, sugar, coffee and alcohol and processed foods. We do reintroduce white rice and white potatoes because I believe these foods are beneficial and most of my female patients don’t do well on a low-carb diet. There is personal tailoring and the signal becomes clearer to the patient at the end of the first month. These dietary recommendations were first anointed by my mentor, Dr. Nicholas Gonzalez, based on different metabolic types and the way that foods compliment the autonomic nervous system dominance in patients. We are just publishing a book by Dr. Gonzalez posthumously that we found on his computer called Nutrition and the Autonomic Nervous System. It’s an incredible gift.
Dr. Beaudoin: You mentioned toxicant influences as a factor to you consider. Do you include aspects of environmental medicine into your practice and program?
Dr. Brogan: Yes, I ask my patients to engage in conscious consumerism. We look at all products they purchase. I feel especially passionate about water filtration because finding that I’d been falsely informed that NYC has the best water on the planet when in fact it has 600 disinfectant byproducts, chloride, fluoride and glyphosate. It is such a powerful move to start filtering water properly. I’m very concerned about what we are doing to this planet. Also, on a psycho-spiritual level, what we do to this planet, we do to ourselves. When you’re thinking about how to clean up this body, you’re also thinking about how to clean up this planet. An intentionality that is necessary to find our way out of this.
I went into the interview anticipating hearing about things like hormones, neurotransmitters, inflammation, gut-brain connection, inflammation, toxicant exposures, the microbiome, histamine imbalances, etc., and instead of taking my left brain down this road, Dr. Kelly Brogan knocked on the door of my soul and shared her unique approach. An approach that encourages and empowers patients to learn and grow from their suffering, to reach into themselves for something more, to care deeply for themselves, in a way that brings them toward a physical and spiritual awakening and transformation.
Thank you, Dr. Brogan