In this episode of Functional Medicine Research, I interview Dr. Robert Hedaya about overcoming PTSD. Post-traumatic stress disorder is an extremely difficult condition to manage but Dr. Hedaya and I discuss multiple approaches that can help patients with PTSD get well. We discussed how PTSD is defined, how it changes the brain, QEEG guided laser, neurofeedback, loneliness, social isolation, social media and much more. I always love having these kinds of conversations with psychiatrists and other mental health professionals because I believe it is the most overlooked aspect of functional medicine today.
Below is a transcript of the interview on overcoming PTSD:
Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research." I'm Dr. Hedberg and really looking forward to today's conversation with Dr. Robert Hedaya. I first heard him speak at the Institute for Functional Medicine last year on PTSD and so I wanted to have him on the show to talk about that. He is a medical doctor. He's been on the cutting edge of medical practice, psychiatry, and psychopharmacology since 1979. With the publication of his first book, understanding biological psychiatry, in 1996, he pioneered the use of functional medicine in the psychiatric field and he is now pioneering the use of G-guided laser treatment of neuropsychiatric disorders.
Dr. Hedaya is a clinical professor of psychiatry at Georgetown University Medical Center where he's been awarded the teacher of the year on three occasions while teaching courses on affective disorders, cognitive therapy, and one of my favorite topics, psycho-neuro-immuno-endocrinology. Since 1983, he's on faculty at the Institute for Functional Medicine, the author of two additional books, "The Antidepressant Survival Guide," and "Depression: Advancing the Treatment Paradigm," and he's the founder of the Center for Whole Psychiatry and Brain Recovery. Dr. Hedaya is an editorial volunteer for Advances in Mind-Body Medicine and Alternative Therapies in Health and Medicine. He's been featured in local and national media on things like "20/20", "60 minutes," "Vogue," "The New York Times," and "The Washington Post" on many occasions. And he's a frequent nationally and internationally recognized speaker. His website is wholepsychiatry.com. Dr. Hedaya, welcome to the show.
Dr. Hedaya: Thank you very much for having me.
Dr. Hedberg: Excellent. So, like I said, I heard you speak at IFM last year and was really interested in your research and studies on PTSD. Why don't we start by you just talking about how your career evolved from traditional psychiatry into functional medicine and now using some cutting-edge treatments for treatment-resistant depression, dementia, PTSD, chronic fatigue, and technologies like laser?
Dr. Hedaya: Okay. Well, it's been a long arc and I would say that the main thing is that I always try to follow where the science guides me, what's the truth that as far as I can best make it out to be. So, rather than being afraid of stepping outside of the box, you know, I just feel it's my responsibility, as a clinician, helping people to always try to do the right thing, and the right thing for me means doing what the science dictates, and sometimes it's benched to bedside science. Sometimes, you know, like translational medicine, sometimes you have the studies, but following the principles of biology and physiology and sometimes you have to take a leap because you can't wait until the studies are there.
So, the way it started for me was, 1983 about, I was treating a woman with panic disorder and she was not really recovering. And panic disorder is pretty easy to treat. Whether you use cognitive behavioral therapy, which I was using, or medications or combination of the two. So, it was about a year and she wasn't getting better and she paged me, I had a beeper back in those days, on a Saturday night, I was at a wedding and dancing and my beeper went off and looked and there was a number and I went to find the phone booth and called her and she was having a panic attack and I was like, what is going on with her? You know, this should have been over a long time ago.
Anyway, I went into the office early Monday morning to see, look it through her chart, see if I can find any clues. And I saw that the size of her red blood cells in the mean corpuscular volume was a little bit larger than the...a little bit outside the range. The reference range was about 101, the normal range is 80 to 100. I was trained to think, well, it's just really not that far out of the norm, so ignore it. And to be frank, I didn't really know what it meant, anyway, so I have ignored it. Well, I did a little research and it turns out that, as you know, is a marker for B12 deficiency, macrocytic anemia, she had a little bit of anemia. So, anyway, I treated her, I did a Schilling's test to double-check my hunch, treated her with B12 and with the first injection the panic disappeared.
At that point, I was like, "Whoa." You know, the head is connected to the body by this thing called the neck and I gotta figure out, what else am I missing? You know, because as you may know in psychiatry, there's a very, very high percentage of people who don't get well. Now, I think it's over 60% of psychiatric patients are on at least three medications. So, it wasn't like that back then, but there was a revolving door phenomenon. So, one thing leads to another and, you know, I've learned over the course of years always trying to understand what's going on. You know, you learn more and more and more and more and before you know it, you know, you're really...I'm practicing psychiatry and neurology, but also doing immunology, endocrinology, gastroenterology, you know, the whole functional medicine thing.
And then that, in the last 2 or 3 years, really since in 2009, I reversed my first case of dementia and in the last 3 or 4 years, I have been treating a lot of neurodegenerative disorders using functional medicine and using other technologies now like hyperbaric oxygen or light treatments to the brain, etc. So it's been a long path but basically, I follow...The principle is that I would say is you have to follow where the science takes you and what the logic of the process is and not really be so worried about sticking with, you know, the traditional approaches because that's what the evidence base shows because the evidence base is skewed. We know it's skewed by the pharmaceutical companies. We know it is...and that's not to say medication is bad, but it's certainly skewed. And we know that there are limitations on who's gonna do what studies if there's not a profit in it. So, now, this idea of evidence-based medicine is nice in theory, but in practice, it has its limitations. So, you have to use logic and common sense. And that's really the main idea.
Dr. Hedberg: Let's dig into PTSD because this is an area of your expertise and I think a lot of practitioners and people as well may look at PTSD as a single event, you know, say a car accident or sexual trauma, something like that. But there can also be ongoing issues, say, with a parent, or teacher, you know, loved one, things like that. Can you talk a little bit about how you define PTSD and the variables involved in trauma that's not just a single adverse event?
Dr. Hedaya: Yeah, sure. So, PTSD really, there's a trauma, the actual post-traumatic stress disorder actually is a repetitive assault on the mind, on the body, the spirit, and this repetition of re-experiencing the trauma over and over again as if it were really happening at this point in time leads to very, very serious consequences in the body. I mean, it's really a whole mind, body, soul event. And, you know, the studies are very clear that PTSD is not a psychological problem per se. It's actually a whole-body problem. It affects...I think there are four studies that show that gastrointestinal ulcers are associated with PTSD, there's type two diabetes is associated with PTSD, there's certainly earlier mortality. Seven out of 10 studies show that there's a 29% increased risk of mortality. Inflammatory markers are up in PTSD, like interleukin 6, 1-beta CRP. Telomere length, which is associated with biological aging, kind of a marker of biological aging, in all of the studies that we've done, six studies, consistently show that people with PTSD have shortened telomeres. So, PTSD puts the person at risk for many, many disorders and it needs to be conceptualized as such. And so, to me, the body is under siege continuously and repetitively in PTSD.
Dr. Hedberg: And childhood trauma, adverse childhood experiences, the ACE scores and things like that, is that going to make the patient's PTSD more severe as an adult? The more childhood trauma they have, the more severe the PTSD as an adult or is that highly variable depending on the patient?
Dr. Hedaya: Well, it's a vulnerability factor. So, if you take a hundred people who have had childhood trauma and there is to some degree, a dose-response, right? The more trauma you've had, the more vulnerable you are. But it is overlaid on other factors. So, how much support does the person have? What's the genetic makeup of the person, you know, the child? There are a variety of genes, which I talked about at the presentation that you were at, but we can think of them as resilience genes. That's the NR3C1, FKBP5, corticotropin-releasing hormone-binding protein, and corticotropin-releasing hormone receptor 1 and 2. These are all associated with the risk for PTSD. And so, if a person has, a child has a high compliment of these variants in these genes, then essentially what it is, is that their stress response, their resilience to stress is reduced, and they have increased risk for PTSD, for immunological problems, for depression, and even suicide. So, it's really a combination of factors that are at play.
Dr.
