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104 Things You Can Do for Depression NOW | Dr. Ellen Vora

Dr. Ellen Vora (she/her) board-certified psychiatrist, medical acupuncturist, and yoga teacher who takes a functional medicine approach to mental health. Today’s discussion is a treasure trove of practical, no-cost actions you can take NOW to improve symptoms of depression without pharmaceutical intervention. From diet to sleep, time in nature to breathwork, tapping to Reiki, Dr. Vora empowers you to see how just a few small habit changes can make a huge difference in your mental health.

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Dr. Ellen Vora

Board Certified Psychiatrist, Acupuncturist, Yoga Teacher

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Website: ellenvora.com
Instagram: @ellenvoramd
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Show Notes

Dr. Ellen Vora on sleep
MindBodyGreen course: How to Control Anxiety, with Dr. Ellen Vora
MindBodyGreen course: Managing Depression, with Dr. Ellen Vora
Trauma work: EMDR and emotional freedom techniques (tapping)

From Dr. Vora: I’m currently working on a book about holistic approaches to managing anxiety, and I have an upcoming online group on holistic approaches to mental health beginning September 5

#melissaurbanreads

Burnout, Emily Nagoski PhD, Amelia Nagoski DMA

MU/EV: 00:03
Hi, my name is Melissa Urban and you’re listening to Do the Thing, a podcast where we explore what’s been missing every time you’ve tried to make a change and make it stick.

MU/EV: 00:20
Today my guest is Dr Ellen Vora, a holistic psychiatrist, medical acupuncturist and yoga teacher. Dr. Vora takes a functional medicine approach to mental health considering the whole person and addressing imbalances at the root rather than reflexively prescribing medication to suppress symptoms. She’s currently writing a book on holistic approaches to anxiety, but today we’re getting to the roots of depression. I first learned of Ellen when she wrote an article about tapering off SSRI safely. I think it was for goop and she mentioned she puts all her patients on the Whole30 so I outreached after that, began reading as much of her work as I could read and we connected online. We met for the first time in real life just a couple of weeks ago when we were on a panel together at Mindbodygreen’s Revitalize conference talking about the role of psychedelics and other drugs in wellness. That was a really interesting conversation and originally I thought we’d reproduce that discussion here for the podcast, but in the days leading up to recording, I realized that that was putting the cart before the horse.

MU/EV: 01:28
If my goal is to help you identify what’s been missing when you’ve tried to make changes and help you find new mindsets and approaches to help you shift, that wasn’t going to happen by talking about ayahuasca, so on the fly, as you’ll hear as the podcast opens, we went all the way back to the beginning. Why do we feel depressed and stuck? What’s really at the root? How can we shift our mindset towards one of self empowerment? What are some things we can all do right now for free to help us have that breakthrough moment and use that opportunity to take a step forward into the light? As you’ll hear, depression has many causes, but Lexapro deficiency isn’t one of them. We discuss all the ways diet and lifestyle impacts, mental health, and how that message can be delivered in a way that creates agency and empowerment, not blame or guilt. And Ellen shares dozens of practical, actionable, small changes you can make today to see a difference in your mental health immediately. This was a great conversation and we jumped in with both feet talking about some of this stuff before I remembered that I had to introduce her on the podcast. So you’ll hear some of this exploration before the podcast officially begins. I found my own light bulb moment here with Dr Ellen Vora and I hope you find yours too.

MU/EV: 02:55
So for this one, Ellen, I think diving into the level of conversation that we had at Mindbodygreen for my audience would be like a lot, but I would love to just kind of go back a little bit to the idea of depression and how we think depression like has been treated over the course of the last 25 years. And what we’ve now learned about depression. And I really love all of the examples that you give about things that aren’t medication-related that we can do. And then at the end I might dive into like, okay, what are some of the emerging treatments using things like ketamine or MDMA in a controlled environment. (EV) Totally. Yeah, I’ve been catching up on Do the Thing and I think I’ve listened to just about all of them now and I was like, Whoa, psychedelics is going to be a departure. (MU) But I was thinking about it from a perspective of, okay, the whole podcast is about helping people like finally do the thing and exploring all the reasons that they’ve maybe been stuck before or haven’t achieved success before. And I feel like this narrative that depression is essentially, you know, a serotonin imbalance at, or like you said, depression is not like a Lexapro deficiency, but that’s all we’ve had for the last 25 years. (EV ) Yeah, I’m all for talking about depression. I, I was just thinking about like Do the Thing topic today, psychedelics, you could see how that could be interpreted. (MU) Yeah (EV) Go trip your balls off! (laughter)

MU: 04:16
So what I’ll say is Dr Ellen Vora welcome to do the thing. I’m so excited to talk to you today. It’s so good to be here today. I think I know your thing, but the first question I ask all my guests is, what’s your thing?

EV: 04:30
Sure. As a holistic psychiatrist, my thing is empowering people to use diet and lifestyle, community and meaning to manage their mental health. And at times that means, um, avoiding the need to go on psychiatric medication and other times in the right circumstances, it even means helping people get off of psychiatric medications.

MU: 04:51
I appreciate that approach very much. A holistic psychiatrist. That’s something, it’s a term I’ve heard and I think it’s becoming more well known in the functional medicine community. But what specifically does a holistic psychiatrist do?

EV: 05:03
Yeah, well I basically made up the term. So the way I interpret it, the way I mean it is that I consider the whole person. I really think about somebody’s wellbeing from the minute they wake up in the morning and everything they eat and the thoughts that they’re having and the relationships in their life and how they feel aligned with their work or if they don’t. Um, and you know, every really every micro data point of your daily life I think is relevant and absolutely your story, your past, your traumas, even your epigenetic factors that relate to your ancestors. So I’m just taking the whole person into consideration. The way I was trained. It’s a lot more just reflexively prescribing a medication, basically saying your symptoms equal depression equals Lexapro and of conversation.

MU: 05:48
Right. And the only support that you gave from, you know, the, your medical training was about compliance. Are you taking the prescription the way that you should or are you taking it compliantly? There was never like a discussion about how to safely get off it or maybe how you could get off it.

EV: 06:03
Yeah. Even that word compliance I’ve always bristled at, it’s so patriarchal, right? It’s kind of like, are you complying with what I’m telling you to do? It’s like, what if somebody had an independent thought about whether or not it was what was best for them? It’s like, well, you’re noncompliant and you’re sort of bullied as a patient if you’re quote noncompliant.

MU: 06:20
So I have some experience with antidepressants. When I was in rehab, they were prescribed to me back in the late nineties as part of my rehabilitation strategy. I also happen to hook up with an incredible psychologist who forced me in my, you know, rehabilitation to unpack my trauma and all of the reasons that I was using in the first place. And talk to me about the idea of like using antidepressants just to elevate me to a point of functionality, but then doing the work through therapy to get off them as quickly as possible, which is exactly what I did. I think that’s a pretty unique approach to antidepressants, especially back in the 90s like we’ve been taught that depression is a chemical imbalance and the way to fix it is with chemicals. And in all the work that I’ve been reading of yours, there’s a much bigger picture at play here, isn’t there?

EV: 07:12
Yeah. I mean you had a uniquely good experience, um, using an antidepressant as a bridge to get somebody to a place where they can do the work and work through their trauma. I think that’s, you know, perhaps the best case scenario of any kind of psycho pharmaceutical experience. Um, so often, even if that’s the intention when something started, it’s pretty tough to then find the practitioner’s going to say, okay, it’s time for us to start tapering you off. Um, it’s hard work. We’re not trained to do that as psychiatrists. And then it comes with a lot of liability and the patients aren’t really necessarily happy campers throughout the process because it’s a real drug. It’s psychoactive and it has a real withdrawal. So people struggle. So, but you’re exactly right. We’re taught the so-called monoamine hypothesis of depression and that’s fancy for, we’re taught that it’s a serotonergic chemical imbalance and, um, this has actually less evidenced space than we’re all like accustomed to thinking because it’s, um, it’s at this point, so just accept it as fact.

EV: 08:12
But in fact, it was deductive reasoning in the first place. There were certain substances really for tuberculosis that impacted serotonin levels and seem to create an antidepressant effect. And then the industry has run with that. And now, you know, there was some really effective marketing, especially in the 90s. If you remember the Zoloft commercial with little bubbles, it had like a sad face and then happy face after so long. Like we’ve all just basically gotten on board with this idea of, Oh, okay, my depression equals a chemical imbalance and there’s this medication that will rectify that imbalance. So let me take that and I’m treating my disease. And it goes with a lot of ideas also that, um, uh, treating mental illness as a more physical disease rather than a moral failing. Um, which, you know, I’m not necessarily opposed to that, right? Like I’m, I, I think at this point we should all be long past the idea of mental health as a moral failing. And I’m all for de-stigmatizing it and for us to treat it like anything else. But I don’t think it’s exactly physically like anything else. And I don’t think that we’ve got it. It’s not answered so simply as a chemical imbalance.

MU: 09:16
We all thought that that’s exactly why we’re depressed. It’s that chemical imbalance. And you’re saying not only is that not what the literature is showing it, there’s so much more to it than that.

EV: 09:28
I did a research fellowship when I was in medical school and I was in a pet scan imaging like a brain imaging lab. So this is as good as it gets in research. And these were big ticket studies and all we were really trying to do was establish an objective basis for different mental illnesses like to use pet imagery to show and to point and say this is what depression is, this is what suicidal thinking is physically in the brain. And uh, we struggled. And so, um, it’s, it’s something that I think for me it’s just always felt right to open my mind and step back and think what the heck is depression? Like what is mental illness? To me it’s 50 different things. And I really take all of those into consideration when I’m meeting a patient and thinking, how do we get you feeling well?

MU: 10:13
And that approach is right. And that approach is true. But that approach is also so much more complicated. And I think from a practitioner’s perspective, but certainly from the perspective of a depressed person, I want it to be simple. I want you to tell me that there’s something wrong with my brain and here is a pill that you can give me to fix it. Like I want it to be a one to one. I want to take some of that responsibility off of myself because if you tell me it’s just a brain imbalance, like, well, there’s nothing I could have done about that. But if you tell me that it’s 50 other factors and then we start detailing them as I’m about to, all of a sudden I have to take some responsibility for this condition that I am now really suffering from.

EV: 10:54
Yes. And, um, we take a deep breath and we hug, and then we both, I don’t usually hug my patients, but, um, but then basically, yeah, I mean we do need to do a little tough love around the idea of personal responsibility, but it’s much different than blame, right? I could never in a million years blame a patient for where they’re at. Um, but personal responsibility is very empowering and it’s actually a lot more hopeful. That stance of I’m, I’m the person with depression and I’m broken and I need you, doctor in the white lab coat with the prescription pad. I need you to fix me. Um, as much as that’s our cultural standard and it feels quote easy to just take a pill that is not an empowering or hopeful way to go about your life. And instead I empower my patients to realize like, this is actually very much in your control. You might need me, you don’t really need me. You might need me for two or three hours just to, you know, run you through the basics and to a pretty bespoke understanding of what’s out of balance for you. So we can point you in the most high yield direction. But really this is the basics. It’s unsexy, it’s the fundamentals. It’s like how we actually take care of ourselves, mind, body and spirit.

MU: 12:00
Yes. And that’s exactly what I wanted to get to is in the beginning. I think to, to learn about some of the dietary and lifestyle factors that can be associated with depression might feel overwhelming and it might feel as though, or you may feel as though you have to accept some blame. You might even feel guilt for some of this. And I’m speaking from my own personal experience, but then once you sit with that for a moment, it does become incredibly empowering and incredibly hopeful that, you know, if some of my diet and lifestyle are contributing to this, then I can make some changes that will also contribute in a positive way. And that’s exactly the reframe that I think needs to happen in this situation.

EV: 12:37
Yeah. I mean, I think it’s my own, um, sort of defensive style. But basically I don’t really ever hate the player. I hate the game. I think that there’s a lot about our modern life that is directing us down a river to making choices. Um, just automatically default setting choices that get us really out of balance. So I really like to empower and inform my patients how they can rebel and opt out of a lot of the mainstream default settings that we’re all in. Um, that changes the way they eat and the way they approach technology and work and community and sleep and things like that. So it’s definitely overwhelming. Um, and the biggest burden of my work is actually behavioral change, which I am not trained in. You know, that would be amazing to just have another degree in the psychology of behavioral change.

EV: 13:23
Um, but basically I do break it down, um, where we start with the physical body because that’s the low hanging fruit and it’s really actionable and it’s actually, it sort of gets you the most rapid change and it’s something that’s really underappreciated mental health is that mental illness, we think of it as like psychological and just in your mind is absolutely a physical illness and a physical body that’s inflamed or out of balance or missing certain micronutrients or having a thyroid condition. All of that impacts the brain, the physical flesh, brain and your skull, and then a brain that’s unhealthy shows up as mental health issues as depression, anxiety, bipolar and so on and so forth.

MU: 14:07
Absolutely. I love what you said in the beginning about this idea of like almost pulling the curtain back and helping people understand the ways that like the system, and I’m using quotey fingers here because whether we’re talking about super normally stimulating, you know, calorie dense nutrient poor foods or the way our society is so focused on like being busy, if you can pull back the curtain on that and people can understand that of course they’re always responsible for their choices, but in some cases the system is setting us up for this fall. It can make you feel less like out of control. If I find that there’s a reason why I’m over consuming and craving sugar this much, then I feel more empowered to do something about it. And I understand the cycle that I’m stuck in.

EV: 14:49
Yeah, I think the is, we’re all swimming in this siege is um, you know, nothing against capitalism, but I think that the most successful companies in the world, the reason they’re successful is that they’re selling a product that the human brain gets addicted to. And that’s a great business model and it’s a horrible health model for us as the individuals. So if someone’s selling you sugar or alcohol or, um, video games or Instagram, which I think I’m addicted to at this point. Um, and, and I would say in a more controversial sense, like certain psychiatric medications, um, all of this, it addicts us and then we’re in these cycles of suffering where we’re not really free and we’re not feeling our best. And so I think, you know, the way rather than just feel defeated by this and feel empowered is to recognize like you can opt out at these things, everyone can opt out of these things and it’s sometimes hard work. You don’t want to overhaul your whole life in a day, but you just start to get conscious of it and start to recognize how it’s working in your life and chip away at it. Little by little.

MU: 15:53
Yes. And it is hard work, but I have said this before, you choose your heart. So doing the hard work of opting out of the system and making these changes and doing the introspection and the therapy and like the brutal self awareness, that’s really hard. But what you’re doing right now living with this depression and feeling powerless and feeling like you’re stuck and like you’re never going to be able to fix it. That’s also hard. So, you know, pick your hard. (EV) Sorry, we’re, we’re like Gretchen Rubin upholders, right? So we’re like hard, it doesn’t matter. And like I get it now after years and years of doing this work…

EV: 16:24
that, you know, for the, the Rebels and everybody, it’s, it is hard to put one foot in front of the other. And, and I think that the real problem is that people don’t feel motivated. They feel defeated by it. You basically are thinking that there is no hope. And so I really liked to get a couple quick, easy wins at the beginning where someone sees, okay, if I make this one small change, I start to feel better. And then we can build on that. People can recognize the shift. Yeah.

MU: 16:51
Can turn around. Yes. Those small wins. We talked about that in another podcast. Don’t deny yourself those small wins. Let’s talk about some of the physical contributors to depression and I’m looking at diet. (EV) Oh yeah. Do you think diet impacts our mental health? (MU) I mean I do and I think that this information is like only now making its way into the mainstream, which to me is bananas cause we’ve been talking about this for like a decade. (EV) Well it’s not just bananas cause we’ve been talking about it for a decade. It’s bananas because like I would have thought it would be intuitive but it’s not. So that’s fair. I still get forwarded emails from friends and family members that are like, look, an article that said gut health or diet impacts mental health. And I’m like, Oh really? Now it’s been validated by the New York Times. Now it’s real. (MU) So I know. But you know when you tell somebody you should quit smoking because the smoke is bad for their lungs. They’re like, yes, I make that connection. When tell someone you should stop eating gluten and you will feel less anxious or depressed. It’s hard. Like we need people like you to make that connection for us.

EV: 17:56
(EV) Yeah. And there is also that issue which is that like smoking is a little bit of a one zero and diet is more of a spectrum. So it’s like, um, you know, if you’re like, okay, cigarettes are absolutely a problem in my life, you can move away from cigarettes, you can stop hanging out outside of your office building where people are smoking and if can be a little bit out of sight, out of mind food. It’s like there is no way, you know, we could, we could just move to a Whole30 island. (MU) That sounds like, it sounds like some kind of theme park. Cool. I’m going to put that in my notes, sign me up. (EV) But in real life, what happens, and I’ve lived this myself as you make the choice to eat in a certain way and then you go out to dinner with friends, which is absolutely part of what makes life good and worthwhile.

EV: 18:35
So you shouldn’t stop doing that. But everybody else is having pizza. And it’s hard because it’s a drug and we’re addicted to it. So diet matters. I’m to use your term, it starts with food. I really start with this in my practice. It is the number one, first thing we do and it’s a little different for everybody. I very much keep Gretchen Rubin’s, um, template in mind because I want to talk in a way that’s the most likely to get buy in and to have someone make behavioral change. So if it’s a rebel, it’s like I will. There’s no like rules, rules, rules, but I use Whole30. It’s what I’ve always used. Um, I’m so grateful that it exists because I used to try to write my own version of a whole30 and it just wasn’t as clever or as pithy. And I used to like really tiptoe around like, yes, this is so hard.

EV: 19:18
And then I read the whole30 rules and they’re like, hard, like childbirth is hard, you know, this is not hard. And I was like, yeah, I can do tough love with this. Um, and so I appreciate that. I just have this handout and I give it to my patients and they get started. And it’s interesting. It’s one of those things in health, which is both, um, therapeutic and diagnostic. So it’s therapeutic in that a month of eating whole 30 and my patients feel better and we’ve started to take the burden of inflammation off their body. We’ve started to fill their plate with nutrient dense foods and that’s starting to replete some of their micronutrient deficiencies, which helps with mental health, but then also as they systematically reintroduce the foods that they’ve been missing, um, then we get a really crisp, clear indication, here’s what your body actually tolerated and here’s what you don’t tolerate. And that knowledge is so worthwhile.

MU: 20:07
Yeah, it is. And I appreciate that. I think that was how I found you is I read an article where you were talking about tapering off SSRIs, and you mentioned you did the whole30. You use the whole30 with your patients. And I was like, sweet. You know, your professional endorsement means a lot. But I also love that you feel like we’ve taken a lot of the legwork out of providing kind of a foundation for your patients. Obviously, however, just doing the whole 30 is not going to fix everybody’s depression and there are other physiological things that could be happening that bacterial imbalances, thyroid issues, hormonal imbalances, um, that all could be also contributing to depression. Is there some testing that you like to do with patients after they’ve implemented some?

EV: 20:48
As functional medicine docs go, I’m really low on the testing. Um, I used to do a lot more testing basically. Sometimes I’m going to take a pretty good, um, sort of multi-angle look at the thyroid. Um, I think that’s one deficits in conventional medicine is people will take a pretty incomplete snapshot of the thyroid and say, you’re fine. Um, or maybe you’re going to have a thyroid issue in a few years. So conventional medicine to be like, Ben, we’ll deal with it then. And it’s like, no, no, no. I want to know now if we’re heading down that path. Um, so I take a pretty close look at the thyroid. Um, and I’ll look at things like hemoglobin A1C to give an indication of how somebody is tolerating, like how much they’re having blood sugar swings and how insulin sensitive they are. Um, and I’ll look at things like B12 cause B12 deficiency is actually also very common.

EV: 21:33
Sometimes I want to see some gut, like a little bit of a stool sample. Um, but basically I think that most of like the first several months of working with somebody is all of these diet, lifestyle practices that I don’t feel required testing. And then if we’re stuck, if someone’s really actually not making progress in the way I would expect, then we’ll start to look under the hood a little bit more closely. (MU) Yeah, that makes sense. So starting with diet, because it starts with food, which I also think there’s a psychological component to it and that I feel like when people believe that, like every aspect of their life is out of control, if they can feel good about the food that they’re eating and feel like they’re in control of what they’re eating, not in an unhealthy eating disorder-y way but just in a fact of like, I know that I am following this plan that is nurturing my body the best it can right now.

EV: 22:24
I think it gives people capacity to tackle other areas of lifestyle and stress management where if you start with something else, maybe you start with exercise or movement or meditation. I don’t know that it has the same trickle down effect. I don’t know if you’ve observed that, but that’s what I’ve seen with Whole30. (EV) 100%. I used to debate whether to start with exercise or start with sleep or start with food. And I always start with food. Um, for exactly that reason and I think I want it sort of helps with that kind of decision fatigue and gives people a baseline of feeling. Okay. Um, but also people are so often not free in their relationship to food and we, someone might initially think, um, okay, I’m, I have freedom with food because I eat everything, I eat anything. I just eat what I feel like eating.

EV: 23:07
And that’s a form of freedom. But if someone, so often what I see in my patients is that it’s actually more like a substance abuse relationship to certain foods and then it’s not freedom. Um, and so I try to cut out the substance abuse, you know, sort of the drug like foods so that someone actually has freedom in relationship to food. (MU) Yes, exactly. I call that like the smells like teen spirit food freedom, like teenage rebellious food freedom where it’s like I can eat anything I want. You can’t tell them what to do, which is very different than the kind of food freedom that we’re talking about. Um, I want to talk about sleep next. Sleep feels a little bit like a double edged sword when it comes to depression because too little sleep obviously is a huge, but also when I’m feeling depressed, I kind of don’t want to get out of bed and that’s not the kind of sleep that we’re talking about.

EV: 23:51
What can you tell me about sleep, (EV) well, yeah, that kind of sleep where you’re sleeping too much when you’re depressed. So first off, sleep is a wonderful treatment for depression, but the way that, um, what we see as when someone’s depressed, they might be what’s called hypersomniac or sleeping too much. Um, to me that’s more of an effect and not a cause. So I don’t think the access of sleeping as contributing to the depression, I think it’s a, it’s an indication to me that there is a physical component to the depression. This is where we talked earlier about the monoamine apotheosis of depression. That’s the serotonin chemical imbalance idea. But I subscribe much more to the inflammatory or cytokine model of depression, which is to say this, um, depression is just a symptom of a body and a brain that’s inflamed, systemically inflamed. And so what you’ll see is someone behaving exactly like we would on the proverbial Savannah if we had just caught a parasite or a bug.

EV: 24:43
So we would retreat and isolate from the tribe because we are contagious. We don’t want to infect everybody else. And then we would rest a lot so that our body, our immune system can fight off the microbial, like the microbe that’s invaded our body. Um, we won’t want to eat in the same way we usually do. We don’t want to socialize. We don’t want to have sex. Um, we don’t necessarily want to focus on work and we just want to rest and heal. And that worked pretty well when it was an infectious agent that our body was fighting. But these days it’s like processed foods. It’s like Doritos that our body is fighting and we get that infection again, every meal. And so it gets real. Our body is like, what’s, how do I fight this bug off? It’s very powerful. And so that’s, I think contributes even to autoimmunity and why we, um, start to like our immune system goes rogue just fighting and fighting Doritos and never winning the battle.

EV: 25:35
Um, but so that kind of hypersomnia of depression I think is just a marker of the fact that we are inflamed and your body is doing its darnedest to try to fight off the agent that’s making you inflamed and using sleep as a tool to treat depression. I mean, it’s like tied for first place. Okay. My first place is like food, sleep, meditation and exercise. They’re all tied. Um, but so basically getting better at giving yourself good quality and sufficient quantity of sleep is such a wonderful medication because it’s free and it feels awesome and it helps with every metric of health, um, including increasing your lifespan, making you creative and productive at work and more patient and a kinder person. Um, and it just works on every level. Um, but it’s usually what I come up against to someone saying, okay, I get it. I buy in, I want to sleep better, but I can’t. And my absolute favorite thing to treat is to help somebody who can’t fall asleep or stay asleep, fix that. Cause that to me is imminently fixable and um, it’s just, uh, we have so many aspects of our modern life that irritate the system. They get in the way of us being able to fall asleep and stay asleep. And so I like people to get really strategic about all of those modern life factors.

MU: 26:46
Yes. I’ve had a couple of really good articles from you even recently about how you kind of set up your own sleep schedule. I will link to those in the show notes because I think we could probably do a whole episode on sleep all by itself. Um, but I do, I believe it is the between sleep and meditation. I think those are like the real MVPs. Yeah. You talk a lot about stress and depression as well. And stress is such a big category because you can have stress from your diet or you can have stress from sleep or lack of sleep. You can have stress from financial, from a emotional, I mean stress is such a big one. And to eliminate stress, I’m certain would help with depression, but then the depression kind of contributes to your stress. So what kind of tips can you give people about managing stress when they’re feeling depressed or having, yeah.

EV: 27:31
(MU) Yeah. I want to say I love treating stress too, but actually do I, because it’s tricky. It’s a little bit different for every situation. I always start with the physical health. So there are physical ways to make your body more stress tolerance and more resilience. So I get someone’s blood sugar stabilized. You get them sleeping better, you get them not inflamed, you heal their gut and then suddenly their body, they’re just physically more stress tolerant. Everything gets easier. I like to, I don’t make any friends with this one, but I like to get people off of caffeine sometimes when they’re really, their body is always like looking for a fight basically. It’s like your nervous system is so amped up by the caffeine. It makes things more stressful. But then

MU: 28:06
I see, yeah, that’s why I stopped drinking caffeine was my anxiety. Yeah, for sure.

EV: 28:10
There’s this whole category of things we know to do, but like you’re kind of like, if you’re not doing it, there’s a high activation energies. So meditation, practice, Yoga, you know, there’s so many beautiful practices that like Tai Chi and Chi Gong, journaling all these ways. I also focus on completing the stress cycle, which is a concept I learned from the book Burnout by Emily and Amelia Nagoski, which is really an incredible book. And so well written and so woke. And they are basically, they teach us how you have to discharge the stress after it’s come in. Um, and so, you know, you either need to exercise or cry or hug someone you actually like or kiss somebody you actually like or journal or make art or sing or just feel connected and vulnerable and that you belong by the community. And that’s a really wonderful way to complete the stress cycle.

EV: 28:56
So it doesn’t just keep building up. But my last way to approach stress, I really do like to encourage people to step back in their lives and make pretty counter mainstream rebellious choices to opt out of all these default settings that are making our culture so burned out and chronically stressed. And so maybe it’s that, you know, just don’t keep technology around you for a chunk of time. Maybe it’s that you say no to more things that are coming up in including certain controversial ideas. Like I think that, um, some people will more reflexively say yes to certain promotions or new projects at work, which sometimes it’s absolutely the right decision, but sometimes it’s actually not. Um, so I, I just don’t want anyone to autopilot any of these decisions and basically saying no and making more spaciousness in your day to day life and then reclaiming that time from the truly restorative practices like um, reading, making art, singing, connecting to someone, talking in real life to somebody rather than all of these distractions that we do that leave us feeling kind of icky afterward.

MU: 29:57
Yeah. Yeah. People ask me all the time, how do you find time to read so much? And the answer has, of course I make time, but the specifics are that at least two nights a week I go to bed, toddler early. I put my son to bed at like eight and I go to bed right after him and I leave the dishes and I leave everything else. And instead of like scrolling Instagram for an hour and a half from bed, I put my phone away and I pull out a book. And I think the more time I spend away from my phone, the less stressed in the happier I am, to be honest. (EV) The phone is this one intervention. It comes up a lot in my practice. Um, with sleep. I like to get people to get the phone out of the bedroom completely. That I think helps so dramatically with difficulty falling asleep and staying asleep for a number of rate ways that I could bore you with.

EV: 30:39
But then I’m also just its presence in her life. You basically want to bring so much consciousness to this little wonderful, useful, helpful and addictive problematic device and just don’t default into the fact that we all keep it at the dinner table and we check it when we’re in the middle of talking to someone. Um, all these practices chip away at our happiness and our satisfaction in our lives. So you just get more conscious and you know, um, I I’d love for people to like absolutely just throw it out the window, but short of that then you just have a lot of customs around how you make space between you and the phone. (MU) I am going to do that. I’m going to get my phone actually out of my bedroom. It’s not out of my bedroom. I put it on do not disturb. But like there are definitely nights where I think there’s something and like I put my book down to order something on Amazon, like 9:00 PM I’m going to do that.

EV: 31:23
I’m going to get my phone out of my room and then I’m going to text you and let you know how it goes. (EV) accountability, not that you need that as an Upholder. (MU) Yeah, and some of those radical experiments can be really like cascading in terms of the inertia to just put one foot in front of the other. Exactly. That’s a keystone habit change and then you start to read in bed more and all this. (MU) I want to mention the idea of trauma too. Trauma is something that many of us have experienced. I guess how I would say it is that trauma is basically whatever you decide trauma is right. There’s no one definition. If you feel like you’ve had a traumatic experience that’s yours to own and, and process and work through, but trauma is also a huge part and sometimes at the heart of depression isn’t it?

EV: 32:09
So often depression, all of the mental illnesses, and amazingly also a lot of physical illnesses, things like autoimmune conditions are also much higher prevalence in anybody with history of trauma. In one of your articles, you talked about some of the various treatments for trauma therapy is a fantastic way going to talk to an expert about your trauma and unpacking it. But there are also some things that you can do on your own that are like free and totally portable, like tapping and you talk about some of those alternative treatments and their effectiveness with some of these, um, traumatic situations and also depression. Yeah, I think that so much of trauma, I personally prefer to approach it in a nonverbal way. I think there’s definitely a time and place when like talking about it with an expert is absolutely transformative. But I think of it as like something that gets almost physically stored in the body and kind of shoved into a closet in the brain and you want to create conditions where your body can do some housekeeping and kind of release it, discharge it up and out and so, um, exercise.

EV: 33:09
But also, um, all kinds of different movements. So tapping is a wonderful thing that combines, um, you’re basically putting pressure on, on acupuncture points, but then you’re also saying positive affirmations or affirmations that just help you work through and change your narrative on the trauma. Um, I like people to do different kinds of dance. Um, especially like when you can get into a little bit of a trance state with dance and I love energy work, which is not necessarily free, but um, can be pretty accessible, especially if you do things like community acupuncture or um, you know, even getting trained in something like Reiki and you can start to do the Reiki on yourself. Um, there’s so many different ways of accessing it non verbally in the therapeutic setting. I love sematic experiencing therapy and then also EMDR, um, as really good, not so, not quite.

EV: 33:56
So verbal approaches to processing trauma. (MU) Yeah, I did some EMDR with my trauma and I found it incredibly empowering and helpful. I can also second the idea of exercise or movement. I often experience, um, enormous releases when I’m in Yoga class, particularly in like hip opening postures. I cry a lot in Yoga, which I think is great because I’m releasing that. My boyfriend Brandon has also talked about how his art has been a really powerful kind of antidepressant that when he’s creating and drawing and using that part of his brain, he feels like the part of his brain that’s always telling him he’s not good enough. It goes quiet. (EV) Exactly. You want some way of getting your conscious that the sort of like over eager, conscious mind vent. We all really sort of obey and privilege all the time. You want to get it out of the way and directly access your unconscious and let it do what it knows how to do.

EV: 34:48
And so basically drawing, journaling, um, crying all of these ways of um, getting out of the way and letting the unconscious put onto paper something that will just help it master when it struggling with. (MU) Yeah. And I’ll again make sure to link all of these and show notes. I think there’s a ton of information here for people. I also want to mention because the panel that we were on together a few weeks ago at mindbodygreen’s revitalize was all about the role of psychedelics in wellness. And while that topic is definitely a little different than what we’re talking about here, we have had some great conversations about the next level use of things like ketamine or MDMA in terms of depression and trauma work. It’s not legal, at least some of it isn’t yet in the United States. But can you talk about some of the promising aspects of these therapists-managed drug interventions?

EV: 35:37
So few things lend themselves to the need for nuance discussion, quite like psychedelics. So basically these are an incredibly promising potential treatment for mental health issues, but that does not mean they’re one size fits all or right for everybody in all situations. So there’s so many contra-indications, someone who has bipolar disorder or schizophrenia or if they’re at risk for these conditions, which could be, if you have a first or second degree relative with these conditions, that’s like that chaotic brain and you really don’t want to introduce more chaos into that brain. But for people who are stuck in certain ruminative or entrenched behavioral patterns, things like Ruminative, depression, addiction, PTSD, OCD, that’s where I see these treatments actually having really high potential benefit. A few of them are now breakthrough treatments. So, um, MDMA for PTSD, now that’s a lot of initials, but MDMA this substance sometimes thought of called ecstasy or Molly, um, being used as a treatment for posttraumatic stress disorder.

EV: 36:39
And then Psilocybin, which is the active ingredient in magic mushrooms as a treatment for end of life anxiety and now also depression. I think there’s also a trial on, on OCD. Um, and then many of these substances are in trials for addiction, for smoking cessation, like tobacco. The results that we see with these trials put conventional psychiatric medications absolutely to shame. But these are really carefully conducted studies and there’s, you know, a lot of people are ruled out and not allowed to participate in the studies. And I think that’s one thing that we shouldn’t lose sight of as we start to see these come to market. (MU) Yeah. And one of the things we talked about a lot on that panel was the need for, for this kind of treatment to be integrated with a big picture holistic approach to whatever your therapeutic practices are. So it’s not like you can just drag and drop and you know, go find a Shama in and do some ayahuasca and you’re good to go.

EV: 37:32
(EV) All of this, your experience, whatever that looks like, needs to be mediated and integrated into what you’re doing as part of your therapeutic practice before, during, and after. The big mystical experience that you can have with these is necessary but not sufficient. And the incurred integration work that you do afterward is really what moves the needle longterm in your life. And that’s where you start to integrate the insights, the experience, the challenges you came up against in the journey and the psychedelic experience. Um, and then with a really enlightened practitioner who can help you make sense of all that and help you put it into practice in your life, that’s where you start to see this making a massive difference in somebody’s wellbeing. (MU) Yeah, I, you know, I think it’s really important to talk about some of these really promising studies, but it’s also important to note that it’s not like you don’t get to skip all of the other work that we’ve already talked about in terms of looking at some of your dietary factors and lifestyle factors and stress management and processing your trauma.

EV: 38:27
None of these therapeutic interventions, these drug interventions are going to replace all of the work that you have to do if you want these lifestyle changes to be sustainable. (EV) They, yeah, if anything, they’re really just a good catalyst for letting those changes stick. So one thing we see with a lot of the psychedelics as they promote something called BDNF, which stands for brain drive neurotrophic factor, um, which promotes neurogenesis and neuroplasticity in the brain. The translation is your brain can change and grow and adapt. So you have an opportunity, a window of opportunity to get unstuck and to un-entrench certain behaviors. So this is an opportunity basically if you have an experience like this, um, you, you have a really good window to do all the work and have it stick and have it really make change. (MU) You’re talking about these interventions as maybe unlocking a window of opportunity for you to sort of, um, experience your brain and your life in a different way and kind of level up from there.

EV: 39:20
But you can do that through other practices that don’t involve taking a psychedelic like meditation or breath work. Right. Can you talk about some of those that also may be available to those of us who aren’t willing to go down the psychedelic route even if we could. (EV) So, so many practices can get you there. Honestly, like what we talked about before, even just getting the phone out of the bedroom, it’s a keystone habit change that starts to make it possible to make other changes, but certain things that more closely resemble a psychedelic experience would be a meditation practice. Um, psychotherapy itself also a good, you know, road to the unconscious self. Um, and then something called holotropic breathing as sort of the non chemical non drug way of, of achieving a psychedelic trip state. I would say with that, like I caution it, I have to do my homework on this, but I don’t think of it as necessarily I’m a hundred percent safe even though it doesn’t involve a drug.

EV: 40:13
I think that it really can induce a, it’s sort of a psychedelic experience so that once you want to approach that with some gravity as well. Yeah. Speaking from personal experience, that is true. (MU) Um, I have definitely had some really intense experiences doing breath work, but things like group meditations, sound meditations, I even feel like I get that endorphin connection to God when I go hiking, there’s always a moment on my hike or I’m by myself and I’m out in the middle of nowhere and I’ve been moving my body or I come around the corner and I get a view in like, there is that moment for me and usually, you know, I’ll cry, I’ll express gratitude and whatever it is. But I think we can achieve that unlocking in really small ways with actions that we can take by ourselves in this moment. And that the key is to take advantage of unlocking that moment and then use that to force or create additional momentum and inertia.

EV: 41:10
So beautiful. Yeah, and I think I saw this like spoof joke commercial ones, which really hit home for me, which is describing depression as nature deficiency disorder. It’s like, rather than, I’m like, you know, Serotonin deficiency. It’s um, it’s nature really. Right? So that’s the best trip. And it’s not even a drug, it’s just what you, it’s just what life used to be for humans. And so are, um, our genes have come to expect that we’re going to see a certain amount of green and we’re going to smell dirt and we’re going to get the perspective that you gain when you get on top of a mountain and you have a view and you realize like this is a resplendent majestic world that we’re a part of. Um, and it involves moving your body and breathing fresh air and being a little bit distanced from being surrounded by Wifi routers and your phone sending you pings and things all day long coming at you. And so, um, just the perspective that comes from that and all of these ways that it charges up your body with what it needs. Um, so yeah, I think that that’s like, you know, also a sec valic experience in certain ways.

MU: 42:10
Absolutely. I mean, talk about the idea of like feeling grounded. We all talk about, oh, I need to feel more grounded or I feel like I’m kind of floating away being out in nature. And when, when my son and I hike, we’re physically like we’re in the dirt, we’re rubbing leaves where we’re engaging with that environment as much as we can because for him, I’ve observed a market change in his attitude and his behavior. If it’s doing that for him, it’s got to do that for us as well. (EV) Yeah. All of the things that impact adults, they’re a little bit more pronounced and obvious and kids like you see how kids are sensitive to sugar or get over tired or really respond well to natural environments and they’re like, oh yeah, that’s what kids need. And it’s actually just a really, they’re just so pronounced cause it’s not muted by layers and layers of different ways that they’re…

EV: 42:54
coping with the world. But it’s all true for us too. We’re sensitive to sugar and we get over tired and we need nature. (MU) Yeah, I would pitch, I would definitely pitch a tantrum in target if it were societaly acceptable. I think I’ve had moments, we’ve spent so much time now talking about really practical application ways to think about depression, to manage depression, to treat depression. I always end episodes with one question. What’s one thing someone listening right now could do if they were ready to take the next step with their depression? (EV) I’m going to say more than one. Eat real food. We didn’t talk about this, but practice gratitude, go to bed early and get the phone out of the bedroom.

MU: 43:36
I like it. All right. Everyone’s going to get, you’re all going to get your phones out of your bedroom and I’m going to do it too when we’re going to talk about it on Instagram and then we’re going to share how it’s impacted us. I love that Dr Ellen Vora, where can people find you if they want to know more, and they will?

EV: 43:50
I’m all over the Internet. Um, my website is Ellenvora.com and then I’m on Instagram at Ellen Vora MD and same thing on Twitter. And you can just search my name on Facebook.

MU: 44:01
wonderful. Thank you so much. Holistic Psychiatrist, Dr Ellen Vora. I loved this conversation. You’re going to be a regular guest on do the thing, I just told you that right now. (EV) You’re an upholder so I can really trust in that. Yeah. Thank you so much. This was a fantastic conversation. I know it’s going to help a lot of people. Thank you, Melissa.


Thanks for listening!

Continue the conversation with me @melissa_hartwig on Instagram. If you have a question for Dear Melissa or a topic idea for the show, leave me a voicemail at (321) 209-1480.

Do the Thing is part of ‘The Onward Project,’ a family of podcasts brought together by Gretchen Rubin—all about how to make your life better. Check out the other Onward Project podcasts, Happier with Gretchen RubinSide Hustle School, and Happier in Hollywood.

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