As someone who supports thoughtful use of complementary and alternative medicine, I absolutely believe that compounds like SAMe or St. John’s Wort can offer meaningful benefits—when used appropriately and supported by evidence. But with the rise of anti-aging influencers, we’re seeing a familiar pattern: mechanistically promising compounds getting pushed far ahead of the science.
Methylene Blue is a perfect example.
🧬 Mechanistic appeal:
Enhances mitochondrial respiration
Acts as a redox mediator to reduce oxidative stress
May support autophagy and protein homeostasis
Studied for cognitive enhancement and neuroprotection
Sounds great on paper—and some early research is encouraging. But…
⚠️ Here’s the caution:
Most data is from animal studies or in vitro experiments
Human trials for cognitive or anti-aging outcomes are small, inconsistent, and early-stage
Long-term safety at “biohacker” doses remains largely untested
Many people are understandably drawn to the promise of longer, healthier lives, but often at the cost of embracing interventions before we truly understand their risks, benefits, or limitations.
Even if the science makes theoretical sense, biology doesn’t always behave the way our models predict.
Let’s stay open—but also skeptical. Not everything that sounds too good to be true ends up being true.
The article “Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder” published in JAMA examines the association between various medical conditions and suicide risk, highlighting the influence of pre-existing mental disorders. Key findings include:
Increased Suicide Risk in Certain Medical Conditions: The study identifies a significant rise in suicide risk among patients with specific conditions, such as cancer, chronic pain, neurological disorders, and respiratory diseases. Chronic illness often contributes to emotional distress, exacerbating the risk of suicide.
Impact of Mental Health History: Individuals with a prior mental disorder are at an even higher risk of suicide when diagnosed with a medical condition. The presence of a mental disorder can amplify feelings of hopelessness, increasing vulnerability.
Interconnected Nature of Physical and Mental Health: The research emphasizes the need for integrated care that addresses both the physical and psychological aspects of health, particularly for individuals with complex medical histories.
The article advocates for more robust screening for suicidal ideation in patients with both medical and mental health conditions and suggests collaborative treatment approaches to reduce suicide risk.
Life is a journey full of ups and downs, and sometimes, we find ourselves at a low point, feeling defeated and uncertain. But remember, it’s not about how many times you fall; it’s about how many times you get back up.
A comeback isn’t just about bouncing back—it’s about bouncing forward. It’s about using your setbacks as a setup for a stronger, wiser, and more resilient version of yourself.
Believe in Yourself:Â Trust in your abilities and your potential. You have everything within you to overcome challenges and achieve greatness.
Set Clear Goals:Â Define what success looks like for you. Break down your goals into manageable steps and tackle them one by one.
Learn from the Past:Â Reflect on what led to the setback. Embrace the lessons learned and use them to fuel your growth.
Stay Positive:Â Surround yourself with positivity. Cultivate a mindset of gratitude and optimism, even in the face of adversity.
Take Action: Don’t just dream about your comeback—take concrete steps towards it every day. Consistency and perseverance are key.
Seek Support:Â Lean on friends, family, or mentors who believe in you. Their encouragement can be a powerful motivator.
Celebrate Small Wins:Â Acknowledge and celebrate every small victory along the way. Each step forward is progress.
Remember, the greatest comebacks are born from the greatest setbacks. Your story is far from over, and this is just the beginning of a new, exciting chapter. Keep pushing, keep striving, and watch as you rise stronger than ever.
Since the start of the COVID-19 pandemic, countless studies have explored its impact on mental health. From both the research and my clinical experience, one thing is clear: the pandemic took a toll on people’s mental well-being.
A study published in JAMA Psychiatry dug deeper into this by asking, “How does mental health differ between vaccinated and unvaccinated people who were diagnosed with COVID-19?” The results? Conditions like depression, anxiety, PTSD, addiction, and even self-harm and suicide spiked in the weeks following a COVID-19 diagnosis. Interestingly, the vaccinated group showed lower rates of these issues, while those hospitalized for COVID-19 had longer-lasting struggles with mental health.
The takeaway is clear: getting vaccinated not only protects against the virus but may also reduce the mental health impact of a COVID-19 infection. It’s crucial to continue promoting vaccination, especially among those with pre-existing mental health conditions who are at higher risk.
I recently had a case involving a person with no prior history of mental illness who suddenly developed acute suicidal thoughts. The only recent change in their life was starting a glucagon-like peptide-1 (GLP-1) agonist for diabetes. They reported noticeable mood changes and even suspected the medication was the cause based on their own experience. While we can’t draw any definitive conclusions about causation at this point, it’s reasonable to advise people, especially those with a psychiatric history, to carefully monitor for mood changes and suicidal thoughts when starting this type of medication.
Anxiety is challenging to manage, and it’s something we all experience to some degree, no matter how mentally strong we might be. Research shows that individuals with chronic anxiety have increased activity in the limbic system, which includes the hippocampus, amygdala, hypothalamus, and thalamus—regions responsible for emotional processing. Over time, chronic anxiety can cause damage to these brain structures.
A study published in the Journal of the American Geriatrics Society found that chronic anxiety was linked to a 2.8-fold higher risk of dementia, while new-onset anxiety was associated with a 3.2-fold increased risk. Participants under 70 with chronic anxiety had an even higher 4.6-fold increased risk. Interestingly, no significant risk was found in participants whose anxiety had resolved. The researchers attributed the increased dementia risk to unhealthy lifestyle choices. While this is an interesting conclusion, it seems to overlook the potential physiological changes caused by chronic anxiety, which could also play a role. The researchers suggest that individuals with anxiety may be more likely to engage in unhealthy behaviors, such as poor diet, smoking, and drinking—all of which increase the risk of cardiovascular disease, a major risk factor for dementia.
I’ve always believed that the key to effective dementia treatment lies in prevention, and lifestyle modification can be a powerful tool in this battle.
People alter the quantity and frequency of food consumption daily and yet the brain seems to have a regulatory process that allows people to maintain a relatively stable body weight.Â
Isn’t that crazy?
Anyone who has ever tried to diet knows all too well about this metabolic set point. There are staggeringly low rates of success with diet programs. A systematic review of studies published between 1931 and 1999 found that only 15% of patients achieved dietary success after 5 years. Most people who diet will slowly return to their preexisting weight within 1 year.
This metabolic set point appears to be controlled by our genetics. There is a strong correlation between the body mass of biological parents and adoptees in adoption-based studies. In the case of weight, genetics has far more influence than environmental factors.
Despite all this obesity rates in the United States as well as other developed countries continues to rise, so what gives?
Our genes have difficulty responding to the modern environment. 3000 years ago, when food sources were scarce, it was advantageous to consume and store as many calories as possible. However, in the modern world where there is no shortage of opportunity to consume calorie dense foods, our genetics are working against us. The weight issue is genetic but also influenced by availability of high-calorie delicious food.
When it comes to weight, energy in (food) must equal energy out (heat and work). The energy out is made up of the resting metabolic rate (calories burned when the body is stationary) and physical activity. The brain has a unique mechanism for managing the RMR. When more calories are consumed the RMR increases and when we diet the RMR is turned down.
To solidify the point, we can look no further than The Biggest Loser competition. Investigators assessed 14 of the 16 contestants before the competition, after completion of the 30-week program, and 6 years after the show. 13 of the 14 study participants regained weight and 4 were heavier than when they started the competition 6 years ago. The real downer was they all burned less calories at rest 6 years after the show ended. Despite exercising more and theoretically being much healthier their RMR decreased.Â
What are the important signals used by the body that indicate when to eat and when to stop eating?
Short-Term signels include:Â
Glucose: This is the primary nutrient that mediates satiety. Hypoglycemia will stimulate hunger and increase eating, while glucose infusions will decrease food intake.Â
Mechanoreceptors in the gut: The physical presence of food in the stomach activates these receptors due to stretching, the vagus nerve transmits signals of gastric stretch to the hindbrain to decrease eating.Â
Gut Hormones: The most well understood is cholecystokinin (CCK) which is released by endocrine cells in the small intestine. This will inhibit further food intake by stimulating the vagus nerve and decreasing gastric emptying. People have tried using CCK as a weight loss measure but all it does is decrease the size of meals but increases the frequency of eating thus producing a net zero effect on weight loss.
Ghrelin is the only gut hormone that stimulates hunger. Some suggest that decreased ghrelin produced by the stomach is the reason gastric bypass surgery is effective for weight loss.Â
It’s now known that adipose tissue releases a hormone that conveys information about energy stores. Leptin is produced by fat cells and increases or decreases based on the total amount of fat. Leptin is a hormone that tells the body to stop eating. In the case of obesity leptin levels are high and energy expenditure increases while food intake decreases. When someone goes on a diet and fat stores decrease leptin decreases resulting in decreased energy expenditure and increased food intake.
Two groups of neurons in the arcuate nucleus of the hypothalamus mediate the leptin signal, proopiomelanocortin (POMC) and neuropeptide Y (NPY). POMC stops eating and NPY increases food intake and decreases energy expenditure. In obesity there is increased leptin which inhibits NPY and activates POMC resulting in increased energy expenditure and decreased food intake. The opposite is true for the lean individual.
Eating and Pleasure
It’s well established that eating can result in pleasure, we have all had this experience after a stressful week a good meal can instantly change our mindset. The pleasure from food is likely an adaptation that enhanced survival when food sources were scarce. Increased dopamine in the nucleus accumbens and release of endogenous opioids appears to be more active when we are eating a meal we enjoy.Â
Omega-3 fatty acids are reported to help with several physical and mental health conditions.
They are termed essential because they cannot be produced by the body and must come from the diet.
In fact, I use 1000 mg of omega-3 fish oil daily as part of my own supplement routine.
How Do Omega-3s Work:
Omega-3’s coat neurons, increase cell membrane fluidity, have neuroprotective properties, and the most well-established mechanism is an anti-inflammatory action. They directly affect arachidonic acid metabolism because they displace arachidonic acid from membranes and compete with it for the enzyme that catalyzes the biosynthesis of thromboxanes, prostaglandins, and leukotrienes involved in the inflammatory process thus reducing the formation of these products.Â
Indications For Omega-3 Use In Psychiatry:
In mental health the most well-established use of Omega-3s is for the treatment of depression. It’s been looked at as a primary treatment as well as augmentation. The results aren’t that great when Omega-3s are used as stand-alone therapy. As augmentation they have an effect size of 0.5 to 0.6.
Given our previous talks about inflammation and depression, people with high inflammatory biomarkers may respond better to Omega-3 treatment.Â
Omega-3s And Schizophrenia:
Maybe the most interesting data comes from studies of Omega-3 use in schizophrenia. It seems to work best when started early in the illness when the first signs or symptoms appear. There also seems to be a reduction in white matter changes on imaging studies.
This raised the important question; can we prevent schizophrenia?Â
Vienna Study:
There was a study published in nature communications that looked at outcomes in the prevention of psychotic disorders in Vienna.
They started with 12-week trial with omega-3s which proved to reduce the risk of progression to a psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared to placebo.
They then completed a long term follow up of the study to show that brief intervention with Omega-3s reduced the risk of progression to a psychotic disorder and psychiatric morbidity.
A year after the Omega-3 treatment only 5% converted to schizophrenia, compared to 28% in the control arm. Seven years later the rates of conversion to schizophrenia were 10% Vs 40% with most of the patients being retained in the study.Â
Side Effects of Using Omega-3:
There are very few risks to adding omega-3 fatty acids to existing psychiatric treatments. Fish burps are a common occurrence and can be mitigated with enteric coated capsules or refrigerating the capsules. Omega-3 can increase bleeding time and require careful monitoring if the person is scheduled for surgery or taking anticoagulants. Keeping doses at 1000 mg/day is advised for this population.Â
Sources of Omega-3:
You can use a supplement, or you can consume fish like salmon, herring, or anchovies two times per week to get an adequate dose.Â
Ensuring the EPA to DHA ratio is 2:1 (EPA: DHA) or pure EPA is essential when selecting a product. Consumerlabs.com to help ensure the purity and potency of the product is accurate.Â
The cost of adding an Omega-3 supplement to your treatment is $8 to $30 per month depending on the specific product.
There is very little downside to increasing your consumption of Omega-3 fatty acids either from whole food sources or as a high-quality supplement.
I will talk about sedative and hypnotic medications in future videos, but I want to start a discussion on sleep with sleep hygiene. I recommend all my patients start here and follow this process at least 90% of the time prior to talking about medication. I find most patients are not doing these things and if they are it’s not consistent enough to see a noticeable improvement.Â
Stick to a routine by waking up at approximately the same time each day. Do this for seven days, and do not alter the time on weekends. This will help you gradually set your internal clock. You have more control over your wake times than your sleep time as you may not feel tired. Try to avoid taking a nap during the day even on nights where you do not get much sleep.
Avoid all caffeine after 12 PM, the effects of caffeine are long lasting and can interrupt sleep. If you can completely stop caffeine that would be best, but at the very least minimize consumption before 12 PM.Â
Try to exercise daily (seven days per week), preferably early in the day and not too close to bedtime. Start with 15 minutes per day and gradually work your way up. A combination of resistance training and cardiovascular training is best.
Stop doing active mental work at least one hour before bed.Â
Avoid watching TV, using a phone, laptop, or tablet before bed. The blue light from screens has been shown to worsen sleep. The bed should be used for sleep and sex only.Â
Create a bedtime ritual to follow every night before bed, warm bath, mindfulness exercise, gratitude journal, reading, or listening to music.Â
Do not use alcohol as a way to promote sleep. Alcohol negatively impacts sleep architecture and the sleep you do get will be unsatisfying.Â
The bedroom should be dark, quiet, and the temperature should be cool but not cold around 65 degrees is ideal. Consider blackout curtains, a fan to cool the room, and ear plugs to facilitate these conditions.Â
Restrict Food and drink 2-3 hours prior to bedtime. This will reduce the chances of sleep being interrupted to use the bathroom.
If you have any pain, take appropriate pain medications prior to bed.Â
The gut microbiome consists mostly of bacteria and that is largely the portion of the microbiome we are focusing on (fungi and viruses exist but their function is largely unknown)
Communication pathways exist between the microbiota-gut-and brain.
Multiple mechanisms exist that allow gut microbiota to signal to the brain and control physiological processes.
These include release of gut peptides from enteroendocrine cells which activate receptors of the immune system and vagus terminals in the gut.
Studies indicate that these bacteria can manufacture and secrete essential neurochemicals including serotonin, dopamine, NE, GABA, and acetylcholine
Depression and anxiety have been linked to a less well diversified gut microbiome.
What can help diversify the gut microbiome? Diet, processed food, sugar, saturated fats, and red meat. Medication can also alter the gut microbiome, a good example is oral antibiotics used to treat an acute infection, sleep, exercise. Sounds a lot like a healthy lifestyle will get you the microbiome you need for optimal mental health.
However, if you want a treatment there have been several studies that looked at fecal transplant to treat psychiatric disorders. Fecal transplants are much easier these days and now there is a capsule version that you take orally. There is not enough data to recommend this as a practical treatment and if the patient goes back to eating a poor diet, sleeping poorly, not exercising then the gut microbiome will revert after the transplant.
What are the practical things you can do? Stop eating processed food, sugar, and red meat. Increase your fiber intake and select a diet like the Mediterranean diet or a plant based whole food diet that will provide those prebiotics. You could supplement with a probiotic but most of what you need can be had from a good diet alone and I think it’s far better to change the diet then to try using supplements to treat a poor diet. Fermented products like kimchi, kombucha and sauerkraut are good sources of live bacteria.
If you choose to take a probiotic make sure it’s a quality, 3rd party tested product.
Increase aerobic activity, I think if you goal is overall general health and you have limitted time, I think aerobic activity is a better bang for your buck.
The way I believe you get and keep a healthy gut microbiome is through lifestyle modification. Improving your diet, exercise, and sleep is a good place to start. If you want to supplement with food products like kimchi or kombucha, go for it. I do not believe there is enough evidence to support a probiotic supplement for psychiatric disorders at this point, but if you want to spend $30 or more per month on a product if it’s a quality one that’s fine. Remember you cannot supplement away a bad diet.
