In this episode, Dr. Achina Stein: and Silvia Covelli: share their experience leading the Healing Depression Project, a holistic approach to treating depression that integrates functional medicine, lifestyle changes, and community support. Drawing from their personal experiences with conventional psychiatry, they discuss the frustrations with traditional treatments and the need to address both physical and mental health simultaneously. The project challenges the conventional narrative around mental health treatment, offering a comprehensive recovery program built on evidence-based practices and a supportive community. Tune into this episode to learn:
- Why we need alternative approaches to traditional psychiatry
- How the project integrates functional medicine with metabolic psychiatry to enhance mental health outcomes.
- How a holistic approach may be especially helpful for those who don’t benefit from medication.
- How community support is leveraged to support the recovery process.
- Future goals include expanding the program and making it accessible to a broader audience.
- And much more!
This episode offers insight into how functional medicine and community-based support can reshape mental health care and foster long-term recovery. Please download and share with someone who would like to hear about this opportunity.
Achina Stein, DO:
You know, I’ve just been given this diagnosis, but no one’s actually explored why I’m experiencing these things, these symptoms. And so, we want to help people understand that this is not something that’s just genetic or inherited. There are reasons why you’re experiencing this. And even though you might have a family history, it’s not about genetics, it’s epigenetics. And what we know about epigenetics is lifestyle and dietary changes that can change the epigenetics and how there’s the expression of those genes. And so, we want to show that we can change epigenetics.
James Maskell:
Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective functional and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
James Maskell:
So, a warm welcome to the podcast, actually, I think for the first time we have Dr. Aina Stein and we have Silvia Covelli. Welcome.
Achina Stein:
Thank you, James. Thank you for having us today.
James Maskell:
Yeah, really excited to connect with you. Obviously longtime listeners of the podcast know that in the evolution of medicine we have sort of three main areas. We have new clinical innovations around functional lifestyle, integrative medicine. We’ve talked a lot about different new models of delivery. And then we’ve also talked about health technology. And I think in this podcast we have the opportunity to get into all three of those. We’re going to be talking a little bit about the Healing Depression project, which is a project that both of you guys are working on. So why don’t we start with you, Silvia, why don’t you just take us to the genesis of the Healing Depression Project, how it started, and sort of where we are today.
Silvia Covelli:
Okay, great. Sure. So the project is inspired in my own story. I had a long battle with depression for 25 years and I did not find neither the support or the kind of treatment that will really work for me. So, I did conventional medicine and I went on medication, different doses, different combinations, but medication never worked for me. It actually made some of the symptoms worse and brought new symptoms. So that was definitely not the answer. I kept looking basically on my own because that was the way I saw it. That was the limitation of the conventional model of psychiatry. That’s just more than medication. The doctors didn’t know what to do or what to offer or there was no other solutions available. So, I also went into a lot of alternative treatments. I did countless programs, retreats, and really trying to look for just a way to feel better.
And some of those things work temporarily I will get a relief, but then eventually the symptoms will come back. So it was always ups and downs in that process. And one of the things that really got me frustrating the process was the message of basically no hope for a recovery. The message from doctors was always just regarding management, how to make this less severe, how you can learn to live with the condition, but that never the work cure or the real recovery, even with medication, it’s always, in my case, it was always just take it and for how long? Well, there was no strategy behind or a plan to actually get you better X amount of time and then we’re going to do this or we can evolve to that. It was just take it for how long, forever. So that was really frustrating. And also, I had a doctor actually at Deepak Chopra retreat and a medical retreat and I had a lot of hope really thinking, this is going to be different, this is going to change things. But after a psychiatrist, after just talking for let’s say 20 minutes and there I, I flew an entire continent across just to go onto this program and to see her and just to hear that her solution was learn to live with it, just this is what it is, this is what you have, this is kind of like your destiny part of who you are. And that was very, very frustrating. So I started growing up very frustrating with what was out there for me.
James Maskell:
Can I just jump in there for a second? I guess I hear your frustration and I totally get it. And Dr. Stein I guess just in this part of the story, there’s always this frustration that makes you want to do something new coming from the other end of it. I can imagine that this is not the first time you’ve heard this story and that ultimately as a conventionally trained psychiatrist who’s now gone into the functional realm and sort of leading the charge to look at a more holistic way of treating things, this story is probably not surprising to you either personally or professionally, right?
Achina Stein:
Oh, absolutely. I hear it all of the time and people who are frustrated with what I call the medication merry, merry-go-round, are often also put on multiple medications because many doctors are also frustrated with these solutions. That’s all they have is psychotropic medications to provide and it usually leads to a slew of side effects and maybe just 50% reduction of symptoms, never really complete remission for the majority of people who take these medications and are. So, there’s very few options out there that are utilized in the conventional world.
James Maskell:
Yeah, absolutely. Alright, Silvia, so you’re feeling frustrated with the situation, totally get it. It’s a certain type of person that decides I’m going to do something about it. So, tell us that story.
Silvia Covelli:
Well, I mean it’s really easy to give up in the process or just to, as I was advised, to just learn to live with that. But I really kept trying and I think when I started feeling a big difference and when I had started having breakthroughs for how to recover was when I link the connection between the physical health and the mental and the emotional health, which was never brought in any of the consultations and in very few of the treatments actually, and just something like optional or passing by, but not really as this connection. So, at that point I understood that, I mean we were looking at the wrong questions. We were trying to, what I was trying to do was not just looking at the symptoms instead of just asking the question of like, wait, where are they coming from? Why do I have these symptoms?
Even if it’s the physical symptoms, like the fatigue for example. So, when I started doing that, I just went back, look at the programs, look at the things that work for me and put a program together for myself and just really with a lot of integrating those things into my daily life and taking a very holistic approach. It was the body, so it was the physical health, it was the mindset, it was the emotions, it was even the spiritual piece. So with doing, I put a program again just for myself and to my surprise about doing it for about a month, I started feeling completely different, but it took about three months to really feel that I was biologically a different person and I implemented a lot of things including nutrition, including sleep restoration, lifestyle habits, therapy, different things that I put together, and that’s what I did for myself.
So I was very surprised. It really took me to a different place. I’ve been symptom-free since then, and at that moment it did not occur to me to offer this to anyone else. When you are in that situation, you’re in a survival mode. The only thing that you’re looking for is just to get better. I was doing it for that, but about two years ago I started feeling the message that a lot of people, and I look at statistics and I started talking to a lot of people and I saw how people are trapped in the same thing that I was. It basically what you talk a lot, James, that is about this chronic diseases that they become just over time and over time and for a long time the person is trying to deal with this and that there was no solutions, nothing offered. So that’s when I thought about putting this program together, I reached out to great psychiatrists like Dr. Kat Toups and Dr. Stein here with us, and we started working together on how to put a program inspire in what I had done, but added with a lot of medicine and just science behind. And we’re doing it now with functional medicine and metabolic psychiatry to really give the person all the chances to heal, kind of address depression from all possible angles.
James Maskell:
Beautiful. Well, Dr. Stein, I know you could keep yourself, there’s so few functional medicine trained psychiatrist, right? It’s starting to get some momentum. Obviously there’s books on metabolic psychiatry and then there’s also a range of mental health books that functional medicine doctors have put out.
James Maskell:
Yeah, absolutely. Silvia, let’s get into the model because obviously just doing functional medicine, psychiatry and doing a more holistic approach is being done in offices around the country and some parts of it scaled in different ways through different organizations and different models. There are some unique aspects to your model, and maybe we can just get into how you decided on the model and just some of the unique areas of it. Because I think this should be sort of like the reason why I wanted to bring you on is because I think you are hitting on something that is always a question, which is how do you make it easy for people to take action to really see results quickly? And let’s get into that a little bit.
Silvia Covelli:
Yeah. Well, the program is 45 days. The first 30 days is in a retreat, so it’s residential and then 15 days at home for integration. The reason for the model is basically what I experienced and what so many people with depression experience that is they really struggle in making lifestyle changes. And if you look at it, it actually makes sense that there’s this struggle because in order for you to change anything in your life, you need hope, you need physical energy, you need a level of motivation. And the paradox here is that depression actually take those things away from you. So, on top of being depressed, then you have this big list of things that the doctor, if you’re lucky, the doctor, functional medicine doctor is suggesting for you to implement. And then there’s really, you try and then you do it for a few days, but then it doesn’t really stick or you don’t even know where to start because you’re already overwhelmed as it is.
So, the idea of the program is to be transformational habits formation. So, it is a training and it is handholding and it will be just so that the person can start in a group, which is also the power of community being activated there. That was the other reason for a retreat that is one is to help the person to get these habits and to help them make all these changes in their lives and showing them exactly how through a training that will give them all the information and the tools and everything that they need to implement it back home. But the other thing was that most of the people with depression, they try to heal in isolation, and that’s also a big challenge for any mental health condition. So what this program does is even if it’s a small group, because it’s 15 people, so still very personalized, it provides the community, so the synergy of a group to really work together, plus it helps the person to build new networks of support which they’re going to need when they go back home and to be friendships there and just people that have gone through the same thing as them.
So, the idea of being residential is grounded in these two things. Just being able for the person to get the new habits and to do it in a community, and also to put all these power things under the same roof because this is the thing with depression, it permeates every area of your being. So it is, if you think about it, it’s in the body, it is in your mind, in the emotions and even in your spirit because how connected, how engaged are you feeling with life? So, it is in so many areas, and that was one of the things that I realized that the current models do not provide what’s needed because they address one or two areas at different moments. So, you might be feeling better. For example, you are regaining physical energy because your body’s feeling better, but then the mindset is completely in the wrong place.
So, the mind will kind of hijack those advances or those benefits that you have gained in the body and just will not let you keep advancing in your recovery. So, the program puts together not only the physical piece because it’s functional medicine and nutrition with metabolic psychiatry, but we also have a lot of trauma work, especially psychodrama, which has been shown very effective to provide results in a shorter amount of time versus talk therapy because it really helps you move through it. And there’s somatic therapy as well to help that trauma to get released from the body. And there’s the mindset piece like meditations to create neurological connections in your brain. So, it’s a very comprehensive program and the only way that I saw this possible was I need these people to be under one house so that we can really implement all these different treatments and address depression from all the possible root causes.
So that’s the reason for the model so that people can get access to all these different healing techniques. And then the 15 days is fundamental because it is 30 days in the retreat, but then what’s the problem with a lot of residential programs that it’s terrifying the way that the day that you go back home, I was there and then you don’t really know what to do, what things to implement. There was this really nice thing that they were doing, but you don’t really know how to do it, or they were feeding you this amazing food and then what do you do at home? You don’t know how to cook for it. What is behind this diet? Instead, what we’re doing is that not only during the program, we’re training people in how to do it and teaching them how to do it, even with cooking classes and for the nutrition piece for example, but then those 15 days, what we are doing is a daily, we’re going to be daily, we’re going back with them at home to help them really integrate these things during the daily life because that was one of my main breakthroughs with depression there.
I had a lot of information, and I knew a lot about certain things that were helpful, but I was not doing them in my day-to-day life. I was not really practicing them. So, the lack of integration will derail any process and in general in life, if you don’t integrate anything that thing into who you are and what you do, then you’re not going to see the results. And so that’s why it’s 15 days of integration to really help people to get into this routine on their daily life.
James Maskell:
Well, I just want to triangulate a few things here based on what you said. If people have listening to the podcast for a long time, you’ve heard that more recently I’ve been talking about the fact that I think that there is a new model for the deployment of functional medicine in a sort of practical way that is economically viable and most clinically successful. And that is that primarily the group is the thing that drives the behavior change, the safety, the connectedness and so forth. And then it’s the therapies that are sort of sprinkled in from the side that drives the long-term health outcomes as opposed to the doctor patient relationship being in the middle and maybe using a group here and there for efficiency of education delivery. The group is the center, the group is the thing that actually allows the people to feel safe. And part of the reason I think is that, and Achina, maybe I can just check in on this before, there’s a couple of things. It seems to me that one of the root causes of the depression is the isolation, is the lack of safety, is the lack of connection with other people. We agree on that, right?
Achina Stein:
Absolutely. Oh, a hundred percent. I mean especially, and that was very evident when we had the pandemic coming around. It became even worse and worse. But the other aspect about the group is that some people aren’t early adopters, and if they see someone that they’ve come to know and trust start something and benefit from it, then they’re more likely to then follow through and do it as well. And so there is this connection of people that also allows that kind of pulls you along, and then you might then have the courage to do things and adopt things early and pull other people along. And that gives you a sense of being able to help others as well. A lot of times people feel like that they’re a burden to others. So there’s all of this self-talk negative that occurs when you’re depressed, and it’s a great way to dismantle that self-talk. People let you know, oh no, you’re not a burden, or you’re not this or you’re not that. I don’t experience you that way. So group therapy is amazing for people.
James Maskell:
Well, it’s amazing to hear words that I’ve said a hundred times over the last five years coming out of your mouth because you’re a psychiatrist. But yeah, I mean we’ve seen that all the time, whether it be through the book, The Community Cure, and then through doing groups in association with different clinics through Heal community seen exactly that, which is that most people aren’t quick starts. There are some quick starts that jump into everything and start getting into it, and maybe they don’t have the longevity of discipline to execute long-term. So those people get started quickly. They inspire the people who have a little less quick start energy, but have more long-term energy. And ultimately that’s the synergy that creates the ability for long-term care. And in the book, I share lots of examples of groups that are still going 20 years later because the people don’t have diabetes anymore, but they know that the group is essential to them maintaining good health, and I think that’s critical.
So that’s the first thing I just wanted to triangulate on. Another thing that you said, Silvia, that I just want to comment on is that I’ve actually thought a lot about this exact model that you’re sharing, but in the context of reversing cognitive decline, because it’s a similar type of thing where obviously there’s brain connected to it, but it’s a very difficult population to get behavior change in because you have to remember to do new stuff. And years ago in 2018, we were, I was in the process of looking at buying a hotel to do some cognitive decline stuff and for whatever reason it didn’t work out. But I’ve always been fascinated by this quick start model because ultimately, like you said, I know Achina, if you’re in practice and you see the patient, you think I know 10 things that could help this person, but I just have to contextualize it through what can they really do in the next 30 days, really in an outpatient sort of structure.
But you wish you could do it all because you know that many different things could help and this creates a structure for that. And so yeah, I’m excited to jump into that. Maybe you could just share with us, doctor, a little bit about how you’ve put the program together clinically, what you think are the most important foundations. Silvia shared obviously a lot about the model there, but from a clinical point of view, what do you see as the absolutely necessary foundations and then what do you think are the nice to haves that it’s lucky that you can deploy in this situation?
Achina Stein:
Sure, sure. So, foundation number one is diet, changing the diet and what our goal is to use the ketogenic diet as our model. Certainly not every single person is going to be able to do the ketogenic diet, but we’ll help people to work towards that by reducing carbs to the goal of 20 grams a day, increasing protein intake because people don’t really have enough protein in their diet. And then the balance of that is fat now. So, it’s basically starting off with a low carbohydrate diet going away from the standard American diet. If you looked at a spectrum of diets, the standard American diet is obviously the worst diet and anything that’s away from that by going to Whole Foods, the Mediterranean diet, there’s tons of research that supports that diet. Next would be the paleo diet, and then with a lot less carbs and more fats would be the ketogenic diet.
There’s a ton of research in the neurological field for the ketogenic diet for basically shutting down seizure disorder epilepsy, and that’s been since the 1920s. And so we have some research that supports that. I don’t know if you’re familiar with Georgia Ede’s work, Change Your Diet, Change Your Mind is her book that’s recently come out and she has presented a number of studies that support the use of the ketogenic diet for depression specifically and other mental health disorders, bipolar disorder, schizophrenia. There aren’t any randomized controlled trials yet, but the Baszucki Group is now supporting those things, those trials to prove that the ketogenic diet is really the way to go in terms of diet for mental health specifically. But there are some smaller studies that really is quite compelling in terms of using the ketogenic diet to reduce depression, improve psychosis, and other metabolic inflammatory markers.
James Maskell:
Beautiful. Yeah, well, what a treat to be able to put this all together and give people all of those assets. I mean, to be able to see what happens. And I can imagine with Kat Toups as the research director, you’re in great shape. I’ve had a chance to work with her through this reversing cognitive decline. She’s one of the trial sites there as part of the reversing cognitive decline program. And I wasn’t really aware until we got to spend some time together just of her sort of rich history in running clinical programs and doing clinical trials. And so I’m sure we’re in good shape there. Silvia, what is your hope here? What is the dream? You’ve got this first location, it’s in Austin. When is the first group starting and then give us the sort of five-year vision for what you think this could be, what The Healing Depression Project could be?
Silvia Covelli:
Okay, so for next year we’re going to be running two programs, two 45-day programs beginning in March. March is the first one, and then the second one is in August. So, the plan is to do this for about two years, just to really see how, because we know how all of these things work as an outpatient, but we want to see, and we know how successful they have been, but we want to see how they interact and how it works in this control environment. And so that’s for about two years what we’re hoping to do. And then eventually we’ll be just to open a center that will be able to offer this to a large amount of people and find a way to get it at least halfway covered by the insurance. So probably we’re looking to more of a rehab, just licensing in order for that to be covered in a way by insurance.
Because right now it’s a big challenge for the programs, especially for depression programs for them to be covered. And then of course if you add to that the functional medicine piece, then it will just, as you know, we have a lot to catch up with that regarding insurance and functional medicine. So the goal is for that to be a program that becomes at least partially covered and where people can go and heal and just dedicate themselves time to do it because that’s one of the things that we try to do with mental health and sometimes even with physical health too. We don’t give it the attention that it needs and we just try to do it on the side as we’re juggling like job, like motherhood or so many other things that we’re doing. So what we’re hoping is to offer this place where people can just come and heal.
And regarding of a broader approach to this, what we really, we want to contribute to the conversation of psychiatry and that the only tool that they’re currently offering in convention in the conventional model is medicine is medication. So we want to come and join that conversation by showing and saying that’s not the way because everybody that is coming to us right now, we already have a significant number of participants register. Everybody that is coming to us, they have been struggling with depression for 10, 15 even more years with some of them all their lives, and they have been in at least four different medications. So we want to come back to that conversation and just say, listen, there’s another way. There’s a better way to do this, that actually people respond. And the other thing that I really want to get across is that there is hope and that there is a possibility for a full recovery because conventional psychiatry says out loud that depression, especially if it’s recurrent, if you are having chronic depression already for a long time, then there’s not a cure. So we want to show there’s a lot of more people like me that have found a solution and that depression is a thing of the past. I don’t have any symptoms and I haven’t had for a long time. So we want to show those cases and contribute to that just saying like, wait, there is a way out of depression and medication is not doing that.
James Maskell:
Beautiful. Well, look, I’m very excited and maybe just to wrap up here. So if you’re listening to this and you are a practitioner that has people who have come to your practice who have struggled for a long time with mental health disorders and you feel like the tools that you have at your disposal are not suitable and you think a 30-day residential program with ongoing support might be the solution, go to Healing Depression Project. You can see all the details there. You can get in touch with Silvia and her team to find people that I really appreciate the thoughtful way you’re going about things to really try and prove the outcomes first and foremost, and to prove the model. I’m excited to see both of you at the Integrated Medicine for Mental Health Conference, which is coming up next weekend. And I would welcome you to have actually two of the golden tickets to the Friday night Vagus Fest, which is a focus on building participatory tools to stimulate the vagus nerve. And hopefully some of that can make it into your programming or you already have plans for that because I think—
Achina Stein:
We already do is—
James Maskell:
Such a critical way, and I’m not surprised given both of your expertise here, but I would love for you to be part of that because part of the goal is how do you make it sort of aspirational and fun to be involved in things that are good for the vagus nerve and the synergy there. So I’m looking forward to that. And I just want to wish you all of the luck on this project because I know that it’s going to help a lot of people. And I know that going about it the way that you are, which is really focusing on getting the outcomes and proving the outcomes in a scientific manner. If you look at the organizations that 10 years ago really focused on that, their trajectory is very different than organizations that thought, well, let’s just do this for a bit and see what happens.
It’s critical to be able to prove that this works and the need is so massive and the market demand is so massive as the world gets a little crazier. But it’s really wonderful to see you guys on the front lines putting it together and showcasing what’s possible to the rest of medicine. And just listening to the story here today, you can’t help but think how totally backwards the treatment of mental health is today, your story, the journey there. And I hope that with conferences like IMMH and projects like yours and the news getting out in different ways, especially about the connection between metabolic health and mental health and loneliness and mental health, we need a 180. I think that many of us are in that opinion and are working towards it.
Achina Stein:
Yeah, I agree, James and I didn’t get a chance to answer your question fully because we are short on time, but I do encourage people to go to the website healingdepression.com and look at all of the different things that we do address more than just the diet piece. And I also am sharing with you in the chat a link to an article in the Frontiers of Psychiatry published in July of 2022, “The Ketogenic Diet for Refractory Mental Illness.” It’s a retrospective analysis of 31 patients. It’s a small trial and there’s no control, but the results are compelling, and I encourage your audience to take a look at that article if you can share it with them in your show notes.
James Maskell:
Beautiful. Yeah, we’ll share that in the show notes. I see Georgia Ede on there. I’m looking forward to connecting with her at IMMH next week. I actually know that on the Sunday there’s sort of a metabolic health rally happening in DC as well. So there’s a lot happening and we’re excited to connect then. So look, I just want to wrap this up, Silvia. Congratulations on where you are so far and look forward to hoping that this helps in your journey. And to all the practitioners who are out there, I think there’s a lot that we can do to think about how can we inject the power of functional medicine into the residential structures that already exist. There are well established memory care centers, there are well established recovery centers, and ultimately it takes a lot to do what you’re doing, Silvia, to get the building and get cat tubes lined up and do this, get the patients.
But I do think that there are synergistic ways whereby with this kind of data, like you’re just sharing, and we’ll share it in the show notes, reaching out to organizations in your community that are doing mental health and saying, Hey, look at this. Look at the way that the research is going. Look what’s possible when you take a different approach. So I think in every community around the country, we don’t have to wait five years for you guys to prove this out. We can take action now on the ground in community to create more holistic solutions. So big shout out to The Healing Depression Project. Go to healingdepression.com. You can find out all the details, you can get in touch with the team. Thank you, Dr. Stein. Thank you, Silvia. Look forward to seeing you next week.
Silvia Covelli:
Thank you, James.
James Maskell:
Here in the Evolution of Medicine podcast, we are grateful to show innovation, clinical innovation, model innovation, and hopefully what you’ve heard today is some serious model innovation and look forward to the next one. So thanks so much for tuning in and we’ll see you next time.
Silvia Covelli and Achina Stein:
Thank you!
James Maskell:
Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.
Subscribe
Download
Click here to download this podcast
music provided by intomusic.co
