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For many struggling with depression, the message they often hear from traditional care is “just live with it” or “there’s nothing more we can do.” In today’s episode, we’re challenging that narrative. I’m joined by Dr. Achina Stein and Silvia Covelli, from the Healing Depression Project – a groundbreaking residential treatment and research program. Dr. Stein, a functional psychiatrist, and Silvia, who’s personally battled chronic depression, are offering a fresh approach to treatment-resistant depression.
Their in-residence program, launching in March, takes a whole-person approach—integrating nutrition, lifestyle changes, trauma healing, and community support. And with research built into the program, they’re not just helping patients; they’re also paving the way to make this approach more accessible for everyone. If you’re ready to rethink depression treatment, this episode is for you. ~DrKF
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Upcoming Program
The team at Healing Depression Project is thrilled to announce an upcoming 45-Day Depression Recovery Program starting in March, 2025.
The program includes a 30-day in-person retreat at a deluxe and serene ranch in Austin, TX, followed by a 15-day at-home integration phase, ensuring sustainable improvement.
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Participants who are invited to apply can also apply for our scholarship program. If a scholarship is awarded, it can cover up to 80% of the total investment. Schedule a free call for information.
Healing Depression Project: Providing Hope For Treatment-Resistant Patients
In this episode of New Frontiers in Functional Medicine, Dr. Achina Stein and Silvia Covelli, creator of the Healing Depression Project, share their groundbreaking approach to treating depression. They discuss how systemic inflammation, mitochondrial dysfunction, and trauma contribute to treatment-resistant depression, and offer insights on integrating functional medicine principles into care. From key lab tests to the importance of nutrition, stress reduction, and lifestyle changes, they highlight a holistic treatment model that addresses the root causes of depression. Most importantly, they offer hope for those who’ve been labeled as treatment-resistant, showing that with the right approach, healing is possible. This conversation is filled with practical insights and actionable strategies for practitioners looking to help patients break free from the cycle of conventional depression treatment.
In this episode of New Frontiers, learn about:
- Depression Statistics and the Shrinking Psychiatric Workforce: Discussion on the increasing prevalence of depression and the decline in the number of psychiatrists, creating a widening gap in care access.
- Treatment-Resistant Depression: The impact of the “treatment-resistant” diagnosis on patients, and why addressing systemic causes like inflammation and mitochondrial dysfunction can offer new hope.
- The Polypharmacy Problem in Depression Treatment: Discussion on the dangers of polypharmacy in depression care, including the high costs of side effects such as weight gain, metabolic issues, and long-term health consequences.
- Inflammation as a Root Cause of Depression: The importance of treating depression as a systemic issue—how inflammation, mitochondrial dysfunction, and oxidative stress interconnect, driving depressive symptoms.
- Key Labs for Depression Treatment: Recommendations on labs to assess underlying causes of depression—focus on inflammatory markers, B vitamins, mitochondrial function, and hormone levels.
- The Ketogenic Diet for Depression: Discussion on the benefits and drawbacks of a ketogenic diet for those with depression and metabolic syndrome—how it can reduce inflammation and stabilize mood.
- The Healing Depression Project’s Holistic Approach: How the Healing Depression Project integrates nutrition, lifestyle, stress reduction, trauma healing, and community to address depression from a whole-person perspective.
- The Healing Depression Project: How the Healing Depression Project integrates nutrition, lifestyle, stress reduction, trauma healing, and community in an in-residence setting, while conducting research to assess the effectiveness of the approach for treating depression from a whole-person perspective.
- Gradual Lifestyle Changes for Depression Recovery: The importance of starting small with diet, exercise, and meditation to overcome the energy barriers that often limit progress in depression recovery—how consistent, manageable changes lead to lasting improvements.
- The Power of Community in Depression Healing: The impact of community support in depression recovery—how healing together fosters accountability, hope, and a sense of belonging.
- Trauma-Informed Care in Depression Treatment: How unresolved trauma can drive depression, and why somatic work and psychodrama therapy are essential for long-term healing.
- Stress Management and Depression: The effect of chronic stress on depression—why incorporating movement-based meditation and breathwork is crucial for calming the nervous system.
- Life After Treatment: Ensuring Long-Term Success: The scariest part of depression treatment: transitioning back to life after a residential program. Why the 15-day follow-up app and community support are essential for sustaining progress.
Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and of course today is no exception. If you’re with me here on YouTube, you can see I am sitting beside two amazing women up to some pretty extraordinary work in the world. I’m going to be talking to them about the Healing Depression Project. You can go to HealingDepressionProject.com if you want to check it out. Let me introduce you and we will jump right into this awesome and really game changing podcast.
Dr. Kara Fitzgerald: Dr. Achina Stein is the clinical director at the Healing Depression Project, the topic of our conversation today. She is a leading expert in functional medicine psychiatry and a bestselling author with over 30 years experience helping people to recover from depression. She’s a board certified psychiatrist, a Distinguished Fellow of the American Psychiatric Association and a certified practitioner at the Institute for Functional Medicine. She’s also a former clinical assistant professor of psychiatry and human behavior at the Warren Alpert Medical School at Brown University in Rhode Island. She had an Amazon international bestseller, What If It’s NOT Depression?: Your Guide to Finding Answers and Solutions, and it offers groundbreaking functional medicine perspectives, instilling hope and providing healing pathways for those facing chronic depression.
Dr. Kara Fitzgerald: Silvia Covelli is the founder of the Healing Depression Project. She’s an honors grad from Boston College and a former social science researcher at Harvard University. She pursued graduate studies in finance and business law and dedicated her career to entrepreneurship, becoming an accomplished businesswoman. In parallel with her really extraordinary career, she also faced relentless chronic depression. She’s been through over 60 different treatment types without finding sustained release.
Dr. Kara Fitzgerald: Her personal struggle combined with her extensive background in human transformation work led her to develop this extraordinary program, the Healing Depression Project. She’s going to talk about her journey with us. Again, her own experience and her own journey prompted the development of the Healing Depression Project, the topic of our conversation today. So we’re going to start with some background on depression. Dr. Stein, give me some stats on the problem that is depression. Maybe the current incidence, but also background. Are we increasing? Go ahead and talk about it.
Dr. Achina Stein: Yeah, thanks. Thank you for that introduction. It’s great to be here. So stats. Major depression is probably one of the most common mental illnesses and it’s affecting more than 8% of Americans. That’s like 21 million people each year, and 15% of youth, that’s 3.7 million ages 12 to 17 are affected by major depression. And 10 times that, believe it or not, 280 million suffer globally. It is the most common form of types of depression. There’s multiple types like bipolar and dysthymia, but it’s increased to the extent that suicide is the second [leading] cause of death in teens. It’s pretty serious and it’s something that we absolutely have to do something different about than the usual way of treating depression.
Dr. Kara Fitzgerald: And the incidence is rising, you know, really just like we see with chronic diseases in general.
Dr. Achina Stein: Yes. Absolutely. It’s rising and it rose significantly since the pandemic occurred. Not just major depression, but also anxiety and other mental disorders. But major depression is definitely up there.
Dr. Kara Fitzgerald: And what’s interesting is that we saw morbidity and mortality numbers, generally speaking, kind of level out now that we’re some years post-pandemic, but depression, we haven’t seen that same–
Dr. Achina Stein: Leveling out. No, it’s still increasing. Yeah, it’s about the same or increasing depending on populations, where they’re located, and how much services that they can get, but there isn’t a supply of physicians, unfortunately, to meet that demand. In fact, the number of psychiatrists and therapists are reducing over the years while these statistics of depression are increasing.
Dr. Kara Fitzgerald: Wow, why is that? Why is that? How come the number of psychiatrists and therapists is…
Dr. Achina Stein: Yeah. Well, I think overall, the number of people that are becoming doctors is reducing. Burnout is certainly affecting people in terms of continuing in the field of medicine. So I think it’s multiple factors and it’s just the overload of the number of people that actually need it. It’s a combination of things, I’m sure.
Dr. Kara Fitzgerald: Yeah, the system is just overwhelmed. Give me just a snapshot. We have a lot to cover today, but give me a snapshot of standard of care and its utility in addressing this epidemic.
Dr. Achina Stein: Sure, yeah. We’ll talk about psychiatrists. Many patients see family doctors who are overwhelmed and aren’t really able to do a full evaluation. I think they do the PHQ-9 (Patient Health Questionnaire for monitoring and measuring the severity of depression), and if they meet the criteria, they’ll be offered an antidepressant. But I don’t think that they are able to do a full evaluation or provide the time and so if they’re not comfortable doing that and prescribing, then they’ll refer to a psychiatrist. It does take quite some time getting in with a psychiatrist. And psychiatrists aren’t the only mental health providers. There’s wonderful nurse practitioners and people, depending on what state they’re in, they have special training in mental health and prescribing psychiatric medications.
Dr. Achina Stein: But once they are seen, generally they are given a full psychiatric evaluation, which can take 60 to 90 minutes depending on the provider’s training. That generally looks at the current symptoms, the past psychiatric history, past medical history, past surgical history, social history, they do a mental status exam and they go down this decision tree to arrive at a diagnosis and it’s essentially matching a pill to an ill. And perhaps they’ll be also offered psychotherapy if it’s appropriate. Sometimes it’s the psychotherapist that will refer to a medical provider for evaluation. There’s cursory blood work done to rule out acute medical issues that might be contributing, and certainly there’s a drug and alcohol history that is taken to determine whether or not substance use is in play as well. Usually there are multiple diagnoses at play, not just psychiatric, but also medical. It’s generally a combination of things that can cause, especially chronic, persistent depression.
Dr. Kara Fitzgerald: There are so many questions from that. I’m just wondering where to go. I mean, you can see just with what you’re saying around standard of care, how it would be tough to coordinate all of those pieces together. You know, just the suggestion… We know perimenopause, menopause, like moving through the transition and hormonal flow… That would be a piece. Thyroid could be a piece. There’s so many pieces you’re alluding to…
Dr. Achina Stein: Connecting the dots.
Dr. Kara Fitzgerald: And creating a cohesive plan around that, it seems to me that’s got to be one of the reasons why we’re seeing this, you know, so-called chronic or treatment-resistant depression. Because perhaps it just hasn’t really been managed that well.
Dr. Achina Stein: Right. What you’re pointing out is absolutely right. What is it resistant to? I mean, the definition of treatment-resistant depression is failing two trials or more of antidepressants, SSRIs or SNRIs. And that is the only treatment that is offered, essentially. Obviously there’s other treatments now, like ketamine and TMS, transcranial magnetic stimulation, but those aren’t the types of modalities that are utilized right from the get-go. It’s usually medication. That’s it. That’s the definition. And so no other modalities are attempted in order change the outlook for the patient. So when a person’s told that they have treatment-resistant depression, that’s a very hopeless type of diagnosis. You might as well say that they have cancer. It’s really terrible. That’s a big pet peeve of mine. I hate that term. I really hate that term.
Dr. Kara Fitzgerald: Yeah. And we’re going to talk about it with you, Silvia, in just a minute, your own experience with that label and how you overcame it and figured out an entirely different trajectory.
Silvia Covelli: Yes.
Dr. Kara Fitzgerald: Ballpark the percentage of people that actually respond successfully to SSRIs and SNRIs. I mean, it’s not impressive.
Dr. Achina Stein: No, it’s not. It’s about a third of the population who are prescribed an antidepressant at the proper dose and for the proper period of time will respond. But what’s considered a response is 48%. I’m not the best person with numbers in my head. Some people are really good about that.
Dr. Kara Fitzgerald: That’s okay. Yeah.
Dr. Achina Stein: But it’s about 48%. That’s what is considered a positive response. I mean, that’s really disconcerting. But then it goes downhill from there. After a while, sometimes people don’t respond as well as they stay on the antidepressants, so typically the dose is increased, and then they might respond for a period of time, and then it’s increased again, but then they start having side effects. So then they go down the dose and another medication is usually added. It might be a different class of medication, but sometimes even the same class. I’m surprised to see that sometimes. Or a mood stabilizer might be added to it. So it becomes this polypharmacy of two, three– I actually have had patients come to me on 5-7 medications.
Dr. Kara Fitzgerald: Extraordinary. And it’s really difficult to change and taper. I think probably all of us in practice have seen the fallout of, maybe not quite that many meds, but I mean, certainly we look at the metabolic fallout– the refractory weight gain, like all of this, the problems with pretty extraordinary side effects.
Dr. Achina Stein: Yeah.
Dr. Kara Fitzgerald: Okay, well, let’s just move on. There was a massive aha early on in my career when I was in a clinical laboratory and the idea that depression was actually driven by inflammation– or certainly a subset of depression was driven by inflammation. It was pretty extraordinary. I mean, I just remember being wowed. When we were looking at some of the laboratories, some of the cool organic acids, it was this extraordinary moment, just really teasing out the idea that there’s this underlying inflammatory phenomenon happening and that it just revolutionized our thinking. But I was already in functional medicine and the laboratory was providing really detailed laboratory analysis for primarily functional medicine providers.
Dr. Achina Stein: Yeah, it is a big aha moment, especially, or even for functional medicine providers because we still talk about serotonin and norepinephrine and dopamine, even still in this space, but I think we understand it differently. It isn’t the cause, it’s the downstream effect. Yes, there are neurotransmitter imbalances, but that’s not the cause of all of the issues.
Dr. Kara Fitzgerald: Yes.
Dr. Achina Stein: There are other issues that are happening in the body, as you mentioned, inflammatory issues, but there’s also mitochondrial dysfunction and oxidative stress, and they all are interrelated and one causing the other almost this vicious cycle downwards. And part of the downstream effects is a change in neurotransmitter balance. That’s why some people may respond to medications, but if the root causes— And I just want to say thank God we do have medications. I think it’s really important for people to understand. I have a foot in both worlds and I don’t diss the other world and it’s life saving for some people.
Dr. Achina Stein: What I envision for the future is to see medications used as an acute form of treatment with the idea that the root causes will be addressed so that those medications can be tapered and discontinued. I hope that’s where we’ll be, maybe 10 years from now, maybe 20 years from now. I don’t know how long that will take. But almost like if someone was hit by a car and they had multiple broken bones, you’re going to want them to go to the hospital, be helicoptered there, and have life-saving surgery and be put in a cast. When a person is put in a cast, they know that cast is going to come off, right? Whereas when people are put on medications, they’re told that they’re going to be put on medications, like this is for the rest of your life. It’s like, what?
Dr. Achina Stein: Now that more more research is coming out about how ineffective medications are long-term and that people can start having side effects as a result of being on medications long-term, I think at some point the pendulum is going to swing to where we reduce and discontinue these medications. And hopefully people will be able to come off these medications without the withdrawal syndromes that are finally being acknowledged, from antidepressants. Whereas before people were told that they’re imagining it and that it doesn’t happen. I remember when people were told that the brain brain zaps that they were having were delusions. I remember. That’s how long I’ve been in practice.
Dr. Achina Stein: It’s just that you see how things evolve over time, of these belief systems and then being proven— The same way that, for the longest time, Zyprexa, which is a major antipsychotic medication that came out, and the company denied repeatedly that it doesn’t cause weight gain, it doesn’t cause metabolic syndrome, diabetes and high cholesterol. And finally, everybody knows that it does and that whole class of medications. So over time, you start really seeing the truth about these medications and hopefully we will adjust our way of caring for our patients knowing these things.
Dr. Kara Fitzgerald: You’ve said a lot. You’ve said so, so, so much. I know that people are listening and just feeling this rage. I mean, we have family members who’ve been on this journey. We have patients who’ve been on this journey. And it’s wildly heartbreaking, the messaging, the gaslighting, you know, really the gaslighting. It almost, reminds me of the idea, you know, in dentistry that mercury is entirely appropriate to use, even as OSHA was sitting over here requiring very stringent protective approaches for mercury exposure in other arenas. But in dentistry, it’s somehow, you know, dentists and assistants and patients could just be exposed to it. It’s just absolutely extraordinary, sort of the disillusion in that. And I’m heartened to hear you just speak so plainly about it, speak about the body of evidence that’s emerging around it to really demonstrate how inappropriate the languaging and the gaslighting has been in that arena and the changes that are taking place. And I just champion your voice and the important work in this arena.
Dr. Kara Fitzgerald: And I also want to say that it’s easy for us to be very critical about meds. You know, they’re all bad, they’re all horrible, nobody should be using them. That’s a very easy, low-hanging fruit. When in fact, to your point, they’re absolutely critical and life saving, so I appreciate your measured, honesty, embracing the nuance of the conversation. All right, so let’s just swing over to talking about this amazing functional approach. I want to know from you the key elements that you’re considering in treatment-resistant depression.
Dr. Kara Fitzgerald: And maybe mention, because you’re speaking to clinicians, some of the key labs you might be considering. Is there a consistent sort of foundational approach? So three questions, the functional approach overall, maybe some of the labs you’re thinking about and some of the interventions that are important for most individuals with depression.
Dr. Achina Stein: Sure. So I start where the patient is, obviously. I gather a ton of information from birth onward. I put all their information on a timeline, and I’m sure people are aware of that, but I actually do it. I don’t know how many people actually do the timeline, but I actually do it, and I gather detailed information. So then we start with where the patient has the greatest motivation, starting with the lowest hanging fruit in terms of where they want to start. And we do start with lifestyle. Lifestyle is very important: getting sleep in order, moving your body, breathing, meditating. These are all basic things.
Dr. Achina Stein: But because I know a lot of practitioners listen to this, I think the best place to start, or at least where I start, and I feel like it gives a lot of bang for its buck, is to really start with digestion. To make sure that digestion is happening, starting in the mouth, and that we’re releasing bile and acid appropriately, which, you know, one triggers the other. You’re going to know just from the history whether or not somebody has problems with digestion, particularly low acid. Especially if they’re low in B12 and iron, right away you know that.
Dr. Kara Fitzgerald: Sure.
Dr. Achina Stein: And if they’re low in vitamin D and vitamin A, then you’re going to know that they’re probably not releasing bile. Certainly, we want to look at their stool. Obviously if they have food in their stool or it’s floating or it’s light colored or white, you know, you can get a lot of information just from looking at the stool. But making sure that they’re completely evacuating, that they are digesting their food and putting practices in place right from the get-go, like breathing before every meal and looking at your food, chewing your food, tasting your food. That could be a really easy way to start a little mini meditation and habit stacking those right away. I don’t feel like people spend enough time with that. And that can tell you a lot about the person who’s even just starting that very small thing, about their ability to tolerate change, their ability to follow instructions, right? Just from those little things.
Dr. Achina Stein: So getting digestion going is going to be really important because once you start getting a flow of the organs, like the liver moving on a cellular level and get these organs working in tandem. So rhythms of the body, really respecting the rhythms of the body. I always say that with digestion, the shop opens and shop closes at breakfast, shop opens and shop closes, you know, shop opens and shop… And there’s this rhythm that you have to respect and most of our society runs around with a big Stanley cup in their hand that has a smoothie, that’s all they drink. They’re in the car, they’re constantly grazing and you’re not even giving your gut a break. And most people follow the standard American diet, eating tons of carbs and sugar, not enough protein, not enough fats. So diet would be certainly the next step and to see how the body receives the food is going to give you a lot of information.
Dr. Achina Stein: Obviously, we do a full diet recall of at least three days and try to get people on a low-carb, low-sugar, and in my practice dairy-free and gluten-free, just because I see so many sick patients that are extremely inflamed and have autoimmunity, and anybody who has an autoimmune disease should be gluten-free. That’s a whole other conversation, but people don’t even know that little piece of information. Really doing whatever you can to, what we call ‘unmuddying the puddle’, by removing these highly inflammatory foods from the get-go and then adding as many vegetables as possible. Just by doing that, a lot can change for people. For the program, you’ll learn or I don’t know if we’ll talk about it more, but for the program, our goal is to have a low-carb, sugar-free diet and increase fats and proteins, which over time, depending on what people need, we’re going towards the direction of a ketogenic diet.
Dr. Achina Stein: Not everybody needs the ketogenic diet, but there are certainly some studies that show that the ketogenic diet is great for the brain. There’s more studies for epilepsy over decades, but not necessarily depression, but those studies are now coming out for depression.
Dr. Kara Fitzgerald: There’s some really interesting work looking at the ketogenic diet in bipolar disorder, I believe. Isn’t it out of Stanford, if I’m not mistaken? Or one of the University of California branches. Some just really, really cool work is happening with that. It does make a lot of sense. I mean, that’s going to just drop inflammation like a stone and those ketones can be really nourishing.
Dr. Achina Stein: Absolutely, and it’s more likely to work for people who have metabolic syndrome.
Dr. Kara Fitzgerald: Oh, okay.
Dr. Achina Stein: One way that I determine what supplements to use downstream, and I’ll give supplements downstream for patients who are still experiencing a lot of distress from depression and anxiety in order to make them comfortable so that they are ‘comfortably’ depressed, for lack of a better word. They’re not in danger anymore. They’re not desperate They’re still depressed, but they’re not in this desperate place. So I’ll use supplements and medications to help a person be comfortable. Then I’ll go upstream to figure out what are the root causes that are causing all of these issues. A ketogenic diet is excellent for somebody who has metabolic syndrome, so if they have metabolic syndrome and depression, then the ketogenic diet is going to work wonderfully for them. I also know that sometimes, people who start the ketogenic diet, they find that their cholesterol goes up, you know, and many of their conventional providers get really panicked about it.
Dr. Achina Stein: But I feel like that is going to be just in flux while you’re starting something new and you’re flushing out your liver of all of these fats. Where are they going to go? They’re going to be in the bloodstream for a period of time until they’re eliminated from the body, right? So eventually those cholesterol levels and triglyceride levels, they’ll go up during that period of time, but then they should come down. You might need to use cholesterol-binding medications like statins or binders to be able to soak those up in the meantime. But yeah, there’s different ways of determining which supplements are helpful. For example, if someone has mitochondrial disorder, there’s some studies that show that carnitine is helpful.
Dr. Kara Fitzgerald: Yeah.
Dr. Achina Stein: Or if they have blood sugar dysregulation, and their blood sugar is shooting up and then crashing down to the point where they’re hangry, chromium would be a great thing to add. Mostly everybody would benefit from a very low dose of lithium. Very low doses like of 10 milligrams can make a difference without any side effects. It’s only above, I think it’s 100. I think the study showed that it was 112 milligrams. Above that, you might start having side effects, but really low doses are not a problem. I’m trying to think if there’s anything else that I would want to say to answer your three questions all at once.
Dr. Achina Stein: The other piece that is really important, at least from my perspective as a psychiatrist, is stress. I think people know, yes, stress absolutely can cause problems, especially with being in fight or flight, you are not in rest, digest and heal mode. So it’s going to be important for you to do all these stress reducing activities, like meditation and breathing. But some people have a really hard time getting into that place. They’re too antsy, their mind is a monkey mind. It’s very, very hard to do. So depending on the person and what else they do in their life, I try to find moving types of meditations.
Dr. Achina Stein: Those are easier to do. But some people who’ve had history of concussion, that then resulted in IBS, which then resulted in anxiety and depression, you’ll want to have them do vagal nerve stimulation. If they’ve had quite a bit of trauma where they’re still reacting again and again and again, you’ll also want to include brain retraining of limbic activation. So it depends on the person, but it’s really important to look at the level of trauma that people may not necessarily talk about to the depth of how it affects them on a day-to-day basis. And they may not even know, so it’s really about looking for that. Being a psychiatrist, I’m more in tuned with those kinds of things and I pick up on those types of things.
Dr. Kara Fitzgerald: Would your book be appropriate? Your book is called, again, I’ll just mention it, What If It’s Not Depression, Your Guide to Finding Answers and Solutions. And we can link to it in the show notes. Would it be appropriate? Would there be some guidance in there for clinicians as well as for individuals?
Dr. Achina Stein: Absolutely. Yes. Right.
Dr. Kara Fitzgerald: Good, good. Because you’re touching on a very in depth functional approach and we don’t have time to go through all of the pieces, but I can see that you’re just casting that wide net. It reminds me of the breadth and depth of our toolkit. It’s very rich. Not everyone is going to respond to B12, but B12 is going to be 100% game changing as a piece of the puzzle for some. And just as you’re suggesting, somebody on the metabolic continuum could respond spectacularly to a ketogenic diet.
Dr. Achina Stein: Yeah.
Dr. Kara Fitzgerald: But another person who is not anywhere near is not going to yield that benefit. So stratifying those interventions is essential. I just wanted to say, by the way, is just thinking about the change in cholesterol patterns with certain individuals on a keto, and this won’t be appropriate for everybody, but I do want to give a shout out to the CLEERLY scan, the CT Coronary scan that’s kind of supplanting the calcium score where we can get a better look at what’s happening with plaque activity. And you’ll see that folks who are low-carb can have just really minimal plaque activity and that can kind of help stratify who needs to go on an aggressive cholesterol reduction protocol.
Dr. Achina Stein: Absolutely, absolutely. And getting other, labs like the oxidative LDL, and getting the fractionated cholesterol panel is really helpful as well to determine whether or not it’s safe in other ways for people. So especially when you’re treating depression and people find incredible benefit from the ketogenic diet, you’re going to want to make sure that the other organs in the body are benefiting as well. But you know, this is all new stuff and we’re going to learn more and more as time goes by with more and more research. I do want to mention though, like you mentioned B12—
Dr. Achina Stein: Yeah, B12 is great and so is folate, but I like to see people take a B complex because to me, it’s like the B vitamins are a group of vitamins that are holding hands and it’s always going to be dependent on the one that’s the lowest. They work as a group, so if you take only one of those, like just B12 or just folate, you end up using all the other vitamins that are needed for them to work as a group. It’s what we call rate-limiting step.
Dr. Kara Fitzgerald: That’s fair. Yeah, and also with inflammation, the kynurenine pathway is going to usurp all the serotonin is very B dependent. A lot of different Bs are playing a role there. Okay, I want to move things over to talking to Silvia. Thank you Dr. Stein for that really nice background in functional medicine and psychiatry and what you’re thinking about more broadly with individuals. Was there anything else you wanted to add before we start to talk about the Healing Depression Project and Silvia’s journey?
Dr. Achina Stein: Yeah, it’s just that it is a journey. It’s a journey and that people ought to see it as a journey, that it takes time to peel back those layers and keep working on it and understand that it’s an evolution in resolving depression and other chronic illnesses.
Dr. Kara Fitzgerald: But we do have a toolkit. We have a very real, vibrant, effective toolkit, even as there can be a journey in the process of identifying the interventions that are going to really work. Which, Silvia, happens to be your own experience struggling with and moving through many different treatments. You were by day this superhero woman tackling the universe and then struggling with really incredible depression. Talk to me about your story.
Silvia Covelli: So it was a very long journey, 25 years with recurrent depression. It would get a little better, but then the symptoms eventually will come back. And I thought it was just a very unique case, but now as I’m hearing so many people and talking to so many people, it happens that my story is extremely frequent. Just people not responding to different treatments regarding depression, and that’s how we have come to this term of chronic or so-called treatment-resistant depression. I did traditional treatments. I started with conventional psychiatry and I did pharmacological approaches. In my case, antidepressants didn’t work, it actually made things worse. I developed new symptoms that I did not have before the medication and I’m not alone there.
Dr. Kara Fitzgerald: Such as? What were the symptoms that you developed?
Silvia Covelli: New symptoms, I mean, extreme fatigue but it was like lethargy. I couldn’t move the body. Before it was like energy drain and that became really intense. I had muscle aches, just my whole body was aching and I became more sensitive to light, to sounds, and I would feel really claustrophobic in crowded places. These are things I did not have before so it was just related to the medication. Those are just a few, but there are many more. So antidepressants didn’t work. I tried several medications that psychiatrists just– I guess everything that we were talking about before. They don’t have enough tools. That’s what conventional psychiatrists learn in school. They’re just taught, you know, these are the pills and they’re supposed to cure A, B, C, D.
Dr. Kara Fitzgerald: Yeah. Yeah.
Silvia Covelli: But they actually don’t, and as Dr. Stein was saying, only one third of people respond to antidepressants. She explained very well what respond means, because it’s very different from getting better or actually curing the condition. Because if you look at how many people have achieved complete recovery with antidepressants, the number is less than 10%. There are amazing studies showing that. So I was among those people and I kept trying different approaches, more conventional like talk therapy, and I didn’t stop there because that didn’t work.
Silvia Covelli: So I tried different retreats to calm the nervous system through meditation. I tried yoga. I tried all sorts of programs and I was really fascinated by going away to a retreat or to any type of program that involved just getting out of my normal setting and just going away. And some of them worked, but again, everything was temporary. The symptoms would come back and the thing is that you never knew when. Just one day you would wake up and all those things that were doing better were not doing better anymore. The whole journey was very discouraging because doctors kept telling me in different ways that there’s no cure. Just the fact that they give you medication forever, just because it’s not being managed, as Dr. Stein wishes it would be.
Silvia Covelli: If the person is in an acute state, then the medication should be for X amount of months and it should be part of a treatment with a strategy behind it. But here there’s nothing. The psychiatrists just give you the pill and then you stay there for 10, 20 years and for the rest of your life. And in my case, I wanted to get off the medications and the doctor insisted that I shouldn’t because I was going to feel worse. And I just thought to myself, like, okay, really? I’m already feeling really bad. How much worse is this going to get. So I just had to do it on my own. didn’t get help like for that. And just these recurring ideas on how you’re going to have to deal with that forever.
Silvia Covelli: I guess hope is not something you hear from a psychiatrist. And they’re right in a way since their treatment is based on just medications, then it makes sense that the patients are not getting better because it requires so much more than that. So I just continued and I tried different things and after 25 years of dealing with it and after being told by doctors that my best bet was to accept the condition, make peace with it, that it was part of who I was. Actually using sentences like ’learn to live with it’. A doctor that says that doesn’t understand the depth of the struggle that depression can be because it’s not something that you can learn how to live with. So I didn’t stop doing different things and then at some point, about 25 years into this battle, I just kind of stopped my entire life. I stopped working, I stopped the things that I was doing, and I concentrated 100% of my time and my energy on just healing. I went back to the programs and the retreats and the medical approaches and all the different things I’ve done and I reviewed them.
Silvia Covelli: It was over 60 different ones over 25 years, and I extracted the pieces that worked the best and I started really making the connection between mind and body and just seeing how disconnected all the doctors that I talked to were because it was this assumption that everything was in my mind or just in my emotions. It was like an aha moment for me when I said, wait, so this thing is actually rooted in my body. There are things that are happening inside that are causing, or at least contributing to, the symptoms. So at that point, I just put a program together and I also had a more functional medicine approach.
Silvia Covelli: I also made significant changes in my diet, in the sleep cycle, and I implemented a lot of the things that I knew were good and that I had gotten some benefit out of. But the thing is, I implemented them every day, and I think that’s when I saw a big change in my life. And I hear it all the time, you know, I felt better when I was eating this way. And then the question is, why did you stop or why didn’t you continue that? Or, oh yeah, I know exercise is good but then we still don’t do it every day and it’s the same with meditation. And again nutrition, because it’s really difficult to change the way you eat and it requires you to get informed, it requires energy, it requires a lot of time. And depending on who you live with, if you’re going to start a specific type of diet and everybody else at your house is eating something different, it’s an added challenge.
Silvia Covelli: So anyways, because I stopped everything and this is the only thing I was doing, I managed to change all the things that I had not been able to change while I had my super busy life. And within a month of doing those things, I started to feel a difference. And I can say three months into it, I felt like a complete different person from even from a biochemical perspective.
Dr. Kara Fitzgerald: Amazing. Incredible.
Silvia Covelli: I was just someone that had energy again. I was waking up with mind clarity, with peace and ready to start the day, which never… It was always something that was a struggle for me, waking up in the mornings. So I got better and I haven’t had those symptoms back. It’s been almost five years.
Dr. Kara Fitzgerald: And let me just ask you– Well, I actually have a thought and then I have a question. We were talking about IFM (Institute for Functional Medicine) and the immune module and one of our first teachers was Dr. Alex Vasquez, and he used to teach something, we were talking about Alex. If you have tenor interventions and each maybe move the needle 10%, that’s 100%. I mean, it’s not that cut and dried in most cases, but generally there’s truth in that. If you can find the handful of interventions that are exactly right for you. And to your point, I think a lot of people do X intervention for a little while and notice some benefit, but they fall off because it’s not quite the full package of interventions they need as you put together.
Dr. Kara Fitzgerald: Certainly, people with depression have, you know, in my practice come to me having tried dietary pattern changes and they’re able to sustain it for a little while, but they really don’t have the energy to do it long term. And maybe it’s just a piece of the puzzle, but it’s not the entire puzzle. So bravo you for tracking this so extraordinarily carefully over your journey, where you found the energy to actually note somewhere that, hey, this helped a little bit, this didn’t, etc. And then to be able to take the time off to do them all. So my question is, you’ve got some non-negotiables in your life. I’m imagining that there’s a structure to your life these days that really has to be in place. Getting enough sleep, getting some exercise, getting some sun, like those things. Your diet, probably, is something you put a lot of attention into. I mean, would you say that’s true?
Silvia Covelli: Yes, all of the ones that you mentioned plus meditation. Up until today, I still have those non-negotiables and I think that’s where you’re really able to find the sustained well-being. And that was the main inspiration for the program because the program is 45 days, but 30 days are in a retreat setting. And that’s just because I know firsthand how hard it was for me to implement these things.
Dr. Kara Fitzgerald: Well, let me just once again say this is the Healing Depression Project, healingdepressionproject.com. So you took what you learned and then you decided, I’m going to create an in-residence program. I’m going to create a place where people can come and do this.
Silvia Covelli: Yes, exactly.
Dr. Kara Fitzgerald: Huge.
Silvia Covelli: Everything came together. I saw my own struggle in putting these things together. I also started hearing over and over from different functional medicine doctors that one of their main frustrations was that they woul tell the patient everything they had to do. They would write it down, and actually, some of them spent a lot of time and energy explaining things.
Dr. Kara Fitzgerald: Sure.
Silvia Covelli: And then the patient would come back three months after and they hadn’t done it, or they have done just a little bit, or they tried it and they stopped. So the doctor is like, well, you know, this is actually the medication, and if they’re not doing it… So it was also as a response to how hard it is for someone with depression to implement a functional medicine treatment and any change in your life. If you think about it, the first thing that you need to make a change is physical energy because if you don’t have any energy, you’re not even going to cook. You’re going to just grab your phone and order online at best.
Dr. Kara Fitzgerald: That’s right.
Silvia Covelli: You need hope and hope has been taken away from people like us because doctors themselves as I was explaining, they don’t give it. Conventional psychiatrists actually take hope away. And then also the fact that you have tried one thing, two things, three, then, you know, that takes away the hope by itself.
Dr. Kara Fitzgerald: Yes. I already did that. I already did it. It didn’t work.
Silvia Covelli: Yes, exactly. You come to the conclusion, I tried it all, I did it all and nothing works. That’s it. And then it’s really hard to move the person from that point. Actually, the way I did it is I kind of challenged myself and I said, well, okay, so how come you’ve been able to do all these other things and what about this? But, this is a specific type of personality that was able to achieve that. What the program is intended to do is, in a gradual way and through the science of habit formation, to actually help the person to change all those things that they need to change and all the things that the doctor like recommends.
Silvia Covelli: It’s to change the nutrition with a lot of awareness, explaining why. Because the more awareness you have and the more you understand, oh, this is why I’m doing this and this is what happens. For example, if you really understand why sugar is bad and what happens to your brain when you’re eating sugar, then you will think twice about it. But we’ve been sold on the idea that sugar makes you happy so it’s really hard to break away from that. So we help the person with the diet. We help the person with a morning routine that includes meditation and exercise. That exercise is a walk outside in order to get sunlight and do it in a special way in order for you to get all the sunlight. You should not be wearing sunglasses or a hat, just sunscreen of course, but in a way that you don’t stop the light from coming into your eyes and then get into the brain. That’s what it needs to get to.
Dr. Kara Fitzgerald: Sure. I have a couple of questions around that, just going back to the point Dr. Stein made. You’re meeting this individual where they’re at. I mean, do you want everybody in the program meditating or might you tweak that for somebody who wants to do something more physical? So that’s question number one. Is there an individualization layer going on? Question number two is something that we haven’t talked about. Depression is an incredibly isolating and lonely journey. It is certainly why we see, to your point, people having a very hard time implementing a functional medicine approach that’s multi-layered and requires some energy and focus. There’s the community element here that we just haven’t really spoken to, so speak to that as well.
Silvia Covelli: Yeah. The program is very gradual, so we’ll meet the person where they are at. It’s not that they will be expected to meditate for 30 minutes the first day and take a 45 minute walk. That’s not how it works. It’s just in a very slow and gradual manner, we’ll take the people through the things. And it depends. Someone that is already doing it, then they will go faster. So I guess the speed of the program can be different, but we’re going to have everyone do, for example, the walk and the meditation. The meditation is because we’re not only addressing the stress and the nervous system there, the meditations that we’re going to be doing are grounded in a neuroscience.
Silvia Covelli: It’s to lower the waves in the brain and therefore, the person is able to access the subconscious mind and therefore to replace thoughts and emotions. It’s that rewiring of the brain in a sense, because there’s a lot of limiting beliefs that are in there that need to be addressed and actually replaced if you really want to heal. Even just having the thought that you can heal from depression is the first thing that we work on because people think, just as I did, that I cannot heal from this and the word cure is something that, you know, happens to other people. This is not something that is going to happen to me. Just opening their brains to the possibility that they could achieve a point in their life where they don’t have these symptoms is very important.
Dr. Kara Fitzgerald: Sure. What’s the structure of the program? Give me the daily flow.
Silvia Covelli: Yeah. First let me answer the previous question about the community. I couldn’t agree more. With depression, we’ve been trying to heal in isolation and that’s extremely difficult because you need the support network and you need other people as well. So this program is unique because it’s cohort based, which means that everyone— it’s only 15 people, so it’s very small, it’s personalized—but they still get all this synergy and support of the group, of the community. Everybody starts on the same day, everybody finishes the program on the same day, there’s even a graduation day. That develops that sense of community and you’re going to relate. You’re going to see, like, here I was thinking that I had the worst case of depression and that nobody could cure it. And then you’re going to see other people and you’re going to see– It’s healing together and gradually getting better together. And that’s extremely powerful.
Dr. Kara Fitzgerald: Sure.
Silvia Covelli: And that also builds new social connections for them for the future, after they leave the program.
Dr. Kara Fitzgerald: And you have the in-person month-long app program, and then you take it online after that. So they’re going to continue as a community.
Silvia Covelli: They continue as a community and it’s 15 days and for those 15 days, we’re with them every day in the afternoons to help them with the implementation at home to integrate everything that they learned during the retreat, to integrate it into their day-to-day lives. Because if they don’t do it in their day-to-day lives, if they don’t do it long term, then the benefits will eventually go away. Their body, their mind, the emotions will go back to where they were.
Dr. Kara Fitzgerald: Sure. That’s right.
Silvia Covelli: It will be an amazing 30 days and that’s going to be it. So the real challenge with these residential programs is what happens when you go back home?
Dr. Kara Fitzgerald: Transitioning. Yeah
Silvia Covelli: The scariest day of all is getting back home and you’re like, my God, I’m alone and I’m supposed to do…
Dr. Kara Fitzgerald: Are you working with them to put together their in-person, their live support circle and how they’re going to be able to kind of manifest the continuation of some of these?
Dr. Achina Stein: Absolutely. Yeah.
Silvia Covelli: Yeah, the last five days of the program is called Life Integration Mastery and it’s just how, on an individual basis, they’re going to integrate this into their life, depending on what are their obligations, who do they live with, where do they live, and what are they committing to. How are they going to replicate this at home? The program is taught as a training and I like to say that the way that we’re seeing every model is that if the person cannot replicate it at home, we’re not teaching it. Unless it’s treatment or therapy that’s different, right? But if it’s something regarding like lifestyle habits, if they cannot do it by themselves at home… And we’re going to provide everything, all the tools, the knowledge and empowerment to make them feel that, yes, you can do this. And they’re going to feel so much better during those 30 days that it’s going to be the reset that is going to make them believe that this works.
Dr. Kara Fitzgerald: Yeah.
Silvia Covelli: It’s not true that they had tried it all. It’s not true that nothing works. Once that change happens in their mind, they’re going to say, oh, okay… And they’re going to be not only willing, but they’re going to comply with doing this when they go back home.
Dr. Kara Fitzgerald: Do you have outcome data? I mean, have you done a pilot?
Silvia Covelli: The program is launching in March. So the first program is going to be in March.
Dr. Kara Fitzgerald: March 2025.
Silvia Covelli: Yes, 2025. And all the professionals that we’re working with, just like Dr. Stein, are people with 30 years of experience. They’re going to be doing what they do in their private practices but in a residential retreat-style setting.
Dr. Kara Fitzgerald: And where is it?
Silvia Covelli: In Austin, Texas.
Dr. Kara Fitzgerald: It’s in Texas. OK. So you’re going to be going out there, Dr. Stein, for the program? You’ll be there?
Dr. Achina Stein: Yes, will be. I’ll be there.
Dr. Kara Fitzgerald: That’s amazing.
Silvia Covelli: Yeah, she’ll be there the entire 30 days. We’re doing metabolic psychiatry and the diet that we’re implementing is a ketogenic diet, especially designed for brain health. And our nutritionists– We’re really lucky to be working with Beth Zupec-Kania. She’s a very, very, very well known person in ketogenic therapy, also with over 30 years of experience. She’s going to be in person just with the implementation. The participants are going to be wearing a glucose monitor and ketones are going to be measured daily. So we’re not going to be guessing if the diet is working. We’re going to know if it’s working and what’s happening inside of them.
Dr. Kara Fitzgerald: Wow.
Dr. Achina Stein: Right. We’re also going to be doing research. Kat Toups is our research director and she’ll be— I know that you know her— she’s amazing when it comes to research and we’ll be gathering data. We definitely are going to publish this.
Dr. Kara Fitzgerald: Amazing. So this is all under IRB and you’ll be able to publish on this data. Wow, that’s absolutely terrific. So there’s the diet, there’s the meditation component, there’s movement, there’s classes on learning and understanding the phenomena of depression and–
Silvia Covelli: And there’s another piece that is the trauma piece. And this is another reason why people don’t get better from depression, because it really requires a whole person approach. It is in the body, it is in the mind, in the emotions, and even in the spirit, like how connected they feel to life. What I saw in what I implemented for myself, is I started getting results when the things that I was putting into work were addressing all the different dimensions of my being. The program does that too. And in a simultaneous way, so that all the parts of you start to heal simultaneously and they help each other instead of derailing the process.
Dr. Kara Fitzgerald: Sure.
Silvia Covelli: Because if you’re doing better in your mindset, let’s say more positive mind, but the body is really at bad place, like lacking energy and feeling bad, then the body will derail that energy that you could have done in your mindset, and so on with the other areas. So the other area is definitely trauma, the emotions. We’re doing 50 hours of group psychodrama therapy, which has been proven extremely effective for people with depression, especially to be able to work through unresolved trauma in a shorter amount of time. And we’re doing that together with somatic work.
Dr. Kara Fitzgerald: Let me just ask Dr. Stein quickly– Comorbidities, I mean, are you leaning mostly on depression or can individuals who have a diagnosis of PTSD, post-traumatic stress disorder,or anxiety, panic disorder, etc?
Dr. Achina Stein: They have to have a primary diagnosis of major depression– chronic treatment resistant, essentially. Yes, they can have other diagnoses, bipolar disorder, and PTSD, anxiety, comorbid diagnoses. But they need to be stable and not suicidal, not desperate, basically in a safe place before they come and have been in a safe place for a period of time where their focus is on getting well and not in this acute depressed place.
Dr. Kara Fitzgerald: Okay, so they’re going to have some commitment and ability to engage actively in their treatment. So, Silvia, talk about the cost, talk about the scholarship, maybe mention whether you’re working on insurance. Just talk about that piece and actually making it happen.
Silvia Covelli: Okay. Residential care is very expensive here in the US. We managed to get really generous scholarships. People that are applying are getting scholarships for up to 80% of the investment. This is a great opportunity for doctors that are listening too. If they have patients that despite the best care are still struggling with depression, maybe because they need a whole person approach or because they need a more immersive approach, then this might be the opportunity for those patients to be able to access residential care.
Dr. Kara Fitzgerald: I’m imagining at some point you might look and see whether out of network benefits or… Likely that’s something down the line, but yeah.
Silvia Covelli: In the future, yes, we will.
Dr. Kara Fitzgerald: Good, that’s fabulous. What else do I want to say? So people can go to healingdepressionproject.com. Physicians can go there to find out how to refer. Project, excuse me. Yeah.
Dr. Achina Stein: It’s healingdepressionproject.com. Yes.
Silvia Covelli: Yes. And the best way to refer is to just ask the patients to book a call with us. The call will be taken by me or by Dr. Stein and we’ll just discuss the journey of the person and see if the program is a good fit for them and talk in detail about the program. It’s healingdepressionproject.com/call is how they can book a call with us and find out.
Dr. Kara Fitzgerald: You have your first cohort starting in March, and then when is the second cohort slated to start?
Dr. Achina Stein: At the end of August.
Dr. Kara Fitzgerald: Okay, so soon.
Silvia Covelli: Yeah, in 2025 we’re going to have a program that begins mid-March and the other will be at the very end of August. So it will be during the month of September.
Dr. Kara Fitzgerald: Okay, perfect.
Silvia Covelli: So it’s only two during the year.
Dr. Kara Fitzgerald: Okay, okay. Well, ladies, thank you very much for joining me on New Frontiers in Functional Medicine. This was just a great conversation. I wish you the best. I just extend all my support to you. We’ll certainly lean on our platform to get the word out for you. It’s just an amazing, amazing opportunity and just potentially game-changing. I’m so glad that Dr. Toups is involved in gathering data and that you’ll be able to publish. Thank you both so much for joining me today.
Dr. Achina Stein: Thank you for having us, Kara. We really appreciate it.
Silvia Covelli: Kara, thank you so much.
Dr. Stein is the Clinical Director at the Healing Depression Project. She is a leading expert in Functional Medicine Psychiatry and a best-selling author with 30 years of experience helping people recover from depression.She is a board-certified psychiatrist, a Distinguished Fellow of the American Psychiatric Association, a certified practitioner of the Institute for Functional Medicine, and a former Clinical Assistant Professor of Psychiatry and Human Behavior at The Warren Alpert Medical School of Brown University.
Dr. Stein’s Amazon international bestselling book, “What If It’s NOT Depression? Your Guide to Finding Answers,” offers groundbreaking functional medicine perspectives, instilling hope and providing healing pathways for those facing chronic depression.
In the 45-Day Depression Recovery Program offered by the Healing Depression Project, Dr. Stein works on identifying and addressing all the root causes of your depression-like symptoms. This program brings hope to those who have long struggled with depression and have not found relief with other treatments, including antidepressant medications.
Silvia is the founder of the Healing Depression Project. She is an honors graduate from Boston College and a former social science researcher at Harvard University. She pursued graduate studies in finance and business law, and dedicated her career to entrepreneurship, becoming an accomplished businesswoman.
In parallel with her thriving career, Silvia faced relentless and chronic depression, exploring over 60 different treatments without finding sustained relief. Her personal struggle, combined with her extensive background in human transformation and mind-body connection, led her to develop a program that remarkably eradicated 25 years of depression symptoms, leaving her depression-free ever since.
This breakthrough later inspired the creation of the Healing Depression Project, and helping others break free from depression became her life mission.
Website:
www.HealingDepressionProject.com
Schedule a free call with Silvia or Dr. Stein at:
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