Integrative Psychiatrist Dr. Ellen Vora on Gut Health and Mental Health

While many people associate psychiatry with using medications to improve mental health, that’s not the only approach. Consider integrative psychiatry, a version of functional medicine that addresses root causes of mental health issues and considers the patient as a whole person, rather than a cluster of symptoms. Dr. Ellen Vora, a board-certified psychiatrist at Dr. Frank Lipman’s Eleven Eleven Wellness Center in New York City, is one of the most prominent figures in integrative psychiatry, and she sat down with WellBe to discuss her practice. Read on to learn more about Dr. Vora’s work in integrative psychiatry, including the link between the gut microbiome and mental health, the side effects of ADHD medication, and more.

*This is a short clip from our interview with Dr. Vora. Click here to watch the whole thing!*

You can also listen to an audio version of our interview with Dr. Ellen Vora on The WellBe Podcast. 

How Sleep Impacts Mental Health

As a practitioner of integrative psychiatry, Dr. Vora turns to holistic, lifestyle-based changes that can help patients treat the root cause of their issue, rather than just pulling out her prescription pad. However, it can feel like there are an overwhelming amount of options when it comes to those changes: diet, supplements, meditation, acupuncture, yoga, relationships, environment, and many, many more. But there’s one thing that Dr. Vora always likes to start with: sleep.

“I like to start with sleep, because I think there’s some low-hanging fruit around sleep,” says Dr. Vora. She suggests simple changes like getting your phone out of the bedroom and making the lights in your home dimmer during the evening, both of which encourage your natural circadian rhythm and set you up to sleep better. 

This is important with regard to mental health because, as Dr. Vora says, “once someone is sleeping better, everything else is easier.” Anxiety, depression, and gut health all improve when someone is getting quality sleep, and when all of those aspects of health are more manageable, it then makes it easier to make other changes. 

Understanding the Side Effects of ADHD Medications

ADD and ADHD are increasingly common issues. It’s estimated that 4.4% of adults have ADHD — though this is an admittedly low estimate — and the number is much higher for kids: 9.4%. What’s worse is that these numbers are continuing to rise, and that most people diagnosed with one of these conditions are also prescribed medication for it. That means that a huge number of Americans begin taking stimulants from an early age. According to Dr. Vora, these stimulants are very effective for treating the symptoms of ADHD, but their side effects may far outweigh the benefits.

One of the major issues with the stimulants used to treat ADHD is, counterintuitively, the fact that they’re so effective. Dr. Vora points out that with a lot of mental health medications, we don’t actually know if they work; antidepressants, for instance, perform equally as well as a placebo for mild to moderate depression. But, according to Vora, “the stimulants, they work.”

That means that many people diagnosed with ADHD get on these drugs early, and stay on them for a long time, and that’s where the issues arise. Dr. Vora has a lot of patients who have been on stimulants for many years, often since childhood, and this can lead to long-term issues and difficulties upon reaching adulthood.

 “There’s a real psychological and physiological dependence,” Vora says, explaining that many of her patients tell her that they can’t even get out of bed until they’ve had their Adderall (or Vyvanse, or Ritalin, or Concerta…). Because of the strength of these drugs, and the length of time most people take them, going off of ADHD medications can have its own set of side effects.

Vora says that the stimulants give people a sense of false energy and alertness, allowing them to skimp on nutrition and sleep while still performing at an extremely high level. So when the medications are removed, there’s a “comeuppance,” as Vora describes it. This can manifest in symptoms like lethargy, depression, burnout, and insatiable hunger, as well as adrenal fatigue. Because of all of the above, it can take months, or even years, to get off these powerful stimulants.

“These medications are not benign,” Vora reiterates. “I don’t dispute that some people really have true blue ADHD symptoms, I just think that there’s a better way of managing it, and I hope that people can learn about that alternative so they can do that before getting themselves on this path of years of medication.”

The Link Between the Gut Microbiome and Mental Health

One of the other serious ADHD medication side effects is that it has a negative impact on patients’ gut health. Dr. Vora attributes this to the fact that stimulants prevent your parasympathetic nervous system (aka the “rest and digest” system) from ever activating. Over the years, this can do serious damage to your gut, because it’s never given the opportunity to rest, repair itself, and digest properly.

This is a very big deal, because the gut doesn’t just deal with digestion, it also plays a role in mental health. “The gut microbiome affects everything, and it affects it pretty profoundly,” says Dr. Vora. 

To explain the relationship between the gut microbiome and mental health, she explains that the brain, just like your liver or kidneys, is a physical organ — which means that if something is off in your body physiologically, it’s going to impact your brain. And the physiological factor that has the biggest impact on the brain? You guessed it, your gut.

See, we’re in a symbiotic relationship with the bacteria and viruses within our gut, each of which have a particular role to carry out. For some of those microbes, that role is to synthesize neurotransmitters, which help our brain function normally. So if something is off in your gut, whether it be inflammation or poor digestion or any other gut issue, it can mean that vital neurotransmitters like serotonin and GABA aren’t being properly produced. This, in turn, leads to mental health issues.

All of the above is made even more important when you realize that about 1 in 5 adults in the U.S. experiences mental illness in a given year, according to the National Institutes of Mental Health. The two most common of these are depression and anxiety disorders, with 8.3% of adults experiencing at least one major depressive episode in the past year and an estimated 19.1% of adults experiencing anxiety disorders. Considering what Dr. Vora explained above, along with the fact that low levels of serotonin are linked with depression and low levels of GABA are linked with anxiety, and it’s difficult to dismiss the connection between the gut microbiome and mental health. 

Watch our full interview with Dr. Vora to learn more about her unique approach to integrative psychiatry, including the role that acupuncture and yoga play in her practice, how we can influence our mental health through epigenetics, and much more.

You can also listen to an audio version of our interview with Dr. Ellen Vora on The WellBe Podcast. 

Have you had any experience with integrative psychiatry? What were your thoughts? Let us know in the comments below!

Citations:

1. Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168-176.
2. Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report .
3. Hyland, Niall P, and John F Cryan. “A Gut Feeling about GABA: Focus on GABA(B) Receptors.” Frontiers in pharmacology vol. 1 124. 4 Oct. 2010, doi:10.3389/fphar.2010.00124

The information contained in this article comes from our interview with Dr. Ellen Vora, MD, a psychiatrist, acupuncturist, and yoga teacher. She is board-certified in integrative and holistic medicine. Her qualifications and training include receiving her undergraduate degree from Yale and her MD (medical doctor) degree from Columbia University. You can find out more about Dr. Vora and her practice here.