Oh hormones…it seems you are my worst enemy and my best friend depending on the day. Sometimes you make me happy, sometimes you make me sad, and sometimes you make my husband fear you. Ladies, I think we can all relate.

How many times have people accused you of being “hormonal”? Feels a bit sexist, right? Was it your significant other as is often typical? I think it’s about time as women that we take this term back- reclaim it. My response is, “Well yes, I am hormonal and in fact, my hormones probably made you attracted to me in the first place. Thank you very much”.

As women we experience dynamic hormone transitions throughout our lives. Whether it is our monthly cycle that may be predictable or highly unpredictable, pregnancy, lactation, and/or menopause, we have all experienced the force of our body’s messengers. Sometimes these changes and transitions are rejuvenating, sometimes just tolerable, sometimes comical, but sometimes they can cause serious disruptions in our mood and overall vitality.

In conventional psychiatry, there is an acknowledgment that hormones may play a role in emotional wellness, yet it remains rare that hormone levels and function are actually tested for and considered with making treatment decisions. Unfortunately, too often psychotropic medications such as antidepressants or mood stabilizers are prescribed without a second thought to addressing hormone balance. Clients may meet every criterion for clinical major depressive disorder and per recommendations, would be a “good candidate” for an antidepressant, and yet lab tests may reveal significant hormone imbalances such as thyroid dysfunction, which when corrected remedies the depressive symptoms. Go figure!

At She Soars Psychiatry, we focus on hormones that we feel are most implicated in influencing your emotional wellness.

For the sake of maintaining your focus, I will not get too wordy with the science, but if there is a take home message, please consider getting your hormones checked before jumping to the conclusion that you have a “mood disorder”. Here are some noteworthy hormones worth consideration.

Noteworthy hormones for women:

Thyroid: Thyroid function is critical to maintaining emotional wellness. Dysfunction may be caused by multiple mechanisms including autoimmune disease. Hyperthyroidism (producing too much thyroid hormone) can cause insomnia, panic attacks, irritability, heat intolerance, and more. Hypothyroidism (producing too little thyroid hormone) can cause fatigue, depression, cold intolerance, weight gain, and foggy thinking. Women can be particularly susceptible to thyroid dysfunction following childbirth, which needs to be considered if postpartum mood symptoms are experienced.

 

Sex hormones: An imbalance between estrogen and progesterone can lead to multiple mood symptoms. Estrogen dominance or excess can cause symptoms of both depression and anxiety along with progesterone deficiency (the two often go hand in hand). Testosterone is also important for women and plays a role in facilitating motivation, sex drive, and energy levels. Our environment is full of xenoestrogens (estrogen mimicking compounds), which can cause further hormone disruption. Sex hormone balance should be particularly considered in women on oral contraceptives, women experiencing pre-menstrual mood changes, women with endometriosis, polycystic ovarian syndrome, uterine fibroids, and women in the peri-menopause and menopause stages.

 

Adrenals & HPA axis function: This is a big topic and one we will explore further in detail. Essentially, your adrenals and HPA (hypothalamic-pituitary-adrenal axis) are an intimate part of your stress response. It all starts in your brain with the hypothalamus, which assesses internal and external information and then communicates with another very important part of your brain, the pituitary gland. When stressed, the adrenal glands (which sit on top of your kidneys) release both norepinephrine/epinephrine and glucocorticoids (cortisol). Many of you may have heard of cortisol and how chronically elevated levels of cortisol may be associated with inflammation, blood sugar instability, weight gain, and depression. In cases where stress is not alleviated such as post-traumatic stress disorder, cortisol levels may actually be depleted and cause symptoms of burn out, chronic fatigue, a lack of motivation, and even autoimmune conditions.

 

 

The good news is that many of these hormones can be tested and there are practical and non-invasive steps you can take to restore hormone balance and vitality!

In the end, our hormones are amazing, yet delicate messengers that deserve the utmost respect for how they keep us feeling motivated, passionate, desirable, confident, and strong. They allow us to birth children, feed our children, run from danger, sleep well at night, and get up the next day ready to go at it again. So, no matter many times they have been your scapegoat or nemesis, they do deserve our praise.

 

 

 

Wishing you balance and dynamism!

With gratitude,

Audry Van Houweling, PMHNP-BC, HNFM certified, DONA trained postpartum doula

Owner & Founder She Soars Psychiatry, LLC. Holistic Psychiatry & Wellness for Women & Girls. 

www.shesoarspsych.com

 

Throughout my years working in psychiatry, the magic word that indicated “success” either in inpatient or outpatient settings was “stability” or “stable”. During my time working as a registered nurse in a hospital-based psychiatric unit, the discharge note would inevitably note something along the lines as, “the patient has achieved stability…the patient is now stable…the patient notes they feel stable…and they are now fit to be discharged. During my years as a nurse practitioner, I would catch myself ending my note stating, “the patient reports stability…no further changes need to be made”.

Can we ponder what being stable actually means for a moment? How have we defined it over the years in conventional psychiatry? Does it mean the patient is no longer suicidal? No longer psychotic? No longer having panic attacks? When they can follow a conversation without being distracted? How much does our personal bias as providers influence what we feel is actually “stable”? What is the actual rubric by which we define this?

Does it matter that a patient may be returning to the same environment that may have led to instability in the first place? Can we really claim a patient is “stable” when they have a myriad of chronic health problems? What about poor diet or a lack of physical activity?

The mechanism by which conventional psychiatry seeks “stability” is primary via pharmaceuticals. I want to state again that in some cases when there is imminent need, medications can be powerful tools to regain a client’s sense of control and awareness. That said, they are tools and in my opinion fall short of being solutions. It is important that we recognize that while medications may allay symptoms, they certainly do not guarantee “stability”.

Perhaps you have been on psychiatric medications and have been through the trial and error process. Perhaps you have had the experience when you started with one medication and then needed to add another or yet another to counter possible side effects or because there was a sense that symptoms were not yet adequately controlled. It can be a frustrating and confusing process sometimes made much worse by side effects.

I have prescribed a lot of medications over the years. If it all goes well, patients often come back feeling pleased with the results, but it is rare that this feeling sustains itself. Perhaps months later they may say, “I don’t think this medication is working anymore…” or “I am concerned about side effects.” I have learned that it is unrealistic to assume that “stability” can continue in the midst of chronic disease, chronic stress, contentious relationships, social isolation, and/or socioeconomic limitations.

Now it is time for a bit of imagery.

Picture yourself sailing in a boat in the water. There are multiple small holes in the boat. You have a bucket and are able to throw water overboard allowing the boat to stay afloat for a while longer. Yet, the holes still remain and at some point you are going to become exhausted from trying to stay afloat. A medication may be a bucket for a while, but often does not address the foundational problem.

I have not come across a medication that seals all the holes in your boat.

This is why I have become passionate about functional medicine. Functional medicine is looking for the holes in your boat. We might give you a bucket from time to time, but the goal is to seal the holes and even better, just give you a new, stronger boat that withstands the rough waters. This is the basis of vitality- when you can function with resilience and “sail” or per our namesake, “SOAR” to your full potential.

At She Soars Psychiatry, LLC we take a close look at all factors including cellular health, immune function, inflammation, organ health, gastrointestinal health, nutrition, physical activity, psychosocial, and psycho-spiritual. When these factors go awry they can cause “holes in your boat” leading to emotional imbalances. We aim to restore not just stability, but vitality.

Everyone feels like they are sinking from time to time. Life happens. Resilience can be strengthened however. We look forward to helping you stay strong and afloat as there are certainly rough waters to navigate out there. Happy sailing!

To learn more about functional medicine, please visit The Institute for Functional Medicine.

To schedule an appointment with us call 541-595-8337 or visit www.shesoarpsych.com

Like us on Facebook @ She Soars Psychiatry, LLC

With gratitude,

Audry Van Houweling, PMHNP-BC, HNFM certified, DONA trained postpartum doula, Owner & Founder, She Soars Psychiatry, LLC

 

Having trouble with focus? Feeling unorganized? Frazzled? Have you ever wondered if you have attention-deficit disorder or attention-deficit hyperactivity disorder? Perhaps you have been diagnosed already and have been convinced that the problem is a dopamine deficiency in your brain that must be remedied with psychostimulants such as Ritalin or Adderall. Perhaps you are on these medications and they likely work to some degree, but chances are if you have been on them for a while, at some point they reach a plateau and your symptoms come trickling back.

It is again important to remember how subjective conventional psychiatry is. We make decisions based on somebody’s subjective reports and often fail to look for objective, physiological data. We also often fail to recognize the contextual and cultural context in which the symptoms occur. Essentially, poor focus can be due to multiple factors and just because somebody meets criteria for ADD/ADHD, does not necessarily mean they have a dopamine deficiency contrary to popular thought.

The functional medicine approach utilized at She Soars Psychiatry, LLC views problems with focus from a  broad lens. Dr. Mark Hyman, a founder of functional medicine, stated wisely, “ADHD is not a Ritalin deficiency”…and he is certainly right. Medication may be helpful, but is very likely not addressing root causes. With that said, here are 5 reasons why you can’t focus that may mimic signs of ADD/ADHD:

1. Tummy Troubles: Gastrointestinal distress and discomfort such as bloating, excess gas, reflux, diarrhea, and constipation can be indicators of leaky gut syndrome, yeast or candida, and/or small intestinal bacterial overgrowth (SIBO). The gut and the brain are intimately connected and thus, when your tummy is upset, it is likely that your brain is not very content either.
2. Nutrient Deficiency: In our Standard American Diet we are often overeating, but undernourished. Deficiencies in iron, Vitamin D, B vitamins, Vitamin C, Omega-3 essential fatty acids, magnesium, and zinc have all been linked to poor focus. One study, compared the administration of Vitamin B6 (pyridoxine)- a vitamin essential to supporting multiple neurotransmitters including dopamine to Ritalin or methylphenidate. Vitamin B6 performed equally well to methylphenidate in allaying symptoms and also supported serotonin and dopamine levels.
3. Immune dysfunction: Infection, chronic illness/inflammation, and autoimmunity may all impact focus. Multiple autoimmune conditions including thyroiditis, inflammatory bowel disease, and Type I diabetes have been shown to be correlated with an ADHD diagnosis.
4. Heavy metals & detoxification irregularities: It is basically impossible to escape exposure from heavy metals in our current environment. There are ways however to reduce the burden. Reducing exposure to contaminated soil, filtering water, investing in an air filter, and testing your home for lead are just a few. Lead, mercury, aluminum, and arsenic in particular have all been associated neurodevelopmental disorders including ADHD. Some individuals may have genetic irregularities in how their body detoxifies metals and other toxins, which makes them particularly susceptible to a toxic burden.
5. Food allergies or sensitivities: Gluten, dairy, corn, soy, dyes and additives, eggs, and nuts are amongst the most common food allergies and sensitivities. It is important to note that a food allergy is different than a food sensitivity. Just because you or your child may be able to “tolerate” a food, does not mean the body is not sensitive to it. A temporary elimination diet that eliminates these more common problem-foods has been associated with significant improvement for children diagnosed with ADHD.

For a more exhaustive list of medical conditions that may mimic ADD/ADHD symptoms, check out the following list from AbleChild.org

To learn more about limiting your exposure to heavy metals, check out tips from Oregon’s Department of Human Services

If you are having difficulty focusing and would like pursue a functional medicine approach and identify your root causes, check out our services and request an appointment. We look forward to working with you!

With gratitude,

Audry Van Houweling, PMHNP-BC, certified HNFM, DONA trained postpartum doula, Owner, She Soars Psychiatry, LLC

www.shesoarspsych.com

 

Throughout my years working in mental health, it is almost an exception that a client presenting with chronic mood instability and/or anxiety does not have some degree of chronic pain, tension, or achiness. Today, the spotlight will be on fibromyalgia.

Among other comorbid conditions, in my work, fibromyalgia seems to be almost synonymous with depression and anxiety.

Fibromyalgia has been somewhat of a trendy diagnosis over recent years- it is a diagnosis of exclusion of which parameters are somewhat vague and often misunderstood. People experiencing fibromyalgia often report widespread full-body pain with persistent achiness. They often have sleep disturbances, fail to wake up rested, feel exhausted by the pain, complain of poor memory/cognition- also known as “fibro fog”, and often have gastrointestinal distress. The pain often is unrelenting even with anti-inflammatory and/or opioid pain medications.

Nine out of ten fibromyalgia sufferers are women. A bit of a staggering statistic, right? As fibromyalgia begins to be more understood, it seems to coincide closely with chronic stress, a history of trauma, and hypervigilance. Serotonin levels are often low and the sympathetic nervous system, which promotes our fight/flight reaction tends to be over-active. It has been found that fibromyalgia and chronic pain is significantly associated with adverse childhood experiences- especially physical and sexual abuse.

In fact, just to stress this point, adverse childhood experiences (also known as ACEs) are associated with a number of negative health outcomes. One of my favorite discussions about this is a TED talk featuring pediatrician, Dr. Nadine Burke Harris featured below- please watch:

Striking, sad, frustrating, and ultimately highlights the importance of addressing trauma and emotional well-being as a means to promote whole-body wellness.

Unfortunately in my work with women and girls over the years, similar to the association with chronic pain, a history without abuse is more the exception as the vast majority of my female clients report a history of physical, emotional, and/or sexual abuse.

Being aware of the multiple intersections between emotional wellness, a history of trauma, and perceived pain underscores the importance of approaching our vitality and health from an upstream model- one that addresses root causes, rather than a downstream approach, which in the case of chronic pain and fibromyalgia often involves a slew of specialists, painkillers, and perhaps costly interventions.

Exercise and psychotherapy have been found to be amongst the most successful interventions for fibromyalgia.

In fact, exercise alone has been shown to have just as much antidepressant effect as a typical SSRI antidepressant medication and when sustained, is associated with less relapse of depressive symptoms compared to when treatment only involves medication.

Sharing our stories and learning to perceive ourselves as survivors and ultimately, as “thrivers” is paramount to healing as the role we play in our story informs and influences not only our emotional wellness, but our body as a whole.

Restoring emotional wellness, which we prioritize at She Soars Psychiatry, may also allow for dramatic and transformative changes throughout the body.

It is a journey worth taking. We are not about quick-fixes, but partnering with you in a transformative process that promotes self-determination and empowerment as you confront your concerns leading to sustainable and long-lasting solutions!

Let’s be kind to ourselves.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

So I am in Los Angeles solo this weekend for a training. It is always a bit daunting acclimating to the big city- the sights, the sounds…the traffic. A bit different from my small hometown in Oregon.

As I was driving my rental car down the 405 to the 101 to my hotel and navigating the LA freeways, I could not help but think of one of my all-time favorite SNL skits,  “The Californians”. Sorry in advance if I offend any actual Californians out there, but I think it might be best that you start this post with a laugh, so please check the video out:

Funny, right? Most of the attendees at my training live close by here in LA and when I tell them I am from Oregon, they say what most people do in response, “oh, it is so beautiful there… so many trees…waterfalls…the coast…the mountains- you are so lucky!”

And while I would certainly agree Oregon’s beauty is hard to outmatch and I do consider myself fortunate for living here, today I want to talk about something not as pretty…mental illness in Oregon.

Did you know that Oregon ranks dead last when it comes to mental health care in the United States?

Mental Health in America reported Oregon to be dead last in an overall national ranking comparing need, access to care, and outcomes in each state. This was attributed to a high prevalence of mental illness and suicide, high rates of child maltreatment, homelessness, and low high school graduation rates. Interestingly, while ranked worst overall (51st) 48th overall for adult mental health, 49th overall for children, and worst (51st) for prevalence of mental illness, Oregon is in the top fifty percent for access to care and mental health services in the 21st spot. So while services could undoubtedly be more abundant, they are not so sparse, but needs are certainly not being met.

Do y’all remember Psych 101 and Abraham Maslow’s hierarchy? Remember the foundations that need to be present (food, warmth, rest, water, safety, & security) in order that a person may move towards self-actualization or in other words, vitality?

Let’s think about those foundations for a minute…Do you have these foundations in your life? Perhaps you have food, water, and warmth, but do you have rest? What about safety and security? Do feel safe in your relationship? Financially? At work? Do feel a threat of danger?

When a person is constantly seeking for these needs to be met, they are in survival mode. They are often in a state of hypervigilance, fight or flight, acute stress, and potentially, trauma. People can become desperate, act seemingly irrational and irresponsible, and may even resort to acts of violence or criminal behavior.

All actions may not be excusable, but I imagine in your most desperate moments, rationality, altruism, and being responsible was not on top of your priority list.

Think about homelessness, the abused child or spouse, new parents who are sleep deprived, poverty, discrimination, and financial woes. For many citizens of Oregon and beyond, the necessary foundations need yet to be fulfilled for true wellness and vitality to be possible at all.

Enter social justice.

Irregardless of how many  medications, supplements, therapies, nutrition interventions, fitness tips, etc a person may be given, if they are hungry, cold, thirsty, sleep deprived, or in perpetual danger, true sustainable progress is very unlikely if not impossible until these needs are met with consistency and predictability.

Mental health and health in general begins with these basic foundations.

Maslow’s wisdom also demands we reevaluate expectations for one another. Should we expect the same academic standards from a child in the midst of family dysfunction or abuse as we do a child coming from a safe, supportive home? If you were to be homeless, hungry, and looking for shelter, would it be fair to expect you to simply, “go get a job”, when even the most basic of logistics can be daunting? What about the new mother who is struggling to keep afloat as she navigates the transition of motherhood? Do we expect her to be joyous or can we give her grace as she might also be grieving?

I think Maslow’s logic can apply to not just individuals, but families, social groups, and even nations that may be struggling in a cycle of poverty, violence, crime, and limited opportunity.

Oregon has a lot of work to do with restoring foundations to its citizens. This is not just the responsibility of politicians and it does little to play the blame game. It is in the end, our responsibility. Being advocates for social justice and simply being kind to another goes a long way.

If you have comments about the state of Oregon’s mental health, contributing factors, etc, please feel free to add to the story!

With peace & gratitude,

Audry Van Houweling, PMHNP-BC, Owner & Founder, She Soars Psychiatry, LLC

www.shesoarspsych.com

 

 

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