Holistic Psychiatry & Hormones

December 2, 2021

Holistic Psychiatry & Hormones

Dr. Nicole Sundene, NMD

Female Hormone Specialist

With Holistic Psychiatry, we are treating your mood disorder such as anxiety, depression, bipolar, ADHD, addictions, PTSD, OCD, and even schizophrenia with natural medicines. We also are more importantly using metrics such as hormone testing, and nutritional testing, to determine if there is a vitamin or mineral deficiency or a hormone imbalance. An easy indicator a woman’s moodiness is caused by hormone imbalance, is seeing fluctuations in the mood during the monthly cycle. You can test this yourself at no charge by downloading a free “Period Tracker App” and rating your mood every day for an entire cycle. 

If the mood is not good the 7 days prior to your period or the first few days of your period then we can work together to change that with Naturopathic Medicine!

Fear not, there IS HOPE! 

When women are generally happy in the first half of their cycle days 1-14, with day 1 being the first day you start bleeding, and then struggle with anger, agitations, depression, anxiety, hopelessness, rage, crying, and sadness during the PMS window or days 21-28 then you need hormone testing as there is likely a hormone imbalance going on that can be addressed with Naturopathic Medicine. 

Also if you have never experienced anxiety or depression until your 40’s or 50’s and your mood suddenly shifts, this is a sign you are experiencing hormone imbalance, such as hypothyroidism, perimenopause, menopause, or even Hashimotos impacting your mood. 

The #1 Sign that something physical is causing the mental health disorder is when nothing stressful or sad is actually going on yet the patient feels anxious or depressed. When women tell me “My life is great, I love my husband, my kids are great, I love my job...I just don’t know why I feel like this…” This is when I think there is a mental health mystery for me to solve!

As a Naturopathic Doctor and Female Hormone Specialist, I love helping patients with depression and anxiety. Especially since I have battled my own depression and anxiety for over 30 years, and it started in my teen years indicating a strong hormonal link. I was never depressed as a child. I had a very happy childhood and wonderful parents. But suddenly, in my teens my attitude rapidly changed, I was angry at my Mom all the time. I was grouchy, depressed, sad, cried a lot, and constantly had anxiety about everything. 

I had social anxiety, anxiety about my school work. I was an overachiever that would cry over an A- or a “Chinese F’ as they call it. First, my parents sent me to counseling to no avail, then I tried a lot of different antidepressant medications, I was even sent to a psychiatrist to try to medicate my mood. Many of the antidepressants they gave me just made my mood worse and caused me to gain weight or have an upset stomach, which made my mood even worse because now I was overweight and my stomach hurt!

HORMONE TESTING FOR WOMEN’S MENTAL HEALTH

Hormone testing is the most important thing we do for women with PMS like hormone imbalance. I like to conduct “Biphasic Labs'' which means we test your hormones while you are happy and feeling good during the first half of your cycle, and then, we test them in the PMS window days 21-25 when you are feeling at your worst, so we can capture the hormone imbalance. You can watch my Free Presentation on “Hormones, Metabolism and Weight Gain” to see my case study about Jenny, who was a crying mess while her husband called me frantically, not sure what to do with her. 

I emailed him a lab slip and said “Take her in NOW to get her hormones drawn.'' Of course, it was the last thing Jenny felt like doing while suffering from a migraine, depression, and anxiety but as a Female Hormone Specialist, I know how important it is to get the PMS labs drawn when the patients are at their worst for me to solve the hormone puzzle. The best thing about getting your labs checked when you are at your best mood is, we can set those aside in the event you need bioidentical hormones someday with menopause, and then I know exactly what numbers I need to have you at, to make you feel your "personal awesome!" For more information about hormone imbalance and the blood hormone testing I conduct via women’s insurance please visit my HORMONE THERAPY page. 

The state of Arizona does not allow Naturopathic Doctors to order labs for Medicaid or AHCCCS patients. But most decent insurance plans including Medicare, allow me to check your hormones per your insurance plan reimbursement. So long as you are at the correct lab which is either Labcorp or Sonora Quest. Be sure to call your insurance and find out which lab is contracted with your insurance, otherwise, the testing can be quite expensive! If you do not have insurance I have cash lab options, and the first panel should be around $200-$500 depending on what is going on, so please do not sign up to work with me if you cannot afford cash labs, or have Medicaid insurance. My ability to help you will be left with just guessing, and that is not how I work, I like to rely on metrics and numbers to ensure each woman is in an optimal range for their hormones and vitamins. 

Vitamin and Mineral Testing for Mental Health

Testing nutritional metrics is extremely important as many vitamins and minerals are the very cofactors, and coenzymes that form the neurotransmitters such as serotonin, dopamine, norepinephrine, and epinephrine that impact our mood. Most of this can easily be done via blood testing through your insurance, although I will say Medicare is the worst at reimbursing for vitamin testing. Basically, the government does not care what your vitamin levels are and they may or may not pay for this part of the testing if you have medicare. If you have a secondary insurance it may be picked up by that, but you still will get the “contracted price” which is generally $20-$50 per vitamin we test, so they usually cover the hormones and then send the patient a bill for the vitamins. Just because I think it is necessary does not always mean the government is going to agree with me. The good news with mental health testing is you are 

making a one time investment in understanding what your personal weak spots are and once we know what those are the follow up lab testing is never as expensive, as the first panel when I am on a Detective Mission to figure out the ROOT CAUSE of your mental health issue. 

Neurotransmitter Testing for Mental Health

Is neurotransmitter testing really necessary for mental health patients? 

Yes and No. 

This is why it is the 3rd step, I list in my simple 3 step process of addressing the physical causes that impact the mental health of patients with anxiety, depression, and mental health disorders. Because, oftentimes we can determine the cause of the mood disturbance via hormone testing and vitamin and mineral testing. This is the final step I resort to when the above testing is not helpful in revealing any physical causes of depression. 

For a small handful of my patients, I will admit that neurotransmitter testing has been a futile waste of their time and money. But for the majority of my patients that do not improve from balancing hormones and nutrition, the neurotransmitter and adrenal testing can unearth some very important neurotransmitter deficiencies or excesses that we can balance with “Amino Acid Therapy.” By using amino acids targeted to boost specific neurotransmitters that are low we can improve mood via a different pathway that an antidepressant works. 

For instance, low dopamine can be related to depression, low motivation, memory issues, ADHD, addiction,  impulse control disorders, dementia and even schizophrenia. Physical symptoms of low dopamine include Pain muscle cramps and stiffness, tremors, trouble swallowing, back pain, balance problems, and constipation, 

Symptoms of low serotonin include depression, crying, insomnia, carbohydrate cravings, weight gain, nausea, poor self-esteem, anxiety, and poor memory.  When serotonin is low then an anti-depressant is often useless for the patient because the way the antidepressant works is to recycle serotonin so if there are “no pop cans in the recycling program” then there is nothing to recycle. The patient gets no benefit from the antidepressant and gets side effects like dry mouth, sweating, weight gain, poor libido, erectile dysfunction or stomach ache. Neurotransmitter testing is also great for patients that have no triggers for their anxiety or depression yet feel flat, blah, anxious, or stressed and don’t know why. If it isn’t a hormone imbalance like what we often find via insurance-paid labs then we need to look at a neurotransmitter profile. This can be done via simple saliva and urine testing.  

So that is my simple 3 step system I used as a Detective process to understand any physical causes of depression, anxiety, and mental health disorders. 

WHAT PATIENTS ARE NOT SUCCESSFUL WITH HOLISTIC PSYCHIATRY?

After serving patients for 22 years, I know exactly the patients I can and cannot help so please read this section carefully and do not sign up for my service if any of the following scenarios apply to you. I cannot help mental health patients in the following scenarios: 

  1. If you are too depressed to take supplements and make dietary changes, or you do not have a caregiver that can ensure the plan I prescribe is implemented, you will not be successful with my Holistic Psychiatry program, and I will not be able to help you. I only want patients that will be compliant with their instructions to enroll in my practice. 
  2. If you do not have insurance to pay for hormone and nutrition testing or do not have finances to pay for the cash lab pricing of this ~$500 depending on the patient’s symptoms, then I will not be able to help you. 
  3. If you are not friendly and coachable and cannot maintain good boundaries with your working relationship I will not be able to help you. Please know, I have battled both anxiety and depression for my entire life, and I have to be protective of my own mental health. As much as I love to help mental health patients, I am very successful at finding the physical issues that are impacting their mental health and talented at prescribing natural medicine and hormones that improve mental health. I cannot do this for people when they are so lost in their depression they cannot move or take supplements, or get blood work done. (I have helped many depressed women with postpartum depression, when their husband takes charge of their care plan. I can help teenagers that have parents who will take responsibility for the care plan being facilitated.) Ultimately, what I ask you to do is MORE WORK than just popping a prozac, or valium.  
  4. If you are unwilling to take vitamins, supplements and make dietary changes to support your mental health. You have to be open to changing your diet to whatever I think you need to change it to. The longer we argue about it, the longer it takes the patient to get better, so if you would rather listen to Dr. Google that is fine. However, I do not have the endurance to work with patients that cannot trust I know how to help them. 
  5. I generally do not provide counseling and recommend you work with a counselor. If you are able to afford to come see me every week for several weeks to do counseling, that is fine, and I am happy to do your counseling. But think of me more as your “Holistic Psychiatrist” that helps you adjust your medications, supplements and vitamins and looks for the root cause of your mental health from a physical standpoint. 
  6. I will not prescribe antidepressants, anti-anxiety medications (valium or benzodiazepines) outside of a scheduled appointment. I refill your medication until you are legally due back in, and it is the patient’s responsibility to schedule their med checks. For narcotic medications like some anxiety medications, a drug test is also required at the patient’s own expense. I cannot prescribe stimulant medications for patients with ADHD, only an MD psychiatrist can do this.
  7. Anyone expecting a “Quick Fix” my mental health patients generally take 3-6 months to improve. Please check my fee schedule to ensure it is affordable for your family. I am not able to accept any new patients “pro bono” at this time. Those spaces are filled, you can submit your new patient paperwork and ask to be put on my waiting list, but it is usually a 6 month waiting list.  
  8. If your anxiety is so bad that you feel the need to call my office multiple times per day, disrupting my visits with other patients, or constantly text me, then you will be discharged from my practice as I have anxiety too and when patients are giving me anxiety and even panic attacks because they are sending me inappropriate text messages it is not a good fit for me to serve you. Likewise if you are very angry and agitated and that is what we are working on if you are the type of person that lashes out at me or my assistant you will also be discharged as my mental health is my #1 priority at all times as a doctor in a difficult Pandemic and while I understand everyone is upset for one thing or another, I will not tolerate patients that lash out at their health care workers in anger it is not necessary and we have already been through too much for one life time. If your family member verbally abuses my staff on your behalf you will also be discharged from my practice. I took enough abuse working as a nurse for eight years and I have a "Zero Tolerance" policy for any form of disrespectful behavior, verbal abuse or threats. I am confident that I provide awesome care and anyone that is not smart enough to see that and respect it will need to go elsewhere.

WHAT PATIENTS ARE THE MOST SUCCESSFUL WITH HOLISTIC PSYCHIATRY?

  1. My favorite and always successful patients are the ones that show up with a pen and paper handy to take notes and want to be a student and learn everything they can about their mental health and how to improve it. They know I have the answers they are seeking and simply want the information to feel better. 
  2. For patients that enjoy making herbal teas, taking capsules and vitamins, and prefer to support their body in this manner, I specialize in food as medicine. You are my perfect mental health patient!
  3. Patients that want to make the diet changes to what I think their brain/body needs.
  4. Patients that have a care team that will ensure they are following their plan if they are slipping. 
  5. Patients that are also working in conjunction with a counselor or therapist on their issues will always have awesome results!
  6. Patients with inquiring minds that also "Need to Know" what is causing their symptoms. I like patients that are just involved in helping me solve the riddle as I am.

So that is how I help my mental health patients as a Holistic Psychiatrist. If you think we would be a good fit working together, pop on over to my SCHEDULE page and book your new patient visit so we can get started helping you feel better immediately. You do not have to live in depression as I did for many years, you do not have to live with anxiety and panic attacks in terror like I did for many years, I am happy to help you with your anxiety or depression. I want to go through this detective process together so we can determine what your individual weak spots are when it comes to your personal mental health. 

Sincerely, 

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroidHashimotosPMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

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