Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics' ISH Dish podcast, practical health advice from Iowa specialty experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

So excited today. We have Amy Larson in the studio with us. And she is a hot ticket in the mental health world, let's just put it that way. Amy is a psychiatric nurse practitioner who provides psychiatric medication services for patients of all ages. She has interests in assessing, diagnosing and treating patients with a variety of mental health disorders in a family health clinic setting. Amy loves spending time with her husband and children, flower gardening, playing piano and organ, kayaking and hiking. She also enjoys spending time with their patients so she can provide patient education and form trusting relationships. How did I do?

Amy Larson: Very good.

Host: So, all of that is still relevant?

Amy Larson: That is still relevant, yes.

Host: Perfect. Welcome to the podcast.

Amy Larson: Thank you. Glad to be here.

Host: Absolutely. And we love having you. So, welcome. Your job seems intense.

Amy Larson: It can be. Yes, it can be.

Host: And I would love to hear now in your own words what it is that you kind of do on a daily basis or the things that you offer. Because I feel like what you do is different than maybe your average mental health counselor.

Amy Larson: Yes. So, there's different types of professionals in mental health care. You have therapists and there's different therapists that do different types of therapy. There are psychiatrists that are a medical doctor that are trained in psychiatry. And there are psychiatric nurse practitioners.

 I like to think of the psychiatric nurse practitioner as maybe a bridge between psychiatry and therapy because we are trained also to do therapy, which not all psychiatric nurse practitioners do, but I am trained in cognitive behavioral therapy. So if someone comes to see me and they're needing medication, and maybe they're going through just a bad spot in their life, a divorce or a death of someone close to them, and they need just some brief, you know, types of therapy, I try and help with that also. Maybe medication is something that they need at that point. So, that is what I do. I see people with different types of diagnoses. So, I would say most common is depression and anxiety, but we also see bipolar, schizophrenia. ADHD is also a big thing.

Host: So if somebody were to call into the clinic, for example, and needed therapy, because that's how, you know, an average Joe is just going to say, I need to see somebody, a therapist, how would they discern between who goes to you and maybe who goes to somebody else?

Amy Larson: It depends on who refers them a lot of times. So if their family practice doctor refers them, you know, maybe they've tried a couple different antidepressants and things are just not getting better, they'll refer to a psychiatric provider. It really depends on what's going on with the situation. And if it's a patient that I see for medication and I think, you know, as you peel back the layers, there is more of a trauma-based or something that's just more than I feel like I can handle from a therapy point-of-view, then I will refer to a therapist so that they get that ongoing therapy in addition to my services as a medication provider.

Host: Okay. That sounds good.

Amy Larson: So, it just depends.

Host: Yeah, it always depends. Yeah. And then, no situation is the same twice, of course. So specifically today, you are here to talk about the connection between our gut and our brain. I have read a lot of information on this lately. I am an avid podcast listener and love hearing things about health and wellness. And recently, I'd say within the last few weeks or so, heard some information about how our gut acts as our second brain. And I think you actually had that in your notes here.

Amy Larson: Yes.

Host: But just a very strong connection about keeping our gut healthy, which in turn then keeps your brain healthy.

Amy Larson: Well, we've all experienced that. We've all experienced when we're nervous, you know, we get butterflies in our stomach or, you know, things speed up that we maybe don't want to.

Host: Fight or flight.

Amy Larson: Yeah, we get into the fight or flight, or you're pondering some decision or you're in a situation, you're like, you just feel it in your gut, you know, you just have that gut feeling about something. So, we've all experienced that. But yes, our brain and our gut are connected even from the beginning as we start developing. They develop from the same tissue. They're connected by our vagus nerve. They're connected through our immune system. They're connected through our hormones. There's a lot of communication between the two.

Host: I actually highlighted in my notes to ask you specifically, what exactly is the vagus nerve? Because I also hear a lot about that and how we can learn to calm that down.

Amy Larson: So, you mentioned the fight or flight, so that's our sympathetic nervous system that gets on alert, which is something we all need. We all need to be alerted when there's danger present. That's how our species has survived from running from the saber-toothed tiger, is knowing there's something going on that I need to be ready to react to. So when that is engaged, our pupils are dilated, our lungs are expanded, we are producing more glucose so that we can run, we have that energy. So, there's a lot of mechanisms that are in place for that. But in our society now, we don't want that turned on 24/7, because that leads to, you know, this overactivation of that all the time. What does having your body producing more glucose all the time do? Well, we run into diabetes issues. You know, so there's just a lot of factors that we don't want that turned on all the time. So yes, that goes into stress management, and that speaks to how we need to shut that off at times.

Host: Okay, good. Well, let's go back to the beginning then. And I will let you take it away. But I just wanted to mention a couple of those things because they were hot on my mind.

Okay.

Amy Larson: Well, it's all connected, and that's why it's hard to, you know, just specifically look at the connection between the gut and the brain because there's all these other factors involved also. But I think this is an important topic because the rates of mental health problems, depression is not going down. I think we've all seen that it's definitely increasing. And when people come to see me, you know, they want a medication. They want something that they can take to make it better and sometimes that's all they need. Sometimes you prescribe an antidepressant, people come back, they're better. They feel like they can then do all those other things in their life that helps them stay better. There are people that get a little better. They're maybe not where they want to be, but they're doing okay. And then, there are people that just, we call them kind of treatment refractory. They don't seem to respond to the medication. So then, I think it's important to look at other areas of what's really going on with that person, it's not just maybe about the pill that we give them.

So, with medications, it's also about finding the right medication for them. There's different medications with different mechanisms of action. And there's also, we've found through doing some GeneSight testing with people, that people metabolize medications differently. So, sometimes that explains why one medication has more side effects for one person, and the other person doesn't see any benefit from it, and the other person thinks it's the best thing since sliced bread. So, that's some testing that we can now do too.

Host: It's not one-size-fits-all.

Amy Larson: No. Also when you find the right medication, the person has to take it, and they have to take it consistently, otherwise it is not going to work.

Host: Is that problem in your practice?

Amy Larson: Absolutely.

Host: I am sensing that.

Amy Larson: Yes. Absolutely, because there's no medication that doesn't have side effects to it. And that's why I try and do a lot of education when people come in because sometimes those first two weeks of taking an antidepressant can be more side effects than benefit. We produce most of our serotonin, which is a neurotransmitter that we target a lot with antidepressants. Well, we produce that in our gut, a lot of it.

Host: Would not have guessed that.

Amy Larson: When you start an antidepressant, you can have nausea, you can have diarrhea, until your body adjusts to that medication.

Host: And you have to just get through that?

Amy Larson: Unless it's really bad, then call and we can try something different definitely. But sometimes that is just those first two weeks is just kind of living with some of those side effects until your body adjusts and then we start seeing the benefit of the medication. So, hanging with it, treating for an adequate length of time, making sure the dose is adequate to treat them so that we can get remission of symptoms.

 Also important for a lot of people is psychotherapy. So, we have to examine some of those habits we get into when we have anxiety or depression for a long time. We get into thought patterns that are kind of like automatic thoughts. Just the way we start automatically thinking about situations. And so, we have to really examine those and then try and change. So, like anything, we can't change a behavior until we recognize it. So, that is what therapy helps people do, is change some of those thought patterns that we get into.

Host: Boy, that's a challenge.

Amy Larson: Yes.

Host: I mean, I have been down that road before, you know, you start negative self-talking and maybe you don't even realize you're doing it.

Amy Larson: It's that conversation that we have going on in our head that a lot of us don't even recognize, but can have a profound effect on how we feel.

Host: Yeah, because what we tell ourselves, we pretty much believe.

Amy Larson: Absolutely.

Host: Yeah. We're such weird creatures.

Amy Larson: It's complicated.

Host: It is. It can be, for sure.

Amy Larson: The other factor when treating depression, I feel like, is really looking at the lifestyle. So, are we just sitting in a chair all the time? Are we sleeping? Sleep is huge. Are we managing our stress that we have going on? What are we eating? Are we socializing? I feel like there is an epidemic of loneliness in this country. And, you know, we don't have that community feeling, I think, a lot of times that people really need. And then, use of substances, alcohol and tobacco and drugs are going to definitely have a negative effect on how we feel.

And now, we are seeing research that shows that the organisms in our gut also play a role on how we feel. And all of those things that we just talked about have an effect on those organisms. So, the antidepressants that we prescribe and how we're managing our stress, all of those things affect the organisms in our gut.

Host: You know, it seems as though, and I'm 90% sure of this, that if we all would just lower the stress, exercise and eat better, those three things right there, we'd be killing it.

Amy Larson: It's huge. You know, there are still people with major depressive disorder. You know, there is still that population that is more complicated to treat, definitely. But for a lot of people with mild symptoms or having some issues where stress is getting high, I mean, if we manage some of those other things, like if we're making sure that we're practicing good sleep hygiene, we're going to bed at the same time every night, we're, you know, getting all of those hours in that we need, and just trying to take a break from the world for a little bit with stress management can be huge. And what they're also seeing now is what you are eating can have a huge impact on your gut and how you feel not just mental health, in a lot of different areas.

Host: Crazy. Food is a drug.

Amy Larson: Yeah. It can be.

Host: I mean it can be used, you know, in a good way or a bad way. So, all those processed foods that everybody's loving, not so good.

Amy Larson: Yes. Our Western diet has been linked to a lot of the issues that we have, including obesity, depression, diabetes, our cardiovascular disease, irritable bowel syndrome, all of those kinds of things is linked to that. And so, research is showing, leaning really strongly towards eating more of a Mediterranean-type diet. And we've all heard that, and we all know these are things that we need to do. But it's hard, it's hard to make such a big change. We're raised eating this way and to change that is huge. So, I encourage people to do little things. You don't have to train for a marathon and change your whole way you're eating overnight. Make little changes at a time.

Host: I think sleep is a big one.

Amy Larson: It's a huge one.

Host: My husband teases me on a regular basis about my bedtime routine. But it's my routine. And I like to be in bed by a certain time, reading, doing whatever, calming down, getting to sleep by 10, which is ideal, you know, because I get up early and work out. And I'm like, "Well, we'll just see how this plays out."

Amy Larson: Important. We need that. We need those deep phases of sleep, you know, that's when we take things that we've learned during the day and integrate it into our brain, and that's when we build our reserves so that we can cope with the stress the next day. If our reserves are chronically emptying over time, things happen, we have these bigger reactions to them than we need to, and, you know, making mountains out of molehills kind of thing.

Host: Also bad choices. You know, those nights when you have two or three hours of sleep, the next day, I'll take a candy bar over a glass of water or whatever. You know, bad choices are always made. It's just keep it to keep it together.

Amy Larson: When we don't feel like we are in that space where we have that balance. It all comes back to balance. And with balance, you know, when we look what they call the microbiota, is all the organisms in our gut. And when that gets off balance, that is called dysbiosis. And when it's in balance, it's called eubiosis.

Host: Okay.

Amy Larson: And when we have dysbiosis, our gut is not as rich and diverse. You see those words a lot in the literature. They want a rich and diverse microbiota. So when it's off balance, we can have more organisms that are maybe not good for us, less of the good ones and just things are not where they should be.

And research is actually looking at different microorganisms that are present in people with depression or other mental health disorders or other health problems in general, so that, I don't know, maybe someday they can know exactly where we're going with some of this treatment.

Host: That would be wonderful.

Amy Larson: So, they also have discovered, you know, going back to the stress that we talked about, stress early in life. So, children faced with some abuse, trauma, sets you up for anxiety, depression, some mental health issues later in life, definitely. And it can also affect what organisms are forming and colonizing in your gut.

Host: Well, at an early age.

Amy Larson: At an early age, yes.

Host: That's amazing.

Amy Larson: So, the gut microbiota begins to colonize at birth, and that depends on genetics somewhat, how the baby is delivered. So if it's a C-section, if it's a vaginal delivery, different things like that can affect what organisms colonize in the gut. And by three, that is established. But it changes. It can change over the course of our life, depending on stress, antibiotics. When we take antibiotics, that can kind of knock everything out. And so, that changes how we're feeling at the time.

Host: That medication right there, doesn't that completely change the flora of your intestines? I know I was a frequent antibiotic user at one point just because I got sinus infections, and it was always just so tough on your stomach.

Amy Larson: Right. So when we talk about that balance, that's where that interferes with that. And sometimes we have to take, you know, antibiotics. But I think overall, the medical community is looking at only when necessary. And we don't want to use them for longer than we need to because it takes out the good stuff sometimes, and that can cause problems. So, we talked about antibiotics, stress, our diet; again, poor diet can affect and cause things to get off balance; use of alcohol causes increased inflammation. So when things are off balance in our microbiota, our gut is lined with cells. And we normally have very tight connections in our lining of our gut. So, that protects us from all of these organisms in our gut, but also allows for us to absorb things, nutrients from our foods. When things are off balance, those junctions can get opened a little bit. And so then, we have some of those bad things that can kind of leak out of the gut.

Host: Leaky gut.

Amy Larson: And so, leaky gut.

Host: I've heard of it. I'm just like, " What does this mean?" Okay.

Amy Larson: So then, we have these organisms in parts of our body that's not used to that. And so, our body goes on alert and here we have the immune system kicking in and say, "Wait a minute, that's not supposed to be here," creates inflammation. So, inflammation is also involved in this whole picture because inflammation is good in the short term. You know, we have an infection, our body, you know, it says, "Oh my gosh, we have to send the army to fix this infection." So, we cure the infection and then crisis is over. We go back to business as usual, just like our sympathetic nervous system. You know, it's there to alert us something's happening. We need to be ready to respond, but then we want that shut off.

It's when inflammation keeps going on a chronic basis, because maybe we're under chronic stress or we've got something else going on, so we've got kind of a leaky gut. So, we're always on this inflammation kick. And so, they have discovered that some people with depression, other health issues, they have these markers, some of their markers in their blood for some of these inflammatory chemicals, cytokines, those types of things, are higher. So, that's where it all kind of comes together, all full full circle.

Host: Yeah. Fascinating.

Amy Larson: So, it just goes back to show we can't treat one part of our body in isolation of everything else. You know, when it's depression or, you know, depression's linked to a lot of cardiovascular issues. You know, it's linked to people with diabetes, which also is inflammation. So, anything we can do to decrease inflammation is important. Exercise is probably the biggest anti-inflammatory thing that we can do.

Host: Any specific type?

Amy Larson: No. I think anything. So, anything you can do besides sitting is important.

Host: Yeah, sitting's bad.

Amy Larson: Yeah, sitting's bad. Anything that you can do that gets you up moving more than not. Like I tell my patients, just get up and walk around the block, anything you can do in small increments. And then maybe the next week or two, then you walk two blocks. It's just doing something, but exercise shows benefit in every system in our body.

Host: And you will just feel better all the way around.

Amy Larson: Because it helps decrease all of those, those factors that are causing the depression or the anxiety, those types of things.

Host: What's your opinion on an anti-inflammatory diet?

Amy Larson: Right. And that's important. That's what we talked about with the Mediterranean diet.

Host: So, that would be a good example of that.

Amy Larson: Yes. So, you want to basically avoid really sugary, highly refined foods, trans fats, highly processed foods, those kinds of

Host: Stay out of the middle aisles.

Amy Larson: You don't want to eat things that have an ingredient list that you can't understand, I think, to a certain extent. Sometimes that's overwhelming for people. "Well, I don't know what that means. I don't know..." So, it's making those small choices. So, you're integrating more variety as far as whole grains, fruits and vegetables, lean proteins, some nuts, some know, beans, those types of things into your diet. And just trying in small phases to make those changes.

Host: My husband and I are kind of embarking on some of those right now. And we have been reading the book called The Obesity Code. And there's a lot of information, a lot of research in this book. But we have kind of embarked a little bit on this intermittent journey, and I already feel better. It's amazing how just those small little changes in a couple weeks can make you feel like a new person, lighter and all the way around.

Amy Larson: It has an amazing effect. Yes. So, I think if we look at how to keep our gut healthy, we talked about some of those things, managing stress, maintain a healthy weight, because, you know, I'm sure you read in your obesity book that, you know, when we are overweight, even some of those fat cells that we have will release some inflammatory markers. So, we want to keep a healthy weight. Getting enough sleep, exercise regularly, all of those things. Socialization, being a part of something bigger than ourselves is also important.

Host: Question, the medication, the over-the-counter that you can take to keep your gut healthier, what are those?

Amy Larson: Probiotics.

Host: Probiotics. I was sitting here thinking, "What is the name of that?" I take those every day. What is your opinion on those?

Amy Larson: Well, as far as probiotics treating major depressive disorder, I think we would have a long ways to say that that would treat that. I don't have any particular type that would be good. I think, you know, eating a variety of foods in your diet, you can get some of that through yogurt and that kind of thing. But research is not really there yet to say that, "Boy, you know, if you take a probiotic, you're immune from depression for your whole life or anything like that." But I think it's a focus that they're looking at.

Host: It is so easy in this day and age to take a pill instead of doing the work. And I am trying to get over that myself. You know, instead of taking this supplement, maybe let's eat some food that has that vitamin in it, and then you get double the benefits.

Amy Larson: And how I explain it to patients is, you know, we're going to start this medication because at this point their symptoms are so severe where, no, they aren't going exercise because they're basically trying to-- it's all they could do that day to get to the clinic to see me or take a shower. That's where we're starting. So, medication can go into place to bring those symptoms under control enough so that we can start looking at the other things. Then, we can start. You know, because when you're in the pit, you're not even going to benefit from therapy at that point because you're in survival mode, right? So, the medication brings symptoms under control enough so that, "Okay, now we can look at maybe some of those thought patterns that we're having" or just being able to talk to someone and get some of this grief out or things like that.

And then, you know, the other part of that I look at as, "Okay, now we can look at the lifestyle stuff." So, let's look at your sleep, let's look at your diet, let's look at exercise. Do you have support? Do you have someone you can talk to when things aren't going well? Do you feel like you've got a community around you? So, all of those things come together. And so when we treat depression that's what we have to look at.

Host: Perfect. It's a lot, but what a great way to start. And if somebody's listening to this podcast and feels like we're talking to you, let's just have a conversation, right? Just make a phone call and make an appointment to see you and go from there. Nothing happens overnight.

Amy Larson: That's right. That's right. And the other thing to consider is there aren't any side effects to, you know, exercise, except a few sore muscles.

Host: Now, tell that to my knee.

Amy Larson: Or stress reduction, you know, doing some guided relaxation, breathing techniques. There aren't side effects to those things, that's why I encourage that as much as possible.

Host: Yeah. And just on a personal note, I I'm a little bit tighter wound, and so I downloaded the Calm app on my phone, and I paid for the premium. And I get alerts now that say, just probably take a moment. And I sometimes, for the most part, I will do that. And it's amazing after I take a five-minute breather with this app, I just, "Okay, I can do this now."

Amy Larson: You do those coping strategies, like breathing, like guided relaxation, it gives your brain another habit, so to speak, instead of going to the anxious thoughts, the depressive thoughts. It allows you to form a new habit around that same emotion that it can go to when you start, you know, "When I'm anxious, oh, I do this breathing technique and it helps me feel better because I've established that connection in my brain."

Host: Yeah. Sometimes you can go a whole day and wonder, "Did I ever take a deep breath today? I don't think so. I'm just breathing right above my..."

Amy Larson: Because you feel tense. And when we're anxious, we breathe in our chest, not in our abdomen, where we should.

Host: So if anybody wants to talk to you further, is it mostly a personal, like a provider that they have who would make the referral or can they call you directly to make an appointment?

Amy Larson: The don't need a referral to see me. People can call directly, and they can call the scheduling number and then they'll be directed to the mental health coordinator and she will handle the intake process. So, there's usually a packet of information that we have patients fill out and that can be done, they can text that to them or email that to them so it's done kind of online and then they can get in to see me.

Host: Perfect. And you are seeing patients primarily in Webster City?

Amy Larson: On Monday, Thursday and Friday, I'm in Webster City.

Host: Okay. And then in Clarion?

Amy Larson: On Wednesdays.

Host: Wednesdays. And hot off the press, we just received information that you will now be seeing patients in our Des Moines clinic. It says here the fourth Tuesday of the month, effective October 24th.

Amy Larson: Right. So, that is just starting. We're going to kind of play it by ear, see how that goes, and that might, you know, expand at some point in the future.

Host: And for anybody listening, that is our Iowa Weight Loss Clinic, but we are expanding that to more service lines. Like, for example, Dr. Nelson sees patients down there for neck and spine, and now you'll be down there for the psychiatric mental health. So, so exciting!

Amy Larson: Yes. Yes, it is.

Host: Yeah, it's great.

Amy Larson: Growth.

Host: Love growth. I'm all about it. Okay. Well, any other parting thoughts or anything you want to tell our listeners?

Amy Larson: I don't think so. I think I covered everything that I wanted to.

Host: Well, thank you so much for coming today. I really appreciate having you on.

Amy Larson: Nice to here.

Host: Love it. Thank you for listening to Iowa Specialty Hospitals and Clinics' ISH Dish Podcast. For more information on the topic we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH Dish Podcast, I'm Gina. Thanks for tuning in.