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Functional Medicine Therapies for the Burned-Out Brain
By Christopher Mote, DO, DC, IFMCP

In my last post, I introduced the concept of chronic stress causation as a broader scope than previously recognized in medicine. We also learned about the three likely culprits of chronic stress, which cause symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain.
In this post, I want to provide you a paradigm, or road map, for non-prescriptive treatments that support the stress response and reduce or resolve symptoms for nearly everyone who implements them.

Lifestyle therapies
Patients with burned-out brain syndrome are typically complex cases and it is often difficult to know where to begin. Over the last twenty years, I’ve seen better responses when recommending with lifestyle and habit changes first. Among the most powerful are the following:

  • Exercise produces increases in dopamine, norepinephrine and serotonin, which all have direct effects on energy, mood, concentration and sleep. This powerful lifestyle therapy also directly releases endorphins for pain control and brain-derived neurotrophic factor (BDNF), which stimulates growth of new neurons. Few therapies can provide better resilience against stress and anxiety than 30 minutes of exercise three or more times per week.
  • Sleep is where the brain performs critical functions in preparation for the next day, including cleaning itself of toxins (autophagy), consolidating memories, growing and repairing neurons with BDNF, and restocking neurotransmitters. Key habits to maximize these sleep functions include getting 30 to 60 minutes of outdoor light each day, blocking blue spectrum light from the eyes at least two hours before bedtime, and avoiding late-night eating.
  • Fasting for at least 14 hours of each 24-hour period improves autophagy, fat metabolism, cellular detoxification and neural tissue growth through increased BDNF release. Teaching patients to eat all food and liquid (other than water) within the same ten-hour window each day can accomplish this.

Mind-body therapies
Cognitive behavioral therapy (CBT) is a traditional approach to understanding thought patterns and implementing behavior modification that has demonstrated effectiveness for pain control, anxiety and depression. While it is a tried-and-true non-prescriptive therapy for these conditions, access to trained and skilled therapists is limited in many areas of the US. Mindfulness-based interventions (MBI), which include mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have shown to be as effective as CBT. These involve learning a non-judgmental approach to thought monitoring and redirecting thoughts to the present. There is a rapidly growing body of evidence that this is a powerful therapy to support the HPA axis and can be implemented independent of worldview or religious beliefs.1
 

Non-prescriptive approaches

  • GABA – a primary inhibitory neurotransmitter that produces a calming effect that reduces anxiety, stress, fear and pain
  • Magnesium – releases GABA and is used up quickly in high stress, making most people moderately to severely deficient
  • Bacopa – has demonstrated effectiveness in improving cognition and memory as well as reducing symptoms of anxiety and depression
  • L-theanine – easily crosses blood-brain barrier to increase both dopamine and serotonin, which reduces anxiety and improves focus and learning
  • Huperzine A – a reversible anticholinesterase inhibitor shown to increase focus, memory and retention
  • Kava – reduces neuroexitability through reversible blockade of sodium and calcium ion channels to reduce anxiety without impairing cognitive functions (as benzodiazepines do)
  • Valerian – can lower cortisol but has primary effect of increasing GABA and serotonin as well as activating adenosine receptors; has shown effectiveness for headaches, heart palpitations, anxiety and insomnia related to high levels of stress.
  • Phosphatidylserine – plays a key role in neuronal energy production and communication in the brain to improve cognitive function, enhances neurotransmitter formation, and prevents excess excretion of cortisol during a stressful event

When evaluating and treating patients struggling with burned-out brain symptoms, many will want to jump right to nutritional supplements, particularly nootropics, but that is often only partially effective, especially in more complex and symptomatic patients. In all cases, lifestyle habits of exercise, sleep and time-restricted eating (fasting) are great places to start and some of the best-tolerated therapies. Teaching your patients mindfulness-based interventions then gives them the tools to deal with episodes of high stress and disabling symptoms. Once these approaches have been implemented, the nutritional approaches become far more effective when needed.

Should none of these non-prescriptive approaches produce the desired results, it will be necessary to consider functional testing for underlying causative factors, such as HPA axis dysfunction, biotoxins and nutritional deficits. Please refer to my previous post for evaluation approaches.

Learn how to be better equipped to support your patients’ stress resilience in our upcoming webinar, “Novel Strategies to Support Patients with Anxiety & Mood Imbalances,” where I’ll unpack each of these concepts in greater detail. Save your spot at the webinar here.

1Randomized-controlled trials comparing MBSR to active control conditions indicate that MBSR is moderately-to-largely effective at reducing anxiety and depression symptom severity among individuals with a broad range of medical and psychiatric conditions. Psychiatr Clin North Am. 2017 Dec; 40(4): 739–749.


Christopher Mote, DO, DC, IFMCP

Christopher Mote, DO, DC, IFMCP earned his doctorate in osteopathy from the Chicago College of Osteopathic Medicine at Midwestern University. He earned his doctorate in chiropractic and Bachelor of Science in human biology from the National University of Health Sciences (NUHS) in Lombard, Illinois, and is certified in Functional Diagnostic Medicine.

Dr. Mote also serves as the SOS Stress Recovery Program Clinical Expert at the Lifestyle Matrix Resource Center. With a focus on addressing the root cause of health concerns, Dr. Mote specializes in the diagnosis and treatment of chronic health disorders.



 

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