In this episode of Thyroid Pharmacist Healing Conversations, Dr. Izabella Wentz interviews integrative psychiatrist Dr. James Greenblatt about a whole-body, root-cause approach to depression. They discuss why many people don’t fully improve on medications alone, the lab work most clinicians skip (vitamin D, B12, ferritin, full thyroid panel), and how digestion, amino acids, omega-3s, hormones, and environmental factors (gluten/celiac, mycotoxins, infections) shape mood.

They also clarify nutritional lithium (lithium orotate) versus prescription lithium, how to approach thyroid-aware monitoring, and why very low total cholesterol is a red flag in stubborn depression and suicidality. Listeners will walk away with practical labs, supplement considerations, and a step-wise framework that can complement therapy and medication.

What you’ll learn in this episode:

• Why depression isn’t a “Prozac deficiency.” Modern research has moved beyond a single-neurotransmitter theory, and depression can stem from many biological drivers: nutrient gaps, hormone shifts, gut issues, toxins, infections, and genetics. Addressing these foundations often makes therapy and medications work better, and sometimes reduces the need for them.

• The lab work most people never get (but should). They walk through vitamin D, B12, iron/ferritin, and a full thyroid panel as accessible first steps, then expand to amino acids, fatty acids, copper/zinc balance, celiac screening, and targeted functional tests. Optimal, not just “normal,” ranges matter, especially for B12 and vitamin D.

• Digestion is destiny for neurotransmitters. You can eat protein all day, but low stomach acid and weak digestive enzymes mean you won’t liberate the amino acids needed to make serotonin, dopamine, and more. Correcting HCl and enzyme deficits can lift mood by restoring raw materials, particularly in those with reflux, thyroid issues, or trauma histories that push the nervous system out of “rest-and-digest.”

• The quiet saboteurs: gluten, mycotoxins, infections, and very low cholesterol. Celiac disease/gluten intolerance can drive global malabsorption – along with anxiety, depression, and even eating-disorder patterns. Mold/mycotoxins and post-infectioussyndromes (PANS/PANDAS, Lyme, post-viral) can inflame the brain. And very low total cholesterol (often genetic) correlates with depression and higher suicide risk.

• Nutritional lithium, clarified. Lithium orotate (low-dose “nutritional lithium”) is different from high-dose lithium carbonate. At low milligram doses, it has been utilized for mood stability and even dementia risk reduction in emerging research. For thyroid health, it is important to monitor labs, personalize dosing, and distinguish carefully from prescription lithium, as dose and monitoring make the difference.

• Medications: a both/and approach. Antidepressants can be appropriate and lifesaving for some; others can successfully taper when foundations are optimized. The aim is personalization: start with biology (labs, nutrients, digestion), layer therapy and meds as needed, and keep revisiting root causes as you heal.

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For the full list of resources and products mentioned in this episode, and to get the full episode transcript, see complete show notes here: https://thyroidpharmacist.com/articles/podcast/

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