As 2018 comes to a close, we caught up with our center’s founder and guiding physician, Beth Ballen, MD. Integrative psychiatry often gets to the root of a client’s issues instead of just treating symptoms, helping many clients who previously thought they were untreatable. Dr. Ballen has become an integral part of Denver’s integrative psychiatry community over the past decade, and we’re excited to share how she discovered holistic treatment, how the center has grown so organically, and what new treatments are on the horizon for the new year.
So what led you to become an integrative psychiatrist? It’s such an interesting blend of psychiatry, nutrition, mindfulness, and many other modalities. It seems like more and more people are talking about it.
I didn’t know much about integrative care until medical school, actually. Dr. Andrew Weil had just started the first integrative medical fellowship in Arizona. While it wasn’t the right time for me to attend, I was so enamored with the integrative philosophy that I just started to adopt that mentality with my own wellness and then it grew from there.
How would you define that philosophy?
Thinking about patients holistically, taking into account their emotional well-being, their physical well-being, spirituality, nutrition, whole body health, and relationships. As a psychiatrist, many people coming to see me have symptoms like depression, anxiety, PTSD, etc. but by going below the surface we often find the underlying cause might be something physical or emotional. This could mean anything from nutritional deficiency to trauma, relationship issues, life changes… In some cases a patient might have Lyme disease or toxic mold exposure and not even realize it. Both Lyme and mold can create psychiatric symptoms, but in traditional psychiatry we simply aren’t trained to look for these.
So how did you go from using an integrative approach for your own wellness to studying it more formally?
I was really fortunate to cross paths with another great integrative pioneer, albeit one more local, Dr. Scott Shannon. I was doing a child and adolescent fellowship at Children’s Hospital when I met him there and worked up the courage to ask him to mentor me. He said yes thankfully, and the result was the first integrative psychiatry rotation at Children’s Hospital. It was literally just me at the time, but today it’s actually a thriving program there and still under his leadership. What I learned for pediatrics applied to adults as well as far as ideas like the importance of diet, natural supplementation, and somatic work.
Wow. That’s amazing that you were part of the inaugural program there. What was it about Scott Shannon that made you want to learn from him?
I don’t think you have to spend more than a few minutes to see what’s special about him. He’s just so warm and charismatic and incredibly passionate about integrative psychiatry. He walks the walk in terms of practicing day in and day out, but he’s also an educator. Scott was the author of the leading textbook on integrative psychiatry at the time, and also a founding board member of the American Board of Integrative Medicine (the sole certifying body for the profession of Integrative Medicine). Needless to say, I was very lucky to learn from him. He’s really been at the forefront of it all. Just a few weeks ago Dr. Shannon was the keynote at an integrative psychiatry conference I went to in Boulder, and he was just as inspiring today as he was back then.
I should also mention that as I learned more about the hormones and neurotransmitters that psychiatric medications work on, I began understanding and conceptualizing that these are hormones made up of protein and needing certain amino acids and vitamins to make the neurotransmitters. So it really clicked and made sense to me that without addressing nutrition first and foremost, people wouldn’t really have the tools to heal with medication alone. And of course learning more about studies on yoga, relaxation, and mindfulness and how they can combat all the damage that stress does. Most people don’t realize stress is such a killer. It’s behind so many diseases and issues.
So when you started to work integratively with children and teens, what was the philosophy behind that? Was it to use less medication?
Definitely to use less medication, but most importantly to look for the underlying causes of psychiatric symptoms. Otherwise you’re just managing symptoms and never truly making anyone better. For example, low thyroid can cause depression, celiac disease can cause psychiatric symptoms… Lyme disease has psychiatric symptoms too as I mentioned.
Is there a good example of all this that comes to mind?
I remember one really striking example that just absolutely made me realize I was on the right path. Scott had treated a little girl around nine or ten years old who’d been diagnosed with psychosis and put on several anti-psychotics. I think she’d actually fallen down some stairs and broken her knee because she was overweight due to side-effects from her medication. When she came to Scott, he put her on EMPower Plus (a strong micronutrient formula similar to an advanced multi-vitamin) and she improved so quickly. In her case it was just a nutritional deficiency that was causing her psychiatric symptoms. She stopped displaying psychosis altogether because she didn’t need the medication anymore. It’s scary to think how long she might have been on that medication and never gotten better if she hadn’t met Scott.
So how did you wind up applying your integrative work to adults more than children? Was that a deliberate choice?
I would say it happened organically. I’m still happy to see children at the center, but I’ve found that a lot of parents that want to treat their children holistically might not bring them to a psychiatrist. They might take them to primary care or even treat at home. The children that do come in are more likely to have more severe symptoms which means they’re more likely to need medication, at least initially. Of course my integrative background still comes into play though. I try to use therapy first when possible, and I still recommend supporting holistic options when possible. I also try to use medication more as a bridge than a long-term solution if I can. No one wants to think their child or teen is going to be on something for the rest of their lives, and thankfully they often just need a little short-term help from medication while other things like nutrition and exercise can take root and start to pay off.
It almost seems like there’s a renaissance in integrative and holistic treatment today. Is that fair to say?
Oh, absolutely. There’s really been kind of an explosion of interest. My philosophy has always been that we meet clients where they are, so if they’re interested in an integrative approach, we discuss all the different options for them, even options outside of the center like acupuncture. But if they’re more comfortable with traditional medication, we’ll work from that starting. What’s been happening lately is really interesting. There’s been a tremendous leap of integrative medicine becoming more mainstream which is long overdue in my opinion.
Can you expand on that a bit? The gut-brain connection comes to mind, for instance.
The gut-brain connection, definitely. If I mentioned probiotics ten years ago, chances are I’d get a lot of funny looks, even here in Denver where the population tends to be very into health and wellness. There’s just been such a surge in books and articles on gut health and the microbiome, including the link to mental health… it’s been really wonderful to see. Ketamine is another example. It was seen as a fringe treatment for so long, and now Johnson & Johnson will be taking it into the mainstream soon. It’s just too effective a treatment for them to ignore. The same thing with NAD (nicotinamide adenine dinucleotide, also known as NAD+). I actually administered my first NAD infusion in 2013, but recently it’s become almost hard to avoid reading about. Now we’re offering stem cells, peptides… It’s important to point out something though. It’s not just awareness of these treatments that’s increased—it’s also the knowledge and the science behind them.
So with integrative treatment really running the spectrum from Western to Eastern medicine, how do you know what’s right for a particular client?
I don’t have a cookie cutter approach, though I usually make sure everyone is taking a multivitamin, a B-complex, Omega-3, and a probiotic. A lot of it is meeting patients where they are. If I have a patient I know would really benefit from holistic treatment, but they want medication and I know the medication will help them, even if I think, “You know, diet and exercise or supplements might be better,” I still want to help that person within their values and what’s important to them. Also sadly, prescription medicine is covered by insurance and is often preferred because it’s more affordable. It can be expensive purchasing supplements and natural treatments or going to acupuncture, seeing a nutritionist, that kind of thing, because it’s usually not covered by insurance.
One thing that’s really clear is that you love coming to work each day. What is it you love about the center?
I’m glad that comes across. I would just say I love the environment. So everything, basically (laughs). I think we really have great staff, not just providers, but all the support staff—we really enjoy working together and respect each other. Everyone’s here for the right reasons. Everyone loves helping people. So whether it’s answering the phone or seeing someone as a provider, everyone is really focused on the patient experience.
I also love working together as a team and looking at different perspectives, putting our heads together to figure out how best to help a patient. I love that we get to see patients get better every day. I love that I get to work with my brother. It’s really nice to come to work every day when you work with people that are delightful and happy to be here and passionate about what they do. And, our patients are great. I don’t know how we attract that, but our patients are lovely and truly great to work with.
That’s all so wonderful, and I really think that translates to a feeling of warmth you can feel when you’re here. Is this all what you envisioned when you started the center?
Well, that’s the funny thing. I didn’t really start with any end result in mind. It’s all happened organically and I’ve kind of gone with the flow. In the beginning it was just me by myself in an office with an assistant and then slowly everyone just came on board. I knew Deede from the last hospital I worked at, and then Tara just found us on the internet. At the time we weren’t even hiring, but soon after we needed her so it was really serendipitous. And then Sarah was a friend of a friend who sent in her resume, and Kelley who just came on board (Kelley Brown, LPC, LAC—our new therapist and addiction counselor) was a referral from a client’s parents. They’d met her in residential treatment and were just blown away by her. I love it when clients play a role in shaping the center like that. It’s really happened a lot, especially with our IV center. A lot of the treatments and programs we do just started with someone wanting to do a particular therapy.
Can you give me an example of that?
Ketamine is a good one. I started offering IV ketamine infusions in 2012 or 2013 when a patient came to me and wanted to do it. At the time I only knew about ketamine’s use for anesthesia, but as we know now, ketamine in much smaller doses can really have profound effects on depression. The patient was actually a Harvard medical researcher, so not surprisingly she had done her homework. We already had the IVs set up for amino acids, so we talked about it a lot, and with her background and all her research she was actually excited to be the first person to do the treatment with us.
And did it work for her?
It did, thankfully. There is a small number of people who don’t experience a difference, but it really works for the majority of people we see (approximately 80%). The remarkable thing is that it often works on people who’ve tried everything else, people we call treatment-resistant patients.
Today ketamine is a pretty common treatment for us…
I started prescribing it a little more after our first patient, but at that time the research was still fairly new and I was using it more for extremely treatment-resistant patients, as well as patients that were severely depressed or suicidal. It was kind of on my list—after multiple medication failures but before sending someone for ECT or TMS. Over the years, as more and more studies have been done and as we have such great evidence that it helps people, I’ve become more comfortable prescribing it with people who aren’t necessarily severely depressed, but that have that kind of that chronic depression that’s never truly lifted. Or to augment medication when the medication just isn’t doing the trick. I’ve also used it to wean people off of medicine. There are also people who don’t want to take medicine at all. They like the idea of ketamine because it’s in and out of their system and works by increasing the BDNF, the brain growth factor, versus taking a pill every day.
It feels like ketamine is really coming into the mainstream now. From what I understand Johnson & Johnson is set to release a ketamine product in the somewhat near feature.
Yes, there’s been a number of published articles, including one in the New York times just this past weekend (you can find that article here). That said, the growth of ketamine has only been possible because of a handful of very dedicated practitioners who pioneered it and continued to gather evidence with it. They endured quite a bit of stigma with it, actually. It’s a shame it took the mainstream so long to catch on.
There are some places where they’ll only practice evidence-based medicine, but it’s nice to be able to offer people options and allow them, you know, within reason, to try things that they’re interested in and not have to not have my own agenda. Not just with ketamine but really anything—like the first time we did high-dose vitamin C for cancer-related therapy. I certainly wasn’t treating cancer at the time, but that’s how we’ve learned over the years. It was the same thing with NAD—because people are coming in, having done the research, wanting a certain kind of treatment to help them. So, we look into it and make the decision to help when it seems safe and makes sense from a psychiatric or medical standpoint.
It’s nice that you can learn from patients too, and it’s not just one way.
Yes, definitely. Our patients are partners in their treatment, and often teachers as well. That makes me think of a family we treated for Lyme disease with NAD. We really saw it make a difference with them, and the mother of that family taught me a lot in terms of Lyme literacy. She had had to become an expert in Lyme as many Lyme patients have to do, unfortunately. More and more research is showing that Lyme—and toxic mold as well—is behind a lot of symptoms that present as psychiatric, in many more cases than we thought. Just this past week a client tested positive for both Lyme and toxic mold, and this might sound a little funny but she was actually relieved to hear the news. She tried so many different depression treatments for years, and now we know why these things weren’t working. She’s relieved that we have a direction her treatment can go.
Speaking of NAD, the IV center has really blossomed over the past couple of years. How did you get into IV therapy?
It all started with amino acids, actually. Back in 2012 I attended a conference on doing amino acid therapy with oral supplements, and it was at that conference I learned there were providers using intravenous amino acid therapy instead.
Was this for addiction treatment?
Yes, for substance dependence and detox as well as depression. That’s when I got the idea to get the IVs up and running and see what we could do to supplement the amino acids intravenously as well as orally. Again, it just kind of grew through our clients, just people making requests here and there. Like our first patient who called and asked, “Do you offer NAD?” And I said, “No, what’s that?” (laughing). The next thing you know I was in Louisiana doing IV NAD training, coming back and doing it, and getting great results. With the vitamin C, I really didn’t see that coming. But once people started requesting it and we saw what it could do, Tara and I went down to the Riordan Clinic in Kansas to learn their protocol for high-dose vitamin C. Now we do a lot of that as well.
And the NAD was back in 2013 I think, which is incredible considering it’s only in the past year that it’s really been all over the news. I have to ask though—with the aminos back in 2012, it must’ve seemed a little like a miracle the first time you saw someone detox with them.
It is pretty astounding to see it work. With the amino acids and the ketamine, it never becomes old. It’s like night and day, watching someone change and feel better. I always think of a wilted flower in water that just perks up and comes back to life.
I feel like you’re touching on the idea of transformation. It seems like integrative medicine is often behind really, really big transformations.
Absolutely. There’s just so much that nutrition can do, and also getting to the root of what’s causing someone’s underlying issues instead of just medicating the symptoms. Transformation can seem a little distant on the horizon for a lot of clients, so I like to talk about baseline. A lot of people settle for feeling average or even poor each day, but so much can be done to improve a person’s daily baseline. Sometimes we have to raise their expectations that it’s even possible to feel better.
Really? They don’t even expect to feel better?
They might be coming from feeling depressed for five years, ten years, or even decades. They might have tried everything they could think of at one point or another. I’d say giving some hope can be a big part of what we do in those cases. Getting people past just surviving or managing and actually looking forward to things. Making their daily baseline actually positive, because it should be. Life has its challenges, that’s normal, but it shouldn’t feel uphill on a daily basis.
That’s really great. So, moving on I just wanted to touch on the community here. What’s our center’s relationship to integrative medicine in Denver and Centennial, and what does it feel like to be part of that community?
I think that as we’ve grown, we’ve become a pretty integral part of the community here. The thing about integrative work is that it really has many, many different modalities, and different treatments work for different people. We’re pleased to offer different modalities at the center, but we’re also really glad to be surrounded by so many great practitioners of acupuncture, naturopathy, nutrition, reiki, you name it. A lot of integrative practitioners know each other, so we share knowledge about difficult cases, we go to conferences together… it’s really wonderful. There’s even great people in our complex that we collaborate with.
That sounds so great. Is it possible to describe how you fit into the integrative landscape?
I’d say we’re fairly unique in that we focus on psychiatry and psychotherapy but we also treat some medical conditions, especially through the IV center. We’ve had extreme athletes come in for an IV right before a triathlon, but we’ve also had clients with stage four lung cancer. I don’t think you can get too much more diverse than that. And then of course there’s the wellness piece. We have some really gifted massage therapists, and I love to see our clients take advantage of our guided meditation and hypnotherapy as well. They make really wonderful adjunctive therapies.
Wellness is a category for the IV’s as well, right?
Absolutely. There’s the Myers Cocktail. There’s vitamin and mineral infusions. We also offer a hydration IV with lactated ringers. It’s a great way to hydrate, especially in combination with another treatment.
Aside from wellness, I feel like performance and optimization are a growing niche for the center. Which leads me back to NAD as well as stem cells and peptides. Could you speak a little about all the new things coming down the pike in the new year? What are you most excited about?
I’m excited about all of it! The peptides and stem cells are new for us, and what’s really exciting to me is the combination of those with NAD. Stem cells obviously work really well for joint pain and other areas of regenerative medicine, but together with peptides and NAD I think the combination holds a lot of potential for treating psychiatric symptoms as well as warding off chronic disease. I have a big conference on peptides in December, so I’ll be spending four days just focused on them and will share what I’ve learned after that.
It feels like on-going learning and education is a big part of integrative psychiatry.
Oh, very much so. I just got back from a three-day integrative psychiatry conference in Boulder, I just did some performance medicine training with Dr. Craig Koniver who works with everyone from professional athletes to Navy SEALS. And now four days on peptides!
Four days just on peptides? Wow. I know one focus of the peptides and the NAD are people who are already very healthy and want to really reach peak performance. Kind of the Ben Greenfield/Onnit crowd. Can you speak to that?
NAD for performance and optimization is really growing. We’re seeing a lot of people who are already healthy and well and want to really go as far as they can. There’s a whole community around NAD and peptides for this, but it’s still in its infancy so I’m looking forward to seeing where it goes. Of course NAD for anti-aging and longevity is getting a lot of mainstream attention now. There’s an oral supplement called Basis that’s being marketed fairly broadly. It was developed by Harvard anti-aging researchers, which is interesting, but we feel that receiving the NAD through IV infusions is a lot more potent.
Now you said anti-aging. My understanding is you don’t really like that phrase.
I think it’s more about aging well. Healthy aging, like decreasing the chances of getting cancer and diabetes, sleeping well, having good energy, minimizing pain, staying mobile and active.
Perfect. So last but far from least, we just got a new therapist on board, Kelley Brown, LPC, LAC. Can you talk a little about her?
Kelley just came on board full-time with us and she’s already doing wonderful work with our clients. She does therapy work with a lot of our mid-life clients, but she also has a tremendous amount of experience with addiction recovery. We just finished developing some new addiction treatment programs with her, and she’ll work closely with our NAD and amino clients who are struggling with alcohol, opioids, benzodiazepine, and other substance abuse.
My understanding is that our IV programs handle the physical detox, but there’s a lot of therapy and counseling needed as well to recover and avoid relapse.
Correct. We have a 10-day IV program that works really wonderfully for the detox portion of recovery, but that can give a false impression that addiction recovery is easy. For most people, recovering from addiction is difficult and the vital component to prevent relapse is the aftercare, which means a lot of therapy, support, accountability… And of course feeling good physically too. As Kelley says, the better people feel in the months after detox, the easier it is for them to continue healing. We help support the time period after the initial detox with counseling components but also somatic support and mindfulness—eating right, sleeping, meditation, and many other supportive behaviors. There’s a lot they can do at home and with other modalities like acupuncture, and then we help them at the center with massage therapy, guided meditation, nutritional supplementation. Self-care is very, very important, especially during the first few months after detox.
Addiction is hard on the family and loved ones, too.
Very hard. As Kelley says, it takes a village to help someone recover from addiction, but that village can need their own support and help too. So treating friends and loved ones is part of our addiction work as well. We help them cope and set boundaries and make sure they’re still taking care of themselves. And then of course we also help them manage the care of whoever is going through the addiction.
There’s a lot of decisions to make with addiction care. It must be hard for people to know where to get started.
Exactly. Kelley can help them assess things and help them weigh the pros and cons of different treatment routes like residential programs vs. outpatient programs, etc. Our programs are outpatient, but we have a wonderful network of residential options when that’s a better fit.
Well, we definitely covered a lot here, but it makes sense considering how many different areas we treat. So, in closing, if people want to make an appointment with you, what’s the best way to do that?
They can call the office, or they can see availability and book on-line through the website. I don’t put all my openings on-line though, so calling the office can be best if there’s an urgent issue. I try to accommodate people who are experiencing acute issues first. We also have a great team to support me. Our nurse practitioner, Leslie, can help with medication management and bridges, and our executive director, Tara, helps if anyone needs information on our IV programs.
Perfect. Well, we look forward to catching up again after your peptide training.
Like what you’ve read about Dr. Ballen and her integrative approach to health and wellness? Here are 3 great ways to learn more about Dr. Ballen and our center:
- Call our front desk at (720)222-0550 to schedule your first appointment with Dr. Ballen or ask any questions you might have.
- Sign up for our center’s newsletter here.
- Interested in learning more about IV therapy? To read more on IV ketamine treatment for depression, anxiety & PTSD, visit here. For more on NAD+ infusion and other IV treatments, please visit our sister IV therapy center, the Colorado Recovery Infusion Center.