Holistic Psychiatry

Holistic Psychiatry

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Holistic Psychiatry
Holistic Psychiatry
The Importance of the Timeline

The Importance of the Timeline

Revealing Underlying Factors & Shifting the Stories We Tell Ourselves

Courtney Snyder MD's avatar
Courtney Snyder MD
Mar 07, 2024
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Holistic Psychiatry
Holistic Psychiatry
The Importance of the Timeline
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“Unicycles on Boardwalk” cut paper & ink. Courtney Snyder

Understanding when someone’s symptoms began or escalated in relationship to other factors is essential in what I do.  A timeline can help point to potential underlying root causes.  It can also help shift the story someone tells themselves about why they are having their symptoms.  In this newsletter I'll discuss the importance of the timeline and give examples of how this guides further testing and treatment.

Prior to speaking to someone for a non-patient phone consultation, I will invite them to share a 1-2 page timeline for me to review. Otherwise, I will put one together when we speak. I give them examples of what they might include:  primary brain symptoms and when they started, adversity or exposures, such as early attachment disruption, trauma, major stressors, onset of medical conditions, antibiotic exposure, known toxic exposures, moves into a home or office that seemed to impact their health, times of chronic stress, other major notable events, treatment, including medication and/or supplements they are currently taking (or have taken if relevant), and therapies, other tools, practices or lifestyle changes that were helpful or not.   I also invite relevant or recent lab results.  

A simple framework to start can allows more time for further exploration and other discussion. For some - especially those with brain fog and fatigue - even putting a simple timeline together, can be a challenge. Still, most people, opt to share one in advance of their consultation.

Brain Symptoms

The first thing that goes onto a timeline is when the brain symptoms first started.  

  • Lifelong symptoms suggests a genetic factor such as a methylation imbalance.  Our early attachment experience, however, can also shape our early physiology. We can start our lives in a home with water damage and mold exposure.  Mold toxins can also cross the placenta.  

  • It is informative to know if symptoms start in relation to hormonal shifts during normal development. For example, if a girl is doing fine until puberty and then starts to have problems with attention, mood, and/or anxiety, I would wonder about copper levels rising due to increasing estrogen. 

  • For many people I see, however, there is evidence of an early vulnerability, but then a step-wise increase in their symptoms as events, illness and/or exposures stack up over time.

Physical Symptoms or Conditions

  • Because physical symptoms or conditions are often coming from the same roots as the brain symptoms, it helps to know the onset of those as well (as discussed in a recent newsletter).

  • If someone had early ear infections and asthma, for example, I would wonder about early mold exposure.

  • If a child’s symptoms followed a strep infection, I might consider an autoimmune condition like PANS or PANDAS, or I might suspect that the antibiotics used to treat the infection resulted in candida overgrowth driving their brain symptoms. 

  • If someone had an onset of symptoms after a surgery, I would think about high oxidative stress, pyrroles and potentially an upper cervical misalignment (during intubation).

  • Similarly, the timing of a physical injury to the head or neck is important to know.  In this weekend's newsletter, I’ll discuss how an insult to the brain (physical trauma, toxin induced, emotional trauma) can cause “priming” of inflammatory cells in the brain.  This means the next insult can result in a more dramatic inflammatory response and escalation of symptoms.

Birth of Children

  • If a woman has had postpartum depression, anxiety or psychosis, that would strongly raise the likelihood of high copper. 

Antibiotic Exposure

  • How early someone was on antibiotics is good to know. The earlier the exposure the more the microbiome can be impacted.

  • A history of long term antibiotics for acne for example, can result in candida, or other imbalance of the microbiome.

  • How frequent someone has needed antibiotics tells me if they have problems fighting infections. Low zinc would be one possibility.

  • If someone has never had problems with infections and then starts to have repeated infections, I would wonder about biotoxins (like mold), high stress, high pyrroles and again low zinc. 

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