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Targeted Healing Inside the Brain: HYLANE Technology for Neuropsychiatric Care

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Guest Bio

Robert J. Hedaya, MD, ABPN, DLFAPA, IFMCP, has pioneered the use of functional medicine in the psychiatric field. He has been at the cutting edge of medical practice, psychiatry, and psychopharmacology since 1979 and acquired specialized training in psychiatry at the National Institute of Mental Health. Dr. Hedaya is a clinical professor of psychiatry at Georgetown University Medical Center, where he teaches courses on affective disorders, cognitive therapy, and PNIE (psycho-neuro-immuno-endocrinology). Dr. Hedaya practices whole psychiatry—a combination of the best of traditional psychiatry combined with functional medicine—at his practice, The Whole Psychiatry & Brain Recovery Center, in Bethesda, Maryland.

Transcript:

Kalea Wattles, ND:
On this episode of Pathways to Well-Being, we’re discussing innovations in neuropsychiatric care with noted psychiatrist Dr. Robert Hedaya.

Dr. Hedaya has pioneered the use of functional medicine in the psychiatric field since 1979. We tend to think of mental health as an intangible problem, but a wide range of neuropsychiatric conditions, from mood and neurodegenerative disorders to PTSD and traumatic brain injury, may be the result of structural dysfunction or impaired communication in neuronal pathways within the brain. With mental illness on the rise, what new modalities are available to help set the foundation for brain recovery? Today, we’re speaking with Dr. Robert Hedaya, who pioneered the use of HYLANE technology, a new framework which includes the use of hyperbaric oxygen therapy, transcranial laser therapy, and neural exercise to normalize dysfunctional nerve tracts and cortical areas in the brain. This approach can reduce or eliminate the use of medication, can reduce side effects of medication, and can improve rates of full remission. Very exciting conversation ahead. Thank you and welcome, Dr. Hedaya!

Robert Hedaya, MD, ABPN, DLFAPA, IFMCP
Thank you so much, Kalea, thank you very much. It’s great to be here.

Kalea Wattles:
We’re so excited to learn a bit more about what you’ve been doing. And we heard that you have this history in integrative psychiatry back to 1979. So I’m sure you’ve identified plenty of trends over your time in clinical practice as it relates to the state of mental and cognitive health in America today. I’d love to hear if there’s any trends that you’ve noticed in your practice right now.

Robert Hedaya:
Well, yeah, there are trends. I would say that generally, the patients that I see are much more ill than the patients that I saw back when I started out. It was quite simple back then, but I think, for a variety of reasons, I think, you know, endocrine-disrupting chemicals, I think the deterioration of the family, the deterioration of community, the deterioration of political discourse, I mean, you know, so many factors there that are disruptive to people. So that now it’s hard to believe, but depression is the number one cause of disability in the world. You know, when I started out, depression was, you know, okay, people got depressed, but it was not that common. Now, it’s ubiquitous, right? So that’s a major trend.

I’d say the trend of psychopharmacology is, you know, it’s trending down now, of course, the pharmaceutical companies are still, you know, coming up with all the new variations on the old theme, but the data on the efficacy of these is pretty clear that they have limited efficacy. And so that’s a clear trend. It’s not that they’re useless. I don’t want to say they’re useless. They have a place, but they were very overused, right? So now we’re at a point in time where we’re looking for new things. And functional medicine is one of those things, and functional medicine has shown itself to be very helpful for people with psychiatric problems, kind of across the board when they can implement it. Treatment-resistant depression—very, very helpful. PTSD—very helpful. But what I found, actually, a few years ago when I looked inside the brain using the quantitative EEG was that people were feeling much better, but their brains were still not, they were still abnormal. They were still having problems that needed to be dealt with.

Kalea Wattles:
Yeah, well, you were one of our esteemed presenters at our Annual International Conference that we had earlier this year. And in that conference, we touched on, for example, social determinants of health, which I think you just highlighted, and how that might be playing a role in these increased rates of anxiety and depression. When you’re treating patients for mental health concerns, especially, you know, the mood disorders, how common is it for you to see patients who maybe try several medications but they’re still not feeling better?

Robert Hedaya:
Well, it’s very, very common. The STAR*D study, which I talked about there, which really was the landmark study, showed that the medications over the course of the year, the efficacy rate in terms of full recovery is under 25%—really probably closer to 10 or 15% of people. And then partial recovery, you’re talking about less than 50% at the end of the year, or maybe around 50%. But that’s partial recovery, meaning you’re better, but you’re still depressed. So meds, you know, they’re useful tools at the right point in time and the right person, you know. I wouldn’t want to be without them, but I certainly use them probably 80% less than I used to 20 years ago.

Kalea Wattles:
Yeah, well, that really highlights something that I always say, that it’s not always about either/or, it can be both/and. And I think a functional medicine approach really encompasses using medications when we need to, but then addressing all of those other…using the whole systems approach.

Robert Hedaya:
Correct, yes.

Kalea Wattles:
Of course, in 2021, we’re coming off of a global pandemic, which has certainly complicated the picture for many of us. Have you found that the COVID pandemic impacted your patients’ mental health, and has that changed the volume of patients you’re seeing with things like anxiety and depression in your practice?

Robert Hedaya:
Well, no, actually. It’s striking to me, because I was reading a lot of papers, for example, talking about suicide rates being up and anxiety going up. But then you also, if you really look, you also read papers that show that actually, some people with severe mental illness actually are doing better then, because they’re kind of used to lockdown, right? The person with schizophrenia, they’re not going out living a vibrant life, they’re in lockdown. And it’s easier for them to see their doc over Zoom, for example. There were studies about suicide being up. But there’s…a couple of weeks ago, a study came out showing that actually, suicide rates were down. Now, this doesn’t mean that there aren’t pockets or even large numbers of people that are more anxious, more depressed, more isolated, but I don’t think suicide generalizations hold. And I think, you know, it’s a time where there’s a lot of money flowing. And people want to say oh, well, look at the suicide, and they want to exaggerate because they want the funding. So, yeah, people are not being careful. It’s…talk to people, and they’ll tell you that wow, I discovered so many great things during COVID. But then talk to people who lost loved ones. And it’s horrible, right? So it’s a mixed bag.

Kalea Wattles:
One thing I found in my own practice was all of a sudden, patients were popping up that hadn’t accessed health care in a long time, because now there was the option to do a virtual visit.

Robert Hedaya:
Right, right.

Kalea Wattles:
And I think that that’s likely true for our mental healthcare providers as well. Did you see more patients accessing mental health services because they could go virtually, they didn’t have to leave?

Robert Hedaya:
My practice didn’t really change. The only thing that I didn’t do is I couldn’t do the transcranial photobiomodulation. I couldn’t do that because I couldn’t do it in person. But I would say no, the thing that happened to me is that I ended up treating a lot of COVID patients. Actually, I treated 50 COVID patients. And using ivermectin and vitamin D and, you know, that kind of thing, and not one in a hospital. Because I’m using a global approach, staying in touch with them daily, I would talk to them once or twice a day, lowering their anxiety, which is important. There was just the paper that showed that high anxiety increases the rate of complications and severity of COVID, right? So, you know, so that was really a change. And then the other thing, which is I ended up working daily or twice daily with the intensive care unit at Cornell, because my niece, a 53-year-old woman with five kids, was in Cornell on a respirator for six, so a little more than six months. And I was trying to hammer functional medicine into their brains, which was not an easy task.

Kalea Wattles:
Wow, well, that certainly was an interesting and unique experience. But this functional medicine stuff, it really works, doesn’t it?

Robert Hedaya:
It does, it does.

Kalea Wattles:
You mentioned some unique tools that you’ve been using. And I’d love to hear more about that. We got a little bit of insight at our annual conference about what you’ve been up to, but I’d love to talk about this HYLANE technology and hear more what you’re doing in your practice. From what I understand, it’s a combination of hyperbaric oxygen and laser therapy and then neurofeedback. Will you tell us a little bit more about what this technology is, just kind of an intro level?

Robert Hedaya:
So, intro level, your… So the hyperbaric oxygen has many mechanisms of action, and it actually helps, can heal traumatic brain injury. So there’s a very large percentage of the psychiatric population that has traumatic brain injury. So I just saw a patient today who is about 40 who said he had a TBI at age 12, and he’s been depressed. But nobody ever identified the TBI because people don’t take a history, myself included. I wasn’t taking a history of TBI. Well, the timeline, using the timeline was like, wow, look at that. So hyperbaric oxygen, that can clear up the TBI, it’s not going to resuscitate dead cells, but there are cells in the brain that are liminal, kind of, they’re alive, but kind of not really doing their thing. And you can actually bring that alive, right?

There are other ways besides hyperbaric oxygen, like nimodipine for a couple of years or something like that. But the hyperbaric oxygen is a very nice thing because it helps the whole body. So that’s one layer, and it’s kind of a general, in a simple level of a general tonic, you could call it, okay? Then you have the transcranial, meaning across the cranium, photobiomodulation, meaning changing the biology through the delivery of photons or light. Now, there are LEDs, light-emitting diodes, on the market, like the DELight, the CytonBrite, etc., a bunch of them. And then, but this is a laser, so it’s coherent light. And it’s higher powered, so we can use 10 watts instead of a quarter of a watt. And, you know, we can control the frequency, whether we use 810, or 1,064, or something like that.

And what I do—this is really what I pioneered was—I was like, well, where are we going to apply the light, and how do we know what it’s doing? And so I was reading about the laser in the body and how it affects mitochondrial function, increases ATP, which is like that’s what life is about—it’s energy, right? You don’t have energy, you don’t have anything. I’m like, wow, maybe this could work in the brain. So I started doing some research, figuring out, and then I said, well, how am I going to know where to apply it? So I looked into qEEG, because you can do that in your office, now we can actually do it in people’s homes. And we get an incredible, incredible picture of what’s going on in the brain. And I can—now I have learned, I’ve taught myself how to analyze this and know based on what I see, based on the symptoms, where should I apply it, and you know, how should I apply it, and what frequency, etc. And then the third modality is neurofeedback, and neurofeedback is a simple thing, it’s been around for a long time. But now it’s become very sophisticated. Again, we can do it in the patient’s home. And you’re basically giving the brain a reward when the pathways that you’ve identified are working the way you want them to work, and you take away the reward when they’re not doing what they’re supposed to do. And the brain unconsciously doesn’t take any effort, the brain unconsciously learns to do what is rewarding.

So now, if you combine these, and we don’t always combine them together, but oftentimes, it could be two or three, but sometimes all three. If you combine them, think about what you’re doing, you’re delivering more nutrients to the brain, with the hyperbaric: more oxygen, stem cell activation, you know, reducing oxidative stress, depending on how much you give, etc. You know, so you’re improving that aspect. Then you’re delivering ATP in a specific place, right? Or places. And then you’re saying, okay, you got the nutrients, you know, you got the ADP, now we’re going to tell you what to do with it. And the changes that you see are quite remarkable. And so that’s when you combine them, sometimes you don’t combine them, sometimes you just do one or the other or two, you know?

Kalea Wattles:
Wow, I have so many follow up questions. That is still, I mean, it’s…I think it’s new to many of us, this whole strategy, right?

Robert Hedaya:
Right, nobody’s doing it.

Kalea Wattles:
Yeah, exactly.

Robert Hedaya:
That I know of.

Kalea Wattles:
So my first question is, what’s the timeline on these treatments? How long is it taking before you’re seeing a clinical response?

Robert Hedaya:
Okay, so it depends on who you’re dealing with, right? So if you’re dealing with a person with a Lewy body dementia, that’s a long haul, but it’s kind of like I did on one woman, 25 laser treatments and clear improvements in her qEEG, but she didn’t get out of her mold and she wasn’t treating her thyroid, etc. So the brain was doing better, but she wasn’t doing better. And if she did do better—and we’re actually going to revisit the laser now that everything’s in place. If she does do better, it’s maintenance, you know, because we have an underlying disease process, right? Now, in someone who’s younger, like, say, this 40-year-old guy had the depression that I told you about. So for him, it’s been 20 treatments, right? And maybe he’ll need maintenance, maybe not, we don’t know, we’re going to spread the treatments out and see if it holds. Another young woman I treated, she had 10 treatments, and her depression was gone, and that’s it. And then I treated a guy who has—I guess anybody would call him schizophrenic. I don’t really think of him that way, but anybody would say that—and when we did the qEEG, and we saw he had a social phobia, by the way, and he thought his whole life that when people were looking at him, they were looking at him in a demeaning way. So when I did the qEEG, I saw that I think it was either the superior longitudinal fasciculus or the inferior longitudinal fasciculus, one of those two, and the vertical occipital fasciculus, those two tracks were not functioning. The rest of his brain was normal, and those two tracks were not functioning properly. So we gave him four treatments. And over the course of a month, his visual distortions melted away. And his social phobia went down. That lasted about nine months, and then I think other factors came in, and it came back. And he’s actually a far ways across the country, so he hasn’t come back here for another series of treatments. But there are other factors involved, but that was pretty powerful.

I had a woman who had something called prosopagnosia, so inability to recognize faces. She also had mild cognitive impairment and temporal lobe seizures, and with her first treatment of the laser—this surprised me, actually, this was my first case. The first treatment, her facial recognition problem came back—went away, her ability came back. And we actually did objective testing with the Cambridge face recognition test, and it was normalized. And so the cells obviously were alive but not doing their job. We gave them ATP, and she did great. And her hippocampus normalized over 25 treatments, actually writing up the paper. Twenty-five treatments, her hippocampus was 2.7 standard deviations out of the norm, and then it was .4, so basically normal, and her memory normal. So everyone’s different. You know, you just have to kind of see what the logic is, and you follow the logic.

Kalea Wattles:
Okay, yeah, I get that, humans are complex. So it sounds to me like there’s really a variety of conditions that this type of approach can offer some benefit. Are there any neuropsychiatric conditions that you’re aware of where this is not going to work, it won’t be helpful?

Robert Hedaya:
I would be cautious in bipolar disorder. I would be cautious in a person who has schizophrenia. I knew this guy very, very well. It was very, really targeting. But I would be cautious there. I don’t have any data on helping autism, for example. I’m not saying it doesn’t, but I don’t have any data. The network involved in autism is so widely distributed. But could it? I mean, it’s possible. Yeah, I mean, TBI, it definitely can help, PTSD, it can help. There are a lot of conditions that can be helped. I think the main thing is, how resilient is the brain? So, for example, ALS, you’re not really going to get benefit, because the mitochondria are not being transported down the axon, to the axon terminal. So you might, but they’re not in the right place to do their job. So it doesn’t really—it’s not going to help.

Podcast HomepageKalea Wattles:
I see. Okay, my next question is, as a primary care physician, of course, I’m thinking, I certainly don’t have this set of skills or equipment or training. Are there any aspects of what you’re doing that someone in a primary care setting who’s across the country from you or far away and can’t get a patient in to see you, what can we do in a primary care setting? You know, how can we take aspects of what you’re doing and apply them in a patient population?

Robert Hedaya:
Well, you need some training, right? We train people. Actually, I just had an inquiry from someone in Australia who’s going to have a group of four clinicians who want training. And I just had someone visit from Florida yesterday for training. So we can do training, we can do with training virtually. But you need training in each of the modalities, you have to know what you’re doing. So you could go to a hyperbaric oxygen conference and learn about hyperbaric oxygen, and that’s something you really should do if you want to do this, right? You’re not going to rely on me, training you for an hour on HBOT, right? You need to go to an HBOT conference, alright? So I can guide people in the neurofeedback so that they can get that going. Learning how to read a qEEG is difficult, I’m still learning, and so I have someone who helps me, right? I don’t know, I need another 20 years to figure it out. So I hire somebody to teach me, someone that I respect. The laser, the thing that I teach with the laser really is, how do you know where to apply it? And how to apply it and all that. That’s the thing that I really—that’s my innovation. My primary innovation is the qEEG-guided laser, you know. We treat a tissue, we want to know where we’re treating, how it’s responding.

Kalea Wattles:
All right, well, you mentioned the quantitative electroencephalogram, which, wow, what a whole phrase there. I’m wondering if you can tell us a little bit about how that compares to other brain imaging options, things like volumetric MRI, or a functional MRI, if you can set the scene a little bit about how that’s helpful in a different way.

Robert Hedaya:
Okay, so well, so first of all, if you look at the laser and see that it does correlate with these different images, and each one is a little bit different, right? So with the qEEG, I’ve seen that it correlates with the volumetric MRI, it correlates according to literature, with DTI, diffusion tensor imaging, it correlates with fMRI, correlates with a PET scan. So, I mean, the correlation is there, but you’re seeing different things. And what you’re seeing really on this is you’re seeing the surface of the brain, the different areas of the surface of the brain, how are they firing? Are they overactive, underactive? You’re seeing the neuronal tracks, you’re seeing the networks, the different networks, and how they’re operating, right? And you’re seeing even deeper nuclei, like the thalamus and sometimes the caudate and the putamen. Yesterday, I saw someone who’s having rage, and you can see the amygdala was overactive, right? So you’re seeing all that stuff. And you’re seeing it in your office on your computer. It is amazing! I can’t tell you, Kalea. The first two years I was doing this, I’d come home and tell my wife, my mind is blown. My mind is literally blown. And it continues to be. And I now think, wow, I can’t believe I practiced all this time without this. And so I’m on a mission really to teach people how to do this.

Kalea Wattles:
Well, just hearing you talk about it, it’s fun. It’s fun to hear you talk about it. And it does sound somewhat futuristic as I’m picturing it. But how exciting that you have these additional tools that allow you to add this layer of specificity to your approach with these patients. Is it fair to say that this approach might be helpful for patients, which I’m almost a little hesitant to say this label, but I’ve had this type of patient in my practice that we would call treatment resistant, right? We’ve tried the medications, we’ve tried the lifestyle things, we’ve tried the nutraceuticals, and nothing seems to work.

Robert Hedaya:
Yes, yes, yes, yes. So the 40-year-old, I told you, with a traumatic brain injury. He did everything I asked of him with functional medicine and his mood dysregulation, it improved by about 50%, okay, cause I had him do daily mood charts, he’s been doing it for a year. So I have all the data, I can show it, 50% improvement. So that’s significant. But it’s 50%, right? And then I also tried a couple of meds, nothing. Then when I added the laser, it was like, wow, lights on. And his family said, wow, we haven’t seen him like this in forever. And I just got a postcard from another woman, from her parents actually, a 31-year-old woman, maybe 35, I don’t know. And severe depression and probably someone would have said, she was kind of like a borderline personality type. Kind of self-destructive, but not terrible and I don’t think she ever really was… And they sent me a card and said thank you for bringing her back to us and better. And you know, but this 40-year-old, I did everything, and it wasn’t till I added the laser, right?

Kalea Wattles:
Well, this is really encouraging. I think patients end up in a functional medicine practice often because they’ve exhausted their other options, and it’s almost their last resort of well, what else do you have? What else can you offer me? So just knowing that there are some other tools out there, I think, is really, you know, gives this message of hope. So when I think about everything that you’ve talked about, and I’m looking at the functional medicine matrix, in my mind, I can clearly see the energy node, and I can clearly see the communication node coming into play. But what elements of the functional medicine model really align with your whole psychiatry approach?

Robert Hedaya:
Well, I mean, all of them. All of them. I mean, that’s why I call it whole psychiatry. It’s a whole system. And they all apply, everything applies. Sometimes more of this, more or less of that, you know, but everything applies.

Kalea Wattles:
So I’m imagining as you’re using these tools that you have to help folks on their treatment plan, that there’s other things going on in the background in terms of their, you know, nutrition, and potentially some supplements or nutraceuticals of the lifestyle piece. I imagine all of that’s happening simultaneously.

Robert Hedaya:
So here’s what we started out doing. We started out not doing the HYLANE technology until they had implemented the full functional medicine protocol, then we do the qEEG and see if anything is needed. Invariably, something was needed, right? So then we would do the HYLANE technology, right? But now, there’s a group of people who cannot do functional medicine. It’s just too much. It’s too overwhelming to them. They can’t do it, like OCD, for example. They want to do it, they like it, but they get frozen. It could take months till they swallow a pill, and then they have a side effect, right? So you get nowhere. So we’re actually starting now, I think this is a brain and terrain thing, the functional medicine is the terrain, and what we’re doing with HYLANE is the brain. And we’ve always done terrain first, and then brain, thinking, you know, the nutrients, everything’s good, the hormones are good, everything’s good. You got rid of the toxins and infections, now treat the brain, ideally, but now we’re actually treating the brain in those people who can’t do the functional medicine, we’re going to do the brain first. And then we think, since it’s really a two-way street, we will then be able to intervene with the terrain, you know? So that’s kind of how we’re doing it both ways, really.

Kalea Wattles:
Well, that’s beautiful. I’m a naturopathic doctor. And so we talk about when we’re approaching patients, first, we have to remove obstacles to cure. And that’s what it sounds like what you’re doing with that, with the HYLANE technology, is you’re removing the obstacles to cure, so that then patients are ready to do that functional medicine model.

Robert Hedaya:
Right. And then, you know, yeah, that’s a new thing, because I’ve been locked in my own paradigm, but I actually broke out of it, about 12 hours ago.

Kalea Wattles:
We’re always reassessing and redirecting and course correcting.

Robert Hedaya:
That’s correct, yeah. It’s a very exciting technology, and to be able to work inside the brain with specificity is pretty amazing.

Kalea Wattles:
Well, I think we’re learning so much about the HYLANE technology and what tools are available. In our last few minutes together, I’d love to hear from you, what else do you think that functional medicine primary care clinicians should know about how they can support their patients in terms of their mental and cognitive health? What can we do? It’s a loaded question.

Robert Hedaya:
No, it’s okay. I personally feel that people need to take the burden, we need to take the burden off them of saying you have a mental illness, okay? Because when you dig underneath, you know, go open the hole, dig down underneath, what you see is, okay, these physical problems, whether it’s somewhere in the matrix, multiple places in the matrix, whether it’s trauma that you endured, which have changed the pathways and how they’re interacting in your brain, or your HPA axis. There’s physical stuff. Now, is there psychological stuff? Yeah, there is, because—but it’s secondary. So much of the time, it’s secondary. In other words, okay, you had adverse childhood experiences. Well, you can’t sit in school without getting anxious, so you can’t function in school. So you start drinking, or you start doing your video games or whatever, and then you can’t perform and everything. Well, who could blame you? Who could blame you when you’ve been traumatized? And you can’t even, your brain isn’t even fine. You can’t even think because you’re so anxious about what happened at home or with your peers or whatever. Oh, here take this Ritalin, that’ll be good.

So I believe strongly that you always have to approach someone and say, let’s see what’s going on physiologically, physically. And when we correct all that, let’s see where you’re at. And then we’ll know what kind of psychological stuff we need to deal with. Now, if someone’s been traumatized, okay, you need therapy upfront. Maybe you need cognitive behavioral therapy upfront, interpersonal therapy, EMDR therapy, I’m not anti-therapy, I’m anti labeling people as having mental illnesses. These are—we know they’re whole-body illnesses. A whole mind, body, spirit illnesses, let’s say, right? You know? I don’t know, where’s the boundary of this thing that it extends, extends into the family, it extends into the spirit, right? It extends. The person is the one who it’s seated in, but I think it’s very important to give people that hope and explanation.

Kalea Wattles:
I think that’s really why it’s so important that our functional medicine matrix has that mental, emotional, spiritual component at the center of it all, and really acknowledging that lived experience and how valuable that is. So that’s helpful to think about, again, going back to that concept that things don’t have to be either/or, that there’s maybe a counseling component or behavioral therapy component as you’re utilizing these other tools.

Robert Hedaya:
That’s right, that’s right. But I think people definitely need to understand these are not black boxes, right? There are answers.

Kalea Wattles:
Yeah. Well, on that note of love and acceptance and connection, I want to thank you so much for your time today. It’s so valuable for us to learn about these emerging technologies. And I think we’re all going to be very eagerly watching the HYLANE technology and how that’s emerging and watching—keeping our eye on your work. So thank you so much for sharing these insights with us. It’s been such a pleasure to talk with you.

Robert Hedaya:
Oh, you’ve been wonderful, Kalea. Thank you so much. Really appreciate it. Take care.

Kalea Wattles:
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