Dr. Suruchi Chandra is a board-certified psychiatrist who specializes in integrative and holistic approaches for challenging emotional, behavioral, and medical conditions. After graduating from Harvard College with honors, she obtained her medical degree from Yale School of Medicine. She then completed a psychiatry residency at the MGH/McLean psychiatry program at Harvard Medical School. Dr. Chandra’s integrative approach is evidence-based, supported by research, and the result of her clinical training at Harvard and Yale and ongoing mentoring and studying with leaders in integrative medicine. Prior to moving to the Bay Area, she worked at a clinic in the Chicago area that focuses on integrative treatment for children with psychological issues and developmental delays. Dr. Chandra also spent 4 years studying and working in a clinic focused on integrative approaches for chronic, complex illnesses, including chronic fatigue and autoimmune illnesses. It was during this time that she realized the importance of epigenetics and seeking to understand the individual factors that contribute to a patient’s condition. In her current work, she attempts to identify and address the root causes of her patient’s conditions and then uses gentle and natural approaches, whenever possible, to help them obtain true wellness. She has special interests in food as medicine, Lyme disease and other tick borne illnesses, environmental issues, and the gut-brain connection.
I’m Doctor Suruchi Chandra. I’m a board-certified psychiatrist, and I practice integrative psychiatry and medicine. I did my undergraduate training at Harvard College. I went to Yale Medical School for medical training. And then, I returned to Harvard to do a psychiatry fellowship. I first became interested in Lyme Disease because, it’s an infection that we know can get into the brain and cause central nervous symptoms, and, they make almost any psychiatric syndrome. And, my practice is not only about supporting the emotional symptoms that are associated with Lyme Disease, but, also addressing the medical complications using a holistic approach. We know now that the immune system is much more connected with the brain than we ever appreciated, and, that inflammation, which can affect not just the whole body, it can also affect the brain.
So, it’s a much broader way of looking at illnesses, and I look not just at things like serotonin, but I look also at things like the mitochondria, which are the power house of the cells. We look also at the immune system. We look at inflammation. So, it’s a much broader perspective. And, one of the things that first drew me to this field is, I felt it offered a greater chance of helping patients who weren’t responding to conventional treatments. So, we look not just at the brain and neurotransmitters, but we look at how the brain’s connected to other places, such as the gut brain access, and the microbiome. Lyme Disease is the most common tick-borne illness. And, there are about 300 thousand cases that are reported every year, but the true number of cases may be 10 times more than that, and that’s according to the CDC. And, many of the cases that aren’t diagnosed don’t have the classic symptoms, such as the bullseye rash, or the tick that was found initially. And, those undiagnosed cases, some of those may present again with psychiatric symptoms.
Lyme Disease is caused by a bacteria Borrelia burgdorferi. The clinical syndrome of Lyme Disease, this is how patients present, maybe caused by not just Borrelia burgdorferi, but other infections. In addition to that, there are what we call co-infections, which are other bacteria, even parasites, that may be transmitted by the same vectors. And, this complicates the pictures. It complicates it for physicians as well as patients to understand it. So, we think of Lyme Disease as a tick-borne illness. It’s an illness where you get a tick bite and the bacteria transmitted. There may be other ways of contracting Lyme Disease. So, for example, it’s in the literature that Lyme Disease can be passed down from mother to child. Clinically, I’ve seen cases where we suspect that. So, for example, I have patients in my practice where the mother had symptoms of Lyme Disease before the pregnancy, and all of her children present with similar symptoms. So, in those cases, we suspect, even if we can’t conclusively prove, that it was transmitted.
Lyme Disease can be difficult to diagnose, because the bacteria is difficult to directly find in tests. So, we can’t easily culture it or find the DNA. So, we rely on indirect measures. And, namely, we look to see there is an immune reaction against the bacteria, to see if the body is making something that we call antibodies. The problem with this is that one Lyme Disease Borrelia burgdorferi can impair the body’s ability to make antibodies. So, you could see in that setting, the tests may not be accurate. The tests look for certain species, but, we know there are other species out there. So, when they present with symptoms, they may be labeled as having chronic fatigue if the predominant symptom is fatigue. They may have fibromyalgia if they have a lot of muscle complaints. If they have a lot of psychiatric symptoms, they can have labels such as major depression, bipolar, ADHD. Patients can also present with arthritic-like symptoms, and be diagnosed with rheumatoid arthritis, cardiac symptoms and then have a cardiac diagnosis. I think the hardest diagnoses for patients, is when they are labeled with either chronic fatigue or fibromyalgia, because, often people don’t even believe in those syndromes. And, on top of that, they’re really disabling. In psychiatry, we don’t really have tests in the same way that you would have a test for a cardiac condition or rheumatoid arthritis. So, a lot of patients with Lyme Disease feel like it’s all in their head because they don’t have a clear test or a clear diagnosis. So, they struggle with that. They struggle with why can’t they function? Why can’t they do the things that they used to? Why aren’t they getting better? And, that’s an additional layer on top of being ill in the first place.
I can’t emphasize enough how multi-systemic Lyme Disease is. I have a questionnaire that I ask all my new patients to fill out. And, patients with Lyme Disease, even the young ones, will have checked off 20, 30 or more boxes. And, they’ll have symptoms, GI symptoms, problems with sleep, joint pain, fatigue and the list goes on. One of the advantages of using a holistic or integrative approach, is you’re not just treating each symptom separately, you are trying to get to the underlying cause.
So, one category of patients that come to me because I’m doing integrative psychiatry, is patients who aren’t responding to conventional treatments. So, this could be a patient who’s be depressed for 10, 15, 20 years, but not getting better despite seeing many therapists, being on multiple anti-depressants. And, in a certain number of these patients, we find something like Lyme Disease or a co-infection. So, rather than just giving an anti-depressant or therapy, often which my patients have done, we want to address the underlying cause. They may need a short-term course of antibiotics given by a primary care physician. And, in addition to that, what you can also deal with these chronic infections by using more holistic approaches, including some herbs that may have the ability to deal with these infections in the chronic state. So, that’s a piece that I do do in terms of supporting the patients and try to really address underlying causes. So, it’s really individualized in the sense that I try to get a detailed history. We do a lot of testing to see what are the issues going on beyond the infection. How is this infection affecting this person? So, it’s less protocol driven, and more individualized.
So, we have to remember that Lyme Disease is a clinical diagnosis, which means that we have to look beyond a test and at the whole clinical picture. So, when I’m working up a patient, I will use testing. I'll use conventional testing involving looking at antibodies, and the immune system response, as well as direct measures for some of the co-infections. Because the tests miss some cases, we also want to look at the history and the symptoms. And, sometimes there is something even obvious in the history, such as a history of a tick bite that was missed, because no one else had asked.
Lyme Disease right now, there’s a lot of controversy in the field. And, I think this results from a few things. One, it’s an illness that’s still emerging in the literature. There’s a lot that we don’t fully understand. And, the tests often miss cases. Right now, there are two camps that advocate different approaches and treatments to Lyme Disease. So, the more conventional approach is that Lyme Disease is difficult to get. Most cases are easily diagnosed and that treatment is a course of about three-four weeks of antibiotics. Another approach that’s based on new literature, and also, I think careful observation of many patients, is that Lyme Disease may be easier to get than we previously thought. There may be many patients out there who aren’t diagnosed. And, that Lyme Disease can be a persistent infection, and then in the later stages hard to eradicate with conventional treatment, meaning just three or four weeks of antibiotics.
So, this is difficult for patients, and also for physicians. It’s difficult for patients, because often they don’t get a diagnosis right away and when they do get a diagnosis, their doubted. People will say, “well how do you know? There’s no clear test.” Doctors are often criticized too, because people will say, “Well how do you know this is a case of Lyme Disease? You don’t have an absolute test.” I think we have to remain humble in this field. We don’t always know what’s helping. But, what I do see is that when we take this approach that looks at supporting the immune system, that looks at building up resilience and using herbs that kill perhaps chronic infections, many patients do seem to improve. So, antibiotics we know, are very effective in the early stages of Lyme Disease. They seem to be less effective in the later stages, and I have a number of patients who come to me having been on antibiotics for many months or years. And, what they report and what they feel is that when they’re not on antibiotics, they don’t feel well. So, one of the things I work on with patients is trying to find a way to get them off antibiotics where they feel well. And again, this can be with a combination of herbs, acupuncture, massage even, and then also trying to support the healthy microbiome.
So, one of the things that I look at with nearly every patient is diet. At the least, we want to try to reduce processed foods, because we know that eating whole foods, eating unprocessed foods is less inflammatory. We also know from the literature coming out of Columbia University that gluten and wheat can cause inflammation. So, some patients actually have less inflammation, and feel better if we take out gluten.
One of the chief problems that patients with Lyme Disease present with is fatigue. And often, the fatigue can be profound. And, dealing with the underlying infection, it can help patients eventually feel better and give them more energy. But, that takes time. So, sleep is a significant issue for many patients with Lyme Disease. And, I would say some of the worst cases of insomnia I’ve seen, have been patients with Lyme Disease. One of the things that we know in the literature is that Lyme Disease can affect the production of serotonin, which you need to make melatonin. So, looking at that pathway in patients and seeing if it needs support. Some of the patients also seem to have disrupted cortisol, which if it’s elevated at night, also caused patients to be awake. So, looking at that also, and helping them support that stress reduction during the day can also help them get better sleep. There are herbs that seem to be calming. So, things such as oral magnesium or Epsom salt baths can help patients. Essential oils, such as lavender, can also be soothing. But, what I’ve found is patients often need to do a few of these things. One of them won’t even make a dent, because insomnia can be that bad. So, helping them figure out a comprehensive way of doing this, and supporting them, can help them get better sleep. I have some patients who come in and they’ve been on an anti-depressant maybe for a decade or more. And, more recently, they found they have Lyme Disease. And, what I’ve seen is that for many of these patients, it’s not that difficult to finally taper them off, ‘cause you dealt with the underlying condition. So, once that pathway is working better, it may be easier for them to get off of SSRI medications.
In the 1800’s, there was a psychiatric condition called General Paresis, which probably none of you have heard of. And, that’s because it was discovered to be cause by syphilis, and it doesn’t occur much anymore. We know that syphilis is related to Lyme Disease. So, my hope in this field is that more and more psychiatrists will recognize not just the relationship of Lyme Disease and psychiatric illnesses, but infections in general. And, that more of us will be educated about this, more of us will look for it, but most importantly, more patients will get an accurate diagnosis earlier on. My other hope is that we’ll have more definitive tests, so that there is less controversy about the existence of the illness and also whether it exists in a chronic state.
It’s really essential that patients with Lyme Disease, because it can be multi-systemic, that they have a really good treatment team. At the same time, it’s often difficult for these patients to trust other doctors, because they felt like they weren’t validated or understood. So, it can be hard to help patients navigate this. I’ve tried to find and identify doctors that I think are more open minded, or who have more experience and understanding of Lyme Disease. And, also to educate other people in the community. So, educate for example, psychologists about this illness. And then, to tell patients both that it’s important that they have these other people who support them and care for them, but also that I’m referring them to people specifically who do have some understanding of Lyme Disease. Now, I say this with the understanding that this isn’t always easily available to patients around the country and just recognizing that this is another struggle that they face.
So, helping patients manage expectations is really important in Lyme Disease. One, because even once you get a diagnosis, treatment can be difficult, challenging and can take a long time. And because it’s an emerging illness, we don’t always know which treatments are going to work for which patient. So, I think just acknowledging that, and telling patients that, helps them manage it. I’m encouraged by the fact that there are more and more psychiatrists who are interested in this integrative approach and looking and underlying causes, such as Lyme Disease. I’m encouraged by the fact that I’ve seen a greater awareness, even in the last 10 years. There are more physicians who are aware of chronic Lyme Disease. There are more physicians treating it. And, there are more patients getting care, even though it’s not close to enough. And, my hope also is that we will have something closer to a cure for this, and that we will be able to help most patients more easily.