1. WELCOME – I AM MARTHA STARK, MD
MY COURSE IS CALLED INFLAMMATION AND DEPRESSION:
WHEN THE DOMAIN OF PAIN IS THE BRAIN
GRADUATE OF HARVARD MEDICAL SCHOOL
AND BOSTON PSYCHOANALYTIC INSTITUTE
HOLISTIC ADULT / CHILD PSYCHIATRIST
AND INNOVATIVE PSYCHOANALYST
BOARD CERTIFIED BY THE AMERICAN ASSOCIATION
OF INTEGRATIVE MEDICINE
FACULTY, HARVARD MEDICAL SCHOOL
CO – DIRECTOR / FACULTY, CENTER FOR PSYCHOANALYTIC STUDIES
ADJUNCT FACULTY, WILLIAM JAMES COLLEGE
AND SMITH COLLEGE SCHOOL FOR SOCIAL WORK
FORMER FACULTY, BOSTON PSYCHOANALYTIC INSTITUTE
AND MASSACHUSETTS INSTITUTE FOR PSYCHOANALYSIS
AUTHOR OF 6 BOOKS
MY 7TH BOOK – THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR:
A HEART SHATTERED AND THE PRIVATE SELF
CHAPTERS TO INTEGRATIVE MEDICINE TEXTBOOKS
AND ARTICLES TO PEER – REVIEWED TOXICOLOGY JOURNALS 1

2. THE PSYCHIATRIST ON THE TV SHOW CHICAGO MED
ONCE DESCRIBED PSYCHIATRY AS
“MEDICAL TREATMENT OF THE SOUL”
OVER THE COURSE OF THE DECADES,
MY OWN APPROACH HAS BECOME
MUCH MORE INTEGRATIVE AND HOLISTIC
ONE THAT APPRECIATES
THE COMPLEX INTERDEPENDENCE
OF MIND AND BODY
AND THE CRITICAL ROLE PLAYED
BY THE IMPACT OF STRESS
ON THE MINDBODYMATRIX
THE LIVING SYSTEM ~ THE GROUND REGULATION SYSTEM
THE DIVINE MATRIX ~ THE WEB OF LIFE
A LIQUID CRYSTAL THROUGH WHICH INFORMATION AND ENERGY FLOW
MORE SPECIFICALLY, I WILL BE SPEAKING TO THE ROLE PLAYED BY
LIMBIC KINDLING AND THE RESULTANT HYPERSENSITIVITY TO STRESS
THAT IS A HALLMARK OF DEPRESSED PATIENTS
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3. STRESSORS CAN TAKE THE FORM OF EITHER
“PRESENCE OF BAD” OR “ABSENCE OF GOOD”
AS A PSYCHOANALYST, I MAKE THE FOLLOWING DISTINCTION
ANGRY, GUILT – RIDDEN DEPRESSIONS
ACCOMPANIED BY GUILT
AND A SENSE OF ONESELF AS “BAD”
WORKED THROUGH IN PSYCHOTHERAPY
BY HELPING THE PATIENT GET ANGRY
ABOUT ALL THE EARLY – ON TRAUMA AND ABUSE
THESE DEPRESSIONS ARE THE RESULT OF TOXICITIES THAT
WERE NOT FULLY PROCESSED AND INTEGRATED AT THE TIME
EMPTY, SHAME – FILLED DEPRESSIONS
ACCOMPANIED BY SHAME
AND A SENSE OF ONESELF AS “NOT GOOD ENOUGH,”
WORKED THROUGH IN PSYCHOTHERAPY
BY HELPING THE PATIENT GRIEVE
ALL THE EARLY – ON DEPRIVATION AND NEGLECT
THESE DEPRESSIONS ARE THE RESULT OF DEFICIENCIES THAT
WERE NOT FULLY PROCESSED AND INTEGRATED AT THE TIME
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4. MORE GENERALLY, RISK FACTORS THAT “PRIME” THE INDIVIDUAL FOR
THE LATER DEVELOPMENT OF PSYCHOLOGICAL DIFFICULTIES INCLUDE
NOT ONLY PSYCHOLOGICAL STRESSORS
EARLY – LIFE ADVERSITIES AND CURRENT REAL – LIFE ADVERSITIES
BUT ALSO IRREVERSIBLE GENETIC FACTORS
SINGLE NUCLEOTIDE POLYMORPHISMS (e.g., THE MTHFR SNP)
AND REVERSIBLE EPIGENETIC FACTORS
LIFESTYLE CHOICES AND ENVIRONMENTAL EXPOSURES
THE CUMULATIVE IMPACT OF THESE MYRIAD STRESSORS
WILL CAUSE THE UNDERLYING GROUND REGULATION SYSTEM
TO BECOME DYSREGULATED, DYSFUNCTIONAL, AND INFLAMED
NO LONGER WILL ITS ORDEREDNESS BE MAINTAINED
AND NOR WILL THERE BE EASE OF FLOW
OF INTELLIGENT ENERGY THROUGHOUT ITS EXPANSE
THE NET RESULT OF THIS
STRESS – INDUCED DYSREGULATION AND INFLAMMATION WILL BE
“LACK OF ORDEREDNESS” AND “DISRUPTED EASE OF FLOW”
MANIFESTING ULTIMATELY AS PSYCHIATRIC AND MEDICAL
“DIS – ORDER” AND “DIS – EASE” 4

5. WHEN
(FOR WHATEVER COMPLEX MIX OF REASONS)
THE TARGET ORGAN IS THE MIND / THE BRAIN,
THE RESULT WILL BE A DYSREGULATED STATE OF MIND
MORE THAN A THIRD
OF DEPRESSED PATIENTS
APPEAR TO HAVE
ELEVATED SYSTEMIC BIOMARKERS
FOR INFLAMMATION
HIGH – SENSITIVITY C – REACTIVE PROTEIN AND HOMOCYSTEINE
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6. AS EITHER MONOTHERAPY OR ADJUNCTIVE THERAPY FOR DEPRESSION
NATURAL ANTI – INFLAMMATORIES
THAT WILL PROTECT THE BRAIN
OMEGA – 3 FATTY ACIDS
CURCUMIN (TURMERIC)
VAGUS NERVE STIMULATION ~ MEDITATION ~ “TAPPING”
TO INDUCE THE RELAXATION RESPONSE AND
STIMULATE THE CHOLINERGIC ANTI – INFLAMMATORY PATHWAY
SHEDDING TEARS RELEASES PRO – INFLAMMATORY CYTOKINES
ABDOMINAL BREATHING ~ YOGA
IT WAS RECENTLY DISCOVERED THAT THERE IS A
REDUCED INCIDENCE OF COGNITIVE DECLINE AND
ALZHEIMER’S DISEASE IN BIPOLAR PATIENTS TAKING
HIGH – DOSE LITHIUM CARBONATE (1200 – 1800 MG / DAY)
IN OTHER WORDS, LITHIUM IS NEUROPROTECTIVE,
PRESUMABLY BECAUSE ITS ANTI – INFLAMMATORY PROPERTIES
LOW – DOSE LITHIUM OROTATE (5 MG / DAY) 6

7. ALSO RELEVANT
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO PROVOKE RECOVERY FROM DEPRESSION
ACUTE STRESS CAN “OPTIMIZE”
EVEN “PROVOKING HEIGHTENED FUNCTIONALITY”
AS A RESULT OF THE BODY’S “ADAPTIVE UPREGULATION”
AGAINST THE BACKDROP OF AN EMPATHICALLY ATTUNED
AND AUTHENTICALLY ENGAGED THERAPY RELATIONSHIP
I WILL OFFER “OPTIMALLY STRESSFUL” INTERVENTIONS
JUST THE RIGHT COMBINATION OF CHALLENGE AND SUPPORT
(ANXIETY – PROVOKING BUT ULTIMATELY GROWTH – PROMOTING)
SPECIFICALLY DESIGNED TO
PRECIPITATE DISRUPTION IN ORDER TO TRIGGER REPAIR
BY TAPPING INTO THE BODY’S RESILIENCE AND
INNATE CAPACITY TO SELF – HEAL
IN THE FACE OF ENVIRONMENTAL CHALLENGE
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8. A 2004 CHRISTOPHER LOGUE POEM SPEAKS DIRECTLY
TO HOW GROWTH PROMOTING “OPTIMAL STRESS” CAN BE
COME TO THE EDGE.
WE MIGHT FALL.
COME TO THE EDGE.
IT’S TOO HIGH!
COME TO THE EDGE!
AND THEY CAME,
AND HE PUSHED,
AND THEY FLEW …
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9. MORE SPECIFICALLY …
THE THERAPEUTIC USE OF OPTIMAL STRESS
TO TRIGGER RECOVERY FROM DEPRESSION
DEPRIVING ONESELF OF HALF
A NIGHT’S SLEEP ONCE A WEEK
PREFERABLY THE SECOND HALF OF THE NIGHT (FOR EXAMPLE, 3 – 7 AM)
CAN PRODUCE A RAPID, EVEN IF SHORT – LIVED,
RESTABILIZATION OF MOOD AND RECOVERY FROM DEPRESSION
INTERMITTENT FASTING
CAN SO SIGNIFICANTLY REDUCE THE TOTAL BODY BURDEN
THAT MENTAL CLARITY AND FOCUS
CAN BE IMPROVED DRAMATICALLY AND
A SENSE OF OVERALL WELL – BEING RESTORED
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10. ON THE SURFACE OF THINGS,
THIS COURSE ON “INFLAMMATION AND DEPRESSION:
WHEN THE DOMAIN OF PAIN IS THE BRAIN”
IS ABOUT FERRETING OUT THE UNDERLYING
INFLAMMATION – PROMOTING CAUSES OF DEPRESSION
AND CORRECTING FOR THEM
BUT, AT THE END OF THE DAY,
MY COURSE IS REALLY ABOUT FERRETING OUT
AND, AS BEST ONE CAN, NIPPING IN THE BUD
THE UNDERLYING DYSREGULATION – INDUCING
ENVIRONMENTAL STRESSORS THAT, MORE GENERALLY,
ARE IMPLICATED IN PSYCHIATRIC AND
MEDICAL DISORDERS / DISEASES
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11. AS OPPOSED TO THE MAINSTREAM / DOWNSTREAM APPROACH
OF CONVENTIONAL MEDICINE THAT TREATS SYMPTOMS
WITH ANTI – SYMPTOM MEDICATIONS
MINE IS AN UPSTREAM APPROACH
THAT ATTEMPTS TO REVERSE
UNDERLYING DYSFUNCTION AND INFLAMMATION
BY
“LIGHTENING THE LOAD”
TO CORRECT FOR TOXICITIES
AND “REPLENISHING THE RESERVES”
TO CORRECT FOR DEFICIENCIES
ALL WITH AN EYE TO
“FACILITATING THE FLOW”
OF INFORMATION AND ENERGY
THROUGHOUT ITS EXPANSE
THEREBY RESTORING HOMEOSTATIC BALANCE, RESILIENCE,
AND THE CAPACITY TO COPE WITH THE STRESS OF LIFE
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12. I CONCLUDE WITH A LIMERICK THAT I WROTE FOR THE OCCASION
INFLAMMATION AND DEPRESSION
TO HEAL DISORDER AND DISEASE
TRY ANTI – INFLAMMATORIES
BUT FIRST YOU ADDRESS
UNDERLYING STRESS
AND THEN PRESCRIBE OMEGA 3s
(STARK 2016)
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