The patient: “Maile,” a 35-year-old hotel concierge.

Why she came to see me: I had met Maile years before when she accompanied her mother to my health center, but the woman who walked into my office was hardly recognizable as the same person. Gone were the stylish clothes, the bright smile, and the engaged, curious demeanor; in their place stood a disheveled, rather gaunt woman who had trouble meeting my eyes.

With some persuading, Maile revealed the following: Roughly a year earlier, she’d begun experiencing bouts of sadness that had fast-tracked from periodical to persistent. As she put it, she went from a high-functioning, organized, happy, and involved woman to someone who felt “robbed of all the glitter that life held.”

After missing several days of work, she’d gone to see her primary care physician at her employer’s request. Maile’s PCP referred her to a psychiatrist, who promptly diagnosed her with depression and prescribed the Paxil. When that failed to work, she’d shifted Maile to Zoloft. The results with both were minimal at best, and before attempting a new antidepressant or other forms of treatment, Maile wanted to explore natural options for relief. Moreover, she wanted to get to the root of her sudden, inexplicable depression.

How I evaluated her: Over the course of a lengthy discussion, it became clear that Maile’s “melancholy,” as she worded it, had no definable source. Her mother was now in good health, and, up until a year prior, she’d “loved” her job as a concierge at one of the hottest hotels in Waikiki, had been happily dating a restaurant manager, and had moved into an adorable, older house she kept busy decorating.

Then, out of nowhere, life turned flat. Her diet had not changed, nor her lifestyle, and yet the blues that arrived were, she said, “of the darkest sort.” Her job became pure drudgery, her friends suddenly irritated her, and her romantic relationship ended because she couldn’t “summon enough energy for anything he suggested.” Indeed, few things seemed to interest her—even running on the beach, which she’d relished since she was a teenager. Away from her work, she remained isolated inside her home, doing “nothing of note.” In addition to depression, she was experiencing stabbing headaches that came on suddenly—this too from an indefinable source—joint pain, muscle aches, fatigue, insomnia, and inadvertent weight loss. While neither she nor her closest family members had a history of depression, she’d accepted her psychiatrist’s diagnosis and took her advice to go on a SSRI, take up meditation, and go into cognitive behavioral therapy. Nothing seemed to work, however, and something inside of Maile said that something more—something physical—was amiss.

The more I inquired about Maile’s medical history personal life, the more she opened up. She came from a big, loving family and had always been healthy. Her fairly new home, she added, was located in Kaneohe.

Upon hearing this, I asked her if she’d noticed any mold in her home, as Kaneohe is situated on the Windward Side of Oahu—a region of the island that typically experiences rain or mist most days. “Now that you mention it,” she said, after pausing for a moment, “I have. But it’s an old house, so it’s to be expected. And it’s not a big deal, right?”

While I neither agreed nor disagreed, I did conduct a battery of tests to check my theory. First, I performed a full physical. Then I ordered a urine test called a MycoTOX Profile to look for mold toxins through The Great Plains Laboratory, Inc. I ordered a blood test to evaluate her hormone levels, as hormone imbalances can place a woman at a higher risk for depression. Lastly, I ordered a separate blood test to assess her reactions to certain antibodies in her immune system.

What my evaluation revealed: Maile’s hormone test revealed what I had anticipated: They were normal for her age, even healthy. (My feeling was that she was still several years away from transitioning into menopause, when women are more vulnerable to depression.)

And yet, the question lingered…why was she depressed? While depression affects more females than males—approximately 25% of women will experience depression at some point in their lives—the illness, which can be debilitating, tends to present in one’s 20s or younger. To have it appear seemingly out of nowhere at Maile’s age was disconcerting.

Not for long, though: The results from her urine test and second blood test came in, and revealed that she had high levels of mold toxins in her system, and that her exposure to mold had caused a chronic inflammatory response that was impacting her brain and leading to the litany of symptoms from which she was suffering.

As I explained to Maile, molds are pervasive, toxic microorganisms that have a wide variety of species. Mold spores, which can be spread through water, insects, and air, “are found year-round both indoors and out, and survive and multiply most readily in warm, damp, shady, and humid conditions,” ABC News reports—and Hawai’i is nothing if not humid. While mold can usually be scrubbed away, a grave mold condition can build and worsen when, say, there’s serious water damage to a home—such as the older home Maile was reportedly in, on one of the rainiest parts of the island.

Generally, we associate damp, moldy homes with respiratory problems (in what’s known as a mold allergy) but mounting research demonstrates that mold can also trigger depression. As psychiatrist Judy Tsafrir, MD, wrote at PsychologyToday.com, “Toxic mold based illnesses is a very prevalent and underdiagnosed condition that can manifest in many different ways, including with symptoms that are exclusively psychiatric, such as depression, anxiety, attentional problems, brain fog and insomnia.” As they also note, “Vulnerability to mold toxicity is only present in 25% of the population, who in most cases, have a genetic predisposition which inhibits their clearance of biotoxins.” In other words, while Maile’s former boyfriend—who often stayed the night—didn’t experience a sensitivity to the mold in her home, while Maile had an inborn vulnerability to it. The good news in all this? It was eminently treatable.

How I addressed her problem: To help Maile get her brain and body—and life—back on track, we discussed her living situation. She loved the home she was renting, but its mold was wreaking havoc on every domain of her life—her career, her relationships, and, perhaps most importantly, her relationship with herself. I asked her to alert her landlords immediately and if the mold could not be eradicated, to begin searching for a different residence.

To mitigate her symptoms, I suggested she adhere to what’s known as the “Shoemaker Protocol.” Developed by Richie C. Shoemaker, MD—a family practice physician and author of Mold Warriors: Fighting America’s Hidden Health Threat—the treatment requires taking nine grams of cholestyramine four times a day—a medication that binds biotoxins in the small intestine, which is then excreted in the stool. Additionally, I recommended she begin taking a broad spectrum probiotic to reestablish healthy bacteria in her gut, which would help “crowd out” the unfriendly bacteria and fungi that could be contributing to her systemic inflammation. I also suggested she begin taking…

  • —an excellent source of Omega 3s that play a vital role in brain function and can positively impact mood and depression.
  • glutathione, a nutrient that is a potent antioxidant that can decrease systemic inflammation especially in the brain and nervous system. In addition, she took supplements to promote her own glutathione production including selenium 200 mcg, lipoic acid 600 mg, and n-acetyl cysteine (also knowns as NAC) 1,000 mg a day.
  • (500 mg a day), as research points to its ability to reduce depressive symptoms.

The patient’s progress: After eight weeks of treatment, Maile returned to my office looking like the girl I’d known years before: Radiant, sparkling, and energetic. The cholestyramine had made her slightly nauseous at first, but the side effects vanished within three days. At the end of the two-week cycle I prescribed, she felt “more alive” than she had in months.

She had relocated to a condo that was not only closer to her work but also closer to the ocean, which allowed her the chance to run on the beach on a daily basis. Best part yet? It was well-lit and well-ventilated, which seemed to lift her spirits even more. So much so, in fact, that work had become enjoyable again and the restaurant manager had invited her on a hike. This time, she was more than ready to join him.

Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.