By: Margaret Christensen, MD, FACOG, IFMCP, ABOIM


Depression, anxiety and chronic pain are some of the most frequent symptoms and co-morbidities that clients present with to Functional Medicine and integrative practitioners. Much national attention is being focused on the epidemic of addiction to opioids, as well as other painkillers including benzodiazepines, along with alcohol abuse because of self-medication for these conditions. It is a major area of interest for the military, as disorders involving chronic pain, stress, PTSD and mood disorders represent the vast majority of military disability.

Toxic mold and mycotoxins need to be considered prominently in any chronic pain or neuropsychiatric syndrome as these exposures are a ubiquitous and pandemic public health issue, with 50% of homes and 60% of commercial buildings having had some type of water damage issues leading to growth of toxic mold species.

it is critically important to obtain a thorough history of exposure to water damaged buildings whether homes, offices [or cars] prior to symptoms starting, and ask if patients are living/working in a current building with water damage or musty smells.  At the same time, it is imperative to get a history of head, neck and spine injuries, along with experiencing traumatic events, particularly in childhood.

Those who already have microglial activation and neuro-inflammation from head injuries/trauma are even more susceptible to the neurotoxic effects of mycotoxins. As well as those who have already breached their gastrointestinal integrity and blood brain barriers because of antibiotics, NSAIDs, stress, SAD diet and alcohol.

One of the reasons these pain/anxiety/addiction symptoms are rampant in the military is poor indoor air quality in many of its housing facilities and older buildings, where soldiers and their families are living. [1,2]

Soldiers are often trained in old moldy buildings, get sent off to third world combat zones with a massive amount of vaccines, (which strongly up-regulates their humoral immunity), then suffer traumatic brain injuries in explosions, along with PTSD from the atrocities they may have witnessed. Their brains are on fire. This combination makes them incredibly susceptible to psychotic breaks.


In the general population 1 out of 3 patients has a chronic pain syndrome. A high percentage experience nerve pain or chronic neuropathic pain (NeP) syndromes which include sensations of numbness, tingling, stabbing, pins and needles. Yet, 35 to 40% of NeP syndromes neuropathy is “idiopathic”.[3]  Known causes include alcohol, diabetes, chemotherapy, toxic substances and uremia. An even higher prevalence of pain and neuro-psychiatric issues are seen among veterans, the elderly and indigent populations. These populations are even more likely to live in mold contaminated housing.

Mycotoxins including aflatoxins, tricothecenes, ochratoxins, gliotoxins, and others have been shown to have multiple devastating effects on the neurological system. [2,3] Because these tiny fat soluble bio-toxins intercalate into the bi-lipid cell membrane as well as mitochondrial membranes, they interfere with energy production and can trigger massive cytokine storms, including being potent inducers of histamine release.

Cytokines such as TNFa, MMP9, TGFb, IL6 and histamine are known to be involved in the anxiety/depression and pain cycles. Thus, pain syndromes such as migraine  and sinus headaches, fibromyalgia, neuropathic pain, and exacerbations of previous injuries are common symptoms of mycotoxin poisoning. [4,5]

A small study presented June 2018 by James Dillard, MD, DC, LAC at the 20th congress of- International Society for Human & Animal Mycology showed a prevalence of mold exposure and + mycotoxins in 15 of 15 patients with new onset of “idiopathic” neuropathic pain and neuropsychiatric symptoms after exposure to water damaged buildings.  [ 6 ]


Additionally, some of the most common symptoms, besides fatigue and pain, in toxic mold exposure are severe anxiety and sleep disruption. Often insomnia is accompanied by night sweats, both signs of HPA (Hypothalamic-Pitutitary-Adrenal) axis dysregulation and neuro-inflammation. Medicating with alcohol or benzodiazepines or narcotics may initially help, but in the long run only fuels the problem.  Alcohol increases levels of acetaldehyde, further irritating the nervous system and disrupting sleep centers, depleting B vitamins and zinc.

Psychiatrist, Mary Ackerly MD, in her excellent article “Brain on Fire”- reviews literature and discusses the mechanism of action seen in anxiety, depression, bipolar and even schizophrenic psychoses that can be the result of toxic mold exposures. [7]


Conventionally, symptoms are medicated and masked with opioid pain killers or psychoactive medications such as benzodiazepines, creating dependency. All too often powerful anti-psychotic drugs are prescribed. To deal with symptoms and side effects, very frequently patients self-medicate with excess alcohol and NSAIDs, causing further disruptions of gut brain barriers and microbiome. Thus, perpetuating the inflammation, anxiety, depression, pain and addiction cycle without addressing the root cause.

Treating for mold mycotoxins, limbic system re-training and neuro-inflammation with functional medicine standards of anti-inflammatory diet and nutrients may be a far more effective strategy than anti-psychotics for the long run.


Current indirect testing is available with blood markers such as TGFB, MSH, C4a, MMP9 as well as direct urine mycotoxin testing now available through 3 different labs.

Mainstays of treatment involve treating both the client and the home/source. These include therapies for mobilization of toxins including glutathione, binding agents such as charcoal clay, zeolite or prescription cholestyramine, decreasing neuro-inflammation with nutrients such as turmeric and fish oils along with rebuilding damaged nervous systems with phosphatidyl choline.


For patients and practitioners to learn more about where to start with diet and nutrients visit

To learn more about diagnosis and treatment of chronic complex Biotoxin illness including mold, Lyme and TBI see and STRONGLY consider joining the International Society for Environmentally Acquired Illness professional list serve.


  4. Campbell, AW. Thrasher JD. Mold and Mycotoxins: Effects on the Neurological and Immune Systems in Humans. Advances in Applied Microbiology 55C (375-406) 2004
  5. Empting LD. Neur
    ologic and neuropsychiatric syndrome features of mold and mycotoxin exposure. Toxicology and Industrial Health 25(9-10) 577–581 2009
  6. James Dillard, MD, DC, Lac Chronic Pain, Indoor Mold Exposure, Mycotoxin Excretion, and Response to Antifungal Therapy. 2018 accessed Feb 20 2018
  7. accessed Feb 20, 2018