Depression and Anxiety
Both Depression and Anxiety have multiple possible underlying causes, which can range from genetic factors, infections, hormonal imbalances, inflammation, psychological and social factors, nutritional factors, substance abuse and environmental toxins.. It is critical to determine if the symptoms of depression or anxiety are the result of one of these factors, or a potentially wrong, ineffective and even possibly dangerous treatment may be the result.
Conventional Psychiatry has traditionally acknowledged that hypothyroidism, syphilis, vitamin B12 deficiency, and some chronic illnesses may cause depressive symptoms, while hyperthyroidism can cause anxiety or mania. When I was in training, in the 1980’s and 1990’s, it was typical to get some baseline laboratory studies to rule out these potential causes of the symptoms. Some psychiatrists and mental health facilities still do these tests, but it is not as prevalent and the tests that are gotten are not adequate,either in the range reported as “normal” or in the type of tests obtained. More on functional laboratory testing on another page. Typical treatment currently consists of either Cognitive Behavioral Therapy, general Psychotherapy, medication or a combination of some type of therapy and medication, usually by 2 different providers who often do not communicate with each other. Antidepressant medications have been found to be effective in adults in only 44% of studies against placebo using the Hamilton Depression Rating Scale; however up to 91% effective compared to placebo when asking about depressed mood alone when according to a 2015 study. The study admitted that the effect was modest to moderate, and could have been due to people expecting to feel better due to knowing they were on active medication due to experiencing side effects. A recent 2016 study revealed that antidepressants, except modestly for Prozac/fluoxetine, were not effective for children and adolescents.
Antidepressant medications can have significant side effects – although typically they are tolerated reasonably well, they can cause activation – irritability, restlessness, difficulty sleeping – and even push someone with undiagnosed bipolar disorder into rapid cycling mania. They can also increase the risk of developing suicidal and para-suicidal (that is, self-harm without the intent to kill oneself) thoughts or behaviors. This latter effect is not common and occurs most often in people under the age of 25 who are depressed. A type of addiction to these medication develops, and if the medicine is stopped abruptly, can result in feeling ill, almost like having the flu.
The Holistic and Integrative model of Psychiatry has a different focus. After getting a detailed, comprehensive history, individualized laboratory tests are often obtained to determine if there is a medical/physical cause for the symptoms (more on this on other pages). One of the first steps is to build a solid nutritional foundation, eliminating any foods to which the person is sensitive, increasing nutrient rich foods and eliminating processed foods, foods high in sugar and often making other modifications to the diet or adding various vitamins and minerals. Other lifestyle changes that are often helpful include at least 3 – 30 minute exercise sessions a week (walking is just fine, it does not require running or a gym workout although these are also acceptable), being outside in the sun and around nature, and optimizing sleep. Adults should have 7-9 hours of sleep nightly while children require 8-12 hours and teens need 8-10 hours. Sleeping medications are not a long term intervention for insomnia. Stress management, including meditation, Heart Math/Heart Rate Variability Training, yoga, QiGong or Tai Chi, breathing exercises, coloring, massage, acupuncture or acupressure among others on a daily basis is crucial. For some people, these are enough; for others, the use of nutritional supplements, amino acids, herbs or even Neurofeedback are beneficial.