Not Satisfied With Management of Depression or Anxiety? Maybe Your Doctor Needs More Tools…

This is going to come as a shocker, but not everyone that we clinicians label “depressed” or “anxious” are actually folks that need long-term management with anti-depressants and anxiolytics. I’ve met and treated a lot of people in my career for diagnoses of “major depressive disorder” or “generalized anxiety disorder” who are probably not. What they HAVE happens to be an adjustment disorder, poor coping skills, or untreated emotional wounds. Sadly, what happens in clinical practice is the widespread use of SSRIs and SNRIs (and even benzos!) -- not just for short term management of symptoms, but for years of misdiagnosis and unnecessary treatment.

Does anyone see a problem with this?

Statistics show up to 16 million adults in the U.S. alone are affected by depression and another 6 million are affected by anxiety disorders. Up to 60% of those who have depressive symptoms and 40% of those with anxiety symptoms are even seeking professional help (https://adaa.org/understanding-anxiety/facts-statistics). Are those people really getting relief of the symptoms that plague them and affect function in their daily lives?

The answer comes as a startling fact documented in the “evidence” we’re all supposed to be following in the medical standard of care:

“Studies involving adults with moderate or severe depression have shown the following:

·        Without antidepressants: About 20 to 40 out of 100 people who took a placebo noticed an improvement in their symptoms within six to eight weeks.

·        With antidepressants: About 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.

In other words, antidepressants improved symptoms in about an extra 20 out of 100 people.”

(https://www.ncbi.nlm.nih.gov/books/NBK361016/ )

When clinicians treat with one tool (medication), what these patients never get to achieve is true healing. They are denied learning the strength to cope, the ability to manage their emotions, positive transformation in their relationships and freedom from emotional scars. In addition, patients endure negative side effects from medications (such as weight gain) which leads to chronic diseases like type 2 diabetes or hypertension. Lastly, the honest truth is WE DO NOT KNOW the long term effects of using these drugs, positive or negative! To put it simply, people never get well and may even end up getting worse.

I can tell you from my own experience as a physician and patient that it’s too easy in busy medical clinics (including psychiatry) to just write meds and follow up in 6 months. Once a diagnosis is made and a prescription is written, the whole “no news is good news” rule goes into effect for the prescriber and the patient never receives any further guidance unless they complain. The complaint is usually lack of efficacy or intolerable side effects. Sadly, the best “relief” the patient will get from their prescriber is a change in medication. (Please understand, choice of medication is still a shot in the dark for psychiatrists and primary care physicians alike.) Even if effective, the medication may make patients gain a little short term relief, but the long term control of what is usually a cyclic or repeated experience always eludes those trapped in this very limited treatment plan. For those who want to get off this ineffective and detrimental train, good luck in traditional medicine finding someone willing to spend the time weaning you off of meds once they’ve made you a dependent!

If you’re not satisfied with current management of your depression or anxiety, perhaps you don’t have a doctor who’s got enough tools to help!

My approach to dealing with these common complaints is multi-modal. It is based on objective and subjective findings, the presence or absence of co-morbidities and a combination of professional therapy, rational supplementation, lifestyle modification, hormonal balancing, stress relief, and the judicious use of psychoactive medications.  I preface treatment options with an end-point. I look for treatable causes and work on those systematically and stabilize and relieve conditions as we can. This approach is individualized, takes time and trust, but is gratifying to both physician and patient at the ultimate outcome.

I particularly like supplements, stress relief techniques and counseling as beginning points for patients. These are low risk, high gain strategies that work well with the average patient in the midst of an adjustment reaction with either positive or negative symptoms. These work at any age, are not harmful and yield immediate results with little to no side effects.

In my approach, I also run tests and ask questions to make sure there are not treatable underlying conditions present. So often I find Vitamin D deficiency, MTHFR gene mutations, poor lifestyle, obesity, type 2 diabetes, hormone imbalance and thyroid disease in my work up. I can’t tell you how many people are just poor at coping with stressors and don’t know how to care for themselves! Often, my patients have been on anti-depressants or anxiolytics only to gain weight, get worse and lose hope. I’m here to tell you, with the right skill set and an open mind there are rare physicians and therapists out there that can help!

If you are in need of a consultation to see if my approach can work for you, please contact the office to schedule an appointment.

To your peace of mind!

Dr. Lydia