A wide spectrum of mood and anxiety disorders affects almost one in five adults in the United States every year, according to the Anxiety and Depression Association of America (some experts think the number might be much higher). About two thirds or more of them do not receive treatment.
Anxiety and depression come in many different forms and can manifest alone or together in the same person. What causes them is not exactly understood, and it appears that several different factors may contribute that include a person’s genetics, biochemistry and life experiences. Many people suffer for years before seeking help.
Conventional approaches to treating anxiety and depression fall into two main categories: psychopharmaceuticals and talk therapy. Several different classes of drugs are available for prescription from a psychiatrist, a medical doctor specializing in the pharmacological treatment of mental health disorders. Often though, anxiolytics and antidepressants are prescribed by primary care physicians. Unfortunately, these drugs have a spotty record, often take many weeks to show an effect, don’t work in more than half of the patients, don’t heal the condition, potentially have wide-ranging, serious side-effects, and can be associated with tolerance, addiction and withdrawal. This issue was recently described in an insightful article by Benedict Carey and Robert Gebeloff in the New York Times.
Talk therapy, also referred to as psychotherapy, is a drug-free approach that can be used alone or in combination with other treatments. Typically, you work one-on-one with a psychotherapist (often a LCSW) or clinical psychologist (with a PhD in psychology). These professionals are not medical doctors. You may also encounter medical doctors or nurse practitioners specializing in psychiatry who offer talk therapy. The most widely recognized form of psychotherapy is cognitive-behavioral therapy (CBT), which has also been extensively researched for its effectiveness and appears to have a higher success rate than pharmacological treatment for anxiety and depression.
In light of the risks associated with anxiolytics and antidepressants, not to mention their limited usefulness, many patients and providers are interested in exploring alternatives that could complement or substitute for these conventional treatment options. Fortunately, we now have an extensive body of traditional empirical evidence and modern clinical research that has accumulated over the last couple of decades, and, to say it in a nutshell, there’s much hope and promise in natural treatments to help patients recover from mood disorders.
Because depression has been associated with systemic inflammation—in fact it often responds to antiinflammatory drugs just as well as to antidepressants—lifestyle strategies to reduce inflammation with nutrition and nutritional supplements should form the foundation for any therapy or combination of therapies in people experiencing anxiety and depression. You’ve heard me say it before, but a good starting point for most people will be eliminating processed foods, sugar and gluten-containing grains from their diet and focusing on an anti-inflammatory, mediterranean-style approach to nutrition.
In addition to several nutritional supplements including GABA and 5-HTP, botanical medicine offers a range of different, non-toxic treatment options. Both Eastern and Western herbal traditions have a rich repertoire of approaches to relieving mental-emotional symptoms and restoring balance. Many of these botanicals have also been shown in clinical studies to be effective and safe. Homeopathy is another approach that can be tailored to a person’s individual condition and is nontoxic. Botanical medicine and homeopathy should be pursued under the guidance and supervision of an experienced professional, not self-administered. Some botanicals such as St. John’s Wort can interact with prescription drugs, so communication and cooperation between your providers is essential.
Acupuncture is one of the most promising avenues to support for people with anxiety and depression. Not only do many individual sufferers report noticeable relief but an impressive number of high-quality clinical research studies as well as systematic reviews have found that acupuncture is as effective as talk therapy and more effective than pharmacological therapy. In fact, we are also beginning to develop a better understanding of how acupuncture appears to upregulate and downregulate certain control mechanisms in the nervous and endocrine systems that are involved in the stress response and mood-related signs and symptoms. Resources for evaluation of clinical evidence for acupuncture in the treatment of anxiety and depression include EvidenceBasedAcupuncture.org and The Acupuncture Evidence Project.
I will wrap up on a more personal note from my own clinical experience. I’ve been finding that each person’s situation and circumstances require a somewhat unique approach. This means there’s really no holy grail, no one-size-fits-all path. We often need to try out a few different approaches, sometimes one at a time, sometimes concurrently, to find what works best. This requires time and commitment. What worked in the past may not work in the future, and vice versa. Often, we have to think outside the box and consider other body systems that may be contributing to a mood disorder. We should prioritize choices that are as safe and nontoxic as possible. In light of the many concerns about psychopharmaceuticals, we should be cautious in their use as a first-line treatment. A collaborative approach between the patient and providers from different educational backgrounds in the mental health field can help create an open-minded and flexible support network.
© 2018 Christiane Siebert