One of the more common concerns expressed by patients is about taking medications for depression or anxiety. Many times, we want to be able to do things on our own without the need for something “artificial”. Other times, we just have a gut reaction to the thought of having to take medications for something that’s “all in our head”.
The most important part, regardless of whether you take medications or not, is to have a comprehensive evaluation by a counselor or mental health practitioner. This ensures that you will have all the information you need in order to make an informed decision. Certainly, psychiatrists and psychiatric mental health nurse professionals will lean towards the use of medications, however you should be aware of the information they have to offer before making up your mind. Information is power, and you should be kind to yourself by allowing all the possibilities to be discussed.
In the case where you have some flexibility in whether you need medication or not, the good news is that Cognitive-Behavioral Therapy (CBT) has been shown to be just as effective as taking medications. This is more than just “talk therapy” where problems are discussed and solutions devised; CBT has a specific, structured approach toward therapy. It often involves a review of thoughts, emotions, and behavioral in conjunction with examining our beliefs about ourselves and the life experiences that have shaped them.
Specific behavioral tasks are assigned as a part of “homework” in order to help. They act as a “lens” to help focus your new thoughts and behaviors to effect change in how you feel. Reviewing progress and feedback are also a critical part of CBT. We tend to have a significant amount of baggage in how we think about ourselves and others, so it can be difficult to pinpoint what are referred to as “automatic thoughts”.
When done effectively, CBT can be performed over the course of 8-12 sessions on average. Additionally, CBT is recognized by insurance as a valid treatment method for both depression and anxiety. The skills you learn will likely benefit you throughout the rest of your life.
As for medications, they do have their usefulness. When symptoms interfere with our lives to such a degree that we can’t focus on change, they can be a lifesaver. Additionally, adding them at the same time as receiving CBT can actually make a significant impact on things. However, if you prefer to try it without medications (and you don’t need them according to your mental health practitioner), then Cognitive-Behavioral Therapy is a time honored method that is both effective and beneficial.
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Which Antidepressant Should I Use?
One of the most difficult issues in dealing with depression is the issue of medications and potential side effects. Antidepressants can have different effects on sleep, changes in weight, sexual functioning, and in how they impact you when you stop taking them.
Some prescriptions are more expensive than others, which can mean a higher insurance copay. Some have fancy names with commercials that suggest they can cure you without any fuss. Add to this the myriad of different choices, different mechanisms of action (SSRI, SNRI, Tricyclic, and so on) and multiple (brand vs. generic) names, and it’s enough to tear your hair out.
The Mayo Clinic published a Depression Decision Worksheet, which can help you to navigate through all the ins and outs of some of the more commonly used medications. It’s worth consulting if you want to be well informed in having a dialogue with your psychiatrist, nurse practitioner, or PCP.
Supplements and Mental Health
Many people are interested in natural methods to help offset the symptoms of mental illness. And who wouldn’t be? As such, many people are interested in seeing what might work before (or even while) pursuing a non-natural solution. Below are some of the more common supplements used.
The difficulty in deciding what is useful by means of anecdotal evidence is one of problems. Primarily, the two issues of correlation does not imply causation paired with the placebo effect. However, when the medical industry has money invested in pharmaceuticals, very few (if any) research is done on non-prescriptive solutions.
Folic acid is one of the B vitamins and comes from citrus fruits and leafy green vegetables. It helps your body make new red blood cells to carry oxygen. If you don’t have enough red blood cells, you have anemia, which can make you feel weak, tired, lightheaded, grouchy or cause you to be forgetful or have trouble concentrating. The body breaks down folic acid into L-methylfolate, which is the active form of the vitamin. Unfortunately, some people are unable to break down folic acid into L-Methylfolate. For these people, taking a folic acid supplement in the already converted form of L-Methylfolate may be a more effective means for treating folate deficiency. Most health food stores do not carry L-Methylfolate; those that do tend to offer it in extremely small dosages (such as 400 mcg). Higher dosages (such as 5-15 mg) can be ordered online at MethylPro. Alternatively, you can get a doctor’s prescription and order it through Deplin, although most insurance companies won’t cover the cost as it is classified as a supplement.
Having adequate levels of Omega-3 are essential to proper health and have been shown to affect concentration, learning, higher dopamine levels and increased brain neuron growth. Additional research has shown a connection between overall mental health and Omega-3. It’s important to chose Omega-3 supplements that contain enough eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as these forms are better absorbed by the body.
There is some evidence that the use of probiotics may encourage the production of serotonin, however this association is implied at best and not directly correlated. Probiotics must be kept refrigerated and discarded after their expiration date. Many people prefer to take these after a course of antibiotics.
Depression can be impacted by taking doses of SAM-E. These pills are sealed individually in foil as exposure to air can affect their potency. SAM-E should never be taken while using another antidepressant due to significant complicating factors.
St. John’s Wort
While the research has been somewhat contradictory, the general consensus is that St. John’s Wort plays a role in depression, anxiety and obsessive-compulsive behaviors. However, it should not be used while taking another antidepressant due to complicating factors.
Vitamin B6 (pyridoxine) is involved making the neurotransmitters serotonin and norepinephrine, which are chemicals that transmit signals in the brain. Vitamin B6 is also involved in the formation of important nerve cell protein layers. Foods like poultry, pork, nuts and beans contain high levels of vitamin B6. Symptoms of vitamin B6 deficiency include a lack of energy and can cause health problems affecting the nerves, skin, mucous membranes and circulatory system.
B-12 supports nerve tissue and brain cell development and promotes better sleep. It comes from animal products, including meat, milk, cheese, and eggs. If you don’t have enough B-12, you can experience weakness, tiredness or light-headedness. Most B-12 supplements are provided in the form of cyanocobalamin. However, the methylcobalamin version of B-12 (Methyl B-12) is better absorbed and retained by the body than other forms of B12.
If you live in areas without sufficient sunlight, suffer from milk allergies or adhere to a strict vegan diet, you may be at risk for vitamin D3 deficiency. Known as the sunshine vitamin, vitamin D3 is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods, including some fish, fish liver oils, and egg yolks. The most accurate way to determine if you are vitamin D3 deficient is through a lab test. Low levels of vitamin D3 are associated with increased feelings of depression. While supplements can help, the best method for acquiring vitamin D3 is through direct sunlight. Tanning beds and other forms of artificial lighting don’t offer enough D3 to be considered a viable alternative.
The issue of supplements and their use continues to evolve as we learn more and more about the biological components to mental health. Supplements can be just as dangerous as prescription medications when used in the wrong dosages or combinations. For example, vitamin D3 supplements are known to cause an increase in certain types of kidney stones (whereas sunlight does not). As such, specific approaches and dosage recommendations are beyond the scope of this article. Don’t approach supplements with a cavalier attitude and never believe something you’ve read on the Internet (including this article) without doing adequate research. The bottom line: Always consult your medical doctor before making decisions on which supplements to use.