Medication Questions

Question

Accepted Answer

Have there been any major breakthroughs for treating anxiety and depression that don’t involve the use of medication? Depression and anxiety are very prevalent and are often chronic conditions that upon reflection, are noted to have been present for many years. These conditions vary in their presentation, severity and impact and therefore need a careful and thorough assessment from a professional working in the area of mental health. My goal in an assessment is ultimately to gain an understanding of the person and their life’s narrative, such that I am able to understand their symptom presentation in a greater context.  I would look at predisposing factors such as genetics and early life experiences; as well as the more current precipitating or maintaining factors to their low mood and anxiety. It is important that I have a very good understanding of the person, before deciding on the best treatment. I also remain flexible with the treatment plan in my ongoing consultations.  I focus particularly on the client’s thinking, both about themselves and the world, so that I am able to identify what might be helpful to their better functioning in all areas of life.   My approach to medication is a conservative one, but it definitely has its place in treatment. Where depression and anxiety are severe and impacting on relationships, work, quality of life, physical health and self-care, it is important to act more aggressively with management. Where conditions are left untreated or under-treated, the secondary effects become another layer to the problem. Ultimately all of health is managed and not treated forever e.g. Diabetes, hypertension etc. The medications generally used to treat depression and anxiety, are the antidepressants. These medications assist in improving the client’s mood and lowering the intensity of their anxiety. In the brain, the emotion and reasoning centres are separated, but connected via neuronal pathways and therefore when emotions are too overwhelming, logical thinking isn’t possible. Decisions become based on emotion and there is a loss of control.  The emotions are mostly based on past experiences and learnt ways of interacting and experiencing the world. Of course, many of these old patterns are no longer functional and effect life in negative ways, but depression and anxiety don’t allow for clarity in seeing reality. The world is viewed through tainted-lensed glasses. The picture isn’t clear. Medication acts to reduce the emotions, so that reasoning can occur. The client can build the skills needed for coping with their emotions more effectively. In many cases, these skills allow for the client to eventually wean medication (they are not addictive!) or to only use medication occasionally during times of relapse. Other times, medications might be needed for life; but, so too for other conditions, such as diabetes or hypertension. The approach should always be based on the individual’s requirements. I always advocate for psychological therapy, with a good therapist, who is able to enhance the client’s self-awareness, mindfulness, coping skills and growth. The underlying issues driving the anxiety and low mood, need to be worked through and integrated in the client’s mind. When the depression and anxiety is less severe, alternate strategies might work e.g. yoga, meditation, alternative healing, exercise, dietary supplements, religion, self-help books, leisure activities, support groups etc. These strategies could also be complementary to medication and should be encouraged. Other non-pharmacological treatments that are proposed in more severe depression are TMS and ECT. I have had good experience with ECT in severe depression. TMS has shown some good evidence, but it is time intensive and expensive. My opinion is that many of these therapies require maintenance treatment, as the biological processes that underpin the improvement to mood, are not permanent. I always support being flexible and self-compassionate when it comes to treatment.  Our vulnerability can be very confronting, but ultimately everyone is vulnerable. If you are able to become more tolerant of your emotions, you are a step closer to managing them. The goal is to build sufficient skills to self-regulate and self-manage and to ultimately, be less reliant on toxic relationships or other self-destructive coping strategies. It is important to exclude any medical causes for the mood and anxiety and to avoid substances as these do numb emotions, but ultimately worsen them. Consistency in any treatment is critical! There are no quick fixes, but I do see change happen for many people. It results in a greater sense of empowerment and happiness with life.

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