Alternative Approaches For Your Depression, Anxiety, Insomnia, And Even A.D.D.

Maybe the increases in these diagnoses began with the COVID pandemic but more likely we just weren’t paying attention. We’ll not really know until a few years from now when statisticians look over the data, compare notes with each other, and can finally say, “Wow! Look at these numbers! More mood disorders, more anti-depressants and anti-anxiety prescriptions, more sleep meds. We even run out of ADD meds every month. What’s happening?”.

Personally, I doubt if there’s any one cause for this increase. Despite COVID, our brains are pretty much the same. Really, we’re more in touch with our emotions and willing to talk to our doctors and accept referrals to mental health therapists. We’re more willing to swallow a pill that (hopefully) will relieve our psychic distress.

With approximately 20% (!!) of the U.S. population suffering from a “mood disorder” (the two most common being depression and anxiety), this does keep psychiatrists, who mainly write medications, and mental health counselors, who don’t, and pharmacists who count pills and fill bottles, all very busy. Significant shortages are predicted everywhere, both among mental health professionals and the medications they prescribe.

Almost 85 million antidepressant prescriptions are written each year, an increase every year for the past six years. The numbers are similar for antianxiety meds, like clonazepam and alprazolam, and sleep meds like zolpidem. Rather cynically I think, insurance companies encourage you to be on meds as it’s a lot cheaper than seeing a therapist. A year of escitalopram costs them less than $30, a smidgen when compared to a few sessions of psychotherapy. Mental healthcare in the U.S.? Return once a year for your “medication renewal visit” (usually about 15 minutes, eye contact not guaranteed).

Here’s a summary of why we’re on so many psych meds:

One: You’re more aware of your feelings. You’re willing to talk about these feelings with a health care professional.

Two: If you’re seeing your Primary Care Provider (PCP) for the typical few minutes visit, she may, with perfectly good intentions, write you a prescription for an antidepressant and/or an anti anxiety med.

Three: She’ll suggest you see a talk therapist. When you can’t find one “in your plan”, or can’t afford one, you start the med and hope for the best.

Four: When you do feel “better”, you postpone the hunt for the therapist and stay on the med, sometimes for years. Many patients in their 40’s and 50’s were prescribed antidepressants in college and just kept refilling them, literally afraid they might return to the ‘bad place’ they were in when the med was originally prescribed. When I point out how they’re not that person now as then, and the circumstances are vastly different, they’re very reluctant to make any change.  

Although I know antidepressants like escitalopram and sertraline and anti-anxiety meds like alprazolam have been game changers when treating mood disorders, the mistake in our thinking (both doctor and patient) is that medications are the only game in town.

For example:

I know of almost no psychiatrists, or PCPs for that matter, who, when starting a patient on an antidepressant, specifically say something on the order, “This is really only temporary. It will get you over this bad period then we’ll get you off it.” Well documented research has shown an episode of depression generally lasts about ten months, and then the medication can be tapered and discontinued.

Most prescribers are vague about side effects: “Yes, weight gain is a possibility, so is loss of libido, and it may interfere with your sleep.”

Most fail to outline a definite plan for effective lifestyle changes: “Many clinical studies have shown that regular cardio exercise can shorten your need of an antidepressant or your antianxiety med.” “Healthy eating is extremely important when it comes to the mood disorders: no junk food; reduce sugar to a minimum; almost no alcohol. High fiber, plenty of fresh fruit/veggies, coddle your microbiome.” (I believe Freud said that.)

Most fail to mention alternatives: “When you get home tonight, sign up to www.calm.com. It is very inexpensive ($69 a year, first month free), and it is the largest library of guided meditation audios online. They use the technique of ‘mindfulness meditation’ for anxiety, depression, insomnia, and even attention deficit disorder. By practicing a daily meditation and living a healthful lifestyle, you’ll be out of the dark forest of your depression and off your meds much faster than taking your pill every morning and waiting each week to talk to your therapist for an hour.”

And finally, the supplements that might be able to eventually replace your meds are:

• St. John’s wort, 900 mg/day (raises serotonin, similarly to sertraline/escitalopram)
• “ZEN” (GABA/Theanine), one capsule three times a day (for anxiety)
• Liposomal GABA/Theanine, two sprays in mouth as needed for acute anxiety
• DMAE (Deanol), one capsule two or three times a day (for focus/ A.D.D.)
• Liposomal Melatonin, 4 mg at bedtime for sleep

Be well,

David Edelberg, MD