What are Anxiety and Depression?

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Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe.  Anxiety and depression are the two most prevalent mental health conditions in the US.  They also potentially share alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning as these endocrine imbalances have been associated with major depression disorder (MDD) and some anxiety disorders. 

Anxiety is a sense of agitation and excessive fear. Though fear is an emotional response to a real or perceived imminent threat, the American Psychiatric Association defines anxiety as "anticipation of future threat". The dread can be so significant that it results in physical symptoms such as muscle tension, restlessness, tremors, or arrhythmias. The diagnosis of an "anxiety disorder" occurs when the concern persists beyond developmentally appropriate periods. These disorders include, but are not limited to, generalized anxiety disorder, social phobias, panic disorders, and separation anxiety. Under this wide umbrella, anxiety disorders are the most common mental illness is America, with an estimated 19.1% of U.S. adults, over 40 million people, having had any anxiety disorder in the past year.

Anxiety disorders all share in common a persistent, excessive fear or worry in situations that are not threatening.  People typically experience one or more of the following symptoms:

Emotional symptoms:

  • Feelings of apprehension or dread

  • Feeling tense or jumpy

  • Restlessness or irritability

  • Anticipating the worst and being watchful for signs of danger

Physical symptoms:

  • Pounding or racing heart and shortness of breath

  • Sweating, tremors and twitches

  • Headaches, fatigue and insomnia

  • Upset stomach, frequent urination or diarrhea

Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, a person may be depressed.  Major depression is one of the most common mental disorders in the United States. For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities.  The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) considers a 'major depressive episode':

  • A period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.

But it can take other, less severe forms as well.  These include persistent depressive disorder, or 'dysthymia', which can be diagnosed when a mood disturbance continues for at least 2 years in adults or 1 year in children.

Symptoms of depression include:

·         Feeling sad or anxious often or all the time

·         Not wanting to do activities that used to be fun

·         Feeling irritable‚ easily frustrated‚ or restless

·         Eating more or less than usual or having no appetite

·         Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment

·         Feeling tired‚ even after sleeping well

·         Feeling guilty, worthless, or helpless

·         Thinking about suicide or hurting yourself

About 21 million U.S. adults—8.4% of the population—had at least one major depressive episode in 2020.  Anyone can get depressed, and depression can happen at any age and in any type of person.

Why use integrative medicine to treat Anxiety?

Around 50% of the patients treated for generalized anxiety disorder (GAD) will not respond to first-line treatment such as antidepressant therapy.  That means there is a lot of room for improvement, such as integrative and naturopathic care!

 

Conventional medicine recognizes that a complex set of risk factors exists for each type of anxiety disorder and that these may vary from one to another, including brain chemistry, personality and life events.  However, an individual's unique physiology is usually not reviewed or considered as a way to discover other underlying causes to these concerns.  Instead, people are often just managed by selective mental health symptoms, with no regard for how these pieces to the larger puzzle come together for every different person.  Some of the well-documented, but often overlooked, contributing factors include:

  • Genetic predisposition and polymorphisms

  • Hormonal Imbalances

  • Infectious diseases

  • Nutrient deficiencies

  • Oxidative stress

natural treatment for anxiety

Once the biochemical abnormalities contributing towards a person's anxiety have been identified, an individualized treatment plan can be created.

Using a blend of vitamins, minerals, amino acids, and neurotransmitters, a naturopathic physician may restore balance and proper function by properly managing the body's constituents.  Other therapies with long histories of use include botanical medicines, acupuncture and homeopathy. 

These benefits are largely without the cumbersome side effects that people often encounter with prescription anxiolytics, including tiredness, addiction, or lightheadedness.

Why use integrative medicine to treat
Depression?

​​​​About 30%-50% of patients experience inadequate response to anti-depressant therapy. This often necessitates cumulative prescriptions and  is usually done in a rote fashion without attempting to take into account a person's specific physiologic picture, as previously described.  When this occurs, a person may end up on multiple prescriptions for one concern.

 

Another reason why people may turn away from prescription medications is due to having adverse side effects.  According to research, approximately half of the people who take Lexapro (escitalopram) may experience weight gain of 7% or more while taking this medication. Gaining weight unexpectedly and struggling to lose it can worsen self-esteem, anxiety, and depression, which ultimately defeats the purpose of taking Lexapro in the first place.  

The increase in weight from some anti-depressants like Lexapro may be attributable to their mechanism of action.  Selective-serotonin-reuptake-inhibitors (SSRIs), such as Lexapro, block the serotonin transporter in the brain and this allows more serotonin to remain localized there – a process that helps improve mental health for those who are taking it. However, research indicates that blocking the activity of the serotonin transporter decreases metabolism, while increasing appetite because serotonin and its transporter influence appetite.

 

Of course weight gain is only one type of side effect which people may experience on that common medication.  Other frequently encountered side effects include nausea, sexual problems, and insomnia.

natural treatment for depression

There are other pharmaceutical anti-depressants with other mechanisms of action, but SSRIs are very commonly used.  Also in common use are medications like Wellbutrin (bupropion), but though common, "[t]he exact mechanism of the antidepressant action of bupropion is not known", which may not be comforting given how far-reaching mechanisms of action can be.  This is particularly of concern since, as documented under a professional monograph for Wellbutrin, "[a]ntidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials". 

Support for patients with Anxiety
and Depression

Evidenced-based herbal medicine

Different botanical medicines have been used for centuries, or even millennia, to help aid anxiety as well as depression.  Some treatments, like kava kava or St John's Wort, have been used for both.  When selecting herbal medicines, it is important to identify as fully as possible the underlying cause for the imbalance, as this will lead to different choices for treatments.  If the goal is to balance adrenal health and modulate cortisol production, we would choose adaptogenic herbs.  If the goal is to decrease inflammation suspected to be crossing the blood-brain barrier, then we would select neuroprotective and even perhaps anti-microbial options.  Thus a good treatment should be quite individualized.

 

Advanced specialty testing

Advanced specialty testing can take many forms for these concerns, and since our clinic has many pediatric patients, we often have an eye on less invasive testing.  'Neurotransmitters' are chemicals released from the electrical signals generated as nerve cells are sending messages to one another.  They help determine neurologic activity in the brain.  These can be measured in blood or non-invasively using a urine collection and may provide insight into imbalances in the brain, though the utility of this testing is still debated in practice.  Less controversial testing options include hormones like cortisol, which can be done through several mediums, such as non-invasive saliva or urine.  Nutrient testing may also be considered, as deficiencies in several vitamins, minerals, fatty acids or amino acids may result in either anxiety or depression.

Effective use of vitamins, minerals and nutritional supplements for neurotransmitter balancing

Another way to improve outcomes for those with anxiety or depression is to include daily additional nutritional supplementation.  Attempting to restore balance to our bodies in the least invasive manner possible is part of the philosophic approach of naturopathic physicians.  Thus we often seek to use the body's constituents to see if better health can be achieved, especially in light of findings from advanced nutritional testing.  These may include vitamins, minerals, amino acids, fatty acids, supplemental hormones and more.

Don't get stuck not trying acupuncture

According to the World Health Organization (WHO), "[t]he effect of acupuncture on depression (including depressive neurosis and depression following stroke) has been documented repeatedly in controlled studies. Acupuncture is comparable with amitriptyline in the treatment of depression but has fewer side-effects".  Furthermore, with regard to anxiety, though the quality of the research is highly variable, the sheer magnitude of favorable findings with consistency of statistically significant results, as well as the wide range of conditions treated and use of animal test subjects, all suggests very real, positive outcomes are to be had. 

Therapeutic lifestyle medicine

Lifestyle considerations are very important when treating anxiety and/or depression.  ​Exercise, stress management techniques such as meditation and massage, sleep hygiene, ​and hydration should all be addressed and reviewed.  Stimulants like caffeine, depressants like alcohol, and compounds like marijuana that can act as both can heavily influence how a person feels.  Even cigarette smoking, which affects adrenal hormone secretion, can influence these concerns.  So lifestyle considerations, beyond just pills and capsules, may be an important part on the journey to wellness. 

We hope you found this information helpful.  If you are seeking guidance, support or treatment, consider contacting our clinic at the number above.

 

 

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References:

  1. National Institutes of Mental Health.  Statistics. https://www.nimh.nih.gov/health/statistics/mental-illness.  Accessed 11-1-22.

  2. National Institutes of Mental Health. Any Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.   Accessed11-1-22.

  3. National Alliance on Mental Illness. Anxiety Disorders.  https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders.  Accessed 11-1-22.

  4. National Institutes of Mental Health. Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.  Accessed 11-1-22.

  5. National Alliance on Mental Illness.  Depression.  https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression.  Accessed 11-1-22.

  6. National Institutes of Mental Health.  Anxiety Disorders.   https://www.nimh.nih.gov/health/topics/anxiety-disorders.  Accessed 11-1-22.

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  8. Rafeyan, Roueen et al. “Inadequate Response to Treatment in Major Depressive Disorder: Augmentation and Adjunctive Strategies.” The Journal of clinical psychiatry vol. 81,3 OT19037BR3. 12 May. 2020, doi:10.4088/JCP.OT19037BR3

  9. Uguz, Faruk et al. “Weight gain and associated factors in patients using newer antidepressant drugs.” General hospital psychiatry vol. 37,1 (2015): 46-8. doi:10.1016/j.genhosppsych.2014.10.011.

  10. Sarwer, David B, and Heather M Polonsky. “The Psychosocial Burden of Obesity.” Endocrinology and metabolism clinics of North America vol. 45,3 (2016): 677-88. doi:10.1016/j.ecl.2016.04.016.

  11. Nihalani, Nikhil et al. “Weight gain, obesity, and psychotropic prescribing.” Journal of obesity vol. 2011 (2011): 893629. doi:10.1155/2011/893629.

  12. Xue, Weiwei et al. “Identification of the inhibitory mechanism of FDA approved selective serotonin reuptake inhibitors: an insight from molecular dynamics simulation study.” Physical chemistry chemical physics : PCCP vol. 18,4 (2016): 3260-71. doi:10.1039/c5cp05771j.

  13. Wellbutrin monograph. https://www.drugs.com/pro/wellbutrin.html.  Accessed 11-09-22.

  14. World Health Organization. "Acupuncture: review and analysis of reports on controlled clinical trials." (2002).

  15. Errington-Evans, Nick. “Acupuncture for anxiety.” CNS neuroscience & therapeutics vol. 18,4 (2012): 277-84. doi:10.1111/j.1755-5949.2011.00254.x

  16. Targovnik, J H. “Nicotine, corticotropin, and smoking withdrawal symptoms: literature review and implications for successful control of nicotine addiction.” Clinical therapeutics vol. 11,6 (1989): 846-53.

  17. **image credits National Alliance on Mental Illness.  You Are Not Alone. 2020.  https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI-You-Are-Not-Alone-FINAL.pdf

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