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Ask the Mental Health Expert Archives 2001-2004

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Alternative Remedies

Q. I have always looked to alternative methods for dealing with my depression: yoga, meditation; holistic health practices. However, it's still there. (for years, decades). I feel I need a medication but feel disappointed that the symptoms have not been alleviated through natural remedies. I'm about to make an appointment with a psychiatrist to help me deal with this disorder. Any advice on getting past this hurdle and not feel as though I'm weak because I need medication?

A. First off, I hope you can give yourself some credit for seeking out a professional evaluation. I think that's an indication of your openness to new possibilities, and the realization that sometimes, even with our best efforts, we all need the help of others. This same kind of thinking may help you get over the hurdle of trying medication--but, first things first: I would not assume that you must take a medication for your problem, though one may be very useful.

Of the various alternative methods you mentioned, you did not say anything about getting into psychotherapy. There is excellent evidence that psychotherapy alone may be effective for mild-to-moderate cases of depression-and perhaps even some severe cases-particularly cognitive-behavioral therapy (CBT). Psychotherapy could certainly be considered, depending on the severity of your symptoms, with medication added on if things don't improve over 1-3 months. (Most of the evidence suggests that the most effective regimen for moderate-to-severe depression is a combination of psychotherapy and medication).

It would also be important to make sure there are no medical factors that might be contributing to your chronic depression; e.g., low thyroid function. Now, as to the notion that taking a medication suggests weakness, this is a fairly common attitude in our culture. I suspect it is a remnant of our Puritan heritage, and the notion that we need to "pull ourselves up by our bootstraps". This is fine, if you have boots, but not everybody does! Almost certainly, some of us are born with biochemical factors that predispose us to depression and other neuropsychiatric disorders. To a large degree, we may be able to think, or meditate, or exercise ourselves out of mild depressive states. But when depression becomes persistent or severe, and begins to interfere with our social and vocational function, medication may be necessary to restore the natural balance of chemicals in the brain. It would be analogous to your having too little of a particular hormone in your body, and needing a hormonal replacement for it. This is not to say that conventional antidepressants are natural body chemicals--but they may help restore the brain's natural balance.

By the way, there are some non-traditional and herbal agents that may have antidepressant properties, though I definitely do not recommend trying these on your own-they may have side effects that are not advertised. However, you can discuss these options with the psychiatrist. Finally, keep in mind this metaphor: medication is not a crutch, but a bridge--a bridge from feeling depressed to feeling better. You will still have to do the walking to get across that bridge. This may mean psychotherapy, or continuing to do many of the things that you already do, such as meditation and exercise. All those things together may be greater than the sum of the parts.

For more information, I recommend John Medina's book, "Depression: How it Happens, How It's Healed" (available through CME LLC). Good luck with your new path, whatever that turns out to be.

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June 2001
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