Anxiety and Depression:
A Summary of Diagnosis and Treatment from a Holistic Psychiatrist
Lance S. Wright, M.D., B.C.E.T.S.


Introduction

Anxiety and depression are both symptoms and diagnoses. As symptoms, they occur in various psychiatric disorders and in other diagnosed illnesses and injuries. The feelings of nervousness (anxiety) and apathetic mood (depression) can occur in the course of everyday life in persons with no specifically diagnosed medical or mental illness.

Anxiety and Depression are diagnostic entities listed in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) with a multitude of subtypes listed. From a more dynamic and neuro-physiological viewpoint, anxiety and depression can be seen as a disturbance of body energy. If we represent human energy flow on a continuum from low (depression) to high (anxiety), they are at opposing ends, although as symptoms, they can exist simultaneously in the same person.

In disease-focused medicine, more emphasis is placed on pinning down the specific diagnostic category and finding the particular neurotropic chemical intervention that will give most relief. That is, the search for the most effective anti-anxiety and anti-depressive medications becomes the standard of practice, thought by some to be more "scientific." This plan may promote many patients to feel inadequate and deficient in some way with minimal participation in their treatment plan. They must have laboratory tests of blood levels to monitor medication to, perhaps, "speak" for the patient. This style of practice has no rationale for looking more carefully into the cause of the energy disturbance so the patient may not be understood in the context of their experience, environment, or life style.

The Holistic medical approach gives priority to relating to the whole person - body, mind, and spirit in a particular time, space and context. Each of these dimensions contribute to the present energy state being experienced.

The Holistic medicine evaluation begins the treatment process as well as promotes the development of insight. The Holistic physician's awareness of his own feelings and the patient's emotional responses in addition to the more objective details of medical history and physical examination, are the building blocks of a healthy human relationship with the patient. This professional association is marked by cooperation, consideration and mutual interest which will promote growth and maturation for both doctor and patient. Roles are defined and clarified for each and the treatment plan is outlined and explained. The importance of patient participation and feedback is acknowledged and the support of other family members and friends is encouraged when needed.

From this comprehensive exploration and assessment, recommendation for nutrition, exercise, life style and behavioral changes may be indicated to facilitate a change of energy flow - the goal of treatment.

Neuro-psychosocial Formulation and Etiological Considerations

Anxiety

The basic problem involves stimulation that produces an intense fight or flight response; this response activates more energy than can be used effectively. The person typically feels discomfort. This discomfort can be manifested as fear and trembling (unused energy) sickness unto death, as described by Kierkegard.

Finding and utilizing an acceptable and potentially satisfying outlet and expression of overstimulation of this energy can help initially (e.g., jogging, swimming, music). The often unknown source of the anxiety must be discovered and reduced (it may be unconscious). For example, this excessive energy may be produced through misperception of someone's actions or words which aroused fear, anger, guilt and can be resolved by awareness, expression and clarification.

Dreams and fantasies can allow more accurate reality orientation and it places everyday experience in a more balanced perspective. If sleep disturbance is a problem, sedative herbs, relaxation, and abdominal breathing exercises with the goal of self-mastery can be helpful. Reductions in the use of caffeine, consumption of regular meals, a structured schedule with balance of work, rest, and aerobic exercise as well as pleasurable activity are all important factors to monitor. Relationship issues in work, family or social areas should be assessed with the need for psychotherapeutic assistance determined.

When anxiety including phobia, panic, or posttraumatic stress is present, EMDR or other desensitization techniques can be used. The Holistic physician promotes the opportunity for verbal and behavioral expression to occur with identification (when possible) and clarification about the overstimulating energy source as part of the intervention.

Depression

The basic core of' depression typically involves loss. This includes the loss of a meaningful relationship, activity, function, or possession. This produces a gap or block in the flow of energy

through our system. When energy flow bogs down or is not available, depression may be experienced. Metaphorically, it is similar to our national economy where money equals condensed energy. When money flow is bogged down or blocked, the economy slumps into depression. There is disequilibrium.

When a person experiences a loss, his/her depression typically lifts in one to six weeks if a satisfactory adjustment and adaptation can be made. If not, he/she may enter a state of clinical depression. The associated changes in neurotransmitter balance serve to perpetuate the stalemate of low energy flow to conserve energy. However, if the patient has the opportunity and support for fully expressing feelings and ideas about the loss (as mentioned with regard to anxiety), the same healing and recovery process can be mobilized in the depressed person.

Through the careful exploration and treatment that is encouraged by the Holistic physician, the patient obtains an optimally balanced view of his/her life situation. The ultimate outcome involves the patient becoming more empowered and feeling more confidence. Steps toward satisfaction and pleasure with self promotes subjective well-being and gloom may be displaced. Regular physical activity such as jogging, yoga, and breathing exercises can be healthy ways to gradually augment energy flow.

In the course of this approach, as mentioned earlier with anxiety symptoms, a more balanced and structured everyday life routine is needed. Exploration and processing the meaning of the loss can lead to insight and gradual acceptance. Such a process may help prevent relapse which otherwise is common in many forms of depression.

The Holistic physician will be alert to signs of guilt, low self-esteem, and self-blame which are often part of a depression. These can be dealt with psychotherapeutically and spiritually in this paradigm of treatment.

Nutrition, Exercise and continued regular activity are essential to promote continued recovery. The use of St. John's wort should be considered as an adjunct to treatment. If sleep deprivation is a problem, herbal sedation and Camomile tea can be used. These approaches may be used as viable alternatives for mild to moderate depressions which may not require antidepressant medications.

If suicidal ideation is present or if there is a history of previous suicidal attempts, then careful supervision and antidepressant medication should be utilized in addition to the aforementioned methods. The patient should be encouraged to continue to actively participate in the treatment plan rather than become passively dependent on medication alone to relieve depressive symptoms. This also helps to prevent social withdrawal and potentially slipping into a chronic state of depression.

If bipolar disorder is present, it may be necessary to use a mood stabilizing medication such as Lithium Carbonate or Depakote to lessen life endangering behavior. In more extreme cases (e.g., if psychotic symptoms emerge), a neuroleptic such as Haldol or Zyprexa may be necessary. Other medications to consider include Zoloft, Paxil, and Effexor.

©1998 by The American Academy of Experts in Traumatic Stress, Inc.