| 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. |
