90. Depression and Anxiety Medications: A Balanced Approach (Depression and Anxiety Coping Skills Podcourse)

November 11, 2023

Here's an important reminder about medications and depression and anxiety: You don't have to choose between medication or a "natural" approach. A truly integrative approach makes room for it all. It's about harnessing science, skills, and the incredible capacity for healing we all possess. In this episode, Dr. Emmons will discuss a more balanced perspective on medication and its role in mental health. He'll share his unique approach to medications with the reminder that healing is an individual journey, and there's no one-size-fits-all solution.

Sources and Notes:

Important reminder: Consult your doctor or other qualified health professional before beginning any diet change, supplement, or lifestyle program.
The mood-supporting supplements that we like can be found by taking our Resilience Quiz and free mini-course. Start here: https://www.naturalmentalhealth.com/resilience-quiz
Where to shop:
- Our partner store at Fullscript: This is where you can find high-quality supplements and wellness products. Except for our CBD Gummies, any product links mentioned in the show notes below will require an account. Sign up for your free Fullscript account here: https://us.fullscript.com/welcome/nmh/store-start
- Resilient Remedies: This is where you can find our line of trusted, high-quality CBD gummies: https://www.resilientremedies.com/
Foundational Supplements:
- Activated B-complex: PureGenomics B-Complex
- Omega 3
  - OmegAvail Hi-Po (non-vegetarian)
  - Omega 3 DHA Vegan
- Magnesium
  - NeuroMag (magnesium L-threonate): our favorite form of magnesium to support sleep and mental health
  - Reacted Magnesium: Another option with a blend of magnesium forms that some folks like for overall support. This is less expensive than magnesium L-threonate and comes in capsule or powder.
  - Magnesium L-glutamate: perhaps the easiest form on the stomach.
- Vitamin D3
  - 2,000 IU
  - 5,000 IU
- Priobiotics
  - Probiotic 225 (high-dose powder option)
  - Two capsule options we love (some folks find one easier on their stomach than the other)
    - Probiotic 50 billion
    - Multi-Probiotic 40 billion
- Convenient, high-quality multi:
  - NeuroMood Pure Pack (contains vitamins, minerals, essential fatty acids, amino acids and curcumin)
  - PureGenomics Multivitamin (vegetarian option)
This episode is part of our Podcourse! To get the most of the course, you may want to follow along in order, beginning with episode #78 and you can visit the Podcourse Page to find all the episodes. However, these episodes can be listened to in any order and you can take action with any strategy that you feel connected to.
Resilience Quiz and free Mini-Course: Based on decades of clinical experience, we've created a model of resilience that is both helpful and practical. True to our approach at Natural Mental Health, we start with strengths. You'll identify these strengths in your Resilience Type. Your Resilience Type highlights your unique strengths, what fuels your joy, what keeps you in balance, and the lifestyle practices that most nourish you. After you find your Resilience Type, sign up for your free mini-course to receive tailored lifestyle practices (e.g., foods to eat more of, ideal forms of exercise, supplements, and mindfulness activities) that can support your mood, resilience, and overall wellbeing.
Resilient Community: Access lots of extra resilience-boosting resources (like our Sleeping Well Workshop) AND you'll join a group of inspiring folks who play an integral role in keeping this podcast going... which means powerful resources (like this podcourse) stay accessible to everyone.
Joy Lab Program: Take the next leap in your wellbeing journey with step-by-step practices to help you build and maintain the elements of joy in your life.
Subscribe to our Newsletter: Join us over at NaturalMentalHealth.com for exclusive emails, updates, and additional strategies.

Please remember that this content is for informational and educational purposes only. It is not intended to provide medical advice and is not a replacement for advice and treatment from a medical professional. Please consult your doctor or other qualified health professional before beginning any diet change, supplement, or lifestyle program.

Please see our terms for more information.

Episode Transcript

Welcome to Joy Lab!: Welcome to the Joy Lab podcast, where we help you uncover and foster your most joyful self. Your hosts, Dr. Henry Emmons and Dr. Aimee Prasek, bring you the ideal mix of soulful and scientifically sound tools to spark your joy, even when it feels dark. When you're ready to experiment with more joy, combine this podcast with the full Joy Lab program over at JoyLab.coach

Aimee: Hi everyone! Aimee here. So, Henry is going to discuss medications in this episode. I really love that we're diving into this. I think it's so important because it can be easy to believe that you have to sort of choose a side when it comes to health.

You're either in the alternative camp or the conventional camp. Now, my area of research is integrative modalities, specifically for mental health, and I can't tell you how many folks have said to me, " So I know you don't believe in medication. So I was wondering..." and then they'll ask me a question. And then I'll say, hold up.

who said, I don't believe in medication? I believe in science, and I believe that we also have so much power to create more healing than we think. That might mean a medication is needed for a lifetime, it might not. So our goal here at NMH and Joy Lab is for folks to not just feel better through evidence-based strategies, but to also step into that healing power that we all have and to like really own that. To know that you can create healing. It may not mean something is cured in that clinical sense, but healing is always there. So listen in for this lesson with Henry as he gets into medications, he gives a really unique approach.

And of course, remember, please, this content is for informational and educational purposes only. It is not intended to provide medical advice, and it is not a replacement for advice and treatment from a medical professional. Enjoy.

Henry: Let's talk a little bit about medication. One of our slogans is more skills, less pills, but I am not opposed to medication. I think there's a place for it. There's sometimes a need for it. It can be helpful. But in my view, we as a healthcare institution, we are medicating too quickly, for too long a period of time, for things that don't always need medication.

The reason I say that is I think that many people who are diagnosed with depression actually have an adjustment disorder, which by definition is stress related and temporary. And if people are given skills to be able to face whatever is stressful in their lives, the need for medication should be less.

I also have a concern when people are put on a medication for a stress related problem and then they stay on it for such a long time that it becomes hard to get off of it. In my view, that takes about a year or two years. If people are on a medication for that long, you have to be very careful about how you come off of it or the risk of withdrawal symptoms is clearly going to be there.

So with that said, let me just talk a little bit about how I think about medication, its proper use, and how you might think about meds differently for those three subtypes of depression or mood problems. For the vast majority of people, the first medication they try is what's called an SSRI, or a serotonin reuptake inhibitor.

And that is probably the best choice for people with the anxious depression and even people who have more of that agitated mood state. In people with an anxious mood, in my view, the dose that is most effective is often a very low dose. So if it's something like Prozac or Fluoxetine, the dose might be only 10 or 20 milligrams.

If it's Zoloft or Sertraline, it might be just 25 or 50 milligrams. And in my practice, I usually give that low dose at least three or four weeks, sometimes even a little bit longer because it really can take, you know, up to six or eight weeks even for an SSRI to really start having its best impact.

So the point being, I don't think we should increase those medications too quickly In mild to moderate, cases. If somebody has really severe depression, sometimes it does need to be done a little bit faster. Also, in my view, somebody who has a stress-related adjustment disorder, which usually shows up as an anxious mood, the length of treatment ought to be on the shorter side.

Maybe it's only 3 to 6 months, or 6 to 9 months, but I don't think it should be in a matter of years unless people have been given the opportunity to really learn some of the skills and still are having a lot of symptoms. So, long term use, it is appropriate, I think, for people with recurrent major depression or clinical depression.

But for people, the vast majority of people, where it's a temporary, stress related problem, I think we ought to be looking at a shorter course of treatment. And then instituting some of these other things that are helpful. So for an anxious mood, kind of low dose SSRIs like Prozac, Lexapro, Zoloft, Celexa, or the generic names Fluoxetine, Lexapro is S Cytalopram, Zoloft is Sertraline, and Celexa is called Cytalopram.

Just the typical starting dose and then cut that by half is how I usually do it. People who have more of that agitated mood state, this is where you really do have to be careful about starting an antidepressant that affects the serotonin system. As I said a little bit earlier, you can get too much serotonin.

And if you do, you might feel that agitation heightened. And for some people, this is a risky time because your mood might still be bad and then there's all this agitated, kind of edgy energy. And, um, this is a time of risk for people who might have suicidal thinking. And sometimes people never have had it before and they develop it when they first start an antidepressant.

In my view, that's the greatest risk for people with that agitated mood state. I still might use medications, but I might start at a really low dose. So, a quarter to a half of the usual starting dose and giving it a little bit longer period of time and really watching closely in those first two to three weeks to be sure that there's not a worsening of mood.

And then people with more of that sluggish mood might not do as well with a serotonin drug because they tend to be sedating. And a lot of times people need something that's more energizing. So the medications that might have more of an effect on the dopamine system are things like Wellbutrin also known as Bupropion. Again, a very appropriate choice for winter depression or people who are sluggish or sleeping too much or just can't get going or can't get off the couch or don't have any motivation.

Medications that affect both serotonin and norepinephrine are things like Effexor, Cymbalta. Effexor is also called Venlafaxine. Cymbalta, is another what's called an SNRI, something that affects both of those neurotransmitters and that might also be a good choice. Some of the newer drugs like Pristiq, Trintellix, those are also things that affect both of those and so might be a good choice for somebody who needs a little bit more energy.

In my practice, I will often add some of the natural therapies to try to boost energy or to try to help sleep. So just to summarize again, we do need to think about how to support brain chemistry in a person whose mood is really struggling, at least for a while. At least for a few months, a few months of feeling good.

At that point, talk to your doctor about whether it's time and it feels appropriate to start reducing the medication. Maybe you could transition to one of the mood supporting supplements or at the very least get on some of those basic foundational supplements which can also be so good for mood or energy or sleep and help as you're transitioning off medications and then also could be really useful for you to try to prevent the depression from coming back in the future.

Thanks for joining us!: Thank you for listening to the Joy Lab podcast. If you enjoy today's show, visit JoyLab.coach to learn more about the full Joy Lab program. Be sure to rate and review us wherever you listen to your favorite podcasts.

Please see our terms for more information.

90. Depression and Anxiety Medications: A Balanced Approach (Depression and Anxiety Coping Skills Podcourse)

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