Myth #5: Depression & Anxiety Medications are for Wimps
Welcome to week 5 of medical myth-busting! (So far, I’ve covered psychotherapy, the new COVID booster, hormone replacement therapy, and aging).
Onward!
Today is about prescription drugs for conditions like depression and anxiety — and some common mistaken beliefs people have about them.
Let’s nip this in the bud right now: Medications like Prozac, Lexapro, and Zoloft are a tool in the tool box to treat mood and anxiety disorders. They are not a panacea. But when prescribed appropriately, medication can dramatically improve patients’ quality of life — and, in certain cases, can be life-saving.
Why does this matter?
We are in the middle of a mental health crisis. I witness the struggle in my office every day. More and more patients are grappling with grief, anxiety, and/or low moods. During COVID, relationships have been strained and routines tossed out the window. Many of us have exhausted our coping skills from two-plus years in a hyper-vigilant state — not to mention the myriad challenges we faced before COVID.
The only thing that’s “normal” about our post-pandemic reality is that no one seems to feel normal at all.
Recall that anxiety is part of the human condition. Our built-in “fight-or-flight” system keeps us alive. The stress hormones called adrenaline and cortisol course through our veins when we’re faced with a threat — keeping us alert and ready to run from danger.
Similarly, we all experience variations in moods. It’s normal to feel blue after a break-up, down in the dumps during a pandemic, or distraught about ongoing political unrest. Sometimes, though, symptoms of anxiety or depression can happen for no apparent rhyme or reason. They settle in like an unwelcome house guest, draining our reserves of energy and lingering far too long despite efforts to shoo them away.
Anxiety and depression symptoms can interfere with our quality of life. They can affect our medical outcomes. Even if driven by situational or environmental stressors, they can make us sick. When excessive worry and/or low moods take on a life of their own; stick around for a long time with no end in sight; and cause cognitive, emotional, physical and/or behavioral problems, it’s time to ask for support.
The DSM V or The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the taxonomic and diagnostic “bible” published by the American Psychiatric Association. In the U.S, the DSM serves as the principal authority for psychiatric diagnoses.
As a clinician, I’m less interested in whether or not a patient’s symptoms exactly meet the DSM V criteria to make a formal diagnosis of Generalized Anxiety Disorder, for example. I’m more interested in the patient having awareness of their own brain chemistry, insight into how their thoughts, feelings, and behaviors interrelate, and tools to manage their emotional health — regardless of where they are on the diagnostic charts.
Just last week, The U.S. Preventive Services Task Force, a panel of medical experts, recommended that doctors screen for anxiety among all patients under the age of 65. The “under 65” part is bizarre to me (of course people over 65 experience anxiety!), but these recommendations were a healthy nod to the sliding scale of anxiety experiences — and the relevance of mental health to our physical health and medical outcomes.
Indeed, we all experience moods, anxiety, loss, trauma, and situational stress. We all have relationships to food, alcohol, and each other. We all have a unique sense of self. My question to patients isn’t “Do you have anxiety?” It’s “How much brain space is occupied by worry? And how might it be interfering with your health?”
At the end of the day, the DSM’s diagnostic codes matter less to me than the action plan to help patients feel better and restore their sense of agency.
I’ll give you an example. One of my generally healthy octogenarian patients recently said to me “Of course I’m anxious! Older people are still dying from COVID!” She’s absolutely right, and of course some degree of anxiety is “normal.” But what she hadn’t yet put together was that her insomnia and blood pressure had flared under a smoldering fire of ruminations about death. Anxiety was infiltrating her life. Once we named the anxiety and connected it to her physical health, she felt more in control — and more motivated to tackle it.
So how do we treat symptoms of anxiety and depression?
Treatment depends entirely on the patient — the nature, severity and duration of their symptoms; the effect on their everyday health; their existing coping tools; their behaviors and habits; their support structure; and environmental factors.
For example, sometimes we treat depression by removing chemical or environmental triggers. For some patients, depression symptoms will lift with alcohol cessation alone. Since alcohol itself is a depressant, removing it (not that this is easy) can help with energy and sense of purpose. For another patient, leaving a toxic relationship can improve mood and hope for the future. For many patients, therapy alone can be helpful. (I wrote about why therapy can help just about anyone here.)
Similarly, exercise, journaling, and reducing social media inputs is enough to quell anxiety in some patients. For my restrictive eaters, simply getting three solid meals a day can restore a sense of calm. But for others, a combination of exercise and psychotherapy put patients back in control of their thoughts — instead of the other way around.
What about pharmacotherapy?
Medication can be game-changing for patients whose anxiety or depression symptoms aren’t amenable to behavioral, chemical, and/or environmental changes and for patients whose symptoms put them in immediate danger. Even though it’s been established that depression and anxiety aren’t due to low serotonin levels in the brain doesn’t mean that SSRI medications that increase serotonin aren’t part of the solution. (Ask me more about this in my weekly Q & A on Instagram tomorrow!)
Of course medication isn’t a cure-all. There’s no pill for insight, no elixir for behavioral modification, no quick fix for facing uncomfortable parts of lives. But when part of a holistic plan to manage a patient’s mental health, medication can make all the difference.
For example, I recently put a healthy, 40-something-year-old new mom on a small dose of Zoloft for postpartum depression — something she had resisted for months, favoring yoga, walks outside, and a mindfulness app on her phone to bolster her low moods. She told me that after two weeks on the medication, she felt like the “lights were on” again. She stopped feeling tearful all day. She started sleeping again. She was able to bond with her newborn and feel hopeful about the future.
“Am I crazy?” she asked me. “Nope.” I said. “You’re human.”
The need for pharmacotherapy doesn’t mean you’re broken. It means you need added support to be back in the driver’s seat of your health.
In fact, I commonly see patients who are valiantly trying to manage their moods or anxiety with lifestyle changes or therapy alone (that is, without medication). They’re tracking their daily steps, cutting back on booze, and growing their self-awareness in therapy. But they’re still anxious or blue. They’re exhausted at work and irritable at home. They cannot seem to talk or walk their way out of how they feel.
These are the patients in whom medication can really help — not as a crutch or a substitute for healthy habits, but as another tool in the toolkit. Just like I treat a patient’s high blood pressure by starting with diet and exercise, I add medication when lifestyle changes alone isn’t enough. This doesn’t indicate failure; it means meeting the patient’s biological, genetic, and behavioral reality where it is.
There’s no diagnostic code for the human condition. There’s no label for how any of us thinks, feels or behaves. Similarly, there’s no one-size-fits-all treatment for common mental health conditions that the vast majority of people will experience at some point in their lifetime.
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Speaking of naming our emotions, 13-time World Champion Boxer Tori Nelson joins me this week on the pod!
Raised by a single mom and her older brothers, Tori spent her childhood stuffing down her emotions and desperately searching for ways to release her pent-up anger. It sometimes landed her in trouble. That was until she found boxing. The sport not only catapulted her into tip-top physical shape; it provided an outlet for her anger.
In this episode, Tori discusses her rough-and-tumble childhood; her dust-ups with the law; and the triumphant moments of her life that propelled her, this year, into the Boxing Hall of Fame.
As always, my newsletter subscribers get early access to the pod every Monday night before the official Tuesday launch. Give it a listen now on Apple, Spotify, or wherever you find podcasts. And pretty please, could you also rate the show and leave a review? Thank you!!
I will see you next week. Until then, be well.