Transcription
Hi, I'm Dr. Joseph Woodbury, and today I want to talk to you about the dangers of a drug-only approach to treating depression and anxiety. So, um, I see a lot of patients, and they'll come and they'll say, "Well, you know, I filled out a questionnaire at the doctor's office, and, you know, it said I had depression and anxiety, and he asked me if I wanted to take a medication, and then I took it, and then, you know, 10 years later, you know, here I am." And it's a, it's a pretty common story.
And it makes sense. You know, a lot of the, uh, antidepressant prescriptions in this, in this country are given out in, you know, maybe Family Medicine offices where, you know, the visits are short, and people may be coming in for 15 minutes. Half of that time, they're talking to the doctor about cardiovascular disease and prevention for that. And then so there's not a lot of time to kind of talk about, you know, why someone is depressed and kind of the things going on behind that. And that's just the reality of the healthcare system here. And it's not just Family Medicine; it can happen with, um, you know, psychiatrists and psychiatric nurse practitioners, but typically it's in, in places where the visits are really short. And, um, and, uh, and yeah, people get started on things and they don't really get revisited.
So, so why is it a problem that, you know, if, if you kind of meet criteria for depression and anxiety, if you only take a medication? Well, the problem is that the medications, they're not benign, and there's a, and there can be a lot of side effects that can be really tricky for people later on. There's common things such as weight gain, which can be an issue. But there's other things such as like manic-type reactions, which can happen over time. If you're on a medication for a long time, you may switch into a mania. That, that's a rare side effect, but it's a serious one, and that can lead you down a path where you could get misdiagnosed with a bipolar disorder if, you know, if, if the provider you see misses it.
The other thing is that, you know, having a drug on board for a long time can put you at risk of some pretty serious things. So when it comes to the antidepressants, I think about post-SSRI sexual dysfunction, things like post-acute withdrawal syndrome, where people try and come off the medication and they develop all of these neurological problems and, you know, significant anxiety. And then the other one is, uh, oh, so rare, but it's a tardive dyskinesia as well. These are rare things that don't happen to end to everyone, but if you're taking these drugs for long periods of time, um, then it's, then you're more likely to develop these side effects.
And so really, when you take these medications, you know, the, the idea behind it should be lowest possible dose for the shortest period of time. And once you look at it like that, you need to start thinking about, well, you know, why am I depressed? You know, so, okay, I'm taking this medication now to get me through, but what were the things that led me to get here?
So when I think about the possible upstream causes of depression, a few things come to mind. You know, it's like not looking after yourself, of course. You know, might have really poor sleep, you may not be able to exercise, you might not be able to, you know, eat food which can nourish your mental health. I think about relationship problems. You know, you may have significant relational structures, you may be having problems with the toxic at a toxic work environment. I also think about maybe lack of support. You know, a lot of single parents out there, they go and they work, you know, 40 hours a week, and they come home, and then they're looking after their children, and there's absolutely no time for them to look after themselves. And that can really lead to burnout.
There's other things such as trauma. And, um, and I guess, you know, the type of personality patterns that people develop when they've been victims of trauma. They may end up going into abusive relationships, and they kind of relive these patterns of abuse, and that can also wear on someone over a long period of time.
So I'm going to stop there. And, you know, as I'm mentioning those things, a lot of those things are problems that someone might be able to address. You know, maybe with family or with loved ones helping helping them out if they were just to tell them about it. Some of the other ones, the things that could be helped with professional counseling, with professionals that know how to help people work through relational problems and maybe identify personality traits that are leading to a stress in their lives.
So other things that you need to look at as possible upstream causes of depression can be medical problems. You know, these can be things like a thyroid deficiency. It may be problems like low iron leading to some anemia that leads to lethargy and, um, you know, B12 deficiency. So you want to make sure that you're not missing any medical causes that can mimic, um, you know, depression.
Other things that you want to make sure is being looked at is other medications that have, um, side effects that can mimic depression. So I think about oral contraceptive pills, there's a common one in young women. I also think about, you know, acne treatments like Accutane. There's also problems, um, you know, with the statins in older patients. Sometimes they, it causes some, some cognitive problems as well, which may be experienced as depression. If you have allergies like allergic rhinitis or asthma, you may be taking something like Singulair, and that's a medication that has a whole range of psychiatric side effects. You know, it's uncommon, but it can happen to people. So you want to make sure you have a really, someone has a comprehensive look at your medications. So if there's anything in there that could be harming you, that it's, um, that it's stopped.
So, and so, you know, the list that I just kind of went through there is what I think is the minimum that, that someone, that that you would want from your provider who is treating you with these medications. You want to make sure that they're looking at all of those things because if you are having one of those problems, you could, uh, really increase your chance of not needing that medication if you're able to, to, to fix one of these underlying causes.
If you looked at all of those things and, you know, none of those things are affecting you, that's okay as well. You know, we do know that depression and anxiety can have a, um, genetic component as well. You just, just may be like that. So, but still, in those cases, you know, sometimes counseling and support from family make it to a stage where you might not need a medication, or if you do need a medication, you could have it at a lower dose where you could minimize the risk of side effects and problems long-term.
So if you are seeing a doctor and they're not really helping you with a more comprehensive evaluation for your depression and anxiety, I'd recommend finding another one. I'd recommend finding a good psychiatrist or nurse practitioner or any other allied mental health professional who could really do a thorough assessment and help you with that. If you're struggling to find one as well, you could, and you want someone that kind of looks at mental health in this way, come along and have a look at our website. It's in the description below, and if we work in one of the states where you're living, it might be something we'd be able to help you with.
So I hope this video was helpful and, um, and I'd be interested in any, any thoughts you had on it. So thank you for your time and your attention.