Holistic Solutions for Anxiety & Depression in Therapy: Combining Natural Remedies with Conventional Care

290 Pages·2015·2.04 MB·English

by  Peter Bongiorno

HOLISTIC SOLUTIONS FOR ANXIETY
& DEPRESSION
IN THERAPY
Combining Natural Remedies with Conventional Care
PETER B. BONGIORNO
W. W. NORTON & COMPANY
New York • London
A Norton Professional Book
This book is dedicated firstly to the patients who teach me something valuable everyday.
Their courage is my inspiration. I want to also dedicate this book to the mental health
practitioners that I have the honor to work with in order to create a true team care
approach. Together, we have learned that working in an integrative fashion truly creates
the best results. Finally, this book is co-​dedicated to the tireless laboratory and clinical
researchers running trials and pouring over statistics to learn how lifestyle and natural
medicines work. Without that hard and often unrewarded work, the information for this
book would not be available.
Contents
Acknowledgments
Introduction: Why Holistic Care for Anxiety and Depression?
ONE
ARE HOLISTIC APPROACHES RIGHT FOR YOUR CLIENT?
TWO
ASSESSING CONTRIBUTING LIFESTYLE FACTORS
THREE
ASSESSING CONTRIBUTING INTERNAL FACTORS
FOUR
EFFECTIVE SUPPLEMENTS FOR ANXIETY AND DEPRESSION
FIVE
MIND-BODY MEDICINE
SIX
WORKING INTEGRATIVELY WITH MEDICATIONS
SEVEN
MAKING RECOMMENDATIONS AND DESIGNING TREATMENT PLANS
APPENDIX ONE
Top Seven CAM Recommendations You Can Offer Your Clients
APPENDIX TWO
Blood Test Recommendations
APPENDIX THREE
CAM Referrals and Resources
APPENDIX FOUR
Supplements for Anxiety and Depression
APPENDIX FIVE
Homeopathics Commonly Used for Depression and Anxiety
APPENDIX SIX
Example Diet and Lifestyle Diary
References
Index
Introduction
Why Holistic Care for Anxiety and Depression?
Insanity: doing the same thing over and over again and expecting
different results.
About a year before writing this book, I worked with a 42-year-old father of two;
let’s call him Jason. Jason came in for his sixth monthly follow-up visit. He had
been dealing with depression for most of his adult life. An avid athlete in his youth,
by the time he was twenty-four he began to experience low mood and low-grade
depression. This was around the time he started having severe difficulties in his
family life, specifically discussing difficulties with his drug-addicted brother and
aging alcoholic parents. He suddenly began to have a very hard time playing
soccer, a game he loved. For almost two decades he avoided athletic events and
fought the “dark cloud,” as he put it, that kept him from enjoying sports, going out
dancing, or even just being social with friends. While functional at his job as an
engineer, he was labeled “dysthymic” by his psychiatrists and bounced from
medication to medication, with equivocal results. At the time we began to work
together, he was also working with a psychotherapist, as well as a
psychopharmacologist, and believed he would always be somewhat depressed, for
that was his “nature.”
Jason’s most recent therapist decided to refer him to me for a more holistic
view and to see if there were any physical reasons that might be contributing
Jason’s mood challenges. After taking his full history and completing a round of
blood tests, we learned that Jason’s vitamin D and ferritin (iron storage) levels
were abysmally low. We also found out through the blood tests that he had a low-
grade reaction to gluten (a protein from wheat) that was likely contributing to the
slightly high inflammation in his body. I referred him to a hematologist and
gastrointestinal doctor to check on the low iron. Once it was clear that no
gastrointestinal or hematologic problems were the cause of low iron, I encouraged
him to eat more iron-containing foods and gave him low doses of an easy-to-
absorb iron supplement with herbs that help absorption. I also recommended
vitamin D3 and had him avoid all gluten and wheat products. We also adjusted his
sleep schedule and added more vegetables and anti-inflammatory foods (e.g., fish
and olive oil) to his diet. After working with these recommendations for about 4
months, his mood gradually lifted. He even went back to working out, and now he
is excitedly considering getting back on a local men’s soccer team this coming
summer. I suspect he will be able to wean off his current medications within the
next few months.
Jason had difficulty absorbing iron. His vitamin D was low because he avoided
the sun after his medical doctor told him sunlight would cause skin cancer, even
though he had no known increased risk for skin cancer. Because he did not have
digestive issues, laboratory tests for gluten sensitivity were never performed. After
we added a gentle but absorbable iron, his red blood cells’ ability to carry oxygen
improved, which helped both Jason’s mood and energy. Giving him vitamin D
likely balanced inflammation in his body and supported his mood. Having Jason
eliminate gluten foods and adding anti-inflammatory foods also lowered
inflammation in the body. Inflammation in the body translates to more brain
inflammation—a contributor to poor mood in susceptible individuals.
At our last visit, Jason asked me a very reasonable question: “fter almost 20
years of going from doctor to doctor, why didn’t anyone think to check and do these
things?” My answer was simple: “Because conventional care rarely looks at the
body as a whole.” Often, when we look at the body holistically, we can elicit much
more information to help support the body’s healing ability.
Jason’s story is an example of a type of patient I typically work with: someone with a
long-term mood disorder who has tried many forms of medication and has had limited
success. I am lucky, for in my New York practice I work alongside like-minded therapists,
social workers, psychologists, and psychiatrists who look to me to assess, from a more
holistic perspective, the physical reasons for a person’s mood issues. In a team care spirit,
I rely on them for their expertise to monitor patients’ safety, work on improving their
psychological well-being, and consider pharmaceutical options when absolutely necessary.
Together, we create a full complementary and alternative medicine (CAM) perspective
that allows patients full opportunity to heal and provides a small community in which
patients feel safe to share concerns, change patterns, and heal.
Most therapists I have the honor to work with in this team care approach tell me that
most of their clientele are either interested in or are already using some type of natural
remedy or holistic modality. However, I have also heard that, whether it be the latest diet
craze, acupuncture, fish oil, vitamin D, St. John’s wort, or some new “miracle mood cure,”
often the therapist does not feel familiar enough with these remedies to give an opinion,
and some have confided in me their concern for drug-nutrient-herb interactions. Even
more overarching is the safety concern that their clients may inappropriately use these
remedies in lieu of more potent and necessary conventional care. This book will help
orient you regarding these concerns and give you a holistic framework to help see where
safe and effective use of CAM can fit with your clients’ concerns.
As a clinician, you probably have noticed that anxiety and depression rank as the top
reasons that people are sick and go to the doctor. Anxiety disorders are the most common
of the psychiatric illnesses in the United States, with approximately 30% of the population
experiencing anxiety-related symptoms in their lifetime (Kessler et al., 2005). Eighteen
percent of the U.S. population have been diagnosed with anxiety disorder.
According to the U.S. Centers for Disease Control and Prevention (2010), 9.1% of the
population meet the criteria for current depression, including 4.1% who meet the criteria
for major depression. A report from the World Health Organization tells us that depression
has become the second most burdensome disease in the world—it causes more lost time
and money than any other condition except heart disease (Ferrari et al., 2013).
Anxiety and depression are generally inextricable disorders—each often occurring
with the other. About 58% of patients with lifetime major depressive disorder have anxiety
disorder, while 48% of patients with generalized anxiety disorder also experience
comorbid depression (Lieberman, 2009). Patients who suffer from both seem to have more
severe, chronic types of anxiety. These patients also have more social and work
challenges, as well as greater rates of alcoholism and substance abuse. Most unfortunate,
patients with both are less likely to benefit from conventional care (Lydiard 2004). While
the Diagnostic and Statistical Manual of Mental Disorders, version 5 (American
Psychiatric Association, 2013) does not acknowledge “nxious depression” as a distinct
diagnosis, it is a very common presentation of mood disorder. In holistic circles, many
practitioners consider anxiety and depression a continuum, where certain stressors, as well
as sleep, environmental, and lifestyle factors, will help decide whether a particular degree
of anxiety, depression, or both may manifest.
Despite decades of drug dominance, many patients are now realizing that they prefer
something else—possibly to avoid toxicity of these drugs, or maybe because they realize
their medication is not fixing the problem. In 2007, over 38% of adults sought out some
kind of natural or CAM support in the United States (Barnes, Bloom, & Nahin, 2008), a
significant increase from the previous decade. In many cases, this CAM support may
involve an anxious person going to the health food store to find a mineral, such as
magnesium, to help with sleep. Or possibly a person with depression might try a
supplement like tryptophan to lift mood. Other people may start regular acupuncture
treatments or yoga therapy. Or they may visit a naturopathic doctor like myself, who may
individualize lifestyle changes, recommend specific supplementation, and organize a
holistic plan.
You have probably noticed this interest in CAM with your own clients—more and
more are asking about this vitamin or that diet. Thus, a basic working knowledge of
available CAM modalities and their efficacy is becoming an essential part of health care
education. A general natural medicine knowledge base is becoming essential for any
health care practitioner who wants to communicate and participate effectively in a health
care strategy with his or her client.
DEFINING ALTERNATIVE AND CAM MEDICINE
Before exploring how to assess your clients for various lifestyle and internal factors that
may be contributing to their anxiety and depression, and the holistic approaches you can
recommend, let’s first get clear on some basic terms.
Alternative Medicine
The term alternative medicine refers to various medical and health care systems,
modalities, and recommendations that are not presently considered to be part of the typical
conventional medical model. These remedies are called “lternative” because they are used
in place of conventional medical care. When defining alternative care, the key here is
understanding that, by definition, “lternative medicine” replaces mainstream medical
protocol.
Complementary and Alternative Medicine
Instead, I prefer to employ the term complementary and alternative medicine (CAM).
CAM is a system that employs alternative modalities alongside conventional care. It does
not necessarily replace conventional care but, rather, keeps all methods of care in mind
when creating a plan of action for a particular patient (National Center for Complementary
and Alternative Medicine, 2013a). In my experience, neither conventional nor alternative
methods are superior. I prefer CAM because it is not mutually exclusive and allows the
opportunity to use whichever treatment might be best for a patient at a given time. Using
both conventional and alternative medicines together is termed integrative medicine.
CAM practitioners may be physicians of conventional medicine (e.g., medical doctors
and osteopathic physicians) or physicians of naturopathic medicine like myself. Also
considered part of the CAM world are nutritionists, herbalists, Chinese medicine and
acupuncture practitioners, chiropractors, energetic healers, and so forth. Therapists who
work with standard psychotherapy along other modalities such as yoga would also be
under the CAM umbrella.
CAM therapies may incorporate nutrient therapies, botanical medicines, Native
American healing, dietary changes, Ayurvedic medicine (ancient medicine from India),
energy healing, hypnosis, acupuncture, spinal manipulation, animal-assisted therapy,
physical medicines, and many other types of therapies.
Holistic Medicine
CAM and integrative medicine are, at their best, a type of holistic care. Holistic medicine
is a system of medicine that fully appreciates the multiple factors that affect a person’s
health. It considers each person to be a unified whole. This contrasts the biomedical
approach of fragmenting the body into parts and specialties such as a nervous system,
digestive system, hormonal system, and so forth. For example, when you have a stomach
problem, you see a gastroenterologist. If you have skin issues, you see a dermatologist. In
contrast, a holistic practitioner may recommend focusing on supporting the digestive tract
to help the skin issues.
Biomedicine too often does not consider how tweaking one body system may affect
the whole person. Let’s take the common example of reflux, a condition affecting 60
million Americans every month. Common conventional treatment includes a proton pump
inhibitor drug such as Nexium, which may help decrease symptoms and avoid discomfort.
However, in the long term, such treatments can cause poor nutrient absorption, which
leads to body deficiencies and risk of osteoporotic fracture (Fraser et al., 2013). A CAM
and integrative approach may consider a drug like this in the short term only if really
needed for symptom reduction or to heal a dangerous ulcer. In the meantime, a CAM
approach will work on the underlying factors, such as balancing a patient’s stress
response, changing diet, modifying meal timing, improving sleeping habits, and using
herbs and nutrients to heal the digestive tract lining—treatments I find work extremely
well in practically all cases.
As the word reflux does not tell us why a person is having digestive discomfort; so too,
the words anxiety and depression do not really tell us much about the underlying causes of
a person’s mood issues. When we hear of people with anxiety and/or depression, we know
they are involved in an experience where they do not feel like at their best and are likely
challenged to function optimally in their life. But we don’t know why. Holistic medicine
seeks the reason why and to help adjust various factors, such as sleep, movement,
digestion, psychology, and spirit, as well as nutrient and supplement intake, to help the
body balance itself.
Your Quick Guide to CAM
In the following chapters, I detail the holistic approach to anxiety and depression. Along
the way, I attempt to provide clinical stories along with the most up-to-date research and
recommendations for practice. This book is designed for the busy mental health
professional looking for a go-to primer about natural health care for anxiety and
depression. As a busy clinician, you probably do not have the time to cull and synthesize
the reams of research available on natural medicines efficacy and safety for depression
and anxiety.
This book will do the work for you, streamlining the information into an easily
accessible read. The appendices include summarizing charts and easy steps that you, as the
mental health professional, can quickly refer to again and again for help in guiding
patients through the new holistic medicine world. Instead of offering the whole kitchen
sink when it comes to CAM recommendations, this book uses my decade of clinical
experience and almost 20 years of research to help distill the most salient underlying
factors and treatment options.
As the interest in CAM and natural medicine grows, a therapist who can speak
knowledgeably about integrative care will be of more value to the anxious or depressed
client. Whether you are looking to integrate yourself or your practice or are simply
searching for the most current evidence-based recommendations on the principles and
practice of natural and integrative medicine care for anxiety and depression, this book
provides the foundation necessary to navigate this exciting approach to treatment. This
book also provides the best available resources to further explore holistic care. For up-to-
date research on natural medicines, please visit my website at www.drpeterbongiorno.com
and join me on Facebook and Twitter (@drbongiorno). Also, please feel free to subscribe
to my clinic newsletter at www.InnerSourceHealth.com.
SAFETY FIRST
Groucho Marx once said, “Be open minded—but not so open-minded that your brains fall
out.” Please remember that while we focus on natural medicine and holistic remedies,
patient safety is always paramount. The “complementary” aspect of this approach reminds
us that sometimes drugs can also be a friend to the patient, and using natural therapies
instead of needed urgent care can cause harm. Any good clinician considers risk and
benefits with any treatment option and should choose safety first.
In cases where patients are severely impaired (e.g., patients with severe depression,
suicidal ideation, or completely debilitating anxiety), first-line therapy may need to
include medication and sometimes hospitalization for monitoring. In these cases, I
recommend using pharmaceutical support to help a patient stabilize.
Once the patient is stable, then consideration of holistic options to work on the
underlying factors can begin. While I typically prefer to have patients use natural care, if a
patient can’t even muster the umph to get out of bed, it is doubtful he or she will, say, go
to the local health food store to buy salmon and kale and cook it up. Nor is it likely the
patient will start exercising. Holistic options can be considered adjunctive in severe cases,
but not necessarily as a first-line therapy in place of possibly quicker-acting drugs for
urgent care needs. We must be realistic and keep patient safety in mind at all times.
THE HEALING POWER OF NATURE
I am thrilled that you are reading this book. Together, I believe we are advancing the
future vision of mental health care. My sincere hope is that this work will impart insight
and greater recognition into what naturopathic doctors refer to as the vis medicatrix
naturae (Latin for “healing power of nature”), as well as bring awareness that the body
truly has the innate wisdom to heal. It is my sincerest hope that this guide brings great
value to you personally and to your practice. Even more, I hope it inspires your clients’
natural healing processes to move forward.