Beyond medication

I ran out of meds! What am I going to do?

The inevitable despair caused by the empty medicine box, as if the only way to fight a mental illness was a pill. As useful as it may be, pharmacological treatment represents only one of several types of treatments available. A large-scale study¹ in the United Kingdom (2018) has shown that antidepressants used to treat Panic Disorder and Generalized Anxiety Disorder offer moderate efficacy depending on the severity of the illness. The issue of effectiveness is addressed in better details in the 'Clinical Analysis' section below.

Even with moderate benefits, medication is recommended during the most acute phase of the illness. It should nevertheless be accompanied by therapy and changes in habits. Unfortunately, health professionals rarely take the time to inform the patient in a satisfactory manner about all the treatments and prophylaxis methods available to them. Criticism towards the so called 'alternative' medicine, which comes mainly from the pharmaceutical industry, claims a lack of scientific evidence, which is highly paradoxical, since the so called 'first-line' treatment with antidepressants has mostly brought inconclusive supporting scientific evidence against placebo. It should be understood that in mental health, there is no 'first-line' or 'alternative', but several different treatments with a varying degree of effectiveness from one individual to another. Pharmacological treatment is not considered 'first-line' for its efficacy, but for its ease of access and profitability.

Here are some suggestions for treatment, by category and alphabetical order:

Psychotherapy

Cognitive behavioral therapy (CBT)
Hypnotherapy
Humanistic therapy
Psychoanalysis

Holistic Therapy
Acupuncture
Herbal Medicine/Phytotherapy
Homeopathy
Reiki
Spiritist 'Passe'

Food and supplements
Cannabidiol (CBD)
Vitamins & Herb supplements

Activities
Charity (volunteer work, social work, support groups, etc)
Meditation / Relaxation
Physical exercise (walking, gym, sport..)
Spirituality (reading, prayer, worship..)
Yoga

Healthy activities often alleviate psychological illnesses. Physical exercise is sometimes avoided or ignored by the patient, yet it favors physiological and psychological equilibrium. The practice of charity in its broad sense, in addition to contributing to the welfare of others, ennobles those who practice it, bringing a sense of achievement and serenity in their lives. It is now empirically proven² that faith, regardless of creed, is a powerful ally against mental disorders, while meditation facilitates thought control, confidence, and self-knowledge.


Clinical Analysis - The Placebo Effect

Clinical trials are meant to evaluate the effectiveness of a given medicine or treatment. Patients participating in the study are informed that they will test a new drug for a period of time and report their experience. An 'active' group of patients receives the actual medicine, while a 'placebo' group receives a medicine without any medicinal property, namely a flour pill. After the deadline, the evaluations of both groups are compiled and compared, thus demonstrating how the medicine performs compared to placebo, and thus determine is efficacy.

The cited study¹ which analyzed 10 clinical trials with a total of 2.151 participants with Panic Disorder concluded that:

For Generalized Anxiety Disorder and Panic Disorder, benefits (of antidepressants) are small at low severity, and the benefit–risk ratio may be unfavorable for these patients.

In other words, for patients with mild and moderate Panic Disorder (1 to 5 attacks per week), antidepressants have an efficacy (0.2-0.5) that is similar to a flour pill. For such patients, the disadvantages of antidepressant such as side effects and health impairment may outweigh its benefits. For severe cases however, the effectiveness of the drug is more significant (3.0+). If in doubt, this issue should be openly discussed with a healthcare professional.

In conclusion, pharmacological treatment should not be considered as the sole, primary or only treatment, but as a part of a broader treatment that encompasses the psychological, behavioral and spiritual aspects of the individual.

Simon Baush

References
¹https://onlinelibrary.wiley.com/doi/full/10.1002/da.22737
²https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671693/