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You would come up with a coherent program that includes medications and therapy treatment. The five components of a total care program are: medications, possibly herbal remedies, diet, exercise, and psychotherapy. I also want you to know that at the end of the posting I'll paste in for you a technique you can use to help when you are in that dark hole of depression and anxiety. When you are feeling depressed and in a dark hole, this is something you can use to help with some relief and you can use it over and over.
Herbal remedies: St. John's Wort is the only herbal remedy that has any clinical evidence supporting its effectiveness for depression. Other "products" claim to, but in the psychological literature, this is the only remedy accepted as having significant evidence. IMPORTANT: do not take St. John's Wort with any antidepressants. You're on antidepressants which rules out St. John's Wort. So if you want to try this option, discuss it with your doctor as an alternative ONLY, not as an addition, to the Wellbutrin and/or Cymbalta. But this is important. Any other herbal remedies are going to be a matter of whether you want to try it for the cost. Remember: no "natural" remedy is going to have the quick and powerful effect you will see from the medications--but not the side effects or withdrawal effects either.
For anxiety, I'm going to make two herbal recommendations. This is because I know there is SOME research evidence for these two herbs. However, it is not that conclusive or even impressive. But it is some and they have the following going for them: in the cultures they come from, they are traditionally used for anxiety. That's encouraging. The first is Black Cohosh, the root of which was used by Indians in our country. The second is Kava, sometimes called Kava Kava, which is from the Pacific Islands. Again, these herbal recommendations are secondary to the medication treatment unless medications show they are not working.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 2-3,000 mg daily. Omega 3 is the main supplement. The research on it and depression is conclusive. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality. Omegas are the best "natural" thing to add to your diet.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Your doctor will verify the research results showing the benefit.
Psychotherapy: this requires to have you reorient your thinking about depression and meds and remedies. Medications and remedies only treat the symptoms of depression and that it is important to treat your depression as a HUMAN symptom.
As I said above this would need you to reorient your view of what's happening to you so that your emotions, which ARE after all, what is being talked about here with depression are treated with human respect and value and given a chance to help you grow and gain as a human being. This would mean changing your focus from the medications being your main "work" on your depression to exploring your emotional reactions of being in such a depressed dark place as being your MAIN work and the meds and remedies as being the boost to help not be so anxious and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? We have emotions because they are part of how we grow and learn and become more fulfilled.
Here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list psychodynamic therapy in their orientations and depression and anxiety disorders as one of the areas they work with. http://therapists.psychologytoday.com/rms/ The idea here isn't that these types of therapy are magic. It's that you want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions. So interview the person first to make sure you feel confident and comfortable.
I wish you the very best!
Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help. So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
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