By: Jadon Webb, MD, PhD
Getting the safe, effective help for depression and generalized anxiety can sometimes seem difficult. Psychotherapy and prescribed medications can be very helpful, and are often the first-line treatments for these conditions. But even these treatments do not always work as well as we would hope, and medications can also have unwanted side effects. We totally understand why so many people are hesitant about starting psychiatric treatments.
Nature itself provides us many proven ways to help with depression and anxiety. Natural things such as bright light, exercise, and socialization are critically important treatments of depression and anxiety.
Lemon Balm (formally known as Melissa officinalis) is an herb that comes from the mint plant family. Some studies suggest it can potentially lower cholesterol and blood pressure. It may also provide help for depression and anxiety.
Certain natural supplements also have scientific evidence for possibly being another one of the natural things to help with depression and anxiety. A scientific review from 2021 suggests that lemon balm appears to help with depression and anxiety, and that it seems to have few side effects.
Many people with mental health concerns also often complain of “brain fog” and impaired cognition. There are also studies to suggest lemon balm may help with cognition, and it has even been considered as a possible adjunctive treatment for dementia.
We caution that supplements (including lemon balm) do not have as much scientific evidence as an FDA regulated medication, and it is hard to be certain of the purity of any formulation. But that said, when considering how to fight depression and anxiety, it is important to consider all possible options, including those that nature provides!
Getting help for depression and generalized anxiety can be tough. Talk therapy and medications can be very helpful, but do not always work as well as we would like. It is especially hard to completely treat severe depression. Treatments can also have unwanted side effects, so it is perfectly understandable why some patients are skeptical about what can be done.
Nature provides us many effective ways to address mental health concerns. Sleep, bright light, and exercise can be extremely effective treatments of depression and anxiety.
Temperature may also be an unexpected ally. A study from 2020 found that briefly freezing people down to -100C (that’s really cold!) 10 times over about two weeks greatly reduced their depression symptoms. These were patients already taking an antidepressant, but not improving sufficiently on it.
Depression symptoms clearly improved, and so did overall quality of life, which is especially impressive. Quality of life is an especially difficult thing to improve with psychiatric treatments.
The idea of nearly freezing one’s self goes way back in our history. Many people in cold climates swear by the health benefits of swimming in extremely cold water for short periods of time. Maybe these “winter bathing clubs” like the Polar Bear Club are onto something more than just giving thrill seekers something to do. Maybe there really are mental health benefits that we never bothered to formally study until now?
We still do not know the mechanism of why freezing would help with depression, and it is certainly possible that this method relies heavily on placebo effect since it is such a dramatic-looking treatment to undergo (dramatic looking treatments often have larger placebo responses). However, this latest study apparently administered a similar looking freeze protocol to the placebo clients, but just did not freeze them with as cold of temperatures as in the experimental condition. Since both groups underwent the dramatic looking procedure, perhaps there really is something specific to the very cold temperatures.
We are by no means advocating you run out and jump into a cold lake, but we felt it was important to share this potentially effective idea of using cold temperature as one of the things to help with depression!
By: Shannon Keane, NP-C
Botulinum toxin type A (BTX-A), also known as onabotulinumtoxinA or Botox®, is commonly known for its aesthetic use in treating glabellar frown lines. Recent evidence suggests that Botox® injections may have beneficial psychological effects. A dermatologist published the first set of case series in 2006, reporting the potential role of Botox® in the treatment of depression.
The research results revealed that Botox® injections were correlated with a significant improvement in depressive symptoms when compared with placebo.
The potential mechanisms behind this correlation has not yet been proven, but many have proposed possible ideas of why Botox® may help ease depressive symptoms. The most common theory is the facial feedback hypothesis. This hypothesis, originated by Darwin in 1872, stated that one’s facial expression may directly affect their emotional state of mind.
There are 42 individual facial muscles in a human being. Current evidence suggests that the corrugator muscle is activated in the forehead when one tends to be experiencing negative emotions. The corrugator muscle is located beneath the eye brows. One study found that depressed people tend to have overactive facial muscles when compared to the facial muscle movement of non-depressed people. Botox® injections into the corrugator muscle limits movement in that muscle, therefore minimizing the ability to frown or make a negative facial expression. This action may block typical sensory feedback from the nerves, particularly to the left amygdala to the brain.
Research has demonstrated that over-activation of the amygdala is associated with negative emotions. Negative emotions may include: anger, depression, anxiety and fear. Botox® seems to actually reduce the activation of the amygdala by blocking the release of the neurotransmitter, acetylcholine. This results in a positive effect on mood.
Another published study proposes that Botox® may produce antidepressant effects due to systemic distribution after injection. It’s important to note that the content of circulating Botox® is actually very low post- injection.
Botox® might be a great option for you if you are opposed to taking a daily medication, or feel that you have tried many different anti-depressants, and have not yet seen improvement in your depressive symptoms. Botox® is a great alternative treatment option for many people suffering from depression. Ask your provider at Bloom about it at your next appointment to see if you are a good candidate!
By: Jadon Webb, M.D., Ph.D.
By the time most of us seek help for depression or anxiety, we usually are in a tough spot. Severe depression, anxiety, bipolar disorder, PTSD, and other diagnoses can become serious enough to clearly be a medical illness requiring prompt treatment. And while you are being treated, it is important to find ways to measure and track your symptoms to help ensure treatment is on the right track.
When someone is suffering from moderate to severe major depression or generalized anxiety disorder, clinical rating scales such as the PHQ-9 (depression) or GAD-7 (anxiety) are very useful ways to gauge severity of the illness and monitor recovery during treatment.
But as someone gets help for anxiety or depression, and begins to recover, these clinical rating scales can start to fade in how useful they are, since they were designed to measure fairly severe symptoms. They are less useful for measuring the overall quality of your life.
Many patients in our practice note that they will recover from acute symptoms of severe depression or generalized anxiety disorder, and will truly feel better, but will; still have a sense that their life is still not as good as they want it to be. They can still feel lonely, and unfulfilled.
There are some newer rating scales that can help measure overall life satisfaction, such as the Oxford Happiness Questionnaire. It can often be meaningful to take a test like this to get another look at how satisfied with life you currently are.
If something is amiss in your life quality, this could mean needing to adjust what you do in talk therapy, or perhaps make some healthy needed life changes (exercise, socializing, job change). On occasion this can be a subtle indicator of a need to adjust medication for e.g. treatments of depression or anxiety.
Life satisfaction questionnaires can be a very useful extra tool to assess how well you are doing overall. Consider trying this out, and talk to your provider about it!
By: Shannon Keane, NP-C
A study conducted in Taiwan in 2020 revealed that a higher reported “happiness” state during ketamine infusions predicted a better outcome in patients experiencing treatment resistant depression.
This study assessed happiness levels three times throughout a low dose ketamine infusion. The researchers used a visual analog scale for happiness (VASH) which is essentially a rating scale from 0 to 10 measuring the level of reported happiness ( 0 being “not at all”, and 10 being “very”).
The researchers found that there seemed to be a correlation between reported higher levels of happiness during the ketamine infusion with a greater reduction in depressive symptoms.
This study demonstrated how the subjective mental state during a ketamine infusion is quite important when predicting if a ketamine series will be effective.
Out of 71 patients in the study, 44 of them reported feelings of happiness during the ketamine infusion. Each patient’s depressive symptoms were monitored from pre-infusion to 2 weeks post infusion using the Hamilton Depression Rating Scale (HDRS). The researchers found that patients who consistently reported higher levels of happiness during their ketamine experience, also reported a reduction in their depressive symptoms for up to two weeks post-infusion.
Ketamine infusions can help with depression, and can help you or a friend fight depression. This treatment for depression has demonstrated to be an effective, fast-acting and revolutionary option in psychiatry.
Chen MH, Lin WC, Wu HJ, Bai YM, Li CT, Tsai SJ, Hong CJ, Tu PC, Cheng CM, Su TP. Happiness During Low-Dose Ketamine Infusion Predicts Treatment Response: Reexploring the Adjunctive Ketamine Study of Taiwanese Patients With Treatment-Resistant Depression. J Clin Psychiatry. 2020 Nov 10;81(6):20m13232. doi: 10.4088/JCP.20m13232. PMID: 33176071.
By: Jadon Webb, MD, PhD
It can be overwhelming being a parent looking for help dealing with depredssion in your child.
You obviously want the safest, healthiest treatments possible. No experiments or high risk ideas! If you are considering medication for help with depression, you probably can see how many different possibilities there are. Dozens of different therapies and medications all promise help for depression, so how can you as a parent sort out the best ones?
A scientific review from 2020 may be able to help you sort through the options. These researchers compared common medications and therapies that are used as treatments of depression, to see which was the safest and most effective.
Surprisingly, the winner of it all was fluoxetine (generic Prozac™). After sorting through mounds of evidence, fluoxetine appears to have the strongest evidence for treating moderate or severe depression.
This is extremely useful as a starting point for selecting a good first treatment for your child. Fluoxetine has been used since the 1980s, so there is considerable short and long term safety data. It is also much cheaper (sometimes literally hundreds of times cheaper) than some of the newer antidepressants that have no proven clinical advantage.
This paper also notes that combining therapy with medication (such as cognitive behavioral therapy) is likely an even more effective approach. At Bloom we strongly encourage all clients with depression to be in therapy while we treat them. It works much better!
If your child needs help for depression, especially for moderate to severe depression, talk to your provider about some of the trusted, older antidepressants such as fluoxetine.
By: Jadon Webb, MD, PhD
If you need help for depression, or are wondering how to help a friend with depression, you first want to know what all of your options are. Most of us know about psychotherapy and medications. These are indeed great things to help with depression, but there are many other types of natural treatments worth considering. One of them is photons (light!).
We’ve known for centuries that many people tend to get more depressed in the winter when things are darker (seasonal affective disorder), and we’ve known for decades that administering bright, white light in the morning can help with depression. What surprised us is that this treatment also works in people who have regular major depression, not just in people with seasonal affective.
We love using natural treatment methods whenever possible, and Aa review paper from 2019 brought us a happy surprise: bright light therapy works as well as antidepressant medications used alone. Amazing!
Even better, when bright light is combined with antidepressants, they work even better than either does alone. This is huge news! Nature provides us with powerful tools to help with our mood and mental health. We should use them whenever possible.
If you need help dealing with depression, talk to your provider about adding in bright light therapy. It may help you feel better, faster.
By: Shannon Keane, NP-C
At Bloom, we are interested in natural supplements that may help for anxiety. There are certain supplements that have some scientific evidence supporting their use! If you are looking for how to reduce anxiety, here are some of our favorites to consider. As always, if you are seeking help to calm anxiety attacks, and are interested in natural supplements, be sure to check-in with your provider at Bloom Mental Health to see if these supplements are safe and appropriate to take!
Magnesium is an essential mineral commonly found in dark green vegetables, nuts, seeds, fiber-rich whole grains and chocolate. It is well known that American’s dietary intake of Magnesium is inadequate. Magnesium has an important role in mental and brain health. Several studies have demonstrated Magnesium’s effectiveness on reducing anxiety.
Phosphatidylserine is a phospholipid that is critical for brain health. This fatty substance decreases cortisol in individuals that produce excess amounts of stress hormones. People with higher levels of circulating stress hormones tend to experience higher levels of anxiety.
3) Valerian Root
Valerian is a plant that can be found in Europe and Asia. This flowering plant increases the activity of GABA and can reduce anxiety levels. It has originally been researched to help with insomnia, but it may also help people feel calmer.
This herb can be found in Asia and has been used for centuries to help people lower stress levels.
It lowers anxiety and improves depressive symptoms by regulating neurotransmitter activity, and managing inflammation. Increased inflammatory markers have been measured in people suffering from depression and anxiety disorders.
This adaptogen can promote homeostasis within the body and reduce anxiety. One study performed on mice revealed that this herb had a significant effect on lowering stress and anxiety levels.
***Before starting any supplements, check in with your provider at Bloom Mental Health to see if these supplements are safe and appropriate to take***
By: Jadon Webb, MD, PhD
Many cases of mental illness are caused by underlying health conditions. When getting help, it is important to always make sure that your body is healthy. One key part of our bodies that is sometimes overlooked is the level of iron in our blood.
Iron is a critical component of hemoglobin, which transports oxygen from our lungs to every cell in the body. If you don't have enough iron, you might have symptoms of fatigue, anxiety, and more severe depression. We have known about the relationship of iron and good mental health for decades. A study took a closer look at the association between iron levels and various psychiatric disorders, including depressive disorder, bipolar disorder, anxiety disorder, autism spectrum disorder, ADHD (attention deficit hyperactivity disorder), and developmental delays.
From this study, it was clear that low iron levels are associated with these severe conditions, and this relationship was especially strong in females. Overall, the risk of most conditions such as depressive disorder and anxiety disorder was double in those with low iron. We still do not know for certain how giving iron supplementation to someone with anemia will, for example, help with depression, but iron deficiency associates with a number of physical symptoms, and deserves to be treated!
When you are getting an assessment for mental health concerns, consider examining your whole health, and include looking at iron!
By: Jadon Webb, M.D., Ph.D.
Depersonalization-derealization disorder (DP/DR) is a group of symptoms and feelings in which the person feels disconnected from themselves or the outside world. Those suffering from it can feel frightened and wonder if they are “going crazy.” This fear can make it harder and more embarrassing to want to reach out and get help. It is also a lonely illness, and it can seem like you are one of the only people experiencing this.
But DP/DR is actually very common. A survey of the general population in 2020 found that almost 9% were experiencing these symptoms, and were bothered by it.
DP/DR is extremely common - every bit as much as well-known troubles such as depression and anxiety. Yet, because the symptoms are often hard to explain, and can sound like more frightening disorders (e.g. psychosis), it seems to often get ignored. This is a shame, as many of the underlying causes are very treatable! Many cases of DP/DR are caused by stress, burnout, anxiety, depression, borderline personality, trauma, and other very treatable problems.
If you are experiencing feelings of numbness, feel like you are in a dream-like state, or feel unreal, consider getting an evaluation. It may be your body’s way of trying to cope with stress or other problems that can be helped.
about the authorS
Jadon Webb, M.D., Ph.D.
Owner, Bloom Mental Health
Psychiatric Mental Health Provider
Disclaimer: this blog is NOT intended as medical advice and does not imply any kind of specific guidance or treatment recommendations, and should NOT be used to guide a treatment protocol. (read full disclaimer)