|Q&A: Endogenous Depression,
Psychiatric Meds, and Chinese Herbs
|There is more than one type of depression.
Many people have heard of bipolar, or 'manic' depression.
And there are various names for major depression such as clinical
depression. There are alternatives to treating depression
with the typical medications (drugs such as effexor, prozac,
and depakote). In this Q&A I discuss natural herbal alternatives
in the light of both psychiatry and oriental medicine.
* This article is
for informational/education purposes only and is not meant to
substitute for the in-person professional advice of one's biomedical
or chinese medical physician. On the contrary, it is advised that
one consult with their health care professionals before making
any changes in well-being strategies.
Would it be possible to give me a little information
on an herbal medicine I bought called Xiao Yao Wan? I spoke to
a young lady who specializes in chinese medicine and told her
that I had suffered from endogenous depression for 1 year that
was 5 years ago but since then I have been on antidepressants...
first seroxat and now effexor. I desperately want to come off
of these pills because of side effects but could not bear the
thought of the depression comming back. I would be grateful if
you could tell me if this is a genuine herbal remedy. I would
give anything to be rid of this awful debilitating disease.
I welcome your reply,
A lot of people want to make the shift from psychiatric
medications to 'natural' solutions and then ultimately to a well-being
that doesn't require constant medication of any kind. This is
an area of particular interest to me. And it is a complicated
issue. Discontinuing psychiatric medications is a major change,
and would be most safely and successfully accomplished under the
care of both a psychiatrist and a well-trained chinese medical
practitioner. Later on I will tell you how to find
one. This is not a well-explored area of medicine, so it is
fraught with risks.
We can't ignore the potential dangers; any change
in your medication falls under the responsibility and expertise
of your psychiatrist. It's good to have a psychiatrist who is
open to alternative medicine. It's not good to go off half-cocked
and make medication changes without the advice of qualified health
professionals. There are a lot of armchair herbalists out there,
and many patients are taking their health into their own hands
by prescribing themselves supplements and other alternative interventions.
They say the doctor who treats himself has a fool for a patient,
and how much more patients who treat themselves? This can range
from harmless to life-threatening, and the reason for modern civilization's
laws which mandate formally trained and licensed health professionals.
Also, in modern healthcare, because there are widely distinct
philosophies and beliefs at work among the different medicines,
because not all health pracitioners communicate with one another,
because the power has moved into the hands of patients, and because
patients often do not feel comfortable telling their M.D.'s the
truth, there is a lot of unmonitored amateur experimentation going
on. As I have said, this can be dangerous.
It is important to remember how debilitating and
dangerous one's depression was before they went on the meds, especially
if they were suicidal. Any change in meds could precipitate a
return to that life-threatening condition. Substituting the most
appropriate herbal medicines while reducing the dosage of antidepressants
might work over a period of 6 months to a year, but during that
time there should be close monitoring by psychiatrist and chinese
As in all medicines, before there is treatment of
any kind (herbs, drugs, surgery, acupuncture), there must be a
diagnosis. Diagnosis means complete knowledge. For a chinese
medical practitioner to get complete knowledge of your situation
(complete enough to prescribe an herbal formula) they must question
and examine you. It is not sufficient to know the western or psychiatric
diagnosis. A chinese medical practitioner needs to know more than
'endogenous depression' in order to prescribe the correct herbal
formula. I'm including a flowchart
to show you a bit of the complexity involved in getting the right
formula. You'll see a modification of Xiao Yao called Dan Zhi
Xiao Yao San on the chart.
|A psychiatrist would make a more specific diagnosis
according to the DSMIV (APA Manual of Diagnosis and Statistics,
Volume 4) such as Major Depression,
|Bipolar type I or II, Dysthymia,
etc. Ideally, after an MD has ruled out organic causes such
as hypothyroidism, adrenal problems, nutritional deficiency,
chronic infection, a chinese practitioner can conduct his
own examination and evaluation to come up with the most appropriate
herbs. Another aspect of chinese herbal medicine is that the
formula you need will change to a degree with improvements
in health. The good news is that herbal formulas in raw, tincture,
or powder form can be personalized to eliminate all side effects,
even the side effects of pharmaceuticals. There is more and
more good info about drug-herb interactions out there in case
your psychiatrist is concerned.
|Xiao Yao Wan is indeed a 'genuine herbal
remedy.' It is a classic chinese herbal formula from the 10th
century A.D. that deals with Liver/Spleen imbalances.
|It is a commonly prescribed formula
in modernized societies because it addresses one type of imbalance
that results from our high stress levels, poor eating habits,
mental overwork and overwhelm, and physical inactivity. But,
none of this is sufficient to prescribe Xiao Yao Wan. Again,
I want to direct you to a local practitioner to diagnose and
treat with in conjunction with your psychiatrist.
Please read my '7
Steps to Preventing Disease with Chinese Medicine' for a discussion
of how to find and work with a good chinese medical practitioner.
It has not escape me that you are writing from the U.K. You will
find plenty of U.K. practitioners from which to choose via the
'find a practitioner' link in the above-mentioned article.
|I know effexor causes some nasty side effects
and withdrawal symptoms (common side effects are asthenia,
sweating, nausea, constipation, anorexia, vomiting, somnolence,
dry mouth, dizziness nervousness, anxiety, tremor, blurred
vision, and abnormal ejaculation/orgasm
| and impotence in men, and withdrawal
can lead to nausea, headache, gastric upset, diarrhea, myalgia,
and fatigue; withdrawal can be helped by a tapered dosage
of ondansetron, a medication more commonly used for the
treatment of nausea and vomiting during radiotherapy and chemotherapy.)
Herbal formulas can also alleviate those side effects and
You will have to weigh your current discomfort
with side effects against the risks of discontinuing your pharmaceuticals.
A middle road might be for your chinese medical practitioner to
start treating you for a period of time to improve your health
and well-being until you hit a plateau, at which point you would
be in a better position to make the transition off of the psych
meds. Or, you might find that professional herbal treatment can
satisfactorily eliminate the pharmaceutical side effects. Again,
this is a complex and sensitive issue, and I hope you submit
to the care of professionals. If you decide to embark on this
cooperative effort with a psychiatrist and chinese medical practitioner,
I would love to hear your about progress and, regardless, please
feel free to ask me for clarification or any more questions you
Yours in health,
Brian B. Carter
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