Just about every day in the office I see patients with mental health issues. Anxiety, depression, insomnia, focus problems and others are increasingly common to the point where we could ask the question: what is normal and what is abnormal?

Psychiatry in America focuses primarily on pharmaceuticals. Diagnose Generalized Anxiety Disorder, Major Depression, Bipolar Illness, Attention Deficit Disorder and use others labels, then select from an array of approved drugs. See you in a month for follow-up. Call me if the side effects are too onerous.

As is so often the case, we take a complicated issue and reduce it to an overly simplistic solution.

The fundamental idea is that for anyone with a mental health issue, through trial and error, the prescribing practitioner will try medications at different doses in various combinations until the magic recipe is achieved. The person would then go forward with their life in a state of balanced contentment.

For those with resistant symptoms, the answer is almost always to increase the dose of one of the medications or add a third or a fourth new medication. It’s a one trick pony show.

The medications often have value, but there are too many people out there with a meager response for me to think that pharmaceuticals are the optimal approach. As with many disciplines in medicine, we need to pull back, reassess our approach and find a better way. I believe now, after many years in medicine, that a focus on nutrition, mindfulness and stress management with individualized supplements and hormone balancing would achieve more success for more people that any concoction of drugs.

There is also growing research implicating an individual’s gut bacteria, the so-called microbiome, into mental health. We are starting to figure out the complex interrelationship between bowel health and our brain function.

To my relief, I am finding more and more practitioners working in this regard. These include Drew Ramsey, Kelly Brogan, David Perlmutter, and Sara Gottfried. The latter has written a tremendous resource with wide applications called The Hormone Cure.
What has worked for you in your efforts to maintain good, stable mental health?
Andrew Lenhardt, MD