Anxiety & depression

A homeopathic guide to anxiety & depression by Dr Jeni Worden

Five to ten per cent of patients visit­ing their GP will be  suffering from “clinical” or “major” depression. This means that as a  GP, two to three of the patients I see in a normal working day will be feeling down,  depressed or hopeless. As well as clinical depression, where symptoms are severe enough to  affect day to day living, 15 to 30 per cent of my patients will have  depressive symp­toms but still manage to continue with work or home life  without serious prob­lems. This is probably the largest group of patients with a  psychological problem that I see in my surgery every day. People come  with a variety of com­plaints, including a feeling of persistent  fatigue, lack of appetite or excess appetite resulting in comfort  eating, not being able to look forward to enjoyable events such as  holidays or family celebrations, poor sleep, feelings of anxiety and low  self­esteem, guilt for “not really being ill”, feelings of not coping,  lack of interest in activities or relationships, loss of sex drive and generally feeling cut off from  the world. Whilst most of us can exper­ience all of these feelings at  some time to a greater or lesser extent, it is when they last for weeks  on end that we start to feel unwell and out of balance. It is in these  circumstances that the body starts to need a little help to recover. 

The good mood hormone 

What causes depression? Most people know that our brain produces a  “good mood” hormone called serotonin. If we do not produce enough of it  or it gets broken down too quickly, then a low mood results. Quite what  triggers off this chemical imbalance is the subject of hot debate by  scientists, but its results are only too clear to sufferers of this  com­mon condition. There may be an inher­ited element to depression,  possibly a genetic factor but scientists are unsure whether depression  is due to nature or nurture. I suspect it is a mixture of both.  Certainly I come across some people whose brains permanently seem to  pro­duce low levels of good mood hormone, meaning they always feel  somewhat under par mentally.

Treatment 

In the past, people with symptoms of depression or anxiety were  often treated with tranquillizers, or benzodiazepines like diazepam  (Valium). This is because depression is really a mixture of feeling low  combined with symptoms of anxi­ety. The latter can range from waking up  with a sinking feeling or butterflies in the stomach or panic attacks to  full blown physical symptoms of acid indigestion, problems with  swallowing, diarrhoea, a feeling of tightness in the throat, diffi­culty  breathing, weight loss, and a sure­ness that “something serious is  wrong with me”. Although tranquillizers may still be used by the medical  profession if symptoms of anxiety are very severe, they are now  generally recommended only for short term use (up to two weeks at a  time).

The most common medications for depression these days are  antidepressants which help to rebalance the mood hor­mones, commonly  selective serotonin reuptake inhibitors (SSRIs) and less often, the  tricyclic antidepressants (TCAs). However, their effectiveness in mild  or subthreshold symptoms is questioned by modern research and they are  now not routinely advised for GP use by the National Institute of Health  and Clinical Excellence (NICE). Herbal treatments also work in a  similar way to conven­tional antidepressants although usually with a  lower rate of side effects: they often have a combination of active  ingredients as opposed to the synthetic medications, which are single  substances in a poten­tially more potent form.

Talking therapies 

NICE suggests that GPs use either coun­selling or cognitive behavioural  therapy (CBT) to treat mild depression. This has been shown to be more  effective in the first instance than medication for most sufferers with  less troublesome symp­toms, but unfortunately availability varies  greatly throughout the UK. I find the so­called talking therapies  extremely use­ful to help people change their sometimes negative way of  thinking and such treat­ments can be life changing, helping peo­ple  regain normal function without a reliance on tablets. I have worked as a  GP in both Dorset and Hampshire and have always been able to refer  patients on the NHS, but waiting times for non­urgent cases have become  longer and longer over recent years, as more and more people are  referred. So although my patients and I can access this invalu­able  treatment free of charge, there can be a three to four month wait to see  a therapist and sessions may be limited to a certain number rather than  what the individual really needs. This can be very frustrating for both  client and therapist!

Homeopathy’s place 

It is whilst waiting to see a therapist that I find homeopathy has a  place for my patients. It can also be used as a sole treat­ment if  patients do not feel that they want to see, or need to see a counsellor  or ther­apist but nevertheless want some help to recover from their  illness. I would emphasise that I am not suggesting that homeopathy  should be used as the only treatment in serious depressive illness where  there are feelings of wanting to die or a risk of suicide, or in mental  health problems such as bipolar disorder (manic depression),  schizophrenia or severe post­natal depression. These are complex and  potentially life threatening illnesses and need advice from a  psychiatrist along­side the GP and other healthcare pro­fessionals.  Homeopathy may have a part to play as an additional or complemen­tary  treatment but NOT as a stand alone therapy in these situations.

There are so many homeopathic med­icines that can be used to treat  the numer­ous symptoms of depression and anxiety that it can be  difficult to know where to start. It is important to make sure that your  symptoms are not due to another illness such as an underactive thyroid  or a stomach ulcer, so please talk to your GP first to make sure of the  diagnosis before starting homeopathic treatment.

Arsenicum album 

One of the first medicines that I think of when I see someone with  all the symp­toms of anxiety with depression, partic­ularly when there  are gastric symptoms of indigestion and diarrhoea, combined with panic  attacks, is Arsenicum album. This medicine is based on white arsenic  which causes severe gastroenteritis if taken in a toxic dose, which is  why it can help similar symptoms when taken in a homeopathic potency.  Somebody doing well with Arsenicum will probably be neat, tidy but  restless. They may look anxious and drawn and tend to have a fastidious  way about them, being able to give a lot of detail to their symptoms.  Often I find that such a patient has to tell me all their troubles in a  very method­ical but sometimes time consuming way.

Arsenicum patients can be convinced that  they have a physical illness which is being missed because they feel so  ill and may in fact end up having a num­ber of investigations such as  endoscopy and colonoscopy before finally accept­ing what is wrong with  them. They can feel that they will never be well again. Fear is a  prominent symptom, causing apprehension and dread, with an over­whelming  feeling that everything will go wrong, and they despair of their  recov­ery. These can be patients that I have to try very hard to  reassure and I will often use a 30c dose, three to four times a day,  with Aconite 30c taken as needed if they are having additional panic  attacks.

Ignatia 

Where depression follows from bereave­ment, loss, or a shock, such as  witness­ing a fatal road accident, Ignatia can be useful. The symptom  picture is typified by emotional ups and downs with mood swings and is  often quoted in homeo­pathic reference books as “laughter alter­nating  with tears”. Having suffered the loss of my own parents, I know myself  the separation feeling that one under­goes when someone close to you  dies and I remember being able to talk quite calmly one minute, and then  being overcome with tears soon afterwards before becom­ing calm again a  few minutes later.

Often the sufferer can prove difficult for friends and loved ones to  deal with as they are SO up and down, being resist­ant to sympathy and  oversensitive to well meaning advice, which may be wrongly taken as  criticism. Ignatia patients tend to “bottle things up” and cry and give  deep sighs during the course of their con­sultation. It may be hard for  them to talk if they are overcome with their miser­able situation and  friends can find it well nigh impossible to cheer up such patients. Poor  sleep is common and so is the feel­ing of a ball or something stuck in  the throat, known conventionally as globus syndrome. I often give a few  Ignatia 30c tablets to recently bereaved patients to take when needed,  especially around the time of the funeral, and will use a 200c on a  weekly or monthly basis for per­sistent depressive symptoms.

Natrum muriaticum 

Another remedy that can bottle things up, but reacts quite  differently to the Ignatia patient is Natrum muriaticum. This is one of  my most frequently used homeopathic treatments for symptoms of stress,  such as those typified by mild depression. I find it very useful when a  patient has never been well since a shock or loss and feel as if they  have a glass wall between them and the rest of the world. Often they  have been unable to cry since bereavement and feel that they have not  grieved properly for their loss. They feel worse for sympathy yet are  very empa­thetic people. They sometimes build up a barrier emotionally  and can appear somewhat cold and distant. They can worry about upsetting  people uninten­tionally by saying the wrong thing and also can take  things the wrong way.

I tend to view these people as the “salt of the earth” type, having a  strong sense of duty, but can find themselves being overwhelmed by the  responsibility of their work, especially if they are caring for an  elderly or sick relative. Such patients can feel that they should be  doing more, not less, and feel they must “just get on with it”, and yet  feel more and more tired and low in spirit as time goes on. Grudges can  build up, with resentment. There may be an increased sensitivity to  noise; certain passages of music may move them to those long awaited  tears, but without relief from their low mood. I have discovered to my  cost that using too high a dose of Natrum mur can cause emotional upset  without improving the symptoms of depression so I tend to use a one off  dose of 200c when there is a clear history of a defi­nite cause to the  illness and a daily 30c dose if the trigger is less clear.

Sepia

When all energy is drained, and my patient feels that they are  unworthy of anybody’s love or attention, I turn to Sepia, a rem­edy  which I have written about in the past for its use in the menopause and  post­natal depression. I have used this almost exclusively for women who  are sad, silent, solitary individuals, completely lacking in zest.  Tears are never far away and a feeling of having to keep emotions under  control otherwise one will have to scream is typical of the strain that  such patients can feel. There is a wish to keep busy but with no  incentive to do so and these patients can spend hours sitting  motion­less in sadness.

Sepia women will often tell me that they love their husbands or  partners but cannot manage the physical side of the relationship, which  they feel is starting to cause difficulties for their other halves.  Sepia usually suits women who tend to feel chilly and they can either  feel incred­ibly hungry, being unable to ever feel full or have nausea  at the mere smell of food. They often have a sinking, or “all­gone”  feeling in the pit of the stomach, espe­cially when they wake, which is  not relieved by eating.

Older people 

One area of depression and anxiety I would like to mention is that  of the older patient. I am really referring to the over 75s and those  perhaps with physical frailty or other health problems and not all  “pensioners”, as the media seems to refer to anybody over the age of 60  these days. Depression in this older age group can sometimes give rise  to symptoms of forgetfulness and memory loss and lead to a mistaken  diagnosis of dementia or Alzheimer’s disease. This is why  antide­pressant medication is often given by doctors if such symptoms  appear. Unfortunately it can take up to three months for conventional  treatment to have a full effect, and because memory problems may affect  an older person’s health, and their ability to stay at home to a great  extent, doctors tend to treat earlier than later. If you have a  sympa­thetic GP, or, even better, one that it is homeopathically  trained, it may be pos­sible to try a remedy such as Alumina for a trial  period first. This is a homeo­pathic potency of aluminium and is  indi­cated where there is confusion about time (“time seems to pass too  slowly”), diffi­culty making decisions, unease in the evening (“as if  something were going to happen”), involuntary weeping without cause and a  dazed feeling, making mis­takes in writing and speaking. All such  symptoms are worse in the morning and tend to improve as the day goes  on.

An alternative to try is Baryta carb,  which I have found especially helpful if symptoms are worse with worry  or come on after a stroke. Both Alumina and Baryta carb can be given at  30c strength daily.

Finding a quiet place 

Depression is all too often seen as a prob­lem of women, and  although it is true that twice as many female patients are treated for  anxiety and depression as men, both sexes can be affected. However, it  does not have to be the “black dog” that the late Winston Churchill  suffered from and does not always need to be treated with medication.  Regular exercise can help, as this increases the endorphins produced by  the brain, which are responsible for the highs that athletes can  experience. Many GPs can refer patients to local “exer­cise on  prescription” schemes which often offer a supervised course of gym  sessions at a reduced fee. Finding a quiet place, through meditation,  painting or walking the dog, can really help rebalance the mind and  body; too many patients look blank when I ask them “and what do you do  for yourself?” after listening to what they do for others. Look for your  own quiet place if any of the above applies to you and please take  further advice. It will be worth it, I promise!

Jenifer Worden MB ChB MRCGP MFHom