6 Things to Try Before Seeing a Psychiatrist

When I started nursing school (so long ago that my tuition was $416/semester, no lie), there was only one model to follow: the “medical model.” That is to say, we were trained to act and think inside the Western medical system.

Something hurts? Take a pill. Lab values are off? Take a pill. Heart has stopped working correctly? Take a pill.


Depressed? Take a pill.


Fortunately, I have had a rich, dynamic career and have worked with so many smart, insightful, brave clinicians over the years that I have broadened my scope of practice exponentially since those early days, and no longer have the knee-jerk medical model pill-popping response of yore. I have a better grasp of how many variables can be at play when someone is depressed, and a few of them, it turns out, are within our control.

So, assuming you are not in any way suicidal (in which case you absolutely must see a doctor and not fool around with trying to treat your symptoms yourself!) here are 6 things you can try before seeking the help of a competent psychiatrist.

1. Get some blood work. There are several treatable conditions that can mimic the physical and psychological symptoms of depression. For instance, ever consider the possibility that you have chronic fatigue syndrome? It’s usually caused by the Epstein-Barr virus (same virus that causes most of the cases of mono.) Don’t panic–it’s actually pretty easy to reverse the symptoms with a course of antiviral medications, allowing you to feel completely back to normal in a matter of a a few days.

Have you had your thyroid function tested lately? When my thyroid tanked, I was certain I was having a depressive episode. But antidepressants just caused me to feel jittery and sleepless. So my doc did some tests and, lo and behold, my lab values sucked. A week on Synthroid and I was feeling 15 years younger.

And since you gotta have a blood draw anyway, why not also request they check your Vitamin D level? Anything reading below 30 could very well be at the root of your exhaustion and mental cloudiness. (See my blog post from last week on the power of Vitamin D in mental and physical health.)

2. Stop taking melatonin. Melatonin is the hormone the brain naturally secretes (originating from the amino acid tryptophan), that helps put the brain into a normal sleep state.  Melatonin supplements, which usually come in 2mg, 3mg or 5mg doses, help create that same natural sleep state in people who have trouble sleeping–a problem many of us with depression often struggle with. Unfortunately, for those of us predisposed to depression, melatonin can bring on a pretty severe depressive episode. And once it’s triggered an episode, you’ll probably need an SSRI to reverse it (for biochemical reasons I won’t get into right now.)

3. Exercise. Yeah, yeah, yeah. I know that in an earlier blog post I skewered anyone suggesting that all we need to do to relieve our symptoms was to get some exercise. But that was because it’s usually suggested as a way of changing the subject or discounting the seriousness of our illness. What I’m talking about here is taking matters into your own hands and forcing ourselves to exercise 30-45 min 5-7 days a week.

If you’re depressed, this will sound Herculean–and may not be possible initially. I get that. But the research on this subject is compelling: 1/3 of all those suffering from depression will have their symptoms relieved through persistent exercise. Think of it: costs nothing, little risk of negative side effects, it’s at your disposal today, and it could quickly start making you feel better (probably weeks before you could even land an appointment with a psychiatrist.)

I had a total hip replacement 6 months ago (the cost of a lifetime of skiing moguls, playing racquetball, hiking mountains…and falling while doing each of those sports!!) and suffered heat stroke during a training exercise in the Army. So working out is tricky for me, especially living in Florida. But I get around those obstacles by walking (not running anymore) 2-3 miles before dawn or swimming laps for 20-30 min. My goal is to work back up to doing one of those every day, but even 4x/wk is extremely helpful for me.

Figure out what obstacles keep you from exercising and then draw up your battle plan for overcoming them.

4. Psychotherapy. Specifically, Cognitive-Behavioral Therapy. The research on this mirrors that of exercise: 1/3 of those with depression had their symptoms relieved by CBT. For those whose depression is rooted in trauma or loss, this can work magic. Read up on it before you make an appointment with a CBT therapist, and then spend some time hunting down someone who is experienced, well-trained, and clicks with you. It’s well worth the extra effort and time.

5. Keep track of the good stuff in life. When Oprah was at her pinnacle of popularity, everyone it seemed was keeping a Gratitude Journal. Sure, it sounds hokey and touchy-feely and girly and everything else. But man-oh-man, does it help. The heaviness that drops over our brains when we’re depressed makes it far more difficult for us to remember, and integrate, the truly good and happy things in our lives. Keeping a running log of the good things on a daily basis gives us a kind of accumulated proof that life has much to still offer us, when we begin to doubt.

6. Learn to meditate and do it daily. About a year ago, I took a week-long course on meditation at the Kripalu Center for Yoga and Health in the beautiful Berkshires of Western Massachusetts. I had no idea what, if anything, I’d get out of it, and went mostly because I love that part of the world and I had that same exact week off between semesters. I knew about the studies that had shown how powerful meditation can be in improving mood and overall wellness. But to experience it firsthand is extraordinary. I was astounded by the impact it had on me, just in those 6 days of regular practice. I can’t recommend it strongly enough–once you “get it” (which doesn’t take long, so don’t worry), you’ll be hooked. It feels amazing.

Have some of your own sure-fire Blue Funk Beaters? Share them with us!

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