The Great British Med Off V.

Stress, anxiety, mood disorders and sleep.

Hi everyone! Today I am going to discuss a group of conditions that is close to my heart. Generally, we can refer to them as conditions of the mind. They include stress, anxiety, mood disorders (depression, irritability, bipolar disease etc) and insomnia (sleep problems). So why are these close to my heart? I think for two main reasons. Firstly is the lack of understanding of these conditions by modern medicine. The brain is by far the most complex organ in our body. Our understanding of its working is extremely limited. This fact hasn’t stopped modern medicine from producing a long line of medicine aimed at affecting our brain. Secondly, people who suffer from these conditions often feel ashamed of their situation. They have no physical ailment as such to show for their difficulties and yet the suffering inflicted by conditions of the mind can often be worse and more debilitating than the physical ailments.

Before I start talking about the specific conditions, there is one general principle that is of major importance. In my opinion there is always a reason, a cause, for these symptoms. If someone is suffering from depression or anger or mood swings or any other mental/emotional condition it is always a result of something that happened, or is happening, in the patient’s life. This may not be obvious, sometimes it is hidden or repressed or happened a very long time ago, but there is always something. This may sound obvious, however, I am afraid to say that there is very little consideration for it when it comes to treatments available in both Chinese and Western medicine.  Both disciplines look at the current symptoms and ask how can we help with these? There is not much consideration for what brought them on, for the underlying cause. In my opinion, until the underlying cause has been addressed the treatment won’t be complete. It may give some help with the symptoms but in most cases it will be only temporary relief. How can we address the cause? I will explain later but for now let’s start the comparison.

As usual I will try and simplify things. For that I’ll divide the subject into two: mood and anxiety disorders, and  sleeping problems (insomnia). The Western medicine (WM) treatment for anxiety is with antidepressants. If this doesn’t work then they may be supplemented with a tranquiliser or antipsychotic or both. These medicines have some success in reducing anxiety-however, the tranquilisers are highly addictive and the antipsychotics tend to have side effects. The antidepressants are usually safe but their effect on anxiety is limited. Chinese medicine treatment with Acupuncture and Chinese herbs will aim at the underlying condition. From a Chinese medicine point of view anxiety is often the result of physical, mental and emotional factors. A careful diagnosis has to take place for effective treatment. For example, a common cause of anxiety is when too much stress and pent up emotions affect the liver. The liver regulates the emotions and therefore, when under pressure, our ability to cope with stress reduces dramatically. Chinese medicine treatment of anxiety is not as powerful as the western medicine tranquilisers, but in mild to moderate cases tends to be a more effective, safer and longer lasting solution. 

In the case of other mood disorders, I think, both WM and CM have more effective treatments than in the case of anxiety (although the general principles for how treatment is carried out is similar). Antidepressants are usually effective in treating the symptoms of mood disorders. If one suffers from low mood, depression, anger or mood swings then antidepressants will often be effective in moderating those emotions and are therefore considered to be an effective treatment.

 Indeed, if these symptoms are stopping you from being able to function normally and the drugs make you functional again then that must be considered a success. However, there are a few problems here: firstly, most users of antidepressants report a general damping down of their emotions. They will often say they don’t feel depressed any more but neither do they feel real happiness or real excitement so although they feel better than they were they want to be able to feel emotions again! ; secondly, the usual problem with WM drugs: they don’t treat the cause, the reason for the mood problems. The symptoms are therefore likely to come back when the medicine has been discontinued. This point, which is true for many WM medications, is particularly important in the case of anxiety and mood disorders. One in every 5 people in the UK has been prescribed antidepressants over the last year! Over 4 million people are long term users. In the US one in 6 people are long term users of antidepressants. These figures are shocking. The fact that so many people need mood modifying drugs to stay functional primarily raises questions regarding the way we live our lives in these modern times-but this is a subject for another post. In the context of this post, these figures clearly indicate that modern medicine is failing in curing these conditions and is instead producing a generation of people who are dependent on these drugs. A great situation for the pharmaceutical industry but not particularly good for the sufferers.

So, what are the CM solutions for these mood related conditions? On the one hand CM has a much deeper understanding of these conditions. The treatment therefore is working on a deeper level and results, when positive, tend to be long term. On the other hand, in my experience CM, whilst often very effective in treating mild to moderate conditions, often tends to struggle with severe forms of depression and anxiety. It is not completely failing with severe cases and can sometimes still work, but much less than is the case with mild to moderate manifestations. Another problem with CM treatment of these conditions is that, like WM, it doesn’t deal enough with the emotional circumstances of the patients: are they in a stressful situation? Are thinking patterns and conditioning affecting how they feel? Is there an emotional trauma or traumas in their past?. With a lot of sufferers until we have cleared these conditions then we won’t be able to truly help them since the emotional problem which is emanating as a result of these conditions will keep on coming back. In these conditions, in my opinion, the patient will greatly benefit from counselling. I am referring here to patient and proper counselling, one that persistently explores the deep seated reason for the mood disorder or the anxiety. It can be hard for the patient and it may take time but in the hands of  good counsellor or psychologist the results will be very good and long-standing. The counselling technique that is used in the NHS called CBT (cognitive behavioural therapy) can be helpful but is limited. It gives you tools to help you deal with your symptoms but, just like antidepressants, it’s not (in most cases) treating the root of the problem.

 So, to sum up: for mood disorders and anxiety, WM medications should be preferably avoided unless the symptoms are severe and no other solution is working. In cases where you feel you need these medications, it is recommended to use them as a temporary solution until deeper and more permanent change can be achieved.

 CM offers more gentle, deeper and non-addictive treatment and therefore will be preferable as a first choice. However, in some more severe cases it may not be effective and WM medicines will be needed. Both forms of treatment are recommended to be supplemented by counselling.

Sleep problems or insomnia is a lot easier to compare. The verdict here is, I think, fairly straightforward. WM has a few different drugs that will make you sleep. The majority of them are tranquilisers but there are a few exceptions. Some will work well but often the patient will still feel sleepy it is time to wake up in the morning and start the day. Another problem with those meds is the usual one: not treating the cause will lead to dependency. Often, as well, one tends to get used to the pills and will need something stronger..and so on.

The CM approach to insomnia is very different. In CM we don’t look to tranquilise the patient or to knock him out. Instead we are looking for the reason, the cause of the insomnia, and will aim to mend it to allow our sleep mechanism to work properly again. There are clearly different patterns of sleep difficulties. Some can’t go off to sleep easily, some will wake up very early in the morning, some will have a very light sleep and will keep on waking up. Other factors are vivid dreams, night heat or night sweats, palpitations etc. Different sleep patterns arise from different reasons and therefore will be treated differently. Different Acupuncture points and/or different herbs will be used to treat different causes of insomnia. With this individual approach of looking at the root of the problem, the treatment of insomnia with Chinese medicines and Acupuncture is very successful. Most importantly there is no dependency-when the patient sleeps well he’ll be able to keep on doing so without the treatment.

So, to sum up. Insomnia: CM has the clear edge. WM should be used only in the most resistant cases.

That’s it for this post. Next time I am going to take a break from The Great comparison series of blogs and turn my attention to sorting out the NHS. 

Good health everyone.

Dr Ilan Shahor