Return to Psychiatry?

I just got back from meeting with an advanced practice nurse (APN) for a psychiatric evaluation. I like her a lot: she was down to earth and personable. I felt like I could relate to her and trust her. She made a real effort to listen to me and ensure that her understanding of my history and current situation was accurate. She took the issues I’ve had with medications in the past seriously.

She screened me for bipolar and OCD, but hasn’t made an official diagnosis. First she wants to see the results of the blood work I had done when I went to see my primary care provider a few months ago. She also gave me a prescription to get a sleep study done to see if my problem might actually be sleep apnea or another sleep disorder. It could be that chronic lack of restful sleep has been keeping my brain from functioning properly and causing (or at least contributing to) my depression and anxiety symptoms.

Finally, she sent me home with a self-report measure to fill in over the 4 weeks between now and my next appointment. Every day I get to rate symptoms such as depressed mood, mood swings, irritability, food cravings, anxiety, sleep issues, difficulty doing things, and physical symptoms. There are spaces to mark day of the week and whether I have my period. As I complete it, I’ll be making a graph; it’s pretty neat.

Perhaps best of all, she agreed to talk with Wakana to coordinate my care. I guess time will tell how well they can work together to help me.

To be honest, I have mixed feelings about the situation. There’s a part of me that’s disappointed because I don’t have medication to take and either (preferably) gain relief from or complain about. It’s basically more of the status quo, at least until the data from the sleep study has been analyzed.

The rest of me likes that the APN is proceeding cautiously and trying to gather as much information as she can before prescribing drugs that may do more harm than good. She seems to be thinking about what is best for me as a whole person, not what will be the most convenient. It may take longer than I’d like before I have a treatment plan that’s truly effective, but hopefully I won’t have any more false starts and stops with medication. I may have found a keeper.

Aromatherapy Treatment of Anxiety and Depression: More Research Needed!

I did some research in peer-reviewed scientific journals about the efficacy (effectiveness) of aromatherapy as a treatment for anxiety and depression. Most of the articles I read seem to support it as a complementary treatment – that is, to be used along with traditional treatments such as psychotherapy and medication. There is a need for research that 1) separates the effects of aromatherapy from that of massage and 2) examines the relative efficacy of specific essential oils. Lavender is an essential oil that might help with anxiety, depression, and sleep disorder.

Here are my notes on three review articles:

A review of 16 studies from 1990 to 2010 found that aromatherapy can safely be used as a complementary therapy to reduce anxiety (Lee, et al, 2011). More research is needed to understand how best to implement it (e.g. massage or inhalation) and why it works biologically.

A review of 6 studies from 2000 to 2008 found that aromatherapy-enhanced massage can safely be used to improve mood in people with depressive symptoms (Yim, et al, 2009). A substance found in essential oils, citral, “produces relaxation and antidepressant effects” (192). It is unclear whether particular essential oils are more effective than others; additional research is needed.

Perry & Perry (2006) examine use of aromatherapy in a variety of disorders, including sleep disorder, anxiety, and depression.

Sleep Disorder – “In one study, a blend of basil, juniper, lavender, and sweet marjoram was applied by hand massage; satisfactory sleep increased from 73% to 97% of patient nights […]” (264). Lavender is the essential oil most discussed in the treatment of sleep disorders.

Anxiety – There is limited support for use of aromatherapy to treat anxiety, but of the essential oils, lavender seems most promising.

Depression – There is some support for the use of chamomile, citrus, and lavender. Controlled trials are needed to confirm efficacy.

For more information about aromatherapy, including safety and quality information, visit the National Association for Holistic Aromatherapy.

References

Lee, Y., Wu, Y., Tsang, H.W.H., Leung, A.Y.., & Cheung, W.M. (2011). A systematic review on the anxiolytic effects of aromatherapy in people with anxiety symptoms. The Journal of Alternative and Complementary Medicine, 17 (2), 101-108.

Perry, N. & Perry, E. (2006). Aromatherapy in the management of psychiatric disorders: Clinical and neuropharmacological perspectives. CNS Drugs, 20 (4), 257-280.

Yim, V.W.C., Ng, A.K.Y., Tsang, H.W.H., & Leung, A.Y. (2009). A review on the effects of aromatherapy for patients with depressive symptoms. The Journal of Alternative and Complementary Medicine, 15 (2), 187-195.