What to Do About the Mental Health Crisis [Part 1 of 9]

More than one in five American adults now live with a mental illness. About 17% of Americans take antidepressants, and billions of dollars are spent on these medications every year. Yet as a society, our mental health continues to worsen.

The average number of mental health visits per adult has nearly tripled since 2001. Among young adults, the number spending half or more of their days in poor mental health doubled between the late 1990s and 2020 [1].

Our “Go-To” Treatment Is Not Very Good

Several large reviews of the scientific literature have concluded that, on average, antidepressants are only modestly more effective than placebos [2–4]. To quote one study, “Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy [2].”

Antidepressants can increase agitation and behavioral dysregulation in a subset of patients

Akathisia (inner restlessness)
Agitation
Emotional blunting or disinhibition
Impulsivity
Suicidal ideation (especially in younger patients)
Sexual Side Effects (Possibly Irreversible): 30–70% of users experience some degree of sexual dysfunction. One review described persistent loss of libido, genital numbness, and anhedonia in a subset of users [5]. This has been well-studied [6,7].

The disparity in the number of patients with sexual side effects has to do with whether they are specifically asked about it. The low number (30%) is for patients who were not asked about sexual side effects. When asked about sexual side effects, 70% say they have them. They are extremely common. In some people, these problems persist after the medication is stopped.

The Solution: Look at Mental Health Differently

If depression and anxiety are not simply “chemical imbalances,” perhaps we should begin asking a different question. Instead of focusing exclusively on neurotransmitters, we should also ask why the brain is not functioning normally in the first place. Is it inflamed? Is it undernourished? Is it exposed to excessive stress hormones? Are there physiologic problems that affect how it works?

Mental Health Is Brain Health

The purpose of this report is not to “treat” depression and anxiety. Mental health professionals already do that. The goal is to suggest strategies that make their job easier and improve results.

People talk about depression and anxiety as though they happen separately from the rest of the body. But the brain is an organ, just like the heart, lungs, liver, or kidneys. When the heart is not healthy, you may experience chest pain, fatigue, shortness of breath, or other physical symptoms. When the brain is not healthy, mood, anxiety, memory, sleep, and concentration can all be affected.

If the brain is inflamed, undernourished, sleep-deprived, or exposed to too much stress hormone, it may not function properly.

Click for Part 2: Inflammation and Mental Health

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