Dr. Aruna Tummala is a holistic & integrative psychiatrist who uses evidence based interventions to help you achieve mental wellness. Find information on integrative psychiatry, functional medicine, the healing powers of Ayurveda, healthy living tips and more.
I was out of town recently and was excited to see Ayurvedic massage, or Abhyanga, offered at the hotel I was staying at. Unfortunately, the experience was very disappointing. The Abhyanga massage and the Shirodhara I chose, was nowhere close to the original technique and the intended benefits of an authentic service. It was sad to see what passes off as Ayurvedic massage at certain places. I am hoping that this spa is an outlier when it comes to providing authentic Abhyanga massage in the US. So, here’s a description of what this massage treatment is about; so, everyone can be informed consumers.
Abhyanga is a traditional Ayurvedic massage done by applying warm herb-infused oil to the body in rhythmic and sequential steps.
There is no greater expression of self-love than lovingly anointing oneself with warm oil—this practice is called Abyanga or Snehana. Interestingly, the Sanskrit word “Sneha” can be translated as both “oil” and “love.” So, the effect of Abhyanga is like the experience of being loved and cared for. The therapeutic aspect of being touched it is enhanced by the Abhyanga techniques, all of which have profound healing effects on the recipient. Hence, Abhyanga can give a deep feeling of stability and warmth. Which is why, in Indian culture, an oil massage is one of the many established routines for a newborn baby, starting as early as 3 to 4 weeks after birth, and continuing till they are at least 1.5 to 2 years old. Babies raised in the traditional Ayurvedic way (or for that matter, the Indian way); will start their mornings with warm herbal oil massage followed by a traditional hot bath. No wonder these babies sleep so well afterwards! Now, in the West, we are learning the benefits of giving babies a massage every day.
Abhyanga has many goals:
Stimulation of the internal organs, especially the digestive tract – very similar to practicing certain yoga postures to stimulate internal organs and their functioning.
Rejuvenation and relaxation of the musculo-skeletal system.
Abhyanga involves energy work and reflexology; by stimulation of the various energy points on the surface of the body (known as Marma points), which correlate with functioning of various internal organs. Stimulation of these Marma points helps to unblock the energy channels and allows for free flow of energy through its channels in the body.
Abhyanga by nature is a lymphatic massage. It helps to stimulate lymph and blood circulation. Which is why, after Abhyanga, it is easy for body to release toxins from all systems.
Drug delivery system. Afterall, the skin is the largest organ of the body and a highly absorbable one. Using skin to deliver therapeutic herbs has the benefit of bypassing premature breakdown of the herb by the liver, which is what happens when herbs and medicines are ingested orally. It also allows for direct local application of the herb. When we use the warm herb infused oil in Abhyanga, oil becomes the vehicle to deliver the herbs to our internal environment. Hence, a traditional Ayurvedic doctor will customize the oils and herbs used for each client.
With these goals and benefits in mind, let’s move on to the technique…Abhyanga starts with abdominal massage because according to Ayurveda, gut is the most important part of body. If gut is healthy then a person is healthy. Belly massage with round strokes and marma stimulation will help to stimulate all digestive organs, so they can work 24×7 without any stress.
After that is an arms and legs massage with long strokes while squeezing the limbs as the hands of the masseuse move from joint to tip of fingers/toes. Along the way, gentle pressure is exerted on marma points. This technique helps to stimulate lymphatic system and drain out excess fluid and toxins from body. This is followed by hand and foot massage with stimulation of all the marma points in our hands and feet. Nerve endings are concentrated in our hands and feet as Marma points. Stimulation of the marma points in the hands and feet is a very important part of Abhyanga as we are able to positively affect the health of the various internal organs through these marma points.
Next comes the face and head massage. There are 7 marma points on face and 15 on head. Abhyanga of the face will help to rejuvenate facial skin, leave it glowing, will reduce fine lines and prevent wrinkling and other signs of aging. Abhyanga of the head, helps in many conditions like migraine, anxiety, depression, and many neurological disorders.
Finally, back abhyanga starts with stimulating all 7 chakra centers through their marma centers. This part of abhyanga is therapeutic for all kinds of back pain, herniated discs, etc.
Traditionally, this service ends with a 10-15 min herbal steam sauna to enhance sweating of the toxins that were mobilized with the massage technique.
In contrast, during my service, the masseuse applied warm sesame oil over my limbs and back. There was no abdominal work, no lymphatic massage, no work on the face, head, hands or feet. No marma stimulation at all. Later, I looked at their brochure and Marma stimulation is an add on service (on top of the $140 I already paid for the massage and Shirodhara). So, Abhyanga is just applying oil??? Needless to say, I was very disappointed.
Full disclosure: I am the owner of Trinergy Ayurveda Wellness & Spa where you are assured of an authentic, therapeutic and deeply rejuvenating Abhyanga service, provided by our traditionally and well trained Ayurevdic massage therapists; should you choose to try us out.
In early 2018, I received a call from a mother whose daughter had “Misophonia.” Frankly, it is a relatively new “disease.” Misophonia is a condition wherein certain common sounds (breathing, chewing, etc) can trigger intense, exaggerated emotional reaction in people with this condition; resulting in secondary anxiety, depression and disability in many areas of life. My research of this condition indicated that people were recommended antidepressants, noise canceling devices, cognitive behavior therapy, etc. But the prognosis was described as poor with the idea that symptoms are chronic and need to be “managed.”
I met with the young lady and used my training in Functional Medicine and Ayurveda, to solve this puzzle. In addition to anxiety and depression, she also had symptoms of heart burn, headaches, acne, skin rash, and was overweight. From an Ayurvedic lens, she was severely inflamed, and this inflammation was manifesting in various organ systems in her body – the gut, brain, skin, etc. I explained the treatment which focused on eliminating this inflammation.
With her participation in the treatment, within 3 months’ time, she had a 17 pound weight loss, no headaches or acne, and her skin was clear and smooth – “like a baby’s skin” was her mother’s description. Anxiety, mood and misophonia were all significantly better. Just with diet and lifestyle medicine (meditation and some psychotherapy), we put out the fires in her body (or inflammation resolved) and every organ system began to heal and flourish.
In contrast, a traditional psychiatric approach would be with antidepressants and psychotherapy. What is wrong with this linear approach is its akin to shooting in the dark and hoping to hit bull’s eye. Not to mention the exposure to the long list of side effects!
With this example in mind, let me explain how an ancient system of medicine can help where modern medicine – with all its technological advances – can sometimes be not helpful. Let’s begin with an understanding of what Ayurveda is…
What is Ayurveda?
Ayurveda is a more than 5000-year-old traditional healing system of India and according to WHO (World Health Organization), is the oldest-surviving, continuously practiced, complete medical system in the world. Ayurveda is a composite word with “Ayur” meaning life and “Veda” meaning science or knowledge. In other words, Ayurveda is a treatise of life in its totality and not just a medical science. It encompasses medical science, philosophy, psychology, spirituality, art, culture, exercise (yoga), etc. Its tools include lifestyle guidance (stress coping skills, emotion regulation with meditation, nutrition, yoga, etc), herbal and other natural medicines, detoxification and purification procedures, massage therapy and other body work (energy work, essential oils, all have their origin in Ayurveda), etc.
Although ancient in practice, its wisdom is timeless as Ayurveda can provide practical and effective treatments, even for the modern illnesses of today’s society. Cancer, Lyme disease; are both illnesses of modern society but Ayurveda has a framework to explain the pathology and hence formulate a treatment plan in conjunction with what modern medicine has to offer. For such chronic illnesses, a combination of Ayurvedic medicine with modern medicine can help create better outcomes for patients.
Ayurveda understands human physiology as a fine balancing act (or homeostasis). Diseases are seen as a movement away from this state of balance. An Ayurvedic practitioner is simply assessing the degree and direction of imbalance and the treatment plan will essentially walk the person back to balance. So far, no illness or disease has escaped this understanding. In other words, the diagnosis is immaterial. Therefore, lack of information about Misophonia was not a deterrent to my understanding of the physiological imbalance or the pathway to recovery.
Ayurveda’s simple yet profound strategy starts and ends with the patient – an individualized, patient-centric approach. Every aspect of the person’s living experience is taken into consideration – the psychology, physiology, life experiences, attitudes, beliefs; to understand their journey towards the diseased state. The treatment plan is also customized to reflect this understanding.
Ayurveda also recognizes that every life form possesses an innate intelligence with innate healing abilities. Symptoms are compensatory mechanisms to overcome the imbalance. Symptoms are also the communication system the body uses to alert the individual of the imbalance so corrective action is taken. It is also important to note that although the symptom presentation may be similar, the underlying physiological imbalance can be varied. So, two people with similar symptoms of depression can have contrasting treatment plans, based on their unique psycho-physiological imbalance. Once again, reflective of the individualized, customized, patient-centric approach characteristic of Ayurveda.
In contrast, allopathic medicine is disease centric in approach and focuses on “managing symptoms,” sometimes at the expense of the whole person. Hence for any disease, there’s a cookie cutter approach – antibiotics for infections, antacids for heartburn, antipsychotics for psychosis, etc. But we are now realizing the folly of this antagonistic approach. Eg: overuse of antibiotics resulting in serious antibiotic resistance; emergence of serious side effects in post market studies, eg: risk of dementia with statins used to reduce cholesterol levels.
Ayurveda’s core philosophy is that we are one with the universe. We are all made up of the same elements that makes up the universe. All the laws of the universe are also applicable to us. That, the microcosm within a human body reflects the macrocosm of the entire universe. So, living in harmony with our eco system is essential for individual health. Taking care of the environment is not an afterthought, but a necessity for the survival of the human species. For this reason, Ayurveda emphasizes green and clean living – especially eating chemical and pesticide free food, non-genetically modified food, etc. In fact, we are seeing that many illnesses of the modern world (from diabetes to cancer to depression to autism) can be linked to environmental pollution and especially, degradation of our food production system.
When it comes to treatment, Ayurveda not only focuses on symptom removal (Shamana therapy) but also in removing the root cause of the problem (Shodhana therapy). For symptom removal, various herbal medicines and formulations are available. Certain procedures like Shirodhara are also used for symptom removal.
Shirodhara is a therapy where warm herbal oil or decoctions are poured rhythmically over the forehead to induce deep relaxation. This therapy is beneficial for many conditions like anxiety and insomnia, and is quickly becoming the fastest trend in the spa industry as well.
Ayurvedic herbal oil massage (Abhyanga) with steam sauna (Swedana) when done correctly is an example of a therapy that provides both symptom relief and also helps remove the root cause.
For removal of the root causes of a disease, balancing the physiology is critical. This is achieved by diet recommendations, lifestyle change and detoxification therapies (known as Panchakarma). All these therapies designed to remove the root cause of the illness fall under Shodhana therapies and are best done in specialized clinics under the guidance of a Vaidya (a doctor of Ayurvedic medicine).
Ayurveda is indeed enjoying rising popularity in the US and elsewhere. Ayurveda spas are the rage now providing specialized massage therapy, natural weight loss treatments, natural cellulite reducing treatments, chemical free herbal products for care of the skin, hair, including chemical free hair dye treatments, etc.
As a medical system, Ayurveda is helping people with various chronic illnesses – neurological diseases like Parkinson’s; infertility, menstrual irregularities and other reproductive issues; diabetes, obesity, thyroid and other hormonal imbalance issues; IBS, Crohn’s, Ulcerative colitis and other gut disorders; Migraine, fibromyalgia and other chronic pain conditions; acne, hair loss, eczema, psoriasis and other skin disorders; depression, anxiety, autism and other psychiatric diseases; prevention of cancer recurrence, etc.
Finally, as a way of life, Ayurvedic principles are helping people enjoy enhanced levels of mental and physical wellbeing!
If you or your loved one is looking to recover from chronic illness or simply enhance their wellbeing, it is worth a shot to see if Ayurveda is right for you.
More than 2000 years ago, Hippocrates – Greek physician and philosopher, widely regarded as the father of modern medicine, said, “Let food be thy medicine and medicine be thy food.” We have also heard the very common phrase, “you are what you eat.” This article will delve into the meaning and the urgent need to incorporate these philosophies today.
Even as recent as pre-1950’s, our attitude to food and health was very different compared to what it is today. For millennia, humanity’s survival depended on access to food. Where humans made their settlements, their economy, culture and in fact every aspect of life; centered around food and access to food. But in post-world war II era, for the first time, food became an after-thought.
With the advent of the post-industrial diet, based largely on synthesized ‘food-like’ particles, our present diet is incapable of meeting our nutritional needs while increasing toxic burden on our systems. With easily available, cheap, processed, junk food; people’s kitchens were hijacked by the food industry. Even natural produce and meats that are produced in huge quantities today, are devoid of nutrition and polluted with various chemicals like pesticides, antibiotics, hormones, etc. As a society, we rely on eating out, consuming fast food, quick meals, TV dinners, etc. Cooking has become a lost art and lost tradition! We seem to have also lost our instincts with regard to eating. Previous generations did not rely on food gurus to tell us what to eat!
Without a doubt, the outsourcing of our kitchens to commercial entities, has resulted in a chronic disease epidemic across the world, the likes of which humanity has not faced before. For most of human history, diseases were a result of “others” like bacterial, viral or parasitic infections. (It looked like we had conquered the “others.” But if current medical literature is to be believed, those little bugs and critters are once again gaining an upper hand! More on this problem later).
The rise in chronic diseases – heart disease, cancer, diabetes, mental illness, autoimmune diseases, autism, etc; is burdening our social-economic fabric tremendously. A few statistics from the National Health Council to share here:
Generally incurable and ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population of this country. By 2020, that number is projected to grow to an estimated 157 million, with 81 million having multiple conditions.
More than 75% of all health care costs are due to chronic conditions. Four of the five most expensive health conditions (based on total health care spending in a given year in the United States) are chronic conditions – heart disease, cancer, mental disorders, and pulmonary conditions.
A 2007 study reported that seven chronic diseases – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness – have a total impact on the economy of $1.3 trillion annually. By the year 2023, this number is projected to increase to $4.2 trillion in treatment costs and lost economic output.
Hence, we need to address these issues at their root. When we look at the root cause of these chronic diseases, they all share common factors in our diet and lifestyle. This article focuses on the importance of “real food” to reclaiming one’s health.
Prior to Hippocrates, more than 5000 years ago, physicians in India practicing Ayurveda (world’s oldest and continuously practiced medical science) recognized the central importance of healthy food for sustenance of life as reflected in many phrases. Two Ayurvedic phrases that encapsulate this philosophy are:
“The body is the outcome of food. Even so, disease is the outcome of food. The distinction between ease and disease arises on account of wholesome nutrition or the lack of it.”
“When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.”
What all these ancient cultures realized is that food is not just about calories. Yes, food provides energy and calories indicate the amount of energy that is available to us from the food we eat. Beyond that, calories do not have any other inherent meaning or value. But as a culture, we have reduced food to just its caloric value. Also, not all calories are created equal. For example, 300 calories from stir fried broccoli in ghee (clarified butter) is not the same as 300 calories from a snickers bar. Although you may be consuming the same 300 calories from the broccoli, it is not going to increase your belly girth or cause inflammation, which is what we see happen with the snickers bar.
Food is connection and memory. Food connects us to our culture/cooking traditions, our relationships, to nature around us (when we allow it to happen). Most of our memories around holidays center around food we grew up with, each generation trying to create that magic around holidays for the next generation.
Food is information – that regularly upgrades or downgrades our genome, the “software” of our body. The genome of the food we eat (in the form of Micro RNA) exerts it’s influence by either up regulating or down regulating critical genes in our body (source). For example: studies have shown that a diet rich in Omega 3 fats down regulates inflammatory genes, where as food made of trans fats, hydrogenated fats, or low in Omega 3 vs Omega 6 ratio; triggers inflammation by up regulating inflammation genes. Inflammation is proving to be the common denominator for almost all chronic diseases (from cancer to depression to heart disease to stroke).
Let me reiterate what I just said above:
The food we eat literally speaks to our genes and influences their expression.
This is the latest in the field of genetics, known as ‘Epigenetics’ – which translates to ‘Above’ genetics; and ‘Nutrigenomics’ – effect of food on our genome, for better or worse. This phenomenon has also been called, “cross-kingdom talk.”
No pill has come close to this effect. This is because, real, wholesome organic food that is not tainted with chemicals is made up of the same biology that makes us up. We are all products of this same earth. Millions of years of co-evolutionary processes have generated a wide range of interspecies, cross-kingdom co-dependencies. Due to this co-evolution, there is common genetic ancestry that makes it possible for communication to happen between the food we eat and our genome (cross-kingdom talk mentioned above). So, imagine, what can happen if this food is tainted with chemicals or maybe, genetically modified. The very nature of communication between our food and our genome is disrupted.
Let me illustrate this with an example. Let’s say you are communicating with your spouse by phone about what you need to prepare dinner. If the connection is clear, you will get the ingredients you need. But what if the phone connection is bad and your spouse gets only a distorted message. You are not going to get the ingredients you need for that dinner you planned. So, your dinner may not turn out the way you planned. Now, imagine this happening night after night! When we consume genetically modified, processed, junk food, made with industrial chemicals (more suited for your yoga mat or Nike shoes, than your bread!); unintended negative health effects result due to the miscommunication that has been caused.
Finally, food is you! The finest product of digestion, the essence of nutrients from the food you eat, is absorbed and used at the level of your cells not only for daily metabolic processes but also, to repair, regenerate, and build you. This is a continuous process that happens as long as there is life. A clear example is your bones and teeth. The two essential nutrients are vitamin D and calcium. Calcium under the influence of Vitamin D, after absorption, becomes your bones and teeth. A deficiency of these 2 vitamins causes structural and functional weakness in the bones and teeth, sometimes a very visible phenomenon. Lack of key nutrients have been associated with many illnesses from Scurvy to ADHD/dementia.
Overall, healthy food is anti-inflammatory, provides essential nutrients, alkalinizes the body (our blood is always slightly alkaline. When acidity increases in the system, it leads to inflammation), balances hormones & blood sugar, eliminates toxins, and is seasonal.
The seasonality of food speaks to the interconnectedness within nature. Let’s consider this question as to why water rich fruits and vegetables (cucumbers, zucchini, watermelons and other summer melons) grow and bear fruit in summer? Whereas, fleshy, calorie rich vegetables and fruits (pumpkins, potatoes, apples) are the bounty in fall and winter. For that matter, why is mulled apple cider or warm soup, a cultural favorite of fall/winter? And popsicles, lemonade, a thing of summer?
Ancient medical and philosophical traditions (like Ayurveda) have theorized that because of the interconnectedness and symbiosis that is an inherent aspect of any eco system, the kind of food that is abundant in a particular season is responding to the needs of the animals in that eco system. Hot, dry summers create the need for water rich fruits and vegetables; cold seasons create the need for warming, energy dense foods. Literally, what we need in a particular season is provided by nature in that season. Once we recognize this intelligence and support we receive from mother nature, we are filled with wonder and gratitude!
Another modern problem with not eating seasonally is to do with the unsustainability of this practice (in terms of ecological burden), the exposure to chemicals (from farming to preservation) inherent in growing food non-seasonally, and lack of freshness (as such food is grown in far off places only to be shipped worldwide).
In summary, favor food that is freshly prepared, seasonal, indigenous, organic & whole. Avoid food that is processed or refined; food with artificial dyes, preservatives, pesticides, additives, hormones, and genetically modified food.
A balanced diet should have all 6 tastes – salt, sweet, sour, bitter, pungent & astringent; 3 main components – Proteins, Fats, Carbohydrates; many minor components: vitamins, minerals, phytonutrients, essential elements etc.
Variety is the name of the game – switch grains, vegetables, fruits, protein sources – guided by the season. Eat and live like our ancestors (at least 3 generations ago). We also need to develop body-mind awareness to assess how the food you eat impacts you. As there is no one diet for all!
As regards food preparation: it’s best to cook in stainless steel, cast iron, ceramic or earthen ware. Non-stick utensils can leach harmful chemicals (endocrine disrupting and cancer causing) into the food. Do not store food or water in any plastic containers for the same reason as non-stick utensils.
Finally, as food researcher and blogger, Michael Pollan says, “Eat (real) food, not too much, mostly plants.”
Aruna Tummala, MD, ABIHM
Trinergy Center for Integrative Psychiatry
12800 W National Ave, New Berlin, WI 53151
Ph: 262 955 6601
There are only a few emergency situations in the practice of psychiatry. However, these emergencies can be devastating not just to the patient, their family, and society, but everyone involved, including the care providers. And suicide is the most feared of them all.
Suicide is a hard topic to raise and discuss. Not only in the clinical situation but also in the non-clinical settings. Families, friends, in school/work and society – we are afraid to talk about suicide. But ignoring it does not make it go away. And one day, we are jarred awake with the ugly presence of this menace in our society.
Two noteworthy suicides in our recent collective conscious is of Kate Spade and Anthony Bourdain. Not to mention the countless number of deaths attributed to suicide by everyday Americans. According to recent CDC (Center for Disease Control) reports, suicide rates have increased by 24% between 1999 and 2014, from 10.5 to 13 suicides per 100,000 people, the highest rate recorded in 28 years. In absolute numbers, nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people aged 15 to 34, suicide is the second-leading cause of death.
Why did they do it? is what all of us are asking, whether it is in regard to Kate and Antony or anyone else. In working with people struggling with mental illness and suicidal feelings, the common factors I have come to recognize are just a handful.
Hopelessness (or despair) and isolation are, in my experience, the 2 most common factors that have been associated with suicidal feelings and attempts. Studies have also identified hopelessness as a close indicator of suicidal feelings. Despair and utter hopelessness is a sense that they cannot solve whatever issue or problem they are facing. Coupled with the sense that no one, absolutely no one else in this world “gets” them. No one can help them. No one else has faced such problems and no one else can have a solution. When one is walking around with thoughts like these, an environment where one is unable to discuss suicidal or other negative feelings only adds to the problem. This terrible isolation can be devastating to us humans.
There is also the issue of co-occurring alcohol and drug use, which can exacerbate faulty thinking and decision making, while also increasing disinhibition – making a suicide attempt all the more likely. The recent increase in opioid addiction also muddies factors, as not all opioid deaths are suicidal…many are accidental in nature.
Parallel to the rising rates of suicide is an increase in the rates of depression, anxiety and other mental illnesses in our population. This is probably not surprising. Our modern society places enormous stress on its citizens in terms of social/economic pressures and also in terms of the onslaught of chemical toxins our bodies have to cope with and detoxify. For millennia, our bodies have relied on robust nutrition to cope with stress and toxicity. But in this area too, our modern diets are failing us. Highly processed food, with refined flours and sugars, lacking essential nutrients, and filled with more chemicals (artificial dyes, flavors, preservatives); is what the Standard American Diet is made of.
Another factor to consider is the social isolation that many of our youngsters are reporting. As we are advancing to a more tech dependent socializing experience, it deprives us of all of the benefits of socializing even at the neuronal level. All these factors can contribute to poor stress moderation, poor coping skills, poor distress tolerance, poor problem solving skills and over time creates the state of apathy and despair that can eventually lead to suicide.
As you can see, this problem of suicide is a complex one, almost like peeling an onion. And it requires a comprehensive, multi modality intervention that addresses not just at the individual level but also at the societal level.
Some economists are calling this recent increase in suicide “deaths of despair” and linking it to the Great Recession of 2007. Interestingly, more than half of the people who died by suicide, did not have a diagnosable mental health condition. Economic despair was seen as the more common factor here. Maybe it is time to view suicide as a public health crisis. However, suicide is commonly viewed as a “mental health crisis” and the common refrain in the media is that more access to mental health treatments should be available.
Unfortunately, we are seeing that the answer to the suicide or mental health problem is not as easy as simply making mental health treatment available. In fact, rates of antidepressant prescriptions have skyrocketed since the 1990’s. A recent study has co-related the increase in suicide attempts and completed suicides in women, to a parallel increase in antidepressant usage. It is well known that antidepressants increase suicide risk in young people. It is also now known that long term use of antidepressants can result in a chronic state of dysphoria (due to tachyphylaxis – a phenomenon in which prolonged use of a substance makes it less effective over time). Of course, one cannot abandon provision of care delivery systems altogether, but it should make us all reevaluate what we are doing in response to a problem of this magnitude.
It is high time that we moved away from a simplistic “medication or therapy” solution and worked at evaluating the underlying root cause not just at the individual level but at the level of the society. For instance, a study published recently found that oral contraceptive pills increase the risk of depression and suicide in young women (aged 15 to 19) by almost 80%. In such a situation, is it justified to prescribe an antidepressant to such a young woman? Or, should we dig deeper and evaluate the hormonal imbalance caused by the contraceptive pill and work to fix that? I would argue for the latter.
Within a holistic, root cause framework, we can evaluate the role of not only hormones, but also nutrition, relationship skills, problem solving skills, etc. and put in place solutions to optimize these areas. At the level of the society, we can work towards reducing stigma surrounding mental illness and suicide, work on enhancing inter connectedness with each other, teaching meditation and other self-help skills, work for equitable distribution of nutritional and other resources, make our environments less toxic, reconnect with nature, increase awareness and provide resources for vulnerable populations (eg: teens, veterans, etc).
But all this can happen only if we talk about the elephant in the room!
J Larsson. Antidepressants and suicide among young women in Sweden 1999-2013. Int Journal of risk & safety in medicine 29 (2017) 101 – 106.