Finding Balance: Medications vs. Self-Improvement for Mental Health

A couple of weeks ago, Dr. G. reached out, interested in becoming a patient. He complained of depression treated with Effexor by his PCP. While his symptoms had improved somewhat, they remained problematic. Initially, he seemed interested in entrusting me with his care. However, after a few attempts to contact him to offer an appointment, he finally got back to me and said, “I have to apologize to you, I did not mean to ignore your messages. At this point, I’ve decided to work on my lifestyle improvements along with the medication I’m using from my family doctor.”

When patients say they are going to work on themselves or improve their lifestyle, the implied message is often, “I’d rather avoid something that’s too involved, like your TMS thing,” or “I don’t like to take medications.” That’s understandable. Medications often come with side effects, and even if they don’t, they can be a burden that patients must incorporate into their daily routine.



With this preamble, I was inspired to write this article addressing how to work on oneself, but also mentioning the medication tweaks I would’ve proposed to Dr. G. had he come in. There will be some generalizations here, given that we only spoke for a couple of minutes and texted once or twice after that. This is not a full psychiatric evaluation—just some ideas he can take to his PCP.

Now, Working on Myself

When patients choose to work on themselves, I recommend several strategies:

1. Rule Out Medical Problems: Simple blood work can identify conditions like anemia, thyroid disorders, or Lyme disease, which can contribute to anxiety and depression. Addressing underlying medical issues is crucial, as medications alone may not be enough.
2. Psychotherapy: If patients haven’t already tried talk therapy, I suggest they do so. This can minimize the need for medications and help build psychological stamina and self-reliance .
3. Mindfulness and Meditation: Regular mindfulness meditation has been shown to reduce anxiety and improve mood . Starting with just 10-15 minutes a day, using apps like Calm or Insight Timer, can be effective.
4. Physical Exercise: Even light activities like walking or yoga release endorphins, reduce stress, and boost well-being .
5. Sleep Hygiene: Regular sleep is essential. A disrupted sleep schedule can worsen mental health. Establishing a bedtime routine, avoiding screens before bed, and minimizing caffeine or heavy meals are all helpful .
6. Diet and Nutrition: A well-balanced diet that includes omega-3 fatty acids from fish oil or flaxseed has shown positive effects on mood .
7. Journaling and Gratitude Practice: Writing thoughts down can provide emotional relief and help patients identify mental patterns. Gratitude journaling can improve awareness and well-being .
8. Embrace Routine: A structured daily routine helps build resilience. Many retirees struggle with losing the goals and structure their job provided. Finding meaningful activities, like volunteering or a part-time job, can help restore balance .
9. Exposure to Nature: Walking in nature has proven psychological benefits. A study in Molecular Psychiatry showed that after just one hour in nature, participants experienced decreased amygdala activity, reducing anxiety .
10. Social Support: Connecting with others is vital for mental health. Isolation can be as damaging as smoking .
11. Minimize Drug Use: Limiting alcohol, caffeine, and other substances is essential for improving mental health .
12. Limiting Screen Time and News Consumption: Excessive screen time and distressing news can worsen mental health. Reducing exposure, especially to negative content, will free up time for more positive activities .

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