A man in his 20’s suffered from 5 years of insomnia since a traumatic event occurred that he obsessed about at night.  A low dose of melatonin failed. The medicine trazodone helped sleep and now that he was better rested, he could use a three step meditation method every night to stop the obsessing. It took him five minutes to learn the technique in my office.  He looked forward to meditating every night instead of dreading insomnia, and this positive expectation allowed him to gradually phase off the trazodone over the next six months. The vicious cycle of the dread of insomnia bringing on the insomnia was broken.

In taking a holistic approach, I look at the biological and psychological and social factors causing problems, and use solutions in the same category as the problems.

I look for biological answers, like medication, when a biological problem has been identified, such as insomnia. For example: we will explore melatonin and chamomille tea and other herbal remedies and meditation, and if they fail use the most effective and least expensive non addictive medication, such as trazodone or Remeron.  Later a slow decrease of the medication can be tries, because the brain can grow new connections to lessen it’s dependence on medication, whether traditional or alternative.

And sometimes there are psychological problems, so they should get psychological answers with new thinking strategies to reduce stress.  A new medication won’t help if a person’s thinking is off track.  And then social problems should get a social answer.  Such as learning communication strategies to meet new people and make friends.

Often people are stuck doing something positive in one category, such as exercising more to help anxiety, but then obsessing about problems which undoes the progress you get from exercising.

Here is an example of a holistic approach using the above strategies:

A 35 y/o housewife and mother of two complains of insomnia and anxiety and depression.  Counseling and prayer help somewhat. She has little time to exercise. Her energy is low from poor sleep and hours spent cooking and cleaning.  She can’t stop obsessing on her mistakes. Her sleep got better on trazodone, mood got better on Lexapro, and she pampered herself twice per day with breaks to enjoy herbal tea and meditation.  With meditation she saw how she was so hard and judgmental towards herself and learned to care for herself more. An app helped this learning as did podcasts she could listen to while caring for her children. Part of her depression was feeling disconnected from her husband, but now that she felt better and more mindful, she opened up to her husband on how she wanted to see them grow closer together.  She also drew up a weekly chorelist and gave some chores to her husband, some to her kids, some to herself and some to a once per month house cleaning person. Gradually as the chaos in the home calmed down, she phased off her sleep medicine, replacing it with meditation, exercise and chamomille tea at night with melatonin. She took a sophisticated approach to her life that she needs to ask for help to get her needs met so she can be happy, like other people do.

One problem I often see is once the brain experiences depression or anxiety or insomnia every day for one month, it can take that as “the new normal.”  Then even doing helpful things for these problems, such as exercise to boost your mood, doesn’t work. The brain has taken depression as the new normal for itself, and will refuse to respond to actions that might otherwise have changed it.

Medication can often “break through” this refusal of the brain to respond to healthy activities that often worked in the past.  This is the advantage of using the modern medical model of understanding the brain because you can catch it going off track and get it back on track.

Exercise and hobbies couldn’t help a worried 16 year old high school from obsessing he was doing poorly in school.  The worries kept him up at night, adding to depression, which in turn lead to worse focus, and grades had plunged from B’s to D’s.  The antidepressant Lexapro helped his mood, melatonin helped his sleep, and the three step meditation stopped night time obsessions.  He had poor focus despite having a good mood. Rating scales from teachers showed attention deficit disorder. With Ritalin, his grades went up to mostly A’s, self esteem improved, as did sleep.  A year later he phased off Lexapro and melatonin because the Ritalin treated the core of the problem. Poor focus lead to the school problems that he took personally, leading to insomnia. With good focus he enjoyed the challenges of learning at school.  His good grades in high school paved the way for success in college and after getting a college degree he got a good job in Denver. (I see stories like this because I’ve been practicing for 20 years.)