THE BLOG
10/11/2013 09:29 am ET Updated Jan 23, 2014

10 Keys to Creating a Mental Illness Management Plan

At least there is a day. A day to recognize that 61 million Americans suffer from mental illness. Approximately 1 out of every 4 Americans have an episode of mental illness in a given year. [1] Antidepressants and anti-anxiety medications are now a billion dollar industry, with many men, women and children battling depression, anxiety or other mental health conditions. [2]

Mental illness crosses all boundaries: racial, socio-economic, cultural, and age. Our celebrities emerge from time to time admitting their own personal struggles with mental health, while the horrors of school shootings and mass violence echo in our collective consciousness. We have a mental health crisis in our country and do not seem to have an effective plan of action.

There is much debate on the best way to handle mental illness or the best strategy to pull a loved one from the abyss that their minds will often create. There are patients that need medication, many that are over-medicated, and some that cannot tolerate prescription drugs. Women are sometimes quickly given prescription medications when they complain of fatigue or trouble focusing. I often find that when one medication does not work, another is quickly added. Alternatively, other patients who are depressed or highly anxious will often be overly ambitious to dump their medications, often finding themselves spiraling downwards or withdrawing.

We need a plan for managing mental health and a more comprehensive strategy to help identify and recognize mental illness. Mental health, like diabetes or obesity, should be approached systematically, accounting for nutrition, lifestyle, emotional support, spirituality and need for medication. Medications should be used cautiously, as some patients lack detoxification mechanisms to use antidepressants or anti-anxiety medications effectively.

Creating a Mental Health Action Plan

Nutrition -- Create a Brain Healthy Diet

Nutrition does impact mental illness. In practice, I see this most obviously with children. Diets lacking amino acids, the building blocks of neurotransmitters like dopamine and serotonin, predispose many adults and children to depression and anxiety. High-sugar diets often promote a yeast overgrowth in the small intestine, resulting in Candidiasis. Food allergies and intolerances can affect absorption of essential nutrients.

- Diet recalls should be a part of all mental health evaluations.
- Keep total protein at 50 grams per day or higher. One serving of meat, for example, has about 20 grams of protein.
- The total sugar load should not exceed 40 grams per day or approximately 6 tsp. This is equivalent to about 1/2 can of Coke.
- Screen for nutritional deficiencies. Poor methylation, or the inability to use B vitamins, can impact mental illness.

Sleep

Anxiety and depression can worsen with an irregular sleep cycle. Sleep consistency is key to preventing flares of mental illness and may be a factor in postpartum depression.

- Maintain consistent sleep cycles at least five nights per week. This requires a repetitive bedtime and awake time.
- If you or someone with a history of mental illness is expecting a child, plan for postpartum help with the infant.
- Many supplements and mind-body techniques assist with regulating sleep. Sleep medications often alter neurotransmitter function, sometimes worsening mood fluctuations. [3] My favorite starting sleep remedy is magnesium, taken approximately 30 minutes before bed. Check with your doctor for appropriate dosing.

Hormones

Women are at greater risk for mental illness, often due to the hormonal fluctuations of pregnancy, peri-menopause and menopause.

- All women should have hormone levels evaluated at least every five years.
- If mood symptoms are concurrent with hormonal symptoms like irregular cycles, hot flashes and night sweats, latent depression and anxiety can become exaggerated.

Detoxification Status/Poly-Pharmacy

Many patients react poorly to prescription antidepressants and anti-anxiety medications. These patients are also at risk for poly-pharmacy, where medications are often layered upon each other with little benefit or sometimes at greater risk of exaggerating mental illness.

- It is now possible to test detoxification capacities for different medications. Testing liver function is also helpful in determining if a particular medication will be a good fit.
- Patients with poor gastrointestinal function often do poorly on medications, since this will affect detoxification.
- Question medications after more than two prescription drugs are started. Multiple medications increases the risk for poly-pharmacy.

Quality of Life/Life Inventories

In practice, I often notice that depression and anxiety is less a functional or chemical issue, but more of a discontent with life circumstances. Learning skills to help manage this discontent is often more helpful than supplements and medications.

I often encourage patients to look at their lives and see which aspect may be neglected or unfulfilled. Are they engaged in passionate work? passionate relationships? Are there unfulfilled goals that are yet to be met?

Sometimes, doing a life inventory helps to identify goals for moving forward. Journaling, counseling and cognitive behavioral therapy are helpful in changing internal dialogue and reassessing goals.

Peer Evaluation

Many that battle mental illness are often alone or present conflicting information to health care providers. Creating mental health peer groups, in the form of church groups, coworkers, family or support groups could provide physicians with insight as to how patients are really doing within their lives. Peer evaluations would be valuable additional information to doctors trying to make prescribing decisions.

Social Support

Much like peer evaluations, evaluating social support is important in managing mental illness. Patients that are alone or isolated should be flagged within a family or even within the medical system, requiring more frequent follow up.

Spirituality

Mental illness, according to most religious traditions, is spiritual disconnection. [4] Encouraging patients to seek spiritual support, regardless of religion, is an important element of mental health.

Medications

Finally, many patients do need medication to manage their illness. Medications, however, should be a part of a comprehensive plan, not just a first step in managing disease.

We have a national and international global mental health crisis. Solving that crisis requires a 10-step program for all patients, not a one step quick fix prescription. Help your loved one create a mental health action plan that incorporates all aspects of health.

References:

1. National Institutes of Health, National Institute of Mental Health. (n.d.). Statistics: Any Disorder Among Adults. Retrieved March 5, 2013, from http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml

2. http://www.medscape.com/viewarticle/511163, http://www.statista.com/statistics/252393/total-us-expenditure-for-mental-health-services/

3. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a693025.html

4. Cassell, E.J. (2004). The nature of suffering and the goals of medicine. New York: Oxford University Press.

For more by Tasneem Bhatia, M.D., click here.

For more on mental health, click here.

Subscribe to the Lifestyle email.
Life hacks and juicy stories to get you through the week.