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A Psychiatrist on How She Treats Mental Health Without Medications

Dr. Aparna Iyer

Dr. Aparna Iyer is a holistic and integrative psychiatrist, specializing in perinatal mental health. She currently works out of a private practice in Frisco, Texas, alongside her position as an assistant professor at the University of Texas Southwestern Medical Center.

Self-described as a “psychotherapist first, psychiatrist second,” Iyer focuses on alternative styles of medicine that involve lifestyle changes and behavioral modifications. While she does prescribe medications, she rarely believes that they’re ever the whole answer. Rather, Iyer implements a holistic medical approach that considers a patient’s background, diet, sleep patterns, exercise routine, career, and relationships.

Why do you focus so much on lifestyle changes and alternative forms of medicine in your practice?

When I first started practicing, I found myself looking at medication as the first step for every patient. I quickly realized that you really can’t have a one-size-fits-all approach for all patients. Everyone has unique histories and backgrounds and medical pictures. Also, medications were not necessarily the right fit for some people. There’s a subset of patients that just don’t respond well to psychiatric medications, or they don’t tolerate them. So, I quickly had to adapt and become creative in my approach.

I also found that a lot of my patients come to me hoping for other ways to take control of their own mental health — more behavioral-focused things that they can do at home, instead of just relying on a medication. Because of this, I’ve started looking at more of a holistic approach, and really having a critical look at whether medications are necessary before I consider prescribing one.

What are some examples of these lifestyle changes that you implement?

Often times, people don’t realize how some of their habits may be harming their mental health. For example, we know that you need an adequate amount of sleep per night to feel refreshed and process information, but also for your mental health to be as good as possible. We also know that oversleeping is detrimental as well. So, I’m very aggressive about addressing people’s sleep tendencies and sleep patterns. We look at how much they’re sleeping, as well as what they do right before they go to bed — are they getting too much exposure to screens and blue light? Or, are they having medical issues that are worsening their sleep quality?

Another example is diet. Sometimes people are drinking too much caffeine or they’re drinking it too late in the day, and they don’t realize that it can make them more energized, or irritable, or anxious. Also, alcohol. It’s pretty common that people will go out and get something to drink with their friends. Before you know it, one drink turns into two, and two drinks turn into three or four. For somebody who has a sensitivity to alcohol or might already be depressed, alcohol can impair their judgment and make them more impulsive or depressed. And, people don’t realize how detrimental of an impact it’s having on them, just because it’s so widely accepted as something people do. So, we work on addressing all of these things.

When treating patients, do you focus more on the symptoms or root of an illness?

I think that it is a combination of both. Sometimes, when someone is having such severe symptoms, to the point where they are unsafe or unable to function, I think that the primary focus needs to be on getting that person to a place where they’re able to be functional and well enough again first. So, we’ll address the symptoms first, and then we’ll look at the root of whatever may be causing their illness. But, it really depends on the person and how deeply they’re being impacted by their symptoms. I use that to help me prioritize which strategy to employ.

How do the outcomes of this type of alternative medicine compare to those of traditional psychiatric medications?

I would say that blindly prescribing a medication to someone, or believing that a medication can be the whole picture for any person, usually is not going to be effective. I think that the biggest thing for me is establishing a strong relationship and sense of trust with patients and understanding them entirely in their complexity. Then, it’s about understanding what their needs are and trying to meet them through a variety of techniques, that may or may not include medication. I think that if I address all of their complex needs, even if medications are not part of the picture, my outcomes will be better than if I were to just prescribe a medication.

Do you encounter certain stigmas or skepticism against alternative medicine? How do you deal with that?

Psychiatry in general carries a certain stigma, unfortunately. I think that people seem to be very opinionated about whether traditional psychotropic medications are the most effective option, or alternative forms of approaches. My opinion is that it [doesn’t] need to be one or the other. I think it can be a combination of everything.

When I talk to the patient, and they’re hesitant about something, or they feel that there may be a stigma against non-psychotropic approaches, I usually first address that by building a level of trust with that patient. I tell them that we arm ourselves with an arsenal of tools to help them with whatever they need help with. Usually, we have to come up with a creative concoction of treatment options, and that may or may not include traditional psychotropic medications. And then, just like with any medication, they need to be able to tell me whether something is working or not, so we can continue to try new things [if needed].

In the future, do you see alternative medicine as being increasingly integrated into the field of psychiatry?

I think so. I think that, especially if we can look at alternative medicines as more of a holistic form of treatment — something that might address the underlying cause — I can see it as being integrated more into the mainstream form of psychiatry.

Now, you’re starting to see psychiatrists integrating different forms of treatment and wisdom from various other cultures around the world. For example, meditation, mindfulness, and yoga — things that were not typically accepted a while back — have become very mainstream. So, I foresee that, in the future, psychiatrists will become more and more open to the idea of integrating various forms of treatment, whether it’s complementary, alternative, or traditional.

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