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Natural treatments for anxiety and depression

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Natural Treatments for Anxiety & Depression

Dr. Murphy:

Just wanted to start off by saying I have no financial disclosures related to this presentation, other than

the fact that I'm employed by American Health Network, which is an Optum company, who asked me to

provide this presentation. Now, of course that's true at all times, with any medical presentation, any

information that's presented, is not meant to reflect medical recommendations for you specifically. Of

course, consult your own physicians for personalized recommendations and guidance.

Dr. Murphy:

I wanted to say, this is a really important subject that we have today. I'm an osteopathic physician, and

an overview of a holistic approach to any subject is very important, and especially this. The focus here is

going to be on a patient-centered, or individualized approach to mental health, and how we can do this

naturally. I'm really grateful for the subject and the timeliness of it, especially given everything going on

in the world. We have a lot of pressures and stress on us normally, and of course now is no better time

to focus on things that can keep us healthy, without going out of our house, maybe.

Dr. Murphy:

So I wanted to say first off, I have experience with this subject in my own family, among friends, of

course among my own patients. I wanted to share with you a specific experience that I had with one of

my own patients. This patient came in during a family member's visit. And this patient came in and took

the opportunity to start asking questions about mental health, even though it was not this person's visit.

This person said and I'll quote, said, "I have felt depressed, and sometimes think about killing myself." I

asked, "Why didn't you bring this up during your appointment, that we had even recently?" She said, "I

know this is my spouse's appointment, so I can just say anything I want, without worrying about what's

going to be recorded, or kept record of."

Dr. Murphy:

So this is a good example, and a sad example of the stigma that still exists around anxiety and

depression, in our society. There's more awareness in our society, but still there's a stigma that we need

to battle, and overcome. Because this is something that affects more people, than we even realized. And

we need to really create more acceptance and awareness of this problem. Remember, you're not alone.

Dr. Murphy:

So let's go on and look at some statistics here. I'm going to see if I can figure out this, screen-sharing

thing and move on here. So the first question is, how big is the problem? So, we're going to just go

through this slide. 46.6 million US adults, which equals 18.1% of the adult population, has a mental

illness, at least as recorded in 2017. Anxiety is the most common of these, with 40 million adults every

single year. Again this is US adults, which is 19.1% of the population that they estimate, experience

anxiety. So again, these statistics are measuring slightly different volumes if you'll notice, and the way

it's recorded through these studies might vary, but nearly 17. [Inaudible 00:03:41].

Dr. Murphy:

4.3% of those have severe impairment, and less than half of those received mental health care. We also

see that recently, this has actually been significantly affected by, some things that have been going on.

And even adolescents recently have had increased antidepressant use. Antidepressant use increased

15% from 2015 to 2019, with adolescents having 38.3% increase. So you can see this is something that,

especially in primary care, we see possibly more than any other medical condition. And it affects people

in their families, it affects their health, it affects risk of other things like, cardiovascular disease, and

heart attacks, and strokes. And so, we really aren't great as a society about understanding, and caring

for those, who go through anxiety or depression. And of course, in this brief overview, we didn't include

a lot of the data about adolescents. That could be a whole other subject. But some argue that our

current society and the model that we have, is not very good at providing mental health care for our

children, or setting up for mental stability, and emotional stability among our children and adolescents.

Dr. Murphy:

Next, I wanted to go through a couple of different graphs, to show this data. Specifically, as it relates to

anxiety, the past year from, this is again from 2001, 2003, this was some data that we reviewed. And

you can see that overall, females have a little bit of [inaudible 00:05:26] males, but it definitely is spread

throughout the age ranges of 18, to 29, 30 to 44, 45 to 59 as well, and 60 plus also experiences

significant amount as well.

Dr. Murphy:

And now, as far as severity goes, it's split between serious, moderate and mild. So mild is about 43.5%,

and moderate is 33.7% that experience that level of severity. The reason why this matters is because

some of the studies are related to, natural approaches. Anxiety and depression show that mild and

moderate anxiety, will have better efficacy for these natural remedies. So these are very effective for

the majority of people that have, anxiety or panic attack disorders. This graphic is showing us that

through SAMHSA, which is a great organization, you can look those up. The past year, go back here. The

past year, prevalence of major depressive disorder among us adults. Again, it's fairly well dispersed. So

again, females more than males, but still significant. There's 18 through 25. The young age ranges are

having, a lot more of these depressive episodes.

Dr. Murphy:

And you can see it's split fairly well between all races. There's some more Caucasians than, others. In

terms of severity of depressive disorders, severe impairment episodes, at least in 2017, was more

common than those without severe impairment. So depression definitely can cause severe impairment,

job functionality, problems with family. There's lots of things that come from this. And any of us that

have had this as either within our family, or ourselves, know how hard it can be. Now I wanted to briefly

hit on a current subject. Some of you may have seen some, news articles saying about COVID and how,

some of the other things going on, including social unrest, have increased stress, and anxiety, and

depression. That's a real statistic, and we definitely see that in primary care, that there's a lot more

people feeling that, and having these worsenings of their anxiety, or depression. There's actually a

recent study that, was put out by Express Scripts that was reported by Medscape I wanted to share, that

show that the number of weekly prescriptions for antidepressants, and anxiety medications, and anti

insomnia medications, jumped nearly 21%, during February and March of this year.

Dr. Murphy:

And it peaked in the week of March 15th, when the World Health Organization declared COVID-19 a

pandemic, and then the US also declared a national emergency that week. So the important thing about

this, is that more than three quarters of those prescriptions, that means 78% of them, in the week of

March 15th, were from new prescriptions. And so that's not refills, or people saying, "I need to go back

on them." That this is new people experiencing new symptoms. Having new stress, having new disability

in their life because of anxiety or depression. So I think that's significant. Again, you're not alone, your

family is not alone. And it's important to remember that, and to be kind to yourself and, we can get

through all this together.

Dr. Murphy:

So let's move on. I wanted to talk first about treatments. Of course I am a physician, so medicines do

have their place. And while this talk is about natural remedies, we'll briefly go through medication.

Many think, that medications are the answer, and they look for a simple solution that they can take, that

will fix it all. And that definitely is vital. So medications definitely have their place, especially it's effect.

There're those that are effective for anxiety, PTSD disorders, panic disorders first-line. There's no

question in data about that. And then, the reason why this matters is, or the way this works, is that

serotonin in the brain, becomes low when you're undergoing stress or pressure. The brain actually can

stop producing as much serotonin, norepinephrine, oxytocin, and some others, including dopamine.

Those levels, they don't bounce back quickly.

Dr. Murphy:

Medications can help the brain naturally, restore those levels of serotonin, which gives us the ability to

cope, maybe with the stress that we have. Again, in a natural way, it's a normal hormone that we're

supposed to have. But there are bad treatments for anxiety, that a lot of people may have heard about.

And so just to review some of those, I definitely feel that the evidence is strong in, the literature about

benzodiazepines, that are used longterm.

Dr. Murphy:

These include things like Xanax or Ativan. They're fine in short term for, brief episodes of panic attacks

or other things, but there's lots and lots of side effects. It's definitely happens more so in older

population, but we see drowsiness, increased reaction time, ataxia, motor incoordination, anterior

grade amnesia. We have cognitive decline, that actually, according to the studies, there was actually a

great meta-analysis, which is a conglomeration of studies about studies, that looked at withdrawal from

people that were going off of higher doses of benzodiazepines. In average of 17 milligrams per day of

diazepam, found that the longterm use, led to substantial decline that didn't resolve, three months after

discontinuation.

Dr. Murphy:

So this can continue to have a negative effect on our brains, for long after we take the medicine. And

that's different from other classes like SSRIs, or SNRIs, or even things like Wellbutrin that don't have that

same effect. Now, motor vehicle crashes that the risk of driving with benzodiazepines, is about the same

as a blood alcohol of about .05, to .079. So 0.08, is actually the level that, above 0.08 is the level that's

considered illegal in all States, in the United States. Interestingly enough also, you see the slide that hip

fractures is increased by at least 50% in elderly, when they take benzodiazepines, whether acutely or on

a longterm basis. And then Zolpidem, which is sleep medicine, also has been shown to increase hip

fractures by 2.55 times that of those, who are 65 and older. That's a significant thing, and we want to

keep that in mind when you talk about medicine.

Dr. Murphy:

So there're good medicines, and then some of these aren't the best to rely on as primary treatment. So

let's define natural approaches. We're going to talk about this, and they're essentially defined for the

purpose of this talk, as non medicinal. So things that we are not using a prescription from a

pharmaceutical for. Things that even though they may be a natural supplement, they're not given

through a pharmacy. And so I think that's why we're all here today. First, many of us have heard about

therapy, Cognitive Behavioral Therapy is the reason that, we have psychologists that do great jobs,

working through some of the things that we have, exploring why we respond to things in certain ways.

There's two different theories here. One is that, we have preconceived notions, or things in our brain

that lead us to act certain ways from birth.

Dr. Murphy:

And then there's another that says that there're things called life traps, that we learn or develop as

we're growing, and as we're developing, throughout our childhood and adolescence. If we experienced

trauma, or abuse, or any kind of loss during our childhood or adolescence, that can lead us to develop,

traps or ways of thinking or coping, that aren't healthy in the long run. So when we become an adult,

maybe that way that we coped as a child, leads us to abandon relationships, or leads us to isolate

ourselves, in a way that isn't healthy. And so Cognitive Behavioral Therapy, can help us work through

some of those life traps. The negative sides to therapy, is that it can cost more than medication, it can

take time. But then on the other side, it can also lead to positive coping skills, that we may not have had

before.

Dr. Murphy:

And that's very valuable, because it can lead to doing things without medicines. And all the studies show

that CBT, which is Cognitive Behavioral Therapy, or general therapy, works very well for anxiety and

depression. And of course, there's the problem with therapy as well, that with insurance coverage, we

all know that challenge. But one other challenge that we see quite often in primary care is that, it can be

difficult, to find a therapist sometimes that you can connect with. So sometimes it takes one or two or

three times, to find the right person. If you've been searching for the right person, just keep searching,

because a good therapist can make a big difference in your life. So onto my favorite subject in this talk,

is exercise. Now this is underestimated treatment. And we don't hear a lot about it, at least in the

media, and from doctors even.

Dr. Murphy:

Exercise is consistently shown, as one of the best ways to treat and manage anxiety, and depression. It's

a great choice. It's cost effective. It can help anxiety disorders, panic disorders, that are resistant to

other treatments, and also unipolar depression. It also is really good for PTSD. Now maybe if I can be a

little bit theoretical here. If we look where we came as a species, and where we've been for centuries,

we were meant to move. So the human body was meant as a long distance animal. A lot of cultures

were hunters and gatherers, we would chase herds of animals across long distances. And our bodies

were designed for that. We're able to do that better than almost any other species that's on this earth.

And so in our modern society, we do so much less activity, less work.

Dr. Murphy:

And so that might be one reason that we see a lot more anxiety and depression, coming in our society.

Remembering that, if we can include exercise in our life, it can unlock parts of our body and our mind

that we haven't experienced, for decades, if not centuries. Now there's no true guidelines in the studies,

as far as what level of exercise helps, and how much you need to do to get that benefit. My general

recommendation is that, 30 minutes a day for five days a week has cardiovascular outcomes, and also

can lead to maybe the earliest parts of weight loss. So in the studies though, they just showed that

aerobic, and resistance training can give us benefits naturally, which is good to know. It's not just

walking. It can also be resistance training, bands, or weights.

Dr. Murphy:

So much more we can talk about there, but in interest of time, let's go on to yoga. There's actually good

data on yoga. It's helpful for very specific things, with depression it can be useful alone, without

medicines. It can actually help and improve things for a fair amount of time. Some studies show that if

you did yoga 60 minutes per week, for one session, each time it can help for six weeks or more, and

that's very effective. And then it also, as an adjunctive treatment can work for anxiety, and depression.

I'm sorry, anxiety and panic disorders. Knowing what we struggle with is important. I'll take this brief

moment to say, if you have any questions about which you struggle with, or what your family members

struggle with, there are some scales that you can look up, to grade yourself, and see where you are.

Dr. Murphy:

One of them is the PHQ-9, that's a good screening tool. We use that a lot in the medical field, and it has

essentially nine questions that we'll ask you, and you can rate where you scale on depression. And then

for anxiety, something called the GAD-7, G-A-D 7, is another good option. And then you can scale that to

determine which one would be better for you. And you can help choose between some of these

methods, depending on which one you feel is primary. You may have noticed in some of the news, they

periodically report that a study comes out about gardening, and that is true. So gardening helps

wellbeing overall. There're great scales shown that overall sense of wellbeing can be improved, with

gardening. And also depression, it can be effective. Partially this may be because we're getting out in the

sun, and we're moving. So we're going back to the exercise component. But it can be therapeutic as

well, just to get out, and get your hands into something that you're building or growing. Meditation is

different from mindfulness strategies.

Dr. Murphy:

And so, both of these work best for depression. This can be effective for six months or more, even doing

them once per day, or once per week, can help center us, and help lead to more of, a centered strategy

where, you're able to cope with some of those depressive thoughts, improved sleep, feelings that you

have greater ability to cope. And so again, works for anxiety and panic disorders, when you're on

medicines as well. That's what the studies have shown, but really for depression, this is excellent. And

then if you're on medicines as well, this can be a great strategy. Now, one that you may have not heard

of, Tai Chi or Qi gong, is a strategy that comes from the middle Eastern, or Eastern cultures. And it's

similar to yoga, as well as some very slow movements.

Dr. Murphy:

So this is different in some ways, not so much strong movements, as gentle movements. Has to do with

body position in space, and combines postures, and gentle movements, with focus, and breathing, and

relaxation. This one in the studies, it did show some positive results in some small studies, but

inconsistent when you look at larger studies, or combining those results. So for this, it's not as good as

some of those other strategies. For medications, there are supplements that actually do work very well.

One of those is St. John's wort. This is probably one of the oldest that's been reported. St. John's wort is

actually very similar to antidepressant therapy especially, some studies have shown that it's equivalent

to tricyclic antidepressants. As a result it also has side effects to antidepressants, that are the same as

antidepressants. So some tiredness, maybe some lethargy initially, and then you can have some other

things that come on.

Dr. Murphy:

So it's not without side effect. I wouldn't recommend taking it without knowing that, and looking at

what those side effects are. But it is an effective method, that's natural. Now it's not regulated by the

FDA. Any of these supplements, they're not regulated by the FDA. So we don't truly know, the

consistency in dosing, or the correct dosing for any of these, because the FDA allows natural

supplements to exist. And rightfully so. So just be aware of that with any of these, but especially the St.

John's wort, because it does have some active, pharmaceutical properties to it.

Dr. Murphy:

Folic acid is an area of study right now. It may help boost antidepressant therapy in men, more than

women. There're theoretical risks with more than one gram of folic acid per day. There's maybe some

studies that suggested an association with breast cancer. I believe that's an association, and not a

causation, it has not been proven. But there is some benefit to taking that, especially if you're already

taking an antidepressant. So this one is S-adenosylmethionine. This is something that you may have

heard, SAMe is the abbreviation. This is actually a natural substance. It exists in our body, and it helps

neurotransmitters like serotonin, norepinephrine, or oxytocin. It helps them work better, including

dopamine. And so in the studies, it was more effective than placebo. Was similar to St. John's wort, it

was equivalent to TCAs in some studies. But because it does have this pharmaceutical action, serotonin

syndrome is a precaution.

Dr. Murphy:

So again, these don't come without warning. Another one is Omega-3. There's a lot of news right now

on Omega-3s, EPAs specifically have been shown to help decrease cardiovascular disease, heart attacks,

and then also some strokes. It can lower triglycerides, but it can also possibly boost immune response to

antidepressant therapies. So if you're on another medicine already, this actually may help. If we got an

EPA only supplement. This does not apply to DHA. Those two types of Omega-3s, and EPA can help more

specifically. There's lots more here to come, again this is an area, new that's burgeoning, and coming

out. So hopefully we hear more about this in coming, months and years. With any fish oil, there is a

small risk of increased bleeding, that you have to mention about. Things that you can do, there are

plenty of apps in our society that can help. There's different reasons for each of these.

Dr. Murphy:

I'm going to go through some of these, and you can record these, maybe jot them down, download

them and play with them to see, which one gives you some benefit. The first one is called 7 cups. That's

a great overall depression tool. It helps with anxiety as well, helps you quantify, what your symptoms

are. There's one called MoodTools. This helps depression, and then FearTools, they're both made by the

similar, the same company, that helps with anxiety. So those are good. BoosterBuddy is another one.

SleepBot is one that helps monitor your sleep. A lot of us have, smart watches that help record sleep

sometimes, but this is just on your phone, and it helps report how you're doing, and that can help

improve your overall sense of wellness. Of course, improving the quality of our sleep is of course a great

natural way to, help with anxiety and depression.

Dr. Murphy:

The next app is called What's Up? This uses CBT, which is going back to our therapy slide, and also

acceptance commitment theory. These are strategies that therapists will use. And so this is a way to use

that in an app, if you don't want to, or are not ready to go see a therapist right now, it is a good useful

app. And recommended by some good professional organizations. The last one, I use a whole lot, and

recommend a lot, it's called Virtual Hope Box. This has some guided meditation, relaxation, and

controlled breathing exercises. It gives you an ability to within five minutes, maybe at work or at home,

take a break, brief break, and to recenter yourself, and to have an ability to put yourself in a different

spot.

Dr. Murphy:

It also has some quotes and things from famous people over time, as well as some brain games, that can

get your brain working on a different level. So that can help if our brain is constantly firing in the anxiety

and depression center. Getting another part of the brain to fire, can offset that a bit, and do some

distraction, which can help. Which gives you an opportunity to, maybe do some of those controlled

breathing, and relaxation programs. And so that is, again in the time that we had, some of the results,

and the best studied evidence on natural approaches, to anxiety and depression. So I'll look to see if we

have any questions here.

Heather:

[inaudible 00:25:51]

Dr. Murphy:

That's a great question. So part of the problems with finding a therapist, is just finding one that your

insurance will cover. I have a selection of therapy sites that I like, that I refer people to. It's not right for

everyone. Some site locations will have websites that give biographies of therapists. That is a great way

to do it. These therapists will post about their specialties and about their focuses. And you can tell a lot

from looking at their picture, and seeing if they focus on trauma, sexual trauma, abuse, neglect, or

family issues, which one would be right for you. So I'd recommend going onto their websites, doing

some of that. And then not being afraid to try a therapist out. And if after three or so sessions, you just

feel like they're not in the way, or communicating in the way that you would understand, don't feel

ashamed to say, "I'm going to try to see someone else."

Heather:

Next question [inaudible 00:26:51], Wendy would like to know, what is serotonin syndrome?

Dr. Murphy:

Serotonin syndrome is a rare condition, it really does not happen very much. It happens more when

you're on an older antidepressant that is not used very much, in combination with other medicines, like

nausea medicines. And it essentially can give you a lightheadedness, nausea, there's a whole list of the

syndromes that you have. Flushing, feeling weak, and it can be serious. Usually it is seen more with

tricyclic antidepressants, or things like that, that are not prescribed, except with certain people that

have not done well on other medicines. Now these TCAs are very effective, but they do have that as a

side effect. So we monitor those very, very carefully. And if a doctor does prescribe that, you want to

make sure that you're asking, enough about that medicine.

Heather:

Another question, does sertraline have the same side effects, as benzodiazepine.

Dr. Murphy:

Sertraline?

Heather:

Yes.

Dr. Murphy:

No, sertraline does not. Sertraline is a very safe SSRI, it's actually one of the safest that's been studied.

It's safe in pregnancy. It's a very gentle medicine, that you typically go on. Now some people still have

problems with sertraline, which is used very commonly, but usually if we start very slowly on that,

people do not have any side effects. Tiredness, is the most common side effect in the SSRI class. Again,

we're not talking about maybe all those medicines with this subject, but sertraline does not have the

same side effects. It's considered a good class of medicine. Your body doesn't develop tolerance to it.

You can wean off relatively quickly with your doctor. So yeah, not the same as benzodiazepine, side

effects. Good question.

Heather:

If we can, another question. I'm not sure, how to say it. What do you think of, 5-HTP as an anti

[inaudible 00:29:01]?

Dr. Murphy:

Yeah, that's actually another good one. Again, it's 5-HTP. There are several medicines that work off of

that receptor. And so you may be able to find some supplements, it's called 5 Hydroxytryptophan. It's

actually an amino acid that can boost serotonin. The science behind it is, it can boost serotonin in the

natural way. It's one that we didn't cover on this presentation, because I don't believe that the evidence

on it is as strong as some of the other ones. But it does actually have some science based on it. It can

help with some weight loss just by feeling like there's, increased feelings of fullness. But that happens

with a lot of SSRIs. The principal there is the same as, serotonin producing medications. But as far as the

science behind it, yes it probably would fall right in there in line with, probably compare it to S-

adenosylmethionine. In that same range.

Heather:

Okay, here is another question, and we want you to repeat the question [inaudible 00:30:15]. In what

use [inaudible 00:30:16] Lexapro?

Dr. Murphy:

What about Lexapro?

Heather:

What about Lexapro, what are your thoughts on Lexapro?

Dr. Murphy:

Sure, so the question was what about Lexapro? Lexapro is a good a SSRI. Again, it's a selective serotonin

reuptake inhibitor. This is a good class in medicine, as it does not have significant side effects or

longterm dependence like benzodiazepines do. It also does not cause... Well, it does list serotonin

syndrome, and QT prolongation as a side effect, it doesn't have that as a major problem. And so, very

effective, it comes on a little stronger than the sertraline that we just talked about. So some people, it

comes on a little faster, maybe have some more side effects in the beginning stages.

Dr. Murphy:

A little more tiredness, but it also takes effect faster than the sertraline would. So sertraline usually

takes about four to six weeks, whereas Lexapro, my experience is about two to four weeks, Lexapro will

take an effect. Some of these supplements that we've talked about, will be in the four to six week range.

So St. Johns wort, the same. Any of those will have a little longer initiation phase. Lexapro is a little

faster than some of those, but in a good class of medicine.

Heather:

[inaudible 00:31:36] Could you tell them that I've added a link to the PHQ-9, and GAD-7, in the chat box?

Dr. Murphy:

Heather has added the link to the PHQ-9, and GAD-7 in the chat box down at the bottom. So if you want

to find that, and click on that, and take the scale yourself, feel free to do that.

Heather:

Is aerobic exercise, [inaudible 00:32:06] better than strength training?

Dr. Murphy:

I'm sorry?

Heather:

Is aerobic exercise, better than strength training?

Dr. Murphy:

That's a great question. So the question was, is aerobic exercise better than strength training, for relief

of anxiety, or depression, or other mental illnesses? The studies do not show that there's a benefit to

one over the other. I definitely promote aerobic exercise, because I think it has benefits that strength

training does not. I think that adding on strength training is good for other reasons, increasing the

muscle mass, and stability, strengthening pelvic girdle, and core strength. All those decrease falls, and

there's lots of medical reasons for that. But as far as anxiety and depression goes, the studies show that

there's no difference between, whether it's resistance training, or aerobic training, and the benefits that

come from that.

Dr. Murphy:

So, choose which one you'd prefer, and go at it. I think the key to either of them, is consistency. If we're

able to do anything consistently, we will get the physical and mental benefits. There are good

pheromones and hormones that come from aerobic exercise. I think that's been proven, from running

studies that have been done. But that being said, not everybody gets the same level of we'll say the

runner's high, as others do. And so many of you probably know that where you say, "I feel terrible when

I run, and I don't enjoy it." And that's a fact. Some people genetically release more of these hormones,

doing aerobic activity versus resistance training. But one or the other, does provide good benefit.

Heather:

Next question. Are magnesium supplements beneficial? [inaudible 00:33:52].

Dr. Murphy:

So again, the question was, are magnesium supplements beneficial? There has been some study on that.

It's been inconsistent in the research and if any, researchers out there are listening, they might debate

on that. I think from my analysis, that evidence is not solid to support that, magnesium supplements will

statistically prove benefit to a population as a whole. If someone has a deficiency, I think that it does,

provide have some benefit. But generally, no. There's also some questions about vitamin D therapy,

especially with this COVID era, where we're thinking about immuno competency, and boosting our

immune systems. There is some evidence that vitamin C and vitamin D can boost immune systems, and

that can lead to healthier overall feeling. But as far as what we see in the major studies know that, none

of those actually help with depression. Although vitamin D might be another one of those cusp nutrient

supplements, that could help.

Heather:

I don't have anymore questions I the chat box.

Dr. Murphy:

Okay. So listen, I just wanted to say, again, if anyone has questions, feel free to add them on, we'll stay

on for just a second. But I wanted to say thank you to everyone for being here. This is again, such an

important subject. We really value your time, and hope that you appreciate. Glad that you're able to

spend this time with, and hope you found it valuable. Of course, if you have any questions, see your

physician we're all here to support you. There's going to be several presentations coming over the next

several months. And I hope that you enjoy those as well. I think there's one last question.

Heather:

Yeah. The question is, are there any other breathing exercises that you can recommend, besides yoga?

Dr. Murphy:

Yeah. That is a great question. Going back to what we talked about, Tai Chi, Qi gong, those ones can

help. I'm sorry, the question was, are there any other breathing exercises other than yoga, that we

might recommend?

Heather:

[inaudible 00:36:03] in the middle of a heightened panic or anxiety attack?

Dr. Murphy:

In the middle of a heightened panic or anxiety attack? Absolutely, I really love this Virtual Hope Box app.

There's some guided breathing exercises in there. There are ways to breathe, other ways that therapists

will guide you in. I don't think that it's easy to describe those, in this presentation, in this format. But

definitely therapists could guide you through alternative methods, that are out there. I think I like this

Virtual Hope Box, it gives you some structure, and you can do it at home, at any point in time. This

information and the presentation will be on the website, if you have a need and wanted to refer to it

later. All right, thank you so much.

Heather:

Again, we'd like to thank Dr. Murphy, for our first in a series of our Wellness Starts Within program, and

this is our first topic. You will be able to access this on our wellnessstartswithin.com, on the website. You

will be able to access the presentation, it is being recorded. Again we want to thank Dr. Murphy, he is

one of our physicians at our Marsh Road practice in Indianapolis. And on the wellnessstartswithin.com

website, we will also have links to the GAD-7 for anxiety, and the PHQ-9 for depression. We appreciate

you joining us, and look forward to providing you many more topics, for overall health and wellness.

Thank you very much.

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In this video, Dr. David Murphy of our Indianapolis office discusses natural ways to treat anxiety and depression. He also talks about overcoming the stigma of mental health problems. The more we know, the more we can help one another live their best lives.