Before You Medicate…. Investigate by Stephanie Strozuk, MD, FAAP

Updated: Jan 14, 2019



Fatigue... low mood... insomnia...mood swings… inattention… agitation…rapid heartbeat…racing thoughts. Sound familiar? These symptoms often times result in a prescription for an antidepressant or antianxiety medication. But what if I were to tell you that these symptoms may be a message that something else may be awry besides a “chemical imbalance “in the brain?

In the six decades that psychotropic medications have been studied, the conclusions about their use and effectiveness have been confusing and conflicting. In October 2004, the FDA issued a “black box “warning about an increased risk of suicidal thoughts or behavior in children and adolescents treated with Selective Serotonin Reuptake Inhibitor (SSRI) medications. In 2006, the FDA extended this warning to young adults up to the age of 25. As an adolescent and young adult medicine physician, I have significant concern about these potential side effects as do many of my patients and their parents. But what do we do when we have symptoms that interfere with our functioning in everyday life? Perhaps we should be digging deep and looking at the root causes of the symptoms before making a psychiatric diagnosis and starting medication.

The symptomatology that we often associate with psychiatric diagnoses may be due to a multitude of medical issues. Burgeoning research is showing that the complex relationship between the gut, brain, immune and endocrine systems may drive symptomatology that may be labeled psychiatric. If you pick up just about any health book or magazine published in recent years, you will likely find information about how inflammation is the driving force behind many illnesses including heart disease, obesity, and diabetes to name a few. We now know that depression as well as other psychiatric illnesses may be driven by the inflammatory process as well. But what creates the inflammation? The answer to this is likely multifactorial and unique to each patient. It is possible that the foods we eat, the integrity of our gut, the diversity of our gut bacteria, the medications we take, food sensitivities and psychological stress in and of itself can be driving forces in inflammation. This can become a vicious cycle where inflammation is at the center.

Other potential triggers of psychiatric symptomatology include autoimmune diseases such as Celiac Disease , Hashimotos’s thyroiditis , Grave’s disease and Lupus to name a few. Endocrine disorders such as hypothyroidism, hyperthyroidism, and adrenal insufficiency may drive symptoms. Metabolic issues such as blood sugar imbalance (dysglycemia), Polycystic Ovarian Syndrome (PCOS) and insulin resistance may drive symptoms. Micronutrients such as B vitamins, folate, magnesium, vitamin D, and zinc are essential to the body’s functionality and production of neurotransmitters and deficiencies may affect mood. Fatty acid deficiencies should be investigated and addressed as deficiency may drive mood symptoms.

The potential causes of mood disorders are vast and there is no “one size fits all” remedy. While there may be a role for psychotropic medications in certain cases, untangling the web to discover your individual cause deserves a closer look in partnership with your doctor. So before you medicate… investigate. You may be surprised about what you find.


Stephanie Strozuk, MD, FAAP is the founder of Evolved Adolescent and Young Adult Medicine- New Jersey's only private integrative medical practice dedicated exclusively to the health and wellbeing of tweens, teens and young adults. Dr. Strozuk is board certified in both Pediatrics and Adolescent and Young Adult Medicine. She has held academic positions at the Mount Sinai School of Medicine and at Rutgers - Robert Wood Johnson School of Medicine. She has also obtained additional training through the Institute for Functional Medicine and uses a functional medicine approach in her practice.

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