Psychosomatics: First Steps — What to Do Before Medication

When someone faces psychosomatic complaints, the first impulse is to look for a "pill." But Dr. Saulitis warns against rushing into medication. First you need to understand what truly lies behind the distress — sometimes you can simply restore the brain's function and your rhythm of life.

Don't Start With Medication

The main mistake is reaching for drugs right away. Before taking anything, it's important to understand whether there's any basis for medication at all. Otherwise you may waste money and time, moving from visit to visit with no clear picture.

"The main thing — don't start with medication right away; you can restore the brain's function and your rhythm."

First Step: Separate the Psychiatric Register

The word "depression" is often used as a basket into which people toss any bad feeling — fatigue, low mood, gloom. But in psychiatry, depression as a disorder is something entirely different: an endogenous, genetically determined condition treated in another way. This causes confusion: the layperson and the psychiatrist mean different things by the same word.

So the first thing to do with psychosomatics is to rule out the psychiatric register: endogenous depressions, schizophrenia-spectrum disorders, organic and psychotic states. These cannot be treated "with talk" — they belong to a fundamentally different level of care.

"Depression is like a basket where people throw all their different bad feelings."

Second Step: Rule Out Physical Disease

Many bodily illnesses themselves secondarily produce distress. The doctor names the thyroid, the liver, the pancreas — these and other disorders can affect psychosomatics independently. That's why you must examine the body.

Which Tests Are Needed

The basic set the doctor mentions:

• blood test;
• urine test;
• biochemistry, especially liver panels (ALT, AST and other liver enzymes);
• electroencephalogram (EEG).

If you want a deeper look at the brain, only a 3-Tesla MRI makes sense. According to the doctor, other CT scans give no informative basis in this context.

Only Then — See a Specialist

When the results are in hand, then it makes sense to see a specialist. Coming without an examination can mean many wasted visits. First a clear picture — then targeted help.

Practice: First-Steps Checklist

1. Pause and don't start with medication.
2. Separate it out: is this a psychiatric disorder (endogenous depression, schizophrenia spectrum, organic states) — or a psychosomatic experience? The psychiatric register needs a different approach.
3. Rule out the physical side: check whether the body and organs (thyroid, liver, pancreas, etc.) are involved.
4. Get tested: blood, urine, biochemistry with liver panels, EEG; if needed, a 3-Tesla MRI.
5. With results in hand, go to a specialist — so the visit isn't wasted.