Anxiety, Depression, Insomnia, and Pain: The Four Horsemen of the Apocalypse


I thought this would be a good time to talk about some issues and problems that I know affect each and every one of us at one time or another. I am willing to bet that 95% of you have had at least one of these four bad boys, anxietydepressioninsomnia, and/or pain. The other 5% of you are either in denial or self-medicating with enough alcohol or drugs to notice! 

In my practice I see people who have at LEAST one of these issues if not all of them and it isn't uncommon. Often times it is the combination of these issues that results in overwhelming dysfunction in people's lives. These four issues feed off each other to create a swirling vortex of negativity, sending the afflicted person to a dark place...and often times taking other people (especially significant others) with them. This may lead to self-medication which could lead to addiction, which could lead to total self-destruction. Ladies and Gentlemen, I give you the FOUR HORSEMEN OF THE APOCALYPSE OF MENTAL HEALTH!

PAIN: Pain comes from the Latin word "poena" meaning a fine or penalty. The medical definition for pain is an unpleasant sensation that can range from mild localized discomfort to agony. Pain has both physical and emotional components. The physical pain comes from nerve stimulation. These nerve fibers carry the information to the brain which in turn sends a signal back to the affected area in the form of the physical sensation. The emotional components of pain varies depending on the degree of pain, but can include increased anxiety, helplessness, aversion, anger, despair, sleeplessness, and hopelessness. Any of those sound like the other three horsemen? 


Treatment for pain varies by the degree and duration of the pain. Acute pain issues like from a cut or a headache can be addressed through readily available means like a band-aid or Tylenol. But chronic pain issues whether mild or severe, are the ones that take a toll on the afflicted person, wearing them down over time, and sometimes running out of treatment options to alleviate the pain. There are various medications you can take for pain, from acetaminophen (Tylenol) to NSAIDs (ibuprofen, naproxen, aspirin, etc) to antidepressants to anti-seizure medications to steroids to opioids. There are non-medication treatment options like physical therapy, psychotherapy, TENS (transcutaneous electrical nerve stimulation) therapy, meditation, relaxation techniques, visual imagery, biofeedback, hypnosis, hot and cold therapy, massage, name just a few 😟😧😨😩😬. Have you had any of these treatments to alleviate your pain? Have any of you tried ALL of them? I have...


INSOMNIA: Insomnia comes from the Latin term "insomnis" meaning sleepless. The medical definition of insomnia is difficulty falling asleep or staying asleep, even when the person has a chance to do so. People with insomnia usually experience any of the following symptoms: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased concentration at work or at school. A study done in 2011 showed that insomnia costs U.S. workforce $63.2 billion a year in lost productivity. Some of the contributing factors include increased mistakes or accidents, frequent sick leave time, chronic absenteeism, substance abuse, and workplace violence. 


The self-medicating addictive crowd factor in here; drinking alcohol and taking drugs to de-stress at night results in disrupted and restless sleep (or none at all), then excessive caffeine intake during the day to stay awake...then rinse and repeat day after day. If you are not self-medicating at night then you are up all night perseverating about various issues you are anxious or worried about, whether from that day or in anticipation of the next day's stress. Either way, when you start your day you are compromised due to the lack of sleep, and vulnerable to some of the symptoms I listed above. I emphasize to my clients that sleep is priority #1; if you are not getting enough sleep you are not functioning at 100% battery life. If you are not functioning at 100%, you are at risk of the other 3 horsemen running you over! Never mind the fact that if you are sleep deprived you probably look like you are a zombie in the apocalypse!!


I won't get into the nitty gritty about anxiety and depression here but I will enlighten you with some interesting facts and statistics about these very common mental health issues:

  • Anxiety disorders are the most common mental illness in the U.S. affecting over 40 million people over the age of 18, roughly 18% of the population.
  • Anxiety disorders are highly treatable yet only about 37% of the sufferers receive treatment.
  • People with anxiety disorders are 3-5x more likely to visit the doctor and six times more likely to be hospitalized for psychiatric disorders.
  • Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
  • 11% of adolescents will have depression by age 18.
  • 350 million people are affected by some form of depression
  • 30% of college students reported feeling depressed which disrupted their ability to function in school.
  • $80 billion annual cost to the workforce from lost productivity and healthcare due to depression.

There is a difference between "everyday anxiety" and Anxiety Disorders. For example, worrying about paying bills, getting a job, or a romantic break-up or other important events are examples of everyday anxiety. Constant and unsubstantiated worry that causes significant distress and interferes with daily life is an example of an anxiety disorder. The same can be said about  "feeling blue" vs. Depression. Feeling down or "blue" is very common in today's society. People are experiencing more stress than before, working longer hours, making less money, etc. So it is relatively normal if someone isn't feeling 100% on a given day. What separates that from clinical depression is the severity of the symptoms and the duration of those symptoms. Typically you need to have these symptoms for a least 2 weeks, and the severity of the symptoms causes significant distress and disruption in the person's life.

Here are some questions to ask yourself, and if you answer 'YES' to any of them you may want to consider talking with a therapist or doctor:

  • Is your mood interfering with your personal relationships or your job performance?
  • Have these feelings lasted for longer than two weeks?
  • Is your stress from a single, identified stress (example: serious illness of child) that does not have a clear end in sight?
  • Are you beginning to feel worthless or guilty about the situation?
  • Is the stress not allowing you to find happiness in other parts of your life?

(PsychCentral, "Depression vs. The Blues by Ben Martin, PsyD.)

Treatment for the Four Horsemen
I specifically chose to discuss these four issues in this post not only because of its interrelatedness in human functioning, but also for the treatment modality that specifically addresses them.

Cranial Electrotherapy Stimulation (CES): CES is a form of neurostimulation that delivers a small, pulsed alternating current via electrodes on the head (or earlobes). It is cleared by the U.S. FDA as a prescriptive non-invasive electromedical treatment that has been shown to decrease anxiety, depression, and insomnia symptoms significantly.



Alpha-Stim (AID) & (M): Alpha-Stim has taken CES, which had been developed in the 1970s, and used its waveform technology to produce a treatment modality that can treat anxiety, depression, and insomnia. The 'M' model combines this waveform technology with microcurrent electrotherapy to provide a non-invasive treatment for pain. 


Shown above are the two treatment modalities that Alpha-Stim provides. On the left you see the electrodes attached to the man's earlobes to treat the symptoms of anxiety, depression, and/or insomnia. The man on the right is using the 'M' model's electrodes to treat the localized pain. 

Alpha-Stim technology is safe, with no serious adverse events reported in 30 years of clinical use. It can be used as a stand alone treatment, or an adjunct to medication and counseling. In my practice I use the Alpha-Stim with many of my clients, as an adjunct treatment modality during the counseling session. Some of them are concurrently on psychotropic medication which, according to studies, show an increase in effectiveness (of the medication) with Alpha-Stim.

It is a 20 minute treatment, with the electrodes clipped to the person's earlobes. The treatments are cumulative, so the more you use it the more effective the results. At the same time though, I have had a number of my clients report a decrease in symptoms after the first treatment. It may last for a couple of days, but still it was quite noticeable to them. 

For the treatment of insomnia, using Alpha-Stim can increase your sleep time, reduce sleep disturbances, and improve overall sleep quality. Some of their research showed military service members with insomnia showed an average increase of 43 minutes of sleep after just 5 treatments. In one study the subjects who rated their quality of sleep as poor dropped from 60% to 5% from the beginning of the study.

For the treatment of pain, Alpha-Stim's research has shown a 71% decrease in severe pain after only 5 treatments. Chronic pain sufferers reported significantly improved functionality with Alpha-Stim treatments. This is most definitely an option to consider if you are experiencing pain issues, instead of taking the opioid pain medications that have become an epidemic in this country. I have used the pain treatment modality from this unit and did notice results; I just didn't keep up with it to see how I would fare with longer term usage. Hey, I never said I was a good patient!! Sooo, do as I say not as I do!! Don't you hate that line?!?!

Either way, if you have the opportunity...and the fundage (it costs ~$800.00 for the AID-which treats anxiety, insomnia, and depression, and ~$1200.00 for the M model which includes the pain management component). Alpha-Stim is not covered by insurance...yet. It's still in the works.

I am not a paid spokesperson for this product, I just really believe in the technology and have seen significant results with many of my clients. Go to to read all the information about this product and show it to your doctor or therapist to see if they would be willing to write you a prescription for it. Yeah you can't just go buy it yourself, at least not from them. They want to have a medical or behavioral health professional make the formal request for this treatment modality. I agree with this policy because I firmly believe this works best in conjunction with counseling, medication or both.

There are many ways to address and conquer the Four Horsemen, do not despair and do not give up. Keep working at it, try different things, be open to suggestions and guidance from the professionals. New treatments are being developed all the time for these issues. Keep digging through, you'll find your way to a better quality of life.


Here's to a Happy and Healthy 2018!! See you next year!


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