Let’s face it, we all know what depression is, especially if you have it or had it.
Depression is when you are continually sad and unhappy in a way that’s not proportional to your circumstances. Depression can be caused by situational issues or a genetic biological vulnerability. Often it is a combination of both. Like most illnesses, depression may be graded by its severity, ranging from mild, to moderate to severe to catastrophic. To some extent the severity of the depression will guide treatment choices.
Symptoms can include sleeping too little or too much, weight gain or weight loss, thinking about suicide more than a little bit, having low energy, impaired concentration, and a decrease in your sex drive.
If you have some of these symptoms, you may be experiencing clinical depression. If the symptoms persist more than a few weeks you will want to consider treatment.
The first step is usually self-care. Some form of exercise is the most reliable way to help yourself. Depending on your physical condition and age, as little as a few 20 minute walks can make a difference. If you are so inclined talking with friends, family members or a trusted mentor can be helpful. Sometimes helping others can be a way of helping yourself.
If self-care does not prove adequate and symptoms persist, some professional help may prove useful. Usually the first step is some form of counseling or psychotherapy. There are countless forms of psychotherapy. Cognitive behavioral therapy is considered most helpful, but many other approaches are also effective. It is critically important to feel that the therapist is empathic and emotionally supportive of your situation and that there is an alliance, a good vibe, between patient and therapist.
If counseling after a few weeks is not sufficient, some sort of biological treatment is indicated. Also, if the depression is severe enough, especially if there is a lot of suicidal thinking, it is best to move into medical treatments more quickly.
The first step is usually some form of anti-depressant medication. There are several dozen antidepressants available, grouped into categories such as serotonergic, noradrenergic or both. Most antidepressants usually take at least a couple of weeks to work, sometimes longer. Side effects have to be taken into account. Generally, the first antidepressant can be prescribed by your family doctor or nurse practitioner.
If the first medicine prescribed is not effective, another medicine can be added, called combination therapy, or a medicine from a different category can be substituted. At this point, it’s best to consult with a psychiatrist or a psychiatric nurse practitioner. These medicines can be quite effective. If they are, they should be taken for at least six months, often longer to prevent a recurrence. There is a saying that antidepressant medications are better at preventing depression than they are treating depression.
If medicines are not adequately effective, and the depression persists, there are some newer options available.
The most accepted is transcranial magnetic stimulation (TMS), which is cleared by the FDA. There are various protocols. The standard protocol is daily half hour treatments five days a week for six weeks at a treatment center. There is also an accelerated protocol which can be done over one or two weeks. TMS treatments are safe, have very few side effects and have a good success rate. Sometimes maintenance treatments are required to continue a positive response.
Another option is infusion therapy. This is a medication that is administered either intramuscularly or intravenously. Acutely for about an hour the patient feels dissociated. Some patients enjoy this feeling while others are frightened by it. There are very few side effects. The treatment tends to work quickly so the patient and therapist should know whether it’s effective after 4 to 6 treatments.
The above represents commonly accepted treatments for depression.
A few footnotes :
Alcohol is a central nervous system depressant. If you drink more than one or two alcohol equivalents a day, no depression treatment is likely to be effective. Until the depression resolves abstinence from alcohol is highly recommended.
There is mixed data and varied views on the use of marijuana and other cannabinoids in depression. Some providers feel that it is not an obstacle to treatment, other providers view it in the same way as alcohol. For many patients, it is effective for coexistent anxiety.
If you are not sure about the severity of your depression, self administered tests can be a good way to measure it. The Beck Depression Inventory (BDI-II) has been available for a long time, is available online and is reasonably reliable. Scores 0 to 10 indicate an absence of depression, 10 to 20 mild depression, 20 to 30 moderate depression, 30 to 40 severe depression, over 40 catastrophic depression. There are quite a few other self administered test to measure the extent of depression.
Often anxiety, PTSD, obsessive compulsive disorder and medical illness are complicating factors that have to be considered when looking for the best approach to treating depression.
If you have taken many antidepressants over the years, it is often helpful to review which medication has been most helpful and try that medication again.
If I medication has not been helpful, it is important to discontinue it rather than keep taking it. Sometimes patients wind up taking many medications and it is rare that a cocktail of multiple medications is really useful.
If there is a clear history of clinical depression in your immediate family, this tends to indicate that there are biological factors at play in your depression. When that is the case, medical treatments are more effective than psychotherapeutic treatments.
Depression can be a fatal illness, either by active or passive suicide. Active suicide speaks for itself. Passive suicide is when you become so careless about your life that fatal events can happen, such as car accidents.
Over-the-counter supplements may be helpful, but only in an adjunctive way. They will almost never be effective as a standalone treatment.
Disclaimer; this simple guide is for information only and is not meant to be a substitute for proper treatment and should not be relied on as such.
Disclaimer; the author of this guide is the CEO of TMS Center of Colorado LLC.
Theodore S. Wirecki, M.D.
Board-Certified Psychiatrist
