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With the mental health care system broken, and many clinicians feeling as though they can offer only stop-gap measures to try to turn back the tide of depression, I think it can be useful for patients themselves to understand that a complete strategy works well more than 90 percent of the time.

No patient should assume that everything has been done that can and should be done to cure them, without reading this blog.

Here’s the strategy (psychotherapy, as a foundation, with other treatments added, as needed):

1. Psychotherapy. No scientist has ever proven that depression is entirely a brain illness divorced from the life stories of those who suffer from it. In every patient I have ever met who suffers with depression, the illness has had roots in unresolved emotional conflicts from the past.

The most talented psychotherapist you can find will be an invaluable resource in conquering your mood disorder. I prefer insight-oriented psychotherapy, but there are very helpful clinicians out there who use cognitive-behavior therapy, or other modalities.

If you don’t “click” with one therapist, or have the sense that he or she is a real expert, switch. There are plenty out there.

Here are some strategies that work well in addition to psychotherapy:

2. Medication. Psychotherapy and medication together is more powerful, often, than either alone. And I would never count on a medicine to work, without any therapy at all.

But today’s medicines can be life-saving. They include relatively new and effective agents like Viibryd, Pristiq and Lexapro. Since combining these with synergizing medicines like Abilify, Adderall and Klonopin may be necessary, opt for a knowledgeable psychopharmacologist to prescribe them. It’s even better if one talented psychiatrist is performing your psychotherapy and prescribing your medicines.

3. Repetitive Transcranial Magnetic Stimulation (rTMS). Exposing certain parts of the brain to magnetic pulses is a very powerful way to treat depression. Many patients who do not respond to medications, will respond to rTMS.

4. Ketamine infusions. While still in the experimental stages at major universities, I have found that giving patients IV infusions of ketamine, just twice a week for 45 minutes each, is a very powerful way to quickly treat depression. This treatment especially works for those whom medicine has not worked, those whom want very fast results while waiting for medicine to work or those whom seem stuck at a partial recovery from major depression and want a more complete solution.

5. Bright light therapy. Exposure to wavelengths mimicking sunlight (without any tanning UV rays) can substantially reduce symptoms of depression. Lights like the GoLite are relatively affordable and can be an extremely effective part of treatment.

6. Vitamins and other supplements. Anyone who is depressed and has no contraindication to taking magnesium, vitamin D and fish oil supplements should consider doing so. I also think maca, a plant-based supplement can be helpful. Your doctor may have other suggestions, too, but make sure to check with him or her before adding any supplement to your diet.

7. ECT. ECT or electroconvulsive therapy has evolved a long way from what people remember. The stigma is entirely unjustified. ECT is painless and well-tolerated and leaves most people without significant memory deficits. If I were depressed and no other treatment had worked for me, I would absolutely be asking my doctor for ECT.

8. Very non-traditional approaches. Some patients who do not respond to anything else can get relief from depression by using substances like marijuana or even oxycodone.

9. Say: SCREW YOU DEPRESSION and do the Harlem Shake!

If your mental health clinician isn’t employing a comprehensive strategy to treat your depression, get rid of him or her.

This list, while long, is not exhaustive. I could easily add to it. And that’s the reason why I can tell depressed patients who come to see me and who ask me if they will get better, “We aren’t going to stop short of making this go away completely. I think you can get 100 percent better. And if you were always a little depressed before this terrible episode, you will feel better than ever.”

Make sure to work with and talk to your doctor and/or psychiatrist before attempting these strategies. What may work for one person, could be harmful for another.

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http://www.foxnews.com/health/2013/0...at-depression/

[cool09]

My agitation and irritability completely drains me and I need to lay down every four hrs or so because I am totally spent. The energy in my head just does not work right which is why my functioning is very poor. The symptoms are 24/7 and barely have had a break in 35 yrs. since 15 yrs old. And the anti-psychotics (for agitation) do not agree with me so I'm stuck.

[clash]

i feel you

[unhappycamper463]

ketamine sounds nice right about now....

[back2ncgirl]

I haven't had any luck getting ketamine treatments. My doctor has tried UNC-Chapel Hill and Emory University (and a few others I can't remember) but hasn't had any luck finding ketamine except in clinical trials (that I don't qualify for). Any suggestions for other organizations to try?

[Rose76]

I view a tendency toward depression, when it has lasted for years, as a chronic condition that can often be managed, but probably seldom cured.

I agree with you that depression probably has it's roots in the past experience of the sufferer. I'm not a big believer in the chemical-imbalance-of-the-brain school of thought. But I would disagree with you that it is a matter of unresolved emotional conflict that can become resolved by the sufferer gaining insight through insight-oriented psychotherapy.

That view was the most popular one for quite a while. It has fallen out of vogue for good reason. Not too many people got "cured" of depression that way. I remember when books would "claim" that people did get cured, but I'm not reading that lately. I'm sure most human beings are walking around psychic conflict. I don't believe that ever does get resolved. I believe we - all of us - die with emotional conflict churning away in our psyches - unresolved.

People who don't get depressed are not necessarily less conflicted than those who do. For whatever reason, their conflict does not make them depressed. Unresolved emotional conflict is one of many of life's stressors. People who tend to get depressed do so, I believe, in response to numerous stressors. One study showed that depressives score higher on reality testing than non-depressives. This study found that optimists with sunny dispositions tend to score lower on reality testing than do depressives.

I think there is something profoundly wrong with the theory that you can "logic" your way out of depression. Believing that you can do that is what underlies the theory you espouse. I disagree. The truth is there is an awful lot, objectively, that is tragic about life. Some people are more mindful of that than others.

It is "Do You Lie in bed all day", not "do you lay" in bed all day?
The misuse of "Whom" for "who" and you are a doctor treating patients?

What is your source for information you're posting other than "Fox News" ? Much
of it seems to be quoted from sources, not from you own experience.

A certain negativity is at the heart of what you're suggesting, despite the fact that
it is an effort to help. For one thing depression can be inherited from a genetic
condition in which there are inabilities to breakdown certain foods to provide
serotonin which can be used by the brain. Enzymes that affect opiate centers
in the brain may be involved.

Psychiatrists are the experts who generally know what's best to treat depression,
and there are many people who live with depression who have learned their triggers
and conditions that help relieve depression, including changes in the diet that are helpful.

I'm sorry, but I don't buy these easily recommended theories knowing what I do about
people who have tried ketamine and other drugs you mention. The side effects of
some medications are serious and dangerous for a few.

One example of natural treatment for depression can be meditative work. Therapy
is another valid way to go, also. And especially the 70% of all depressed people
who have an inability to utilize folic acid because they lack the enzymes in the
stomach to manage folate so that it can cross the blood-brain barrier is an illustration
of one type of treatment that you completely ignore and is a valid form of help for those
whose genetic testing indicates that they need it.

I simply do not believe that you are a therapist or psychiatric physician or medical
doctor who is able to prescribe for depressed people.

Another factor you ignore is that strong stress is a creator of acidic conditions of the
fluids and tissues of the body and it can be relieved by the use of the simple lemon
squeezed into water and drunk at intervals.

You do not account for the fact that negativity is a loading for depression.

There is so very much that you ignore except the recommendation for extensive
use of psychotropic medications, ECT, or magnetic stimulation to treat depression.
I'm here to tell you that there are other just as effective means to work to either cure
or cause a remission in depression. There is a place for medication use in depression,
but that is best left to the advice of those experts who know how and what to administer.

One just doesn't go into a psychiatrist's office and request magnetic stimulation or ECT.,
Ketamine, etc. Usually, those things are recommended by the psychiatrist based on
careful knowledge and experience about people's needs who see psychiatrists.

Orthomolecular physicians also have a valid way to treat depression, bipolar illness, ADHD,
ADD, etc. Those are channels of help that have not been exercised, in my view, as much
as the pharmacological products that have been presented to psychiatrists and general practitioners for ways to help in depression (and almost every other illness, frankly).

It may turn out to be a highly debatable subject after all in science vs. natural healing
techniques and methods. I, for one, am becoming more and more interested in the
Chinese theories of depression and treatment through accupuncture. Maybe one of the
reasons some psychiatrists are studying accupuncture more carefully is a recognition
of the ineffectiveness or medication resistance of many people treated for depression
and other mental illnesses.

It is, at least, a very controversial subject. I appreciate you input, but must also
present some other things that are relevant and effective in treatments.

[Rose76]

Actually, it's: Do you lie in bed all day? (The verb is non-transitive, and I believe I have the correct spelling.)

Originally Posted by Rose76

Actually, it's: Do you lie in bed all day?

Yes, I caught the error and changed it, Rose. Thanks
I'm notorious here for spelling errors.

Yes, it's an intransitive verb.