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Depression treatment can be viewed through the lens of talk therapy, medication interventions, dietary changes and physical activity variables. Aging, stress, substance use, trauma/traumatic injuries and a general understanding of happiness (see a session example that highlights happiness) are also considerations when treating depression and depression symptoms. Like most mental health conditions where the duration, frequency and intensity of the symptoms are assessed by a licensed clinician, severity will generally direct the most ideal approach for improved outcomes. For example, if a person has depressed symptoms for weeks or for years (duration), single occurrence or re-occurrences (frequency), with or without suicidality (ideation and/or action) and impacting ability to engage in activities of daily living (intensity) – these three variables (with different indicators) may make talk therapy a good place to start or it may make medications (and in certain scenarios even hospitalization) the place to begin.
Feeling bad about an ending relationship, having mood changes the coincide with substance use, being down due to the death of a pet or a loved one, sorting out the heterocentric inhibitions involved with sexuality variations, and being upset during high levels of stress – may mimic depressive symptoms, however these would not be indicators of a depressive disorder. Life stressors where depression (and other) symptoms are evident would be better viewed through the lens of a stress related disorder.
Depression often is experienced as being made up of highs and lows by those living with it – and therefore it is often confused with mood swings by them, such as might be included in bi-polar. In depression there are high’s and lows, as would be necessary for a person to be able to sort out what is lower than normal (where normal might be experienced as a high to the depressed person). Depression, once accurately diagnosed, can be mild, moderate or severe. For the person dealing with the disorder, a “mild” level is hardly a good one; feeling a little down for a significant amount of time is pretty horrible for those who are depressed.
Anxiety often is a counter part to depression, and often these two disorders co-occur. Why? In a cognitive perspective the difference between depression and anxiety would be the time line in which a person most often thinks. Rumination is a past review and worry is a future review – in the negative ways of thinking. In the positive ways of thinking reminiscing would be a past recollection and in the future it would be called anticipation. From a medical model perspective serotonin, the key neuro-chemical involved in mood and repetitive thought patterns, may be operating at levels that are too high (closer to obsessive like thoughts and anxiety) or too low (closer to depressed like thoughts and rumination). As such nature (the biological patterns with serotonin) and nurture (ways of thinking about the life one has lived/lives) can be “players” in both diagnosis and treatment of depression.
Most people self diagnose, sometimes accurately and sometimes inaccurately, and generally they pursue the interventions that seem to them, to fit their paradigms. That is, once a person has decided they are depressed, usually due to web searches that can be misconstrued (Dr. Joel Paris once labeled the diagnostics of the DSM5 as the “medicalization of normal”), and they look into treatment options – often the easiest “fix” is the one chosen. Many will attempt medications, as the first line of defense. In some cases medication is needed and works to alter the inhibitory and excitatory neurocehmical processes of serotonin in the brain – and that is all that is needed. More common, though, is that medications will be partially successful where environmental factors must also be addressed. Most medication efficacy research for depression treatment suggests that 6 months of improved mood directly related to the medication will be maximized, after the treatment window is achieved.
What is the treatment window?
The treatment window is the area in which research and patient reports, while taking medications, find and report that the medication is working. The efficacy window is the point in time where the medications have been adjusted (titrated up at first and possibly down later) such that the depression symptoms reduce or improve. The treatment window does not usually kick in when medications are started; when clients report immediate improvement it is possible the effect is placebo or that the persons metabolism is different than the average population. Generally it can take many weeks from starting the medication to get to the place where treatment is effective.
Adjusting medications must be done by a medical doctor, and in mental health the ideal MD would be a Psychiatrist (see more here about the differences between mental health professionals). Psychiatrists are trained in mental illness specifically and in the medications that work in various ways in mental health disorders, such that for the treatment of mental health this medical specialty would be the rationale for the statement “…the ideal MD would be a psychiatrist.”[ INSERT TREATMENT WINDOW PPT HERE ]
Non-traditional treatment options can help with depression treatment, such as clinical hypnosis and transcranial magnetic stimulation. TMS would be provided by medical doctors where clinical hypnosis may or may not be provided by an MD. Hypnosis for depression treatment can usually be resolved within a 3 to 5 hour CHT cycle (either intensive singular sessions or broken up over several weeks time). TMS would be done at the instruction of the MD and includes several sessions over several weeks time.
Other ways of treating depression would be multi-level/multi-modal/combination therapies. “Combination therapies” that are most supported in literature and research in the treatment of depression include talk therapy and medication along with lifestyle changes. Eclectic interventionists are ideal in setting up multi-level treatment plans and in coordinating care between professionals of varying disciplines, provided the person seeking treatment agrees. Outside of safety concerns, clients control the trajectory of their care – even if they elect to decline recommended approaches (see patient bill of rights for more information in regards to controlling your care).
So many factors can be at play in looking at depression (see the list of resources and articles linked below for ideas and more information). Aging can be a player, life transitions, health conditions, stress, biological factors impacting serotonin, sleep, diet, chemical uses, exposure to light and under exposure to light, nutrition, exercise as well as a person’s perspective and view of life in general.
For those persons who wish to get an overview of how natural remedies, diet and talk therapies, sleep, exercise, non-traditional treatment options and medication considerations the following summary of “try this” and “if that happens it might mean…” more or less help is needed, take a look at the list that follows.
DISCLAIMER NOTES and PROFESSIONAL EXPERTISE CONSIDERATIONS: The following list is provided for informational purposes only and it is not intended to diagnose or recommend particular interventions. Nutrition, exercise, medication, hypnosis, sleep, and talk therapies of various kinds should be provided by experts who are credentialed and licensed to do so. State and district statutes, rules and regulations govern those who can and cannot claim expertise in any given area. As such anyone who reviews the following information is advised to consult a licensed professional who can assist and coordinate care as appropriate to your particular mental health concern.
- FOOD: Also fish, not fried, baked slow, not well done or raw … it has the omegas … fatty acids are said to be good for mood. Like the stew though, there are no mood agents in omegas. The fatty acids, if the patient responds favorably suggests a dietary intake issue. To find experts in nutrition, have a look here.
- Healthy fat foods can help too. Brain needs healthy fats for generativity and for memory mostly. If this works the body needs good ole healthy fats … olive oils, avocados, unsalted and raw nuts.
- OTC: St. John’s Wort is the most common. Your client may want to know that while this is a popular item, it had no mood affecting ingredients …. it is actually an anti inflammatory. If the patient has an anti-depressant outcome it is likely inflammation … and that possibly is a stress factor, not depression.
- Vitamins: Vitamin deficiency may be a player too …see food. Otc vitamins may help but they are not natural to be clear. The additives to administer the active ingredients is a challenge here. So, back to dietary intake may be a reconsideration. To look at what “uncle Sam” says about the wise use of supplements, take a quick look here.
- Water: dehydration, mild if long term (if not mild the patient would be very ill) can create a depressed like mood, along with head aches. Add water and metabolism speeds up alone. Between hydration and metabolism there are the cleaning effects of water. Reducing toxins, giving cellular growth what it needs, and speeding up metabolism can do allot for mood.
- Sugar: High carbs are an up and down player too. The sugar high is liked; the sugar crash is not (at least by those who are not a fan of the depressed / buzzed sensation anyway). The simple carb cycling can be similar a depressed feelings. Adjust the simple carbs down and if this works carbs are a suspect.
- Tart cherry juice, unsweetened can help too. If the patient responds favorably it suggests something is off with sleep. Sleep hygiene then is a natural remedy. Keep the tart juice … 100% and unsweetened. Add sleep hygiene… where 3 biggies are key: consistency, darkness and cooler temps. While there are reported effects involving melatonin factors, other therapies are generally seen as more “evidenced based” according to the folks at the NIH.
- Sleep Hygiene: Sleep is an under studied area for mental health experts, however studies are increasingly showing the impact of sleep deprivation as it relates to mental illness symptoms. The question is whether the mental illness is causing sleep deprivation or if the sleep deprivation is causing the illness. Since both could be true, to include sleep hygiene in the treatment of mental illness, makes sense. The American Sleep Association may be one place to look. Blue light (and red light, and incadescent light – #all light), room temperature, use of alcohol, certain medications, behavioral patterns in the bed itself, eating and drinking food/fluids close to bedtime — are all players in sleep deprivation.
Movement: Exercise helps here too. It increases BDNF, impacting dendrite growth, leading to more synaptic activity. More activity has the impact of moving serotonin a good bit. If this works then sedentary factors are at play. Here’s some research on how it is that exercise and BDNF work.
Oxytocin: A good bit of trust and care will impact mood too. It can be very short lived in the context of orgasm. It can be more long term, and less dramatic than orgasm, as in being with pets, family and friends. Oxytocin can be a consideration when people engage and do things for those they care about. If this works, then socialization and sexual factors may be suspect related to depressed mood.
Humor and Stress: telomeres break off as we age; stress makes this worse. Telomeres impact many things in the brain – mood is one thing and memory is another. Memory loss can be a sign of depression, and aging telomeres too. Laughter about things in common causes these guys to grow! To learn more about Telomeres here’s a good TedTalks to check out.
Caffeine, nicotine and added substances (alcohol, cbd/thc, antihistamines) are players in mood too (and in their impact on sleep). Adding and/reducing these are key. For more information on the impact of chemicals in the brain take a look at this presentation from experts dealing with substances.No responses above: Mood is biologically kicked up and down by serotonin.
- TMS: This is not medication. It is a medical treatment via magnetic stimulation (non- chemical). And it can really change things in more difficult cases. The left side of the prefrontal cortex gets some regular stimulation. Interestingly when happy people are studied their prefrontal cortex, particularly the left side, is more active than other folks. For more information about TMS, see what the folks at Mayo Clinic have to say.
When nothing helps: It’s possible that nothing is wrong. First, be sure that there is an actual diagnosis of depression. This can be tricky, as the DSM5 (the American Psychiatric Associations text for all mental illness criteria in the United States) lists indicators and subtypes may not be so evident (see NIH for more). Consider too that even an outlook on life, that is the idea that happiness is not achievable, may activate illness in the body (see what Dr. O’Sullivan found in the study of psychosomatic illnesses). If depression is diagnosed, and all of the behavioral factors have been addressed, there is the fact that biologically the serotonin levels are off and these may need the added jolt of medications – and this must be done under the direct care and supervision of a medical doctor.
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LaRose is licensed in both DC and in FL in the area of talk therapy, particularly clinical social work, with added credentials in hypnosis and clinical supervision.
First Ed. 5/18/19, Kurt LaRose, TalkifUwant