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November 12, 2014

Best Treatments for Depression

 

Type of Depression Research What Should be Done Therapeutically
Severe depression – - requiring hospitalization; complete social isolation; complete collapse in functioning Antidepressants have the best outcomes in severe depressions when medication is taken over time; multiple trials may be necessary and/or other drugs like lithium or an antipsychotic drug may need to be added. Aggressive medication treatment has a remission rate up to 65%.  However, a rigorous NIH study (the Star D study) has shown that gains are not maintained and recurrences and relapse rates are very high, even if patients continue to take their medication. Aggressive medication treatment in conjunction with psychotherapy have a greater likelihood of helping people maintain their recovery and prevent relapse.  People in therapy learn coping skills, identify stressors, and learn relationship skills, which helps patients prevent relapse and lead a more meaningful and balanced life. When you then add exercise and nutrition success rates go up sharply. 
Mild to Moderate Depressions- depressions most people experience periodically throughout their lives, frequently triggered by relationship problems, significant losses, or trauma. A lot of psychological treatments have been shown to be as or more effective than medication.Available treatments: psychotherapy, Cognitive Behavioral Therapy, CES-cranial electrotherapy stimulation (FDA approved for depression, anxiety, and insomnia), light-therapy, yoga therapy, and an anti-inflammatory diet. For this group of patients antidepressants are most likely not the best option, due to their side effect profile of weight gain and sexual dysfunction.  A holistic approach that supports the minds with:

  • New skills to balance thoughts and feelings
  • Skills to care for relationships

… and support of the body with:

  • A healthy diet and exercise
  • Remedial therapies

… present the best treatment options for this group of patients.

Bi-Polar Depression- when there is a lot of irritability, at times reduced need for sleep, anxiety and panic, and/or too many thoughts. Antidepressants make this kind of depression worse; they can cause an increased frequency of episodes, they can cause mania and psychosis, and an increase in aggression that can lead to suicide or homicide.Medication Treatment usually involves mood stabilizers (anti-seizure meds) and anti-psychotic medications. It is very important that a differential diagnosis is made by clinicians.  Unfortunately, misdiagnoses are frequent, esp. since physicians and psychiatrists only have a few minutes for their assessment.While medications are necessary for severe forms of this illness, milder forms (Bi-polar II, Bi-polar NOS) can be treated with a combination of psychotherapy, family treatment, lifestyle regulation, diet and exercise.

Depression is a serious illness and requires a lifelong conscious effort to bring into balance the needs of the body and mind.  

Medications can assist in initially restoring a bio-chemical balance; they cannot teach skills to lead a balanced life. 

In psychotherapy patients learn skills that they can rely on their entire life.

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