I am always unpleasantly surprised when I listen to some of the advertising done by some clinics on radio shows claiming that they can treat depression without medication.
The Real Definition of Depression
I cannot stop but wonder if they are confused about what the word ‘depression’ means for psychiatry versus the meaning that it has in the vernacular language. One of the most frequent claims is that alternative treatment can be a substitute for antidepressant treatment for depression, but they fail to specify the kind of depression helped by that treatment.
Medication Is Often Medically Necessary
While I truly believe that integrating all modalities of treatment, (or as many as possible) creates a more effective approach in addressing all types of mental illness, including depression- I think it’s a mistake to suggest eliminating medication when it is oftentimes medically necessary, or to claim that it’s not needed when the alternative treatment has not been proven to be an effective substitute.
The Prevalence of Depression Worldwide
Depression, in its medical sense, is a chronic, multifaceted illness, that has plagued humanity from the beginning, and has a higher than ever prevalence worldwide. By 2030, it will be the most common cause of disability. Out of 14 million Americans, only 7.2 million are adequately treated, leaving at least 7 million or more struggling with this chronic disorder. Depression needs, first and foremost, a correct diagnosis, followed by an individualized treatment approach.
Diagnostic Criteria for Depression
Somebody complaining of feeling ‘depressed’, meaning feeling sad because of a recent or anticipated loss, doesn’t mean that he or she suffers from depression, in its medical understanding, but that she or he has an appropriate emotional reaction. If the sadness persists and becomes associated with cognitive impairment, changes in appetite, weight, and sleep patterns, then they could have either an Adjustment disorder, acute or chronic, or even Major Depressive Disorder when suicidal thoughts are associated. Chronic Depressive disorder, or Dysthymia, defines long periods of time of less than optimal mood, and other symptoms, including lack of energy, and changes in sleep patterns.
Strategies for Managing Depression
In mild and moderate states of depression, exercise and implementing good sleep hygiene and a healthy diet could help stabilize the mood to a normal level. However, in patients with severe depressive states, while these changes could be helpful, they can rarely be initiated by the depressed patients because of their lack of interest, energy and self-worth, as well as their feeling that life is not worth living which is characteristic of this level of depression. In these situations, it is more effective for the patient to try using medication to at least improve the drive and the energy level, This will help them initiate lifestyle changes that they could not maintain in the more depressed state.
Integrative Psychiatry Practice And Depression
In my practice as a integrative psychiatry provider, I do a comprehensive evaluation to assess if there are other factors that may impact a person’s mental health. Sometimes by addressing any vitamin or mineral deficiencies one can make a positive impact on relieving symptoms of depression. For example, when I discover that someone is deficient in certain vitamin or has endocrine disorders, I might recommend supplements that can address that deficiency. The research shows that individuals with deficits in vitamins D, and B12, can present with symptoms characteristic of depression.
Depression and Genetic Testing
In recent years, deficits in methylation that can now be easily diagnosed with genetic testing ( to determine the MTHFR mutation) that assesses the ability of the individual to properly utilize folic acid ( vitamin B9) which can also be associated with symptoms of depression. In the presence of this mutation, the organism has limited ability to eliminate homocysteine, creating, in time, a chronic state of inflammation that has also been correlated with depression.
Depression and the Brain
Folic acid in its methylated form is also essential in the production of the serotonin and norepinephrine that are two key mediators whose low concentration in certain area of the brain underlie the symptoms of anxiety and depression.
Medication and Depression
In this particular situation where there is a high level of depression and there is a biological condition that could be addressed- exercise and lifestyle changes alone are not sufficient. Also, when there is a genetic predisposition for depression, as seen in families who have multiple members afflicted with affective disorders, these cases cannot oftentimes be addressed with lifestyle changes only, but with an integrative approach that would include medication, and/or Transcranial Magnetic Stimulation (TMS), a non-invasive neurostimulation technique.
TMS As Alternative to Depression
TMS uses electromagnetic induction to produce weak electric currents using a rapidly changing magnetic field. These electric currents cause activity in specific or general parts of the brain with little discomfort, enabling the medical provider to study of the brain’s functioning and interconnections. TMS uses magnets instead of an electric current to activate the brain. An electromagnetic coil is held against the forehead and short electromagnetic pulses are administered through the coil. The magnetic pulse which can easily pass through the skull, produces small electrical currents which stimulate nerve cells in the brain region that is targeted.
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