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Treatment Options for Healing Depression

December 11, 2002 | 57,379 views
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Depressive disorders, which pose a substantial risk of death and disability and are associated with suicide and poor work productivity, affect about eight percent of adults. Moreover, close to twenty percent of adults will suffer from some type of mood disorder that requires treatment during their lifetime. Mood disorders often have tragic results -- 15 percent of those affected commit suicide.

Depression, a common type of depressive disorder, is responsible for about 66 percent of all suicides. The disease occurs twice as often in women as in men and the risk increases if depression is present in an immediate family member. As the leading cause of premature death and disability in people between the ages of 18 and 44 years, it is surprising that there are no universally accepted diagnostic criteria for depression.

There are often errors in the diagnosis or treatment of the disease, and only 33 percent of depressed patients receive proper treatment. These errors are associated with insufficient questioning of the patient leading to diagnostic failure; failure to receive adequate information regarding the patients symptoms from family members; diagnosing a mood disorder and starting treatment despite a lack of diagnostic criteria; attempting to blame depression on stressful events, rather than diagnosing or treating the disease.

One set of diagnostic criteria commonly used to assess depression is known as "SIGECAPS" (see table below). This stands for sleep, interest, guilt, energy, concentration, appetite, psychomotor and suicide. If four or more of these items are a concern, it indicates major depression. However, other criteria, such as watching for symptoms other than just mood change and obtaining supporting information from family members, is important.

Diagnostic criteria for major depressive disorder*
A. The patient has depressed mood (e.g., sad or empty feeling) or loss of interest or pleasure most of the time for 2 or more weeks plus 4 or more of hte following symptoms:
  Sleep
Insomnia or hypersomnia nearly every day
  Interest Markedly diminshed interest or pleasure in nearly all activities most of the time
  Guilt Excessive or inappropriate feelings of guilt or worthlessness most of the time
  Energy Loss of energy or fatigue most of the time
  Concentration Diminished ability to think or concentrate; indecisiveness most of the time
  Appetite Increase or decrease in appetite
  Psychomotor Observed psychomotor agitation/retardation
  Suicide Recurrent thoughts of death/suicidal ideation
B. The symptoms do not meet crieteria for mixed episode (major depressive episode and manic episode)
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other improtant areas of functioning
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition

E.

The symptoms are not better accounted for by bereavement

*Adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

The cause of depression is thought to be a disruption of the brain’s neurochemistry. Central norepinephrine neural pathways in the brain play a role in vigilance, motivation and energy levels. These pathways are associated with serotonin neural pathways, which are involved in controlling impulsivity, and share a role with the dopamine pathways in appetite, sex and aggression.

Depression is expected to be the second leading cause of disability for people of all ages by 2020. In general, an unhealthy lifestyle is more common among those depressed than those who are not. Additionally, children of those with depression are thought to have increased rates of behavior problems and lower levels of self-esteem than children with mothers who do not have depression.

In cases of moderate to severe major depression, antidepressant drugs are often used for treatment. Typically, about 60 percent of patients respond to the treatment, with the amount reaching 80 percent when a second drug is tried if the initial antidepressant drug fails. The goal of treatment is a full remission of symptoms, which may take up to four months. Patient recovery is not linear, however, as symptoms may reoccur after resolving.

Current guidelines suggest that antidepressant therapy should continue for at least six months after recovery in order to lessen the chance of a recurrence of depression, which occurs in more than 70 percent of patients.

Maintenance therapy, using antidepressant therapy for an indefinite amount of time, is considered as a treatment option for those who have additional risk factors of depression, such as especially difficult episodes or two or more episodes in a five-year period. The therapy’s goal is to prevent recurrence of the illness, however, costs and side effects of continued medication should be reviewed.

Another therapy, electroconvulsive therapy (ECT) is an effective treatment for about 60 percent to 80 percent of depressed patients who receive it. ECT is often used in patients who have psychotic features, display active suicidal tendencies and do not respond to antidepressant chemotherapy. The reason why ECT is effective remains unclear, but the therapy is typically associated with a slowing in the prefrontal cortex, which likely affects a fundamental neurobiologic process. ECT is usually given in courses of 6 to 12 treatments, with improvements usually occurring after the fourth treatment.

Phototherapy, or light therapy, is particularly used for fall/winter seasonal depressions. Treatment, typically prescribed for mild to moderate cases, consists of exposure to full-sprectrum white light for at least 30 minutes per day throughout the episode.

Another treatment used for mild to moderate major depression is psychological treatment. This type of intervention, including interpersonal and cognitive behavioral therapies, has been found to be as effective as antidepressant therapy. The treatment can be administered individually or in a group setting and usually lasts for 8 to 16 weekly sessions.

Combined treatments, for example anti-depressants with psychological treatment, are also used. The decision of which treatment to use should be based on patient preference, advice from a clinician, cost, practicality and success rates of different treatment types within an individual patient.

Canadian Medical Journal November 26, 2002

 

Dr. Mercola's Comments:

This is an excellent chance to review one of the most important challenges facing nearly every clinician: How to address "depression" in their patients.

This recent review provides a wonderful starting place as it provides a current and comprehensive overview of the subject. However, please recognize that the perspective is traditional.

When it comes to documenting the devastation that depression has on us, the material is identical from a natural approach. Depression, or more accurately, unrepaired emotional short-circuiting, absolutely devastates our health and, in my estimation, causes far more profound negative health consequences than all the rotten food, toxins and poisons we expose ourselves to.

The review also points out that only one-third of patients receive "adequate treatment." This is where you need to begin separating fact from fiction.

The fact is that two-thirds of people with depression are missed; this is a sad testimony to the clinical astuteness of most physicians. The diagnostic clues provided in the article are telling indicators that you or someone you love might be suffering from this illness.

The fiction is that patients receive adequate treatment once diagnosed.

Adequate treatment in a traditional model is a nearly universal synonym for drug therapy or ineffective cognitive counseling. Earlier this year another major review clearly showed that there is very little difference between most all antidepressants and a placebo.

Does this mean that antidepressants don’t work? Absolutely not, but in the vast majority of cases a benefit is felt because the person taking the pill believes that the pill will heal their depression. The "science" is quite clear on this.

Similarly, I posted an article earlier this year on the multi-center placebo randomized controlled trial on arthroscopic knee surgery for arthritis. Amazingly, the study showed that the surgery is no better than a placebo, yet 650,000 people in the U.S. receive this infective surgery each year, at a cost of about $5,000 per procedure. This equates to a total cost of about $3.3 billion every year in the U.S.

But that cost and waste is a mere drop in the bucket when it comes to the devastation that results when people’s lives are damaged by the trauma of inadequately treated depression.

The other major fiction is that of "expert" psychiatrists’ justification to keep people on antidepressants for the rest of their lives for so called "maintenance therapy." Most experts believe that one-third of depressed patients need this therapy.

I have been to many lectures at major medical schools given by prominent psychiatric department chairmen and I have asked the question from the audience, "Are there any non-drug options for this large group of people?"

The consistent response was that these "experts" said no, and each of them would recommend lifelong drug therapy as the lesser of two evils. They justify this because of the fact that over 70 percent of patients relapse with depression once they stop their medications. What a pity that so many are suffering because these "experts" are living in a delusion. Rather than recognizing that depression returns once a patient is off their medications because the drug doesn’t treat the cause, they elect to continue their Band-Aid approach.

To give some background of how I first became interested in depression, the treatment of depression has fascinated me ever since I listened to an Audio Digest tape of Dr. Joseph Tally about 20 years ago. He was an animated physician who provided a compelling story of some of the issues I am presenting here. Of course, back then his main focus was helping people with using drugs.

At that time, the drugs were the first generation non-SSRI, primarily tricyclic antidepressants, and had plenty of side effects. The main challenge was to convince patients to stay on the drugs long enough to notice them working. They would cause terrible problems with dizziness, drowsiness, weight gain and dry mouth. For the most part, these drugs are rarely used today.

Prozac was the first SSRI antidepressant that seemed to work without the terrible side effects. When it came out I was like a kid in a candy store. I was a recent medical school grad and was totally brainwashed in the drug paradigm. I put well over 1,000 patients on Prozac -- probably closer to 2,000.

However, with time I gradually came to realize the futility of this approach and have since adopted a course of care that addresses the cause of the illness.

Like most families, I have been personally affected by depression. My own mother suffered from this problem several years ago and actually made several unsuccessful suicide attempts that really devastated me. This occurred just as I was making the transition into energy medicine, so initially she was treated with medications.

However, the medications and inpatient care were a terrible failure. Ultimately it was energetic techniques that helped her fully recover from the depression, and she is now healthier emotionally than she has ever been in her life.

Optimizing the diet is clearly an important step, and one of the most important tools will be to make sure you are getting enough omega-3 fats. I have had large numbers of patients spontaneously take themselves off their antidepressants once they started the fish oils.

Dr. Stoll, director of the psychopharmacology research lab at Boston's McLean Hospital and assistant professor of psychiatry at Harvard Medical School, discusses this topic extensively in his book The Omega-3 Connection. I highly recommend this book, which reviews new evidence supporting the use of omega-3 oils for depression.

I also recommend a high-quality source of fish oil. It is necessary to have a quality source to ensure that toxins and other impurities have been removed from the oil.

However, when it comes to the major player here, it is certainly energetic rebalancing techniques, my favorite of which is EFT. You can view my EFT DVD and Book to learn how to perform the EFT technique, however, depression is best treated with a trained EFT therapist. To find an EFT therapist, you can review Gary Craig's EFT Practitioner Referrals.