DEPRESSION TREATMENT IN SCOTTSDALE AZ

Depression treatment has been a specialty treatment at my office in Scottsdale, AZ since 2001. Treating depression is very important for psychiatric as well as other neurological and physiological reasons. There are many different causes of depression and varying degrees as well. Untreated depression can be very serious, this will be addressed towards the end of this article with regards to the effects of depression and volume loss in the hippocampal area of the brain. The overall immune system suffers from depression thus making someone who is not being treated more susceptible to other illnesses. This is why vitamin D is so important to us – daily sunshine being a great resource. Some studies claim that vitamin D encourages the production and release of serotonin into the system. Scientists are not sure of the mechanism of action that vitamin D has on the nervous system.

Many people suffering with depression don’t even know it. Their lives have been “as good as it gets” and they don’t know what it is like to live a life free of depression. Depression and anxiety often share similar symptoms. This is especially the case when differentiating between clinical and situational depression. Depression is a physical illness as with most mental disorders. The PET scan of the brain of a depressed person is much different from that of someone who is not suffering from it. Most mental illnesses have a basis in physiology and should not be confused with psychological or personality disorders. Finding the causes are is crucial in treatment. Other illnesses can also present depressive symptoms and should be ruled out during the evaluation. A short rule-of-thumb: think of depression as having the blues, and anxiety as worry, panic, guilt, or fear.

Causes of Depression

We know that psychological abuse, personal conflicts, major events in your life, death or loss can make you more vulnerable to triggering depression. A history of drug or alcohol abuse can make you susceptible as well. Major depression is a chemical imbalance caused by neurological chemistry, stress, menopause, genetics, inflammation, and other issues. We think that depression is caused by a deficiency of the neurotransmitters in the brain and the chemicals serotonin, norepinephrine, and dopamine. An imbalance of these cause all of the symptoms of depression. Sometimes the changing of the seasons can trigger an episode of seasonal depression.

These symptoms must be present for a period of two weeks or longer to meet the definition of major depressive disorder. In the more severe cases patients can have recurrent thoughts of suicide. If anyone in your household has had thoughts of suicide it is important to remove any firearms or other instruments that might be a danger to them. We know that if a person has repeated severe stressors in their life and they have a genetic predisposition to depression, their risk of developing depression is quite high. When and individual has a single episode of depression the likelihood of subsequent episodes are more likely.

Depression Treatment Process

When doing an initial evaluation, I will first be looking for medical causes (problems with the thyroid gland, diabetes, medication issues). We also know that genetics plays a role in depression as well as early fetal and child development. So, I will be looking to see if your family members have had or do have depression because if they do, it puts one at greater risk. Reviewing the symptoms and associated history of the patient gives enough insight to reach a diagnosis for the specific depressive disorder. Sometimes the changing of the seasons can trigger a depressive episode or bipolar depression. Environment plays a substantial role in all mental health. As with most mental illnesses, the environment can affect the genetics behind these diseases. Even stress can affect a developing brain in young adults as well as those who suffer from traumatic events in life.

Treatment Options

Depression is very treatable and with today’s medications, the success rate is often near 90% with the first line of treatment. Although the medications have a high success rate with the patients they work for, still 20%-30% of depression is treatment-resistant. In these stubborn cases we will use other antidepressants and possibly recommend other therapies such as TMS, DBS, Ketamine, etc. I have treated a lot of depression and have developed the discernment for treating this debilitating illness. Often a comorbid disorder will accompany the depression, such as anxiety. If so, it is important to establish the primary illness and distinguish it from the secondary illness. We treat depression with the use of antidepressant medications and psychotherapy. Depression sometimes requires augmentation of two or more medications. The newer antidepressants are very effective. Studies have shown that the two used in conjunction is the most effective way to treat depression, especially when dealing with treatment refractory episodes. The antidepressants get to the root of the illness by correcting the neurotransmitter deficiency and elevate their levels.

Medication Management

Sometimes, it is a shorter amount of time and other times it takes longer because the medication needs to be changed due to problematic side effects. Often, a benzodiazepine will be prescribed during this ramping-up period to ease the discomfort. Usually when the correct antidepressant is given, people don’t have any problematic side effects and their depressive symptoms are no longer present. The role of the antidepressant medication is to increase the neurotransmitters, and therefore correct the deficiency and chemical imbalance among the three. The more common medications used today are the group of SSRIs, SNRIs, NDRIs, and other newer A-Typicals.

These medications inhibit the reuptake of chemicals in the brain responsible for our moods. The 3 chemicals are serotonin, epinephrine and dopamine. The first is responsible for pleasure, the second, for fighting pain, the third for motivation. The brain releases these chemicals in the brain and then regulates them by taking them out or re-absorbing them. The brain of depressed individuals removes these chemicals too often and leave the person depressed. These medications prevent the body from removing the chemical too soon and too fast and helps the brain maintain an even mood. When a patient isn’t fully responding to the antidepressants, we have found that medical foods such as L-methyolfolate augmentation works well to help the brain metabolize the medications.

Depression and Physiology

Depression damages brain cells. Depressive episodes can last from six months to one year, before they self-remiss. Often during this period of remission, patients may cease getting help; and the depression could have deleterious effects on your heart, brain cells, and other aspects of your physiology. Starting on antidepressant medication can help with some of these physiological issues, and cause the symptoms can go away as early as four weeks into treatment. We have also discovered that the antidepressant medications SSRIs protects the neurons (brain cells) from damage from the stress hormones. They protect the sheathing of the neurotransmitters thus increasing overall brain health.

Depression Rates in Women vs Men

Women develop depression twice as often as men. One reason may be the various changes in hormone levels that women experience. For example, depression is common during pregnancy and menopause, post menopause for 2 years, as well as after giving birth, suffering a miscarriage, or having a hysterectomy. These are all times when women experience huge fluctuations in hormones. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), an extreme form of PMS, may also cause depression. Environmentally or psychologically speaking, women are prone to stuff or hold in their emotions, especially anger, they have also been in the past less athletic than men these lifestyle issues might contribute to their propensity to be effected by depression 50% more than men.

Depression and Suicide

Most people who suffer from depression do not attempt suicide, but according to the NIH, 30-70% of suicide victims have suffered from some form of depression. This figure demonstrates the importance of seeking professional treatment for yourself or someone you love if you suspect depression. If you are ever on an antidepressant and begin to have thoughts of suicide, go immediately to the nearest ER. Esketamine might be given to remit the suicidal thoughts. This ketamine derivative is also good for treatment resistant depression.

Somatization Disorder

Pain caused by depression is called somatization disorder. There is often a notable presence of aches and pains with no particular cause, this is sometimes the cases with fibromyalgia. Having depression may also cause the symptoms of an illness to last longer and intensify its symptoms, but the true relationship of depression-induced illness, in terms of major disease, has not been thoroughly defined. It is important to seek the advice of your doctor if you think you or someone you know may have depression.

Depression – Future Treatments

Scientists may have isolated a certain area in the brain that is responsible for pleasure and likewise displeasure or depression. Genetic therapy might be able to repair or change the brain function by adding a missing brain protein p11 to this specific area of the brain. If this is the case, depression may be curable. This study gives hope for finding a cure for depression and other mental illnesses through altering the genes in the brain. As researchers have been searching for a cure for Parkinson’s disease, they have found that the p11 gene has a lot to do with the production of serotonin, and may treat depression and anxiety. This protein plays a role in the recruitment of serotonin receptors on the surface of the cells and increases levels of serotonin in the system. Researchers are working on ways to increase the level for the expression of the p11 protein. This is the closest we have come in genetic engineering and is one of the paths to a cure in the future for depression. Much research is also going into the relationship between inflammation & depression and someday might change mechanism of actions for antidepressants. DBS and TMS will likely be the next technologies to almost cure depression. Deep brain stimulation DBS, is progressing well in the cases of treatment resistant depression as well. Read about the breakthroughs in DBS for depression

If you are seeking depression treatment and an experienced psychiatrist in Scottsdale, AZ; please contact me to make an appointment. I look forward to working with you back to a life of wellness and hope! Don’t let depression get the best of you – this is a very treatable illness.

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