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 hippocampal volume loss. Additionally the overall immune system suffers from depression thus making someone who is not being treated for depression more susceptible to other illnesses. What is depression? The truth be known, 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 have similar symptoms so understanding these symptoms are critical to seeking help; which entails diagnosing and proper treatment. This is especially the case in differentiating between clinical depression 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 depression. Most mental illnesses have a basis in physiology and should not be confused with psychological or personality disorders. Finding the causes of depression is crucial in depression treatment. Treating depression begins with a complete physical history, psychiatric evaluation in an attempt to discover the causes of the depression so that the best treatment option can be applied which will yield the best prognosis. Depression is very treatable and with today’s medications, the success rate is often near 90% with the first line of treatment (assuming the practitioner has the judgment, discernment, and experience).
Looking for the Causes of Depression
When doing an initial evaluation I will first be looking for medical causes (i.e. 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 will put you at greater risk of having depression. Sometimes the changing of the seasons can trigger a depressive episode or bipolar disorder. Living in the Scottsdale or Phoenix area can often mitigate these episodes for obvious reasons. Environment plays a substantial role in all mental illnesses and the debate between genetics and environment is as old as the feud between the Hatfield and Mc Coys! I believe that with most mental illnesses, the environment can affect the genetics behind these diseases and even stress can affect a developing brain in young adults as well as those who suffer from traumatic stress.
We know that psychological abuse, personal conflicts, major events in your life, death or loss can make one more vulnerable to depression. A history of drug or alcohol abuse can make you susceptible as well. So as your doctor, I will be exploring these issues as well. Depression is a chemical imbalance caused by the aforesaid reasons of body chemistry, stress, menopause, genetics, and other issues. We think that depression is caused by a deficiency of the neuro-transmitters in the brain (i.e. serotonin, norepinephrine, and dopamine) which cause the symptoms of low mood or apathy, decreased energy and motivation, feelings of worthlessness or excessive feelings of guilt, psychomotor agitation or retardation, poor concentration and memory, a change in appetite with weight gain or loss; and a change in sleep with either hypersomnia or hyposomnia. 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 of depression, 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 of depression are more likely. Depression can also be viewed as situational or clinical.
Depression Treatment Options
How do we treat depression? Treating major depression sometimes requires augmentation of two or more medications. Having practiced psychiatry since 1997 and beginning my practice in Scottsdale in 2002, I have found that every single case is different. I have treated a lot of depression and have developed the discernment for treating this debilitating illness. Sometimes I will see comorbid depression with anxiety in which case 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, 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 depression. The antidepressants get to the root of depression by correcting the neurotransmitter deficiency, in that; they elevate the levels of these neurotransmitters. There are side effects of serotonin reuptake inhibitors some of which are quite benign and some a bit more severe, none the less, they do a good job of treating depression. Exercise is a great augmentation to all therapies since the effects of exercise on depression are tremendous. Exercise assists the body in producing neurotransmitters, endorphins, hormones; and should never be overlooked in conjunction with a low fat diet. Sometimes acupuncture can be used to treat the physical effects of depression such as somatization disorder and fibromyalgia.
We have found that depressive episodes last from six months to one year, before they self-remiss. Starting on antidepressant medication, the symptoms can go away as early as four weeks into treatment. 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. Sometimes I will prescribe a benzodiazopine during this titration period. Usually when the correct antidepressant is given, people don’t have problematic side effects and they don’t even know that they are on them except that their depressive symptoms are no longer present. The role of the antidepressant medication is to increase the neurotransmitters, and therefore correct the chemical imbalance that is from a deficiency of the neurotransmitters.
Treating Depression with SSRIs Can Protect Your Brain From Damage and Memory Issues
A new function that we have also discovered through research is that the antidepressant medication protects the neurons ( i.e. brain cells) from damage of the stress hormones called glucocorticoids. This is a preliminary study and has been challenged, yet the study should give us cause to pursue this protective feature of the anti-depressants; especially in the elderly. It protects the sheathing of the neurotransmitters thus increasing overall brain health. Studies have shown that the hippocampus region of the brain will shrink due to depression thus causing memory issues. When SSRIs are taken they have an effect of taking the stem cells in the brain and transforming them into adult brain cells, thus replacing those that have been destroyed by the depression. So, getting the proper medication has its value well beyond dealing with the symptoms of depression. There are even studies that show some promise in the future for a cure for depresssion through genetic repairs. These studies are in the early stages and inconclusive-yet give us cause for the hope of someday finding a cure. If you are seeking depression treatment and an experienced psychiatrist in Scottsdale or a Phoenix psychiatrist who has been through a rigorous residency program and handled some of the toughest medical cases, 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. Read some of my articles of interest or go to NAMI’s website to read more on depression.