Key Takeaways:
Depression is mental health diagnosis in which individuals typically feel down or sad, among other things.
Treatments should include medication, therapy, and lifestyle changes in one comprehensive plan.
Depression and treatment for depression is different for everyone. An integrative approach that addresses root causes increases the chances of long term success.
What is depression?
Depression is a one of the most common diagnoses in America – and not just in mental health but in all of medicine. Depression can have a significant impact on a person's quality of life. Depression can make it difficult to enjoy activities that were once pleasurable, cause changes in appetite and sleep patterns, and lead to feelings of sadness, hopelessness, and thoughts of suicide.
We still do not have a definitive answer as to what causes depression on an individual level. Meaning, we know depression can be the result of chemical imbalances, genetics, biological factors, an individual’s environment, and lifestyle but we cannot look at a specific case and say with certainty what causes depression. This is why I use a holistic approach to comprehensively assess each patient in order to more appropriately address root causes with solutions that work long term.
So what are the treatments for depression?
Medication:
Antidepressants! These medications work from a chemical perspective by regulating the levels of neurotransmitters in the brain, which are thought to improve mood and reduce symptoms of depression. Some of the most commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs) like Lexapro or Zoloft, and, serotonin and norepinephrine reuptake inhibitors (SNRIs), like Prisiq. There are other medication classes used for depression too, but the principles are the same: correcting perceived chemical imbalances.
Most antidepressants are prescribed by primary care providers, which typically don’t have the capacity to fully evaluate and treat depression. (This is not to say the provider is incompetent or lacking knowledge – most simply don’t have the time or bandwidth to manage the complexities of mental illness).
The problem here is that medication for depression, especially when prescribed in the primary care setting, is viewed as a curative treatment when in reality medication for depression is a supportive treatment at best.
What does that mean? That means people operate under the assumption that the pill will fix the problem. Perhaps we think of antidepressants this way because when we get strep throat or pneumonia we take antibiotics and that cures the disease.
Breaking news! Depression cannot be cured with just a pill.
Antidepressants will not single handedly alleviate symptoms of depression long term. Study after study has shown that long term use of antidepressants without any other interventions is not different that a placebo (and that’s giving antidepressants a conservative analysis). It's important to note that antidepressants can take several weeks to start working, and they may have some side effects, such as nausea, dry mouth, or difficulty sleeping. Additionally, not everyone responds to medication in the same way, so it's important to find the right medication and dosage based on symptoms, genetics, and environmental factors.
I probably sound like I hate antidepressants, don’t I? Actually, I don’t! I believe that antidepressants have a place at the table for the treatment of depression – just not the only place. I view antidepressants (and most psychiatric medications) like training wheels. To me they are supportive tools that provide targeted relief and in most cases should not be considered the singular long term fix.
Psychotherapy:
Talk therapy is a must-have treatment for depression. In fact, much of the time therapy is more effective than medication. If symptoms of serious enough for medication, therapy must also be used without an exception.
I am going to say something controversial: prescribing medication for depression without concurrently prescribing psychotherapy is malpractice.
I’ll say it again: antidepressants should not be the only intervention used for depression. In my practice, I will not prescribe unless therapy is a part of the treatment plan either with me or another provider.
As a provider, I use acceptance and commitment therapy (ACT), which is similar to cognitive-behavioral therapy (CBT). In ACT we work toward becoming more in line with our values while working to accept the challenges of life rather than eliminate life’s difficulties.
There are many different types of psychotherapy available, including ACT, CBT, interpersonal therapy, and psychodynamic therapy. CBT is one of the most commonly used types of therapy for depression, and it focuses on identifying and changing negative thought patterns and behaviors that may be contributing to depression. With ACT and CBT, a therapist will work with the individual to identify negative thoughts and behaviors, and then help them develop more positive and adaptive ways of thinking and behaving.
Lifestyle changes for effect depression treatment:
Maintaining a healthy lifestyle changes is essential for managing depression symptoms and improving mental wellness. Below are a few key components of a healthy lifestyle that should be a part of an individual’s routine for optimal mental health.
Exercise
Getting regular exercise has been shown to improve mood and reduce symptoms of depression. This is a must!
Sleep
Getting enough sleep is crucial for overall health and it's especially important for people with depression. We need 8-9 hours of sleep each night that follows a healthy sleep/wake cycle. Also a must-have!
Nutrition
Nutrition is also crucial. What we eat impacts so much within our bodies and has a direct link to our emotions and the way we feel. Another must!
Mind-body practices
Practices such as yoga, meditation, and mindfulness can help reduce symptoms of depression by bringing awareness to the present and calming the mind. This is icing on the cake!
In addition there are several other factors that can contribute to the success of depression treatment. These include:
Support
Having a strong support system, whether it's friends, family, or a therapist, can be crucial in managing depression. People with depression should be encouraged to reach out for help when they need it, and to maintain close connections with loved ones.
Self-care
Taking care of oneself, both physically and emotionally, can help to reduce symptoms of depression. This could include anything from taking a warm bath to practicing self-compassion.
Mindset
Maintaining a positive mindset and focusing on small victories can be a powerful way to manage depression. This could include celebrating small accomplishments, practicing gratitude, or focusing on the things that bring joy and meaning into life.
It's important to remember that while depression treatment can be effective, it's not a one-size-fits-all approach. Everyone's experience with depression is different, and what works for one person may not work for another.
Treatment for depression is never a linear process. It's not uncommon for people to experience setbacks or relapses, and it's important to recognize that this is a normal part of the process. With time, patience, and support, people with depression can learn to manage their symptoms and live fully.
Conclusion
Wrapping up, depression treatment can be effective with an individualized approach that addresses depression in a comprehensive sense, including with medication, psychotherapy, and lifestyle changes. In addition to these treatments, factors such as support, self-care, and mindset can contribute to the effectiveness of depression treatment. It's important for individuals with depression to work closely with their healthcare providers to find the treatment approach that works best for them, and to be patient and compassionate with themselves throughout the process.
If you have questions about integrative psychiatry, are interested in seeking care, or are interested in learning about how to practice integrative psychiatry, please reach out to me via email at ryan@proactivepsychiatry.com. I am working to spread the word about integrative psychiatry, so feel free to repost this blog, just be sure to cite my post!