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Treatment for depression

Depression is a crushing illness that can make it difficult to function at work and at home. Fortunately, due to advances in medical science, depression is more treatable today than ever. At Centre for Counseling of Aventura, we have helped many people overcome the debilitating effects of depression.

Medications used to treat depression

Nearly 70% of people with depression must try more than one medication before finding relief from their symptoms. There is a wide variety of antidepressants, which can be divided into types.

Tricyclic antidepressants (TCAs) are an older group of medications used to treat depression. They include  amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Side effects can include blood sugar level changes and blood pressure changes.

Monoamine oxidase inhibitors (MAOIs) are another very early treatment for depression. Medications in this class are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch). Although MAOIs are effective, they have serious interactions with other medications and certain foods, including aged cheese and cured meats.

Selective serotonin reuptake inhibitors (SSRIs) date back to the 1980s and are the most common class of drugs used for depression. Examples include sertraline (Zoloft), fluoxetine (Prozac, Sarafem), citalopram (Celexa), paraxetine (Paxil, Paxeva), and escitalopram (Lexapro).

Serotonin modulators and stimulators (SMSs) are a newer class of medication that affect serotonin and other receptors. They include vilazodone (Viibryd) and vortioxetine (Trintellix). Side effects, including nausea, weight gain, and headaches, can be uncomfortable for some people.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of antidepressants. They include venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima).

Bupropion (Wellbutrin, Aplenzin) is a unique antidepressant affects norepinephrine and dopamine. Bupropion may be less likely to cause sexual side effects than other antidepressants.

Mirtazapine (Remeron)  is thought to affect serotonin and norepinephrine through different brain receptors than other medications. It is can cause drowsiness, weight gain, and elevated triglycerides, among other side effects.

Trazodone (Desyrel) is one of the few antidepressants that does not produce weight gain. It causes drowsiness so it can be used to treat insomnia associated with depression.

Using TMS to treat depression

Patients who do not benefit from medication or who find side effects intolerable can often find relief from depression using transcranial magnetic stimulation (TMS). This course of treatment requires a serious commitment by the patient; it involves at least 5 treatments per week over a 4-6 week period, with each session lasting about 1/2 hour. However, many patients report that depression is "cured" for a year or more following TMS therapy.

How grief differs from depression

Grief can resemble depression on the surface. Many people experiencing grief feel sadness and despair, lose interest in food, have trouble sleeping, and are plagued by fatigue and poor concentration. Depression, however, takes things a notch higher. In depression, people experience feelings of worthlessness, oppressive guilt, a pervasive sense of powerlessness, agitation, extreme fatigue, and suicidal thoughts.

Grief is a natural process that occurs with loss. Most people manage grief without needing medication. Occasionally, grief tips over into depression. When this happens, medication can be a short-term crutch that helps an individual "get over the hump." It is important to seek psychiatric help if your grief seems overwhelming, you have thoughts of suicide, or your grief seems atypical. As psychiatrists, we can help you know where you stand and what to do about it.

How clients can aid in their recovery from depression

Recovery from depression is not always as simple as taking a magic pill.  For one thing, it can take several weeks for medication to work. For another, medication is more effective when clients have coping strategies in place. Clients who take care of themselves by eating well, exercising, and spending time with friends tend to do better than clients who isolate and ignore their health.

Staying connected is one of the best ways to fight depression. Loneliness can trigger depression, but just being around people can help clients feel less isolated. This can be as simple as hanging out in the local coffee shop for a few hours. Research has shown that face-to-face interactions are more healing than social media, so depressed clients should look for support from people who know how to listen attentively and compassionately. If clients lack a support network, volunteering can be a powerful substitute. In fact, research has shown that being helpful to others boosts mood more than receiving help. Also, caring for a pet has been shown to be extremely beneficial to people with depression.

Engage in pleasurable activities or hobbies that were once pleasurable. Depression grays out life, so clients may have to push themselves to engage in pleasurable pursuits. However, participating in sports, hobbies and creative pastimes can elevate mood significantly and is worth the investment.

Maintain healthy habits by getting the right amount of sleep, eating well, and being physically active. Sleep is especially important; clients should aim to have a regular sleep schedule with approximately 8 hours of uninterrupted sleep. Eating well helps the body be healthy, and the brain is part of the body. Foods that are high in anti-oxidants, "smart carbs" such as whole grains and vegetables, and protein-rich foods are all important ways to support the body.

Avoid stress, which can aggravate depression. Money and relationship issues or a toxic work environment can prolong or even trigger depression. Psychotherapy can help clients deal with stress. Further, the practice of meditation on a daily basis can also help calm the mind and make stressors seem less important.

Get enough sunlight because depression has been linked to low levels of vitamin D. If you are unable to spend 15 minutes a day in the sun, a vitamin D supplement may be of help. Some people benefit from using a light therapy box, especially if they do not easily absorb vitamin D.

Challenge the negative thinking that perpetuates depression. Depression leads to negative self-talk, which in turn can feed depression. A psychotherapist can help clients challenge negative thinking and replace these cognitive distortions with more realistic ways of approaching the world. Cognitive therapy is an extremely effective way to help clients take control of their thoughts and perceptions.

Types of clinical depression

Major depressive disorder

Major depressive disorder affects 1 in 15 adults each year. There are two subtypes: atypical and melancholic. People with atypical depression tend to over-sleep and overeat; it is common among young adults. Melancholic depression is more common in seniors and displays as insomnia and moody rumination. Major depressive disorder is highly treatable with a combination of medication and talk therapy.

Treatment-resistant depression

Some people with major depressive disorder do not respond readily to treatment. These clients may need to try many drugs or drug combinations before relief  is found. South Florida's Centre for Counseling of Aventura specializes in working with clients who have treatment-resistant depression. In addition to medication and psychotherapy, we offer trans cranial stimulation (TMS) for the treatment of depression.

Subsyndromal depression

Sometimes a person does not have all the symptoms of major depression, but still has trouble functioning. This person may have subsyndromal depression, or depression that does not quite hit the mark for a diagnosis of major depression. Subsyndromal depression is a serious condition that requires careful diagnosis and care.

Persistent depressive disorder (dysthymia)

Dysthymia is a chronic low mood accompanied by at least two other symptoms of depression. Dysthymia may not have the deep lows of major depression, but it robs life of joy and can produce a distorted outlook.  We treat people with PDD with a combination of medication and psychotherapy.

Premenstrual dysphoric disorder (PMDD)

PMDD affects approximately 1 in 10 women of childbearing age. It is a severe form of PMS that can manifest as depression, severe anxiety, and irritability. It can be challenging and disabling, but is highly treatable with antidepressants, certain contraceptives, and even light therapy.

Bipolar depression

To be diagnosed with bipolar depression, a person must have also experienced at least one period of mania or hypomania (a less severe form of mania).  Bipolar disorder occurs on a spectrum, so some people with bipolar depression may have a "down" mood where others feel hopeless and suicidal. Treatment for bipolar depression requires treating the whole illness, so that mood swings are evened out and the client is more stable.

Disruptive mood dysregulation disorder (DMDD)

Children often struggle to expression their emotions. Children with DMDD may be persistently angry and let loose emotional outbursts and temper tantrums. They have trouble functioning in school, with friends, and at home. At Centre for Counseling of Aventura, we treat DMDD with medications and talk therapy and help parents to cope through parent training.

Postpartum (perinatal) depression

Postpartum depression affects 1 in 4 women and 2 in 8 men. It can occur at any point during the year following a child's birth, but usually appears within the first few weeks. It is linked to hormonal shifts and life stressors in women. It is linked to life stressors, including changing roles, in men. We provide treatment for postpartum depression using psychotherapy and sometimes medications.

Seasonal affective disorder (SAD)

SAD is less common in South Florida than in four-season areas. SAD usually occurs during the fall and winter, and has been linked to serotonin and melatonin imbalances. It is most common in women and young adults. Sufferers typically oversleep, crave carbs, and isolate. Light therapy, vitamin D, and psychiatric medications can be helpful in the treatment of SAD.

Substance-induced depression

Alcoholism, the abuse of opioids and benzodiazepines, and withdrawal are all associated with depression. This depression usually resolves on its own once the underlaying cause is removed. The physician must be careful to look for causes unrelated to substance abuse.

Psychotic depression

Psychotic depression is a severe depression accompanied by a psychotic break from reality. This can take the form of false perceptions of reality (such as paranoia that someone is trying to poison you) and hallucinations (auditory or visual). We treat psychotic depression with medication; it is recommended that a client with psychotic depression be hospitalized for their own safety and the safety of others.

Illness-related depression

People who have a serious or chronic condition, like cancer, HIV/AIDS, or MS, often face depression too. Partly, their depression is rooted in environmental reasons. But there is also clinical evidence that many disease release inflammatory chemicals that affect the brain and trigger depression. We treat this type of depression with medications to alleviate the depression and psychotherapy to help clients cope their circumstances.

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