With the mental health care system broken, and many clinicians feeling as though they can offer only stop-gap measures to try to turn back the tide of depression, I think it can be useful for patients themselves to understand that a complete strategy works well more than 90 percent of the time.
No patient should assume that everything has been done that can and should be done to cure them, without reading this blog.
Here’s the strategy (psychotherapy, as a foundation, with other treatments added, as needed):
1. Psychotherapy. No scientist has ever proven that depression is entirely a brain illness divorced from the life stories of those who suffer from it. In every patient I have ever met who suffers with depression, the illness has had roots in unresolved emotional conflicts from the past.
The most talented psychotherapist you can find will be an invaluable resource in conquering your mood disorder. I prefer insight-oriented psychotherapy, but there are very helpful clinicians out there who use cognitive-behavior therapy, or other modalities.
If you don’t “click” with one therapist, or have the sense that he or she is a real expert, switch. There are plenty out there.
Here are some strategies that work well in addition to psychotherapy:
2. Medication. Psychotherapy and medication together is more powerful, often, than either alone. And I would never count on a medicine to work, without any therapy at all.
But today’s medicines can be life-saving. They include relatively new and effective agents like Viibryd, Pristiq and Lexapro. Since combining these with synergizing medicines like Abilify, Adderall and Klonopin may be necessary, opt for a knowledgeable psychopharmacologist to prescribe them. It’s even better if one talented psychiatrist is performing your psychotherapy and prescribing your medicines.
3. Repetitive Transcranial Magnetic Stimulation (rTMS). Exposing certain parts of the brain to magnetic pulses is a very powerful way to treat depression. Many patients who do not respond to medications, will respond to rTMS.
4. Ketamine infusions. While still in the experimental stages at major universities, I have found that giving patients IV infusions of ketamine, just twice a week for 45 minutes each, is a very powerful way to quickly treat depression. This treatment especially works for those whom medicine has not worked, those whom want very fast results while waiting for medicine to work or those whom seem stuck at a partial recovery from major depression and want a more complete solution.
5. Bright light therapy. Exposure to wavelengths mimicking sunlight (without any tanning UV rays) can substantially reduce symptoms of depression. Lights like the GoLite are relatively affordable and can be an extremely effective part of treatment.
6. Vitamins and other supplements. Anyone who is depressed and has no contraindication to taking magnesium, vitamin D and fish oil supplements should consider doing so. I also think maca, a plant-based supplement can be helpful. Your doctor may have other suggestions, too, but make sure to check with him or her before adding any supplement to your diet.
7. ECT. ECT or electroconvulsive therapy has evolved a long way from what people remember. The stigma is entirely unjustified. ECT is painless and well-tolerated and leaves most people without significant memory deficits. If I were depressed and no other treatment had worked for me, I would absolutely be asking my doctor for ECT.
8. Very non-traditional approaches. Some patients who do not respond to anything else can get relief from depression by using substances like marijuana or even oxycodone.
If your mental health clinician isn’t employing a comprehensive strategy to treat your depression, get rid of him or her.
This list, while long, is not exhaustive. I could easily add to it. And that’s the reason why I can tell depressed patients who come to see me and who ask me if they will get better, “We aren’t going to stop short of making this go away completely. I think you can get 100 percent better. And if you were always a little depressed before this terrible episode, you will feel better than ever.”
Make sure to work with and talk to your doctor and/or psychiatrist before attempting these strategies. What may work for one person, could be harmful for another.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.