Tuesday, June 28, 2022

Is depression treatable?

Executive Summary

In 80 to 90% of patients, depression is treatable. Plus, almost everyone with depression finds improvement in his symptoms by using some of the treatment options.

Depression management has six pillars:
1. Medicines;
2. Dietary and nutritional changes;
3. Lifestyle changes;
4. Behavioural therapy;
5. Device-based management; and
6. Complementary therapies.

Disclaimer: The information, including but not limited to, text, graphics, images, and other material, contained on this website is for informational and educational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Overview

Before asking about depression treatment, you will need to know if you really have depression because many other medical conditions have symptoms similar to depression. Then you should check what type of depression you have since there are many varieties of depression. After that, you should know how serious your depression is. Is it mild, moderate, or severe? The treatment changes based on the severity of depression. Finally, you will need to know how long you should take treatment before starting to see results and how long to continue the treatment. You can not decipher these details yourself; only your doctor can enlighten you.

If you prefer to watch a video instead of reading, a significant part of this article is covered in my video on my YouTube channel: Health Sachet. Here is that video:

Introduction

Depression is a common medical condition that makes you feel, think, and act in a negative manner. It can make you feel sad and lose interest in activities that you enjoyed earlier in your life.

The medical term for depression is a major depressive disorder or clinical depression. It affects nearly six per cent of the people in any given year. In fact, fifteen per cent of people will face it at least once in their lifetime. Obviously, some will face it multiple times and over multiple years.

Curing versus Treating

Before we dive into the subject of depression, let me clarify this issue about curing depression versus treating it. Curing means once you treat the problem, it goes away permanently—just like your fever. Unfortunately, that is not possible with depression, as of now.

But you can treat depression, so much so that if you take your medications as well as supplements and do the lifestyle changes advised, you can live a long and healthy life without any of the depression symptoms hampering the quality of your life. To me, that is complete recovery, if not cure.

What is Not Depression

Feeling low for a long time does not mean you have depression. Even I felt depressed during the COVID times. But such a feeling is not depression.

Feeling down can happen in normal individuals, who may lose a relationship, a loved one, or a job. Feeling low in such times is normal and is not depression.

The way to distinguish such grief from depression is to check your feeling of self-worth. If you feel guilty, have self-hate, or feel low on self-esteem, it is not grief; it is depression.

Signs, Symptoms & Diagnosis of Depression

Many of the symptoms of depression are also seen if you have an underactive thyroid or hypothyroid, vitamin B12 deficiency, or rarely, a brain tumour. So doctors need to see multiple symptoms simultaneously to confirm a diagnosis of depression.

At least five of the following symptoms need to be present every day for at least two weeks and should hamper your level of functioning for the diagnosis of clinical depression.

  1. One may feel sad or down. Children or adolescents may be more irritable than downcast.
  2. One may lose interest in activities that one enjoyed earlier.
  3. On the physical side, one may have trouble sleeping or on the other side of the spectrum, one may sleep too much. Nearly ninety per cent of depressed individuals face this.
  4. One may sense increased levels of fatigue or lack of energy.
  5. One may lose appetite and weight.
  6. One may do random hand movements, become restless, or pace the room.
  7. One may become irritated or agitated easily.
  8. On the other hand, one may become withdrawn and walk slowly as if carrying a heavy burden on one’s shoulders.
  9. On the mental side, one may not be able to focus on one’s work, think clearly, or make quick decisions. Note that these are to be observed in relation to the earlier status of the person. If someone always talked slowly or dilly-dallied, we cannot term that depression.
  10. A dangerous sign, especially in adolescents and youth, is thoughts of suicide. They or their family members must seek medical help without wasting time in such cases.

Causes of Depression

In our society, depression carries a lot of stigmas, as if it is the fault of the person. But there are many causes of depression, most of which don’t depend on the person. They are as extrinsic as a fever is—pretty much not their fault.

There are physical, genetic, personal, environmental, nutritional, and medical causes of depression.

Physical Causes

There are brain chemicals called neurotransmitters that help different brain cells communicate with one another. The three main neurotransmitters involved in depression are Serotonin, Dopamine, and Norepinephrine.

They transmit different types of messages and so show different effects on our behaviour.

  • Serotonin affects mood, energy, appetite, and sleep;
  • Dopamine controls motivation and pleasure;
  • Norepinephrine regulates concentration, attention, and energy.

All these three neurotransmitters are depressed, pun unintended, in depressed people. But science still does not know why their levels are low in depression.

Genetic Causes

Depression can run in families. A gene called SERT helps in serotonin transport. Families with a particular variation of this gene are more vulnerable to low levels of serotonin and therefore, depression.

Personal Causes

Someone who is low on self-esteem or is pessimistic by nature is more likely to suffer depression.

Environmental Causes

Some depressive people may have had long-term stress, possibly from abuse or neglect in childhood, social isolation, etc.

Nutritional Causes

  • Omega-3 fatty acids play a role in brain functioning. They affect mood and memory. The deficiency of omega-3 fatty acids can lead to depression;
  • Vitamin D deficiency is linked to depression;
  • Many depressed people are found to be deficient in vitamin B12;
  • People deficient in vitamin B9 don’t respond to antidepressants, which are the medications for managing depression;
  • Protein deficiency can cause mental fog. It may make you lack focus and depressed; and
  • Minerals such as iron, zinc, selenium, magnesium, chromium, and iodine help in brain health and may help avert depression symptoms.

Medical Causes

Certain medical disorders such as Parkinson’s disease, heart attack, and cancer are found to be associated with depression.

Finally, certain medicines used for high blood pressure and high cholesterol can also lead to depression.

Types of Depression

There are many types of depressions besides the commonly observed form. Here are the two that you should keep in mind:

  1. A type of depression called Seasonal Affective Disorder (SAD) arises in regions where nights are very long in winter. It comes at the same time of the year and disappears once spring appears.
  2. Another type of depression called dysthymia or persistent depressive disorder involves less severe symptoms of depression but they are present for a long time, such as two years or more.

Treatment of Depression

There are six pillars in the management of depression once it is diagnosed and its severity is determined:

  1. Medicines;
  2. Dietary and nutritional changes;
  3. Lifestyle changes;
  4. Behavioural therapy;
  5. Device-based management; and
  6. Complementary therapies

Medicinal Treatment

Since low levels of serotonin, dopamine, and norepinephrine are common in depression, medicines try to elevate them and manage the symptoms. Since this uplift is short-term in nature, one may have to be on the medicines for life or whatever duration one’s doctor advises.

The first line of treatment is a class of medicines called SSRIs. They lift one’s mood by raising serotonin levels in the brain.

Medicines called SNRIs are used at the next level. They raise serotonin as well as norepinephrine.

In earlier days, a class of medicines called tricyclic antidepressants (TCA) were used. These days, they are used only if the other classes of medicines don’t seem to work.

Another class of medicines are MAO Inhibitors. They form the oldest class of antidepressant medicines and have many side effects. But if the other medicines don’t work, doctors prescribe them.

There are some other atypical medicines that address specific symptoms of depression.

Of course, your doctor will select them and their dosage. The details above are only to tell you about the tools that your doctor has. It is also to educate you that if your doctor changes medicines, it is because she finds the earlier medicine is not effective enough.

Five Points about Antidepressant Medicines

  1. You have to take the antidepressants every day, not just on the days you feel depressed.
  2. You should not stop them when the symptoms disappear. Else, you run a risk of your depression returning because antidepressants will not make the symptoms go away permanently.
  3. Antidepressants may take at least 3 months before you see their effects. So don’t prejudge if the medicine is working. That is for your doctor to decide.
  4. You can take these medicines lifelong, though in some cases you may not need to take them after some time. But let your doctor decide that.
  5. Finally, if you want to stop taking the antidepressants for whatever reason, don’t stop them abruptly. Talk to your doctor, who may help you gradually reduce the dose. Else, you may get withdrawal symptoms.

Dietary & Nutritional Changes

Stress is a trigger for depression. Control your stress by drinking a lot of water, taking adequate sleep, reducing caffeine and alcohol, stopping smoking, and eating healthy food.

Make sure you do not have deficiencies of protein, vitamin D, and B-vitamins, especially B12 and B9.

Similarly, take sufficient levels of minerals such as iron, zinc, selenium, magnesium, chromium and iodine. The best way will be to take all these minerals through a good multimineral supplement, which is naturally sourced and not chemically composed. Why natural? Because the bioavailability (or roughly, the absorption into your blood) is much higher for naturally sourced minerals than chemical sourced ones.

Even Ginkgo Biloba, saffron and St. John’s Wort are found to help with mild symptoms of depression.

Lifestyle Changes

Amongst lifestyle changes, exercise is found to help depression. Try at least 3 hours a week of some exercise.

Being outdoors helps you get a better connection with the world. Breeze, scenery, and people outdoors may help reduce depression symptoms.

As mentioned earlier, stress can trigger depression. So practise yoga and mindfulness to reduce it. You can also increase your interaction with family, friends, and social groups.

Behavioural Therapies

Behavioural therapies help you identify harmful thought patterns and then teach you to break out of them. Some therapies are:

Cognitive behavioural therapy (CBT) teaches you to identify and reframe thoughts and behavioural patterns that are common in depression. You learn to change your thoughts and actions to improve your emotions.

Interpersonal therapy (IPT) teaches you to improve communication and interpersonal interactions. It goes on for 3 to 4 months.

Therapies are designed to help you identify thinking traps, which make you think in a similar pattern of thinking.

Some thinking traps are:

  1. Overgeneralising (“I failed in the past; so I will always be a failure“);
  2. Filtering: ignoring anything that contradicts your belief (“all people tell lies to me“);
  3. Binary thinking: all–or–nothing (“either I will be a big success or a total failure“);
  4. Selective memory: focus on one thing and ignore everything else (“things were always this bad, there is no hope“);
  5. Jumping to conclusions (“she did not pick my call; I am sure she hates me“);
  6. Taking things personally (“I did not get selected in the interview; I must be awful“); and
  7. Catastrophizing (“if I do not get admission to the engineering college, it will be the end of the world for me“).

Once you identify a thinking trap, the therapy teaches you how to control your thinking in that situation.

Device-Based Therapies

If depression persists for a year or more in spite of medicines, or if it is a very severe form of depression, device-based therapies may be used. They involve stimulating the brain in different ways.

  1. Transcranial magnetic stimulation (TMS) stimulates the nerves in the brain to increase brain activity;
  2. Electroconvulsive therapy (ECT) involves giving small electric shocks to the brain under sedation to restore normal brain activity;
  3. Vagus nerve stimulation involves implanting a device in the chest and aims to raise the levels of neurotransmitters in the brain.

Complementary & Alternative Therapies

Amongst complementary therapies, here are a few that are found to help to differing degrees. Don’t rely on them exclusively for managing your depression but you can add them to your repertoire after discussing them with your doctor.

  1. Acupuncture;
  2. Music therapy;
  3. Yoga, meditation, and mindfulness;
  4. Massage and reflexology;
  5. Guided imagery.

My Views

  1. You have a whole host of options available even if you are diagnosed with depression.
  2. Be patient; be trusting; and seek medical help as soon as you can.
  3. Remember, depression does not mean you are less of a person.
  4. Just as a diabetic has blood glucose disorder or I have an eyesight accommodation disorder (I need glasses to read), you can say that you have a brain neurotransmitter disorder. Don’t be ashamed of your problem.
  5. With proper treatment, you can live a perfectly healthy and normal life.
  6. You do not need to check for nutritional deficiencies before increasing nutrient intake. The tests are often expensive—more expensive than simply taking the nutritional supplements in the first place.
  7. Unlike medicines that are designed for a specific problem, nutrients cover many systems in the body. So increasing their consumption improves overall health, too.
  8. It might be a good idea to supplement with protein, a good multivitamin, a naturally sourced multimineral, and omega–3 oils derived from fish harvested from open seas. Each of these also helps in many other body systems such as the heart, liver, kidneys, pancreas, lungs, and immune system.
  9. There is no harm in trying complementary therapies as long as you continue with your medications. The least they will do is improve your quality of life.

For More Reading

First published on: 12th March 2022
Image credit: Pixabay on Pexels
Last edited on: 26th June 2022

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