Medication-free Interventions for Depression
These treatments have been proven to be effective for mood disorders and are backed by scientific research:
The last thing a depressed person wants to do is exercise but it is well known that regular physical activity elevates the mood and provides a sense of well being. This is done in part by increasing certain brain neurotransmitters and in part by modulating stress response.
2. Bright Light Therapy (BLT)
This refers to the use of bright light to treat symptoms of depression. Sleep disturbance is a core symptom of depression and of other mood disorders. BLT helps regulate the circadian rhythm, It triggers and increases the amplitude of melatonin production as well as higher serotonin levels. Sleep regulation helps the depressed person start to feel better.
4. Behavioral activation Therapy (BAT)
This behavioral component of CBT has been found to be a “stand alone” treatment for depression and it is highly effective.It guides the person to understand that their emotions are the result of their actions. It helps the depressed person to identify activities that add meaning to their life, like reading, listening to music, volunteering, visiting with friends and family, etc. The person is told to do these things without waiting for their mood to get better.
6. Transcranial Magnetic Stimulation (TMS)
During TMS treatment a large magnetic coil is held against the scalp on the Left Prefrontal Region of the brain. This area is near what is thought to be the “mood center”. Without pain, magnetic pulsations pass through the skull to stimulate the nerve cells. TMS helps normalize the activity of brain circuits involved in depression. The treatment is not invasive and there is no need for an anesthetic. In October, 2008 the US Food and Drug Administration cleared the first TMS device for the treatment of Major Depression
3.Cognitive Behavioral Therapy (CBT)
This is a type of “talk” therapy but also a “do” therapy relying in the delegation of “tasks” to the patient. It focuses on changing negative thought patterns, on learning to redefine problems and on finding new ways to approach them
5. Mindfulness Training
People are told to pay attention in a particular way: to do it on purpose, in the present moment, and without judging. They are thought to bring their mind to mundane objects or activities in everyday life. You practice mindfulness by eating mindfully, walking mindfully, “observing” your breathing, connecting with your senses, resting between actions, listening attentively with mind and heart and “getting lost” in doing what you love.
Changes in hippocampal function are believed to play a role in the onset of psychosis. A study published today in JAMA Psychiatry suggests that the concentration of the neurotransmitter glutamate and several other metabolites in the hippocampus may offer clues about patients who are most likely to transition to psychosis.
The findings suggest that measuring hippocampal metabolites could help psychiatrists better predict outcomes in patients at risk of developing psychosis.
For the study, Matthijs G. Bossong, Ph.D., of the University Medical Center Utrecht in the Netherlands and colleagues used an imaging technique known as proton magnetic resonance spectroscopy (1 H-MRS) to measure baseline levels of glutamate and several other metabolites in 86 individuals at high risk for psychosis and 30 healthy controls. On the day of the scanning, the researchers used several scales to assess the participants’ functioning as well as symptoms of anxiety and depression. About 18.5 months later, the researchers met face to face with 57 of the 86 participants in the high-risk group to assess whether the patients had transitioned to psychosis; they also assessed the overall functioning in this group.
In total, 12 people in the clinical high-risk group experienced a first episode of psychosis; 19 showed “good overall functioning” (Global Assessment of Function, or GAF, scale equal to or greater than 65), whereas 38 of the 57 had “poor functional outcome” (GAF less than 65), Bossong and colleagues reported. The group of patients who transitioned to psychosis were found to have had significantly higher hippocampal glutamate levels at the start of the study than those patients who did not transition. These patients also had significantly higher levels of the metabolites myo-inositol and creatine than those who did not develop psychosis. Moreover, patients with higher levels of hippocampal glutamate at baseline were found to have lower levels of overall functioning at follow-up, the authors reported.
“The findings indicate that adverse clinical outcomes in individuals at high risk for psychosis may be associated with an increase in baseline hippocampal glutamate levels, as well as an increase in myo-inositol and creatine levels,” the authors wrote.
“Pharmacological treatments that engage glutamatergic targets have been generally unsuccessful for treatment of psychotic, negative, and cognitive symptoms of schizophrenia,” Juan R. Bustillo, M.D., of the University of Mexico and colleagues wrote in an accompanying editorial. “However, because schizophrenia is highly heritable and glutamatergic-associated genes are among the most involved, in vivo glutamate measurements may still assist the delineation of subgroups of patients with vulnerable disease stages.”
Source: American Psychiatric Association
It has been established with certainty that regular exercise (aerobic or anaerobic) is beneficial to one’s overall health. This is especially true if combined with a regimen that includes a balanced diet with plenty of fruit ,nuts and vegetables.
Lately, there has been a series of studies linking physical exercise to improvement of mood and mental health. It has been known for a long time that Tai Chi exercises and Yoga movements and poses improve balancing, muscle strength and flexibility with the concomitant benefit of an improvement of anxiety and depression. More recently the understanding of the relationship of multiple internal body systems with the brain has shown there are specific benefits from physical exercise to achieve and maintain better mental
health. One of the benefits comes from the “neutralization” of stress during physical exercise. This effect is related to a better autonomic nervous system regulation of the heart function as well as modulation of the body’s inflammatory response (HPA axis). Major depression and anxiety by virtue of their pro-inflammatory status cause to endothelial dysfunction that ultimately lead to “arterial stiffness”. The association between depression and cardiovascular disease is bi-directional. Both entities share common pathophysiology. Following a myocardial infarction the presence of depression has a cumulative effect on morbidity and mortality. At Central California TMS Centers in California and in Guatemala we emphasize lifestyle modifications as part of a comprehensive treatment plan. These key changes include: to achieve a BMI 25% or under, exercise regularly, do yoga or Tai Chi, smoking cessation, reduce alcohol intake, modify or better manage stressful conditions, change diet to one low in carbohydrates, with plenty of vegetables, nuts and fruits.
But when I went to college – away from my support system – I started thinking about suicide. Hearing this, a campus psychiatrist had me hospitalized, which only increased my despair. I attempted suicide and was institutionalized even longer.
However, my depression never entirely left me alone. Dysthymia, a persistent, mild depression that insidiously eats away at self esteem, meant I couldn’t feel sustained pleasure or pride in the accomplishments for which I had fought so hard.
But that was nothing compared with what happened a few months ago. Without warning, I slid back down into the dark hole of severe depression, complete with thoughts of suicide.
Major depression strikes both sexes, but is more common in women, in part, it is thought, due to hormonal differences. Its incidence is on the rise, but it already is the leading cause of disease burden – a measure of both health and financial impact — in women worldwide, according to the World Health Organization.
As my case illustrates, major depression affects the entire family. My husband and in-laws took care of the children. Friends brought dinners. And I dragged myself through the days, desperate to stay out of the hospital, leaning on my psychoanalyst and the psychiatrist who prescribed my medications.
It wasn’t enough.
After many grueling weeks, my psychiatrist suggested that I consider transcranial magnetic stimulation (TMS) – a treatment I had never heard of.
‘Like an electronic woodpecker’
TMS is a noninvasive treatment administered by a physician in an outpatient setting daily for approximately six weeks. A magnetic coil that produces pulsing energy is placed on selected parts of the scalp, carefully set to the level of energy needed to stimulate a patient’s brain cells. You remain lying down, wearing earplugs because the machine makes a loud clicking sound like an MRI. In my experience, TMS feels like an electronic woodpecker hammering on my head. But oddly enough, it isn’t painful, and I sometimes even drift off to sleep during treatment.
It sounded so promising – and I was so desperate – that I quickly scheduled an appointment with John O’Reardon, a Voorhees psychiatrist who has long seen patients close to giving up.
During our 1½-hour consultation, O’Reardon confirmed my severe depression, accompanied by high anxiety levels. He thought I might not be on the right combination of psychiatric medicines but also recognized I was in no condition for the agonizing process of recalibrating them. Since age 18, I’ve tried roughly 15 different drugs, without lasting success.
My experience is not uncommon. Statistics about the efficacy of antidepressants vary and indicate that those with moderate to severe depression benefit the most. Studies of adults with moderate to severe depression showed that about 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks, though research also indicates that some of this gain may be due to a placebo effect.
Putting any major shifts in my medications on hold, O’Reardon recommended a full course of TMS, which the Food and Drug Administration approved in 2008 for the treatment of depression and migraines. I live in Bala Cynwyd but chose to drive every day to see O’Reardon because of his 21 years of experience, first at the University of Pennsylvania in a clinical research setting and now in private practice. I also took heart in his telling me that although I might feel “hopeless,” I was not a “hopeless case.”
“The amount of patients who have severe, what we call treatment-resistant depression, is about four million at any one time in the U.S.,” O’Reardon said later in an interview. “These are patients who do not respond to medications, who may not respond to therapy, and really need something else. And for those patients, in particular, TMS is very useful.”
The treatments stimulate connections of nerves or neurons called circuits to restore their normal activity.
“These circuits are disabled, or if you like, off-line in depression,” O’Reardon said. “And because they’re not working as normal, the patient has many things like depressed mood, low energy, poor sleep, and can, of course, even feel suicidal. By stimulating these circuits with magnetic energy, we can restore them to normal activity.”
A typical course of TMS is five days a week for a total of 30 to 36 sessions. The treatment is very safe and, unlike psychiatric medications, has few side effects. The most serious issue is a risk of seizure in about one out of every 1,000 patients. People can drive themselves to and from appointments and conduct normal conversation during treatments.
Expanding TMS’s reach
Approximately 1,000 TMS centers have popped up across the country since 2008. Clinicians around the world are studying TMS to treat conditions from post-traumatic stress disorder to autism spectrum disorder.
Deborah Kim and Susan Rushing, psychiatrists who jointly run TMS Associates of Pennsylvania in Haverford, do what is known as deep TMS.
“Really, the main difference is that it works on a larger part of the brain so it gets more of the circuit that we think is involved in depression,” said Kim, who is also an associate clinical professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. “This is as close as we can get without doing deep brain stimulation,” she said of the surgical procedure used most often to help address some symptoms of Parkinson’s disease.
She notes that TMS is especially useful for treating depression in women who don’t want to use medication while pregnant or nursing.
Yvette Sheline, director of the Center for Neuromodulation in Depression and Stress at Perelman, and her colleague Desmond Oathes are researching using MRIs of people’s brains to better pinpoint where the magnetic energy should be applied to maximize benefits. Showing brain activity on an MRI while the device is in use enables “the correct target to be identified at the outset and keeps the stimulation on target during treatment,” Sheline said.
Roy Hamilton, a Penn neurologist, is looking at TMS for improving language development and motor skills after brain injuries such as stroke. “Plenty of patients who’ve been through physical therapy still have pretty dense motor deficits,” Hamilton said, adding that a goal of his research is to “accelerate the course of recovery and to extend the overall level of recovery.”
O’Reardon has used TMS “off-label” to help people with obsessive-compulsive disorder, post-traumatic stress disorder, auditory hallucinations caused by schizophrenia, and chronic pain.
Up out of the hole
I had 30 sessions at $300 a pop, which I paid for out-of-pocket and then submitted to my insurance company – after receiving prior authorization – for out-of-network reimbursement.
The sensation over time was like climbing up a staircase out of the hole, back into my daily life. I began working and parenting again and ultimately feeling brighter, more hopeful, and more resilient than I had in as long as I could remember.
“Some people really just feel like a light is turned on in a way that it never felt like when they were on medications,” Kim said. “The world looks colorful again.”
O’Reardon and I are now discussing how to maintain my gains, most likely through once or twice monthly session of TMS for the indefinite future. He will also continue to manage my medications.
As remarkable as my recovery feels, what may be more astonishing to me is discovering that depression may no longer be a life sentence for me.
“I had never had somebody tell me before that I could get fully well,” I recently told O’Reardon. “That was really an eye-opener when I came in here, and you talked about remission.”
“I think it speaks to some degree to under-treatment in the community – that [depression is] not always treated intensely enough, and then I guess maybe people don’t think about it the way we should think about it: as a reversible illness,” O’Reardon said.
“We should be treating depression more like treating hypertension or diabetes. If you had the right tools, you should be able to reverse things fully and get back to a normal balance. Now we don’t always achieve that, but you’ve got to start with that goal in mind.”
Source For The Inquirer