For my last blog before my synopsis I want to focus on some of the treatments that surround depression and how they affect individuals interacting within society. I, as I’ve said before have been diagnosed with depression so some of these therapies are near and dear to me. I want to explain some of the treatments health care providers can offer, as well as give some of my own insight on these therapies and how we can possibly make them better for patients in the future.
Cognitive behavioral therapy (CBT) is an effective way to help individuals with depression and the first therapy I want to look at. At the heart of CBT is an assumption that a person’s mood is directly related to his or her patterns of thought. Negative, dysfunctional thinking affects a person’s mood, sense of self, behavior, and even physical state. The goal of CBT is to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking. At the same time, therapists who practice CBT aim to help their patients change patterns of behavior that come from dysfunctional thinking. Negative thoughts and behavior predispose an individual to depression and make it nearly impossible to escape its downward spiral. When patterns of thought and behavior are changed, according to CBT practitioners and researchers, so is one’s mood. Often times CBT is groped into a more general term called psychotherapy or “talk therapy” (Pruthi, 2011).
I feel like the stigma that surrounds the name and idea behind psychotherapy undermines the positive outcomes CTB has had for its participants. But this system isn’t perfect, what I would like to see is a therapy that takes all the good qualities of CBT and with the research of scientists, bridge the gap between the fields of biology, (medications, GxE theory, knowledge of the structure and function of internal organs) psychology, and general wellness (diet, spirituality, exercise, meditation, etc.) to come up with a step by step program that resets all root aspects of life and gives each individual the tools to overcome the stressors and negative thoughts that do come up during life but is still specific to their situation.
The next type of therapy I want to talk about is medications. Many types of antidepressant medications are available, including those below. Possible major side effects are possible with each.
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications are safer and generally cause fewer side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR) and levomilnacipran (Fetzima). Norepinephrine-dopamine reuptake inhibitors (NDRIs). It’s one of the few antidepressants not frequently associated with sexual side effects.
- Atypical antidepressants. These medications don’t fit into any other antidepressant categories. Trazodone and mirtazapine (Remeron) are sedating and usually taken in the evening. Vilazodone is thought to have a low risk of sexual side effects.
- Tricyclic antidepressants. These antidepressants — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren’t prescribed unless you’ve tried an SSRI first without improvement.
- Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other medications haven’t worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications including birth control pills, decongestants and certain herbal supplements. These medications can’t be combined with SSRIs.
It states that you may need to try several medications or a combination of medications before you find one that works. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as your body adjusts. Sometimes doctors require others medications such as mood stabilizers or antipsychotics, as well as anti-anxiety or stimulant medications for short-term use. Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic tests (done by blood test or cheek swab) may offer clues about how your body may respond to a particular antidepressant. However, other variables besides genetics can affect an individual’s response to medication (Pruthi, 2011).
This treatment was a nightmare for me and has forever scarred me for taking any long term medication again. I was given two types of antidepressants: one for the actual depression that was called Cipralex, an SSRI that completely fogged out my mind so I couldn’t concentrate, let alone function and another that I can’t remember the name of but it was thought to be a better sleep aid by doctors so I took it for that. Because I feel so negatively about antidepressants it is hard for myself to be unbiased but I know a lot of people would not be able to even get out of bed without them. I want to see a better system of diagnosis and maybe not have the practitioner just jump to medicating. I saw a blog post from another student that talked about gut flora health and the connection to the individual’s state of mind, they explained that even though it needs more research, evidence shows that there is a connection between mental health and GI health. The quicker governments realize that it will be cheaper for doctors to send individuals to other outlets (spiritual wellness centers, diet coaches, counselling, etc.) instead of messing up their insides with medications the day they get diagnosed, the quicker they will see less return patients with disorders that have developed in response to the hasty, ill-conceived treatments.
Other treatment options:
For some people, other procedures may be suggested:
Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. Performed under anesthesia, this procedure is thought to impact the function and effect of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don’t work. Physical side effects, such as headache, are tolerable. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide.
Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, you sit in a reclining chair, awake, with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you’ll have five treatments each week for up to six weeks (Pruthi, 2011).
Psychiatric Service Dog:
I love the idea of a service dog as an option for someone that suffers from depression or an anxiety disorder. I found an article on Health-line that highlights psychiatric service dogs and their benefits, but it also explains the many ‘hoops’ one must jump through to acquire one or even train their own.
An individual must meet several criteria to be eligible for a service dog. This may include:
- having a physical disability or debilitating illness or disorder
- being able to participate in the dog’s training process
- being able to independently command and care for a service dog
- having a stable home environment
Service dogs are trained to meet a person’s needs before they’re placed in someone’s home. A dog that has already served as a pet usually can’t be trained later as service dog. To apply for a psychiatric service dog, you will need a recommendation from a medical doctor or licensed mental health professional. About 18 percent of American adults experience some form of mental health disorder. Overall, about 4 percent of American adults experience a severe or debilitating mental health disorder. This means that only a fraction of people who have a mental health disorder are qualified for a psychiatric service dog (Legg, 2016).
People who have anxiety that isn’t as debilitating may benefit from an emotional support animal. These domestic animals aren’t limited to canines. They’re intended to provide comforting companionship. Emotional support animals are still regarded as pets in most situations. This means they don’t have the same legal protections as service animals in public and private spaces. These animals are afforded a few of the same provisions, though. A person with an emotional support animal is still qualified for no-pet housing and may fly with the animal without paying an extra fee (Legg, 2016).
This is something that I have a new found passion for. I believe that with the proper programs, human/animal interactions will not only help the individuals specific symptoms; it will also teach them loyalty, accountability, pride and a sense of accomplishment. But, this idea needs to be thought through carefully. I wrote in a previous blog specifically about service dogs and it talked about some of the hardships the animals faced with being stressed and working 24/7. I think the main idea to take away from this option is balance and it definitely needs to be paired with another option like CBT.
The last treatment I want to talk about (which is still controversial) is the marijuana plant, commonly known as weed. There have been many sides to the argument over the validity of the benefits of THC, but with what I have gathered over my years and through some scholarly research believe that it’s not all bad.
Through an internet survey (to gain participation for medical and recreational users) 4400 individuals completed a survey regarding depression and marijuana use. What they found was positive but by no means a breakthrough. Despite comparable ranges of scores on all depression subscales, those who used once per week or less had a less depressed mood, a more positive affect, and fewer somatic complaints than non-users. Daily users reported a less depressed mood and a more positive affect than non-users. The three groups did not differ on interpersonal symptoms, but separate analyses for medical vs. recreational users demonstrated that medical users reported a more depressed mood and more somatic complaints than recreational users, suggesting that medical conditions clearly contribute to depression scores and should be considered in studies of marijuana and depression. These data suggest that adults apparently do not increase their risk for depression by using marijuana (Denson & Earleywine, 2005).
Now I’m not saying that everyone should put down their pills and pick up a joint, but what I want to put out there is that everyone is different and by trying to diagnose individuals by putting them in a “box” and categorically treating them is simply not working.
I clearly do not have the knowledge or resources to come up with a treatment schema that can systematically take what an individual is experiencing (physically, cognitively, and emotionally) and come up with a treatment plan that gives the individual the resources they need reset their mental health or the tools to continue their way into a healthier lifestyle. But, what I can do I continuously educate myself and go after what works for me because at the end of the day if you’re happy, the treatment is working.
Photo: Love Hate [Photograph found in Timeleo Blog]. (n.d.). Retrieved March 23, 2017, from https://www.google.ca/search?q=blog image weighing options&tbm=isch&tbo=u&source=univ&sa=X&ved=0ahUKEwiK56LOpO7SAhWh24MKHddDDKAQsAQIGw&biw=1366&bih=651#imgrc=hzqbGDAAfc5Q7M:&spf=192