It's the time of year when individuals vulnerable to mood difficulties begin to experience symptoms of depression. Therapists who treat depression and anxiety see an increase in requests for psychotherapy evaluations and treatment as the days become shorter and there is less available sunlight. If you're considering medication for depression, you've likely tried other things, including: psychotherapy or talk therapy, exercise, sunlight, anti-inflammatory diets, supplements (SAMe, St John's Wort), extra B vitamins, fish oil and meditation or mindfulness, yet you're still struggling with symptoms. Depression is a complicated matter because there are many reasons people become depressed and different expressions of depression including: major depression, seasonal affective disorder (SAD), bipolar disorder, psychotic depression, premenstrual dysphoric disorder and postpartum depression, as examples.
Because depression can be a challenge to treat, it's unlikely that one form of treatment will address all the symptoms of depression. For instance, individuals with a milder form of depression may respond positively to lifestyle changes such as exercising several times a week, yoga, meditation, supplements for brain and gut health, dietary changes, education about depression, connecting with friends and families and taking steps to avoid isolation. Working with a depression expert can help you develop skills to cope better, in addition to the connection that you develop with another human during the psychotherapy hour. Counseling offers emotional support and may be an opportunity for you to explore suppressed feelings of loss, grief or even abandonment. Unexpressed emotions and thoughts, when given the opportunity for exploration, may provide clues about the nature of your depressive symptoms and even chronic pain and body symptoms. The previously mentioned strategies for mild depression may not require medication. However, sometimes a combination of approaches will provide help for you If you're still depressed after working with a therapist and making lifestyle changes. It may be time to consult with a psychiatrist or psychopharmacologist.
We've established that depression is complicated, we also have some understanding of the many factors that contribute to depression, they are:
- drug use (recreational, prescribed, over the counter)
- alcohol abuse
- medication side effects
- social isolation
- sexual and physical abuse
- nutrient deficiencies (B6, B12)
- loss and unresolved grief
- life challenges
- sex hormone deficiencies and imbalance
- physical conditions such as cancer, thyroid disease, heart/arterial disease, kidney disease, diabetes, strokes, Parkinson's Disease, MS and chronic pain.
Many are reluctant to seek treatment. They suffer in silence, feeling hopeless and resigned to living with depression. A licensed mental health provider who has experience with mood disorders is a good place to start for an evaluation, treatment plan and the support you need to feel better. A licensed psychiatrist, psychologist or psychotherapist is in the best position to evaluate the nature of your depression and help you with important next steps. It's important to know that It's not your fault. Many are caught in a cycle of self-blame.
Exactly how complex is depression? Our brains communicate via chemicals called neurotransmitters. Neurotransmitters allow the chemical transmission of signals from one nerve cell to another nerve cell. You may have heard these chemicals referred to as serotonin, dopamine or norepinephrine. Serotonin is found not just in the brain but in the gut and blood platelets. Many scientists believe that serotonin is the body's primary neurotransmitter responsible for mood regulation, and an imbalance or lack of this chemical contributes to depression. Many researchers believe that trauma, stress and other factors lead to a disruption of the normal amounts available for the function of this complex system. We believe that depression is caused by excessive, deficient or disordered neurotransmitters.
What about antidepressants? There are different types of antidepressants that help with serotonin and other neurotransmitters. You might already know about SSRIs or selective serotonin reuptake inhibitors. SSRIs are thought to reduce depressive symptoms by increasing levels of serotonin, more specifically, making sure that serotonin stays between the neurons and is not reabsorbed to quickly by the nerve cell. Antidepressants block the "reuptake" system so that serotonin or other targeted neurotransmitters remain available for cellular use. It is this mechanism that is believed to decrease depression and improve emotional wellbeing. SSRIs can take weeks to produce results. Mental health experts and psychiatrists can explain side effects and benefits as well as monitor your progress. For many, antidepressants are ineffective or could work better leading some clinicians to experiment with supplements such as Deplin, which is essentially folate. Depline delivers the B vitamin folate in a form that has already been converted to L-methylfolate, so it can automatically be used to create serotonin, norepinephrine and dopamine in the brain. Many are having good results using medical food supplements.
Some treatments that help with depression in addition to medication are: EMDR therapy, CBT, interpersonal psychotherapy, corrective nutrients and supplements and mind-body therapies. A book that I find helpful and recommend to clients who prefer a holistic treatment approach in the treatment of their mild to moderate depression is the The Mood Cure by Julia Ross, MA which entails a 4-step natural approach to treating depression. Please do not stop taking medications without the support of your prescribing physician.