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Health & Fitness

THE OPTIONS FOR DEPRESSION TREATMENT ARE EXPANDING

BY CHRISTINE TYLKA, MD, AUTHOR. Valuable update on the ever-expanding treatment options for clinical (medical) depression.

Clinical Depression is a Medical Condition

More and more, clinical depression is being recognized as a medical condition, as evidenced by abnormal brain activity seen in brain imaging and unique biochemical markers found in blood tests. Major depressive disorder, is characterized by a syndrome of dysfunctional mood, sleep, energy, and cognition and has a 15% risk of suicide.  With the stakes so high, depression is a condition that should not be ignored or overlooked, and needs to be treated. 

 

History of Depression Treatment and Antidepressant Side Effects

There are many different types of medication prescribed to treat clinical depression. The first antidepressant was discovered in the 1950s accidentally while looking for a cure for tuberculosis. These early antidepressants had many side effects including heart problems and even death in overdose. In the 1980s the first selective serotonin re-uptake inhibitor (SSRI) was introduced on the market. But even with these new and improved medications, as with any treatment there is still the potential for side effects.  Antidepressant side effects range from mild to severe and depend on the individual. There are also treatments for depression that do not involve medication that will be discussed below.

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How Depression Treatment with Antidepressants Works

Antidepressant medications affect brain chemicals called neurotransmitters, focusing on those that regulate mood.  Older antidepressant medications, such as the tricyclic drugs and the monoamine-oxidase inhibitors, can be very effective, but can more easily cause untoward side effects than the more popular, newer antidepressants called selective serotonin re-uptake inhibitors (SSRIs).  SSRI’s act to increase serotonin levels, affecting brain cell receptors and the activity of brain cells. All SSRI’s are now available in generic form, so these can prove to be more economical choices. Medications that target two neurotransmitters implicated in depression, serotonin and norepinephrine (also know as SNRIs) are also becoming more popular. There are many different SSRIs and SNRIs to use and your doctor will base the choice on specific symptoms, side effects you wish to avoid (such as weight gain, sedation) and even family history (a medication that works well in one family member will typically work well in another due to similar genetics).

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Common Antidepressant Side Effects and Alternatives

Common side effects of SSRIs and SNRIs are nausea, headaches, and jitters.  It is important to know that some of these side effects are your body getting used to the medication and will disappear over time. Other side effects include insomnia, weight gain and sexual problems.  Since there are many different types of SSRIs and SNRIs, it is important to work with your doctor and report your symptoms so the right medication can be tailored to your condition. Sometimes it will take two or three trials of medication until the right one can be found.

Another option is genetic testing that will allow your doctor to determine how your specific genes influence how your body metabolizes, or breaks down, certain medications. Genetic testing can help your doctor determine what medications your body can handle and which should be avoided. Testing also gives information about levels of vitamins your body may not be digesting properly that can increase depressive symptoms.

It is important you tell your doctor about any other medications or even herbal remedies you may be taking as there is the potential for interactions. Like any other medical condition, depression can be effectively treated with the right medication as a part of your treatment plan. Many people are able to tolerate medication without serious side effects, but like any treatment, there are risks.


Treating Depression Without Medication

Other treatments for depression exist, such as talk therapy. A particular type of therapy called cognitive behavioral therapy (CBT) exists to deal with depression. The basic principle of CBT is that you can examine and change your negative thoughts and in turn change your behavior and how you react to things. CBT alone may not be enough to treat some individual’s depression and your doctor can help determine if this treatment would be right for you.

Another non-medication treatment for depression is bright light therapy, which involves the use of a specific spectrum of light to stimulate brain activity and promote a better sleep rhythm.  Transcranial magnetic stimulation (TMS), is a relatively new a procedure that was cleared by the U.S. Food and Drug Administration in 2008. TMS applies magnetic pulses over certain areas of the brain to stimulate neurons and the release of the brain’s own chemicals. It is not invasive and is administered by a psychiatric specialist in an outpatient setting over one to two months.

Since it does not circulate in the blood, TMS treatment does not have the common side effects of antidepressants. Side effects most commonly reported were scalp or facial discomfort and headaches. This mild to moderate discomfort tends to subside after the first week of treatment and is usually managed with over the counter medications such as Tylenol.  A doctor can determine whether medications, talk therapy, bright light therapy, TMS, or other options are appropriate approaches to your particular situation.  

You do not have to suffer alone. West Coast Life Center in Sherman Oaks at 818-990-5901 is available for consultations.

About Dr. Christine Tylka & The West Coast Life Center:

Christine Tylka, MD recently joined The West Coast Life Center of Sherman Oaks as an associate psychiatrist.  Dr. Tylka earned her medical doctorate from Wake Forest University School of Medicine and completed her training at Columbia University’s St Luke’s-Roosevelt Hospital psychiatry residency.  West Coast Life Center is a leading boutique emotional wellness center focused on cutting edge, evidence-based, integrative psychiatric care for our patients.  Led by medical director, Kira Stein MD, we are a team of experts who help those struggling with mood disorders, anxiety disorders, insomnia, ADHD, personality, and other disorders. We approach emotional health from a holistic point of view, and individualize care using a wide array of techniques, including talk therapy, mindfulness meditation, bright light therapy, nutritional and medication management, as well as non-invasive brain stimulation. 

West Coast Life Center 818-990-5901

Sherman Oaks, California

 

 

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