Treat depression

How do I treat depression?

Perhaps the standard treatment methods we use don’t really treat the reason why patients feel as they do? That’s why I prefer an eclectic approach and use a bio-psycho-social perspective to change what doesn’t seem appropriate. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy are awesome tools in this.

Treatment-resistant depression is a term used in clinical psychiatry to describe a condition that affects people with major depressive disorder (MDD) who do not respond well enough to antidepressant medication.  Maurizio Fava, a world leader in the field of depression according to some, defines treatment-resistant depression as an “inadequate response to at least one antidepressant trial of adequate doses and duration” and says that TRD is a relatively common occurrence in clinical practice, where up to 50% to 60% of the patients do not achieve adequate response following antidepressant treatment.

So then what? Another point here is that if the depression is “treatment-resistant” the antidepressants obviously didn’t solve the problem and we get one point to the fact that things are more complex than just too little serotonin somewhere. Anyway, taking an antidepressant OR going through therapy eases symptoms for most people, but with treatment-resistant depression, “standard treatments” aren’t enough.

That, in combination with the fact that a placebo could do a lot, takes us closer to getting philosophical – if you think medication is necessary might depend on how you look at it.

Is depression something natural and a sign that something’s not really right?

Is it something truly pathological?

Is it an illness where you need to “cure” it with medication?

Is it an illness… or rather just a bunch of symptoms?

Is hunger, thirst, or sleepiness worth medicating? Both hunger and sleepiness could be affected by amphetamines, but does that sound like a reasonable idea at all times?

What determines when feelings are worth throwing pills at?

There’s plenty to be said and reflected on within this topic. In my opinion, depression isn’t something you cure passively or by just talking. So, questions, reflection, and discussion are a great start. That’s the beginning – to then act on those insights. Why you’re depressed is a big question to ask, and likely completely necessary, before concluding how it’s treated, but there are definitely other ways to do this than through pure medication.

Acting, changing, and doing something to solve the problem is likely necessary.

If we couldn’t and didn’t influence mental health with anything but pills, people would be far more depressed before discovering the drugs, which doesn’t seem to be the case. There’s something else at fault.

Is your life in order, or could the depressive symptoms be there for a good reason?

Preferred and usual treatment methods?

The standard way of doing this is by using pills. No doubt about it. The most common ones used are the Selective Serotonin Reuptake Inhibitors. After that one there are the SNRI, Serotonin-Norepinephrine Reuptake Inhibitors, the TCAs, tricyclic antidepressants, and MAOIs, Monoamine Oxidase Inhibitors. That’s not all, but those are the most common ones. In addition to those it’s common to get something to sleep on and something to relieve anxiety; generally anti-histamines, benzodiazepines, or something similar.

My approach to treating depression is inspired by the astonishing amounts of prescribed anti-depressants.

Since the number of patients who suffer from depression is still increasing, those are obviously not the answer.

I use an eclectic mess for a reason

I mention an incredible amount of reasons when I’m discussing why we’re getting depression. If there are plenty of reasons and we haven’t put our finger on that one mechanism that causes depression, the eclectic approach seems absolutely necessary.

When I talk about how we treat burnout, I mention that to solve a problem, we’ll have to know what the problem IS. When dealing with stress, we need to decrease the stress – but that’s not done by decreasing stress in and of itself. It’s rather about changing what causes the stress or how you respond to it. Same thing here, but in some cases, it could be trickier. We need to solve a problem, but we’re not quite sure what the internal mechanism IS that makes you feel bad. We can, however, likely change it indirectly, by changing things in and around you.

The initial step of getting a good enough analysis of the situation is still useful since we do have a clue about what people need. We want to look at life and question things. Why could you possibly feel as you do?

If you keep ignoring the problem – because I do think there is at least one if you’re depressed – you might as well keep digging your own grave. But… that’s rarely necessary.

Change

Is it time for cheesy quotes like “be the change you want to see in the world?”

Not necessarily.

Unless it motivates you to change.

If emotions bother you, they’ll keep doing so, unless you change something. Without change, there won’t be less darkness. The gothic embrace will feel more natural and obvious over time. You’ll normalize it, the longer you stay there. Soon, that’s the normal state where you don’t feel as if you’re in darkness; others are watching the world through pink glasses making them naive and simple-minded. You’re the objective one. The perspective changes to “This is it. This is how things are, and it’s how things will be”.

Changing it as soon as possible makes it as easy as it ever gets.

It’s not possible to just quit depression, but it is possible to do practically everything else differently – and that might just give you the results you want. That doesn’t necessarily mean you should do everything opposite to what you do today, even if you could.

It’s well researched and established that you can change thoughts and emotions by changing behaviors. That’s the concept of cognitive behavioral therapy. By changing your behaviors you could change your entire world. Thoughts, emotions, physiology, and your environment. If you’re unwell or displeased and can change all of those, there ought to be hope. With that, you should be able to create something worthwhile.

If you believe we’re made for a more primal world, live that. If you do believe we’re created for inactivity, sugar, stress, and office work – try that for a while, though, I doubt you’ll feel great. Or find a decent enough middle ground where you’re not a complete outsider, but you also avoid the most treacherous traps in the modern world. Inactivity and sugar, Netflix, comfort and short-term gratification are comfortable things, where change isn’t. You might have to accept some short-term discomfort when you change. You might have to do unpleasant things to improve long-term. Practice usually does include discomfort, and that’s fine. Being completely at ease and comfortable without adversity isn’t the meaning of life.

In short:

If you don’t change, you’ll get the same outcome as usual.

/separator

”What we fear doing most is usually what we most need to do.”

– Tim Ferriss

In said eclectic mess it’s necessary to look at what might be relevant, and not just stay at “mess”. Doing things sloppily in a confused way isn’t the point. The point is to cover the entire spectra of whatever might be relevant. Again, with the bio-psycho-social.

Is the biological – the physical part of you – fine?

Are you hurt?

Are you in decent shape?

Do you eat decent food?

How are you psychologically?

Ah, depressive symptoms.

Are you feeling down?

Anxiety?

What thoughts go around and around?

Does anything feel meaningful?

Do you have thoughts of death and suicide?

Those are tricky to change in and of themselves, straight off the bat, but when treating depression, those are a big part of the end goal. When looking at psychological parts, it’s relevant to cover acceptance, mindfulness, ambitions, dreams and similar things.

It is said that Lao Tzu said:

”If you are depressed you are living in the past. 

If you are anxious you are living in the future.

If you are at peace you are living in the present.” 

How is your social life?

This is highly relevant to depression since we’re really social creatures, even though introverts are less so and depression doesn’t really motivate us to care about social activity. Here’s another one of those where you might have to go against the feeling and do it anyway to get where you want in life.

Are you pleased with your relationships?

Do you have friends and family and get what you need out of the relationships?

If you don’t – how can that be solved?

If you do have relationships, but you’re not pleased with them, how can you start changing them?

If a relationship does nothing but drains you it might be time to break up.

The pure depression part of the book is more than 50 pages and covers my favorite tools and thoughts on how to combat depression if you want further reading. Other parts of the book are highly applicable in addition to those. Those are useful if you can muster the strength to do it yourself. If you don’t, so you’d prefer to get hands-on help head on over to www.mbdolor.com/contact to get in touch with me.

Full series:
The Big Three: What Is Depression?
Why Do We Get Depression?
Treat Depression