Treatment for Depression

How common is Depression?

If you have Depression, you are not alone. In the United States, 21 million adults and about 4 million adolescents ages 12-17 live with Depression. Only about 40% of people with Depression get treatment at all, and only 25% get treatment that could be considered even minimally adequate.

Why should I seek help for Depression? 

Depression causes sadness, diminished energy, loss of motivation, inability to feel pleasure, and changes in appetite and sleep. Untreated or inadequately treated Depression can make it difficult to work and engage in your regular activities, and is one of the leading causes of disability in the United States and the world. Fortunately, effective treatment for Depression is available. With treatment, people with Depression can return to their usual emotional state and can live healthy, happy, satisfying lives. 

What causes Depression?

Depression is caused by three main factors:

1) Genetics. If someone in your immediate family (parents, siblings, or children) has Depression, you are 1.5-3 times more likely to have it yourself.

2) Trauma and psychological stressors. Adverse experiences such as poverty, violence, abuse, and discrimination increase risk for Depression for decades afterward.

3) Other health problems. Chronic physical illness, substance abuse, and medication side effects can also increase risk for Depression.

What are the types of Depression?

There are multiple types of Depressive Disorders, including Major Depressive Disorder, Dysthymia, Postpartum Depression, Seasonal Affective Disorder, Bipolar Depression, and Schizoaffective Disorder, Depressive Type. Each subtype presents differently, and each responds to different treatments.

Accurate diagnosis can be essential to creating an effective treatment plan for Depressive Disorders. The board-certified psychiatric nurse practitioners and psychotherapists at Owl & Eagle Health and Wellness have extensive experience and expertise in diagnosing and treating all types of Depression.

What are the symptoms of Depression?

Symptoms of Depression can include sadness, tearfulness, negative thoughts, loss of motivation, lack of interest in activities, lack of pleasure from activities that are usually enjoyable, reduced energy level, sleeping more or less than usual,  increased or decreased appetite, feelings of hopelessness or helplessness, feeling like a failure or disappointment, trouble with memory or concentration that is worse than usual, and movements or speech that are either slowed down and sluggish or sped up and agitated.

Sometimes people with Depression are able to go through the motions of their normal activities despite these symptoms, and sometimes they aren’t able to do normal activities at all. In some cases, people with Depression may wish they didn’t exist, or may have thoughts of harming or killing themselves.

Major Depressive Disorder causes episodes of depression with periods of normal mood in between depressive episodes. Symptoms of Major Depressive Disorder can be mild, moderate, or severe, depending on the number of symptoms and impact on function. MDD can sometimes present with Mixed Features (some symptoms of mood elevation along with symptoms of depression), Psychotic Features (hallucinations, paranoia, or delusions with symptoms of depression), or Anxious Distress (symptoms of anxiety along with symptoms of depression).

Dysthymia, also known as Persistent Depressive Disorder, causes a constant milder level of depression, but patients with Dysthymia may have episodes of Major Depressive Disorder as well.

Postpartum Depression is depression that occurs after giving birth. Postpartum Depression is a serious condition that requires prompt psychiatric treatment, as it can cause significant negative outcomes.

Seasonal Affective Disorder is depression that occurs at the same time every year, usually at the change of season to Autumn or Winter.

Bipolar Depression is depression that occurs in a patient who also has manic or hypomanic episodes. Bipolar Depression tends to cause more atypical symptoms than MDD, such as low energy level, sleeping more than usual, and increased appetite, although this is not always the case. Bipolar Depression tends to be harder to treat than MDD and often doesn’t respond well to treatment with SSRIs.

Schizoaffective Disorder, Depressive Type causes psychotic symptoms with episodes of depression. In this disorder, psychotic symptoms occur during times when the patient’s mood is normal, not just during depressed episodes. This differentiates this disorder from MDD w/ Psychotic Features, where psychosis only occurs during episodes of depression.

What is the best treatment for Depression?

At Owl & Eagle Health and Wellness, our team of board-certified psychiatric nurse practitioners provide expert treatment for Depression. We use a holistic approach to help with depression, combining up to date depression medication with psychotherapy, nutritional psychiatry, and other alternative treatments for depression to maximize treatment efficacy.

Mild Depression can sometimes be treated solely with non-pharmacological treatments such as psychotherapy, exercise, good sleep hygiene, vitamins, supplements, and increasing social activities. For moderate to severe Depression, medication can be very helpful. Medication for Depression usually has very manageable side effects, and most resolve in the first weeks of treatment.

Depression Medication

The best medication for Depression depends on which type of depression it is, so accurate diagnosis is essential. At Owl & Eagle Health and Wellness, our board-certified psychiatric nurse practitioners have experience and expertise in diagnosing and treating all types of Depression.

First line treatment for Major Depressive Disorder is an SSRI, such as sertraline or escitalopram. If SSRIs are ineffective or cause intolerable side effects, there are many other antidepressants that could be considered. The following medications are frequently used to treat Major Depressive Disorder:

• SNRIs such as venlafaxine or duloxetine
• Tricyclics such as amitriptyline or nortriptyline
• MAOIs such as phenelzine or tranylcypromine
• NDRIs such as bupropion
• Monoamine modulators such as vilazodone and vortioxetine
• Augmenting agents such as lamotrigine, aripiprazole, or cariprazine can be added to help an antidepressant work better

All of these options are also appropriate treatments for Dysthymia as well.  

For Postpartum Depression, a new medication called zuranolone may be considered, but other antidepressants may be effective as well.

For Seasonal Affective Disorder, light therapy is the first line treatment. Vitamin D supplementation may also be helpful. If these treatments are not sufficient to alleviate Seasonal Affective Disorder, antidepressants can be added.

For Bipolar Depression and Schizoaffective Disorder, Bipolar Type, antidepressants may be ineffective or may even worsen symptoms if used alone. Treatment starts with mood stabilizers and/or antipsychotic medication, after which antidepressants may sometimes be added.

Genetic differences can cause some people to respond better to certain depression medications rather than others. We select medication for Depression by using clinical guidelines, our clinical judgment, and your preferences, but we sometimes need to try multiple depression medications to find the one that works the best with the fewest side effects. We can also use genetic testing to help identify which medications are more or less likely to be effective and well tolerated for you.

If Depression does not fully resolve after trying two or more medications, it is considered Treatment Resistant Depression. Ketamine Therapy is a safe, highly effective treatment for Treatment Resistant Depression, and can be added to your treatment plan. Transcranial Magnetic Stimulation (TMS) is also a safe and highly efficacious treatment for Depression, and TMS is usually covered by insurance for Treatment Resistant Depression. The vast majority of patients we treat for Depression are able to effectively control their symptoms and achieve meaningful recovery, returning to normal or even improved levels of function and wellness.

If you would like to learn more about psychiatric evaluation and holistic psychiatric treatment for Depression in children, teens, and adults at Owl & Eagle Health and Wellness, Contact Us with questions or Book Now  to request an intake appointment today. Appointments are available either in-person in our offices in Golden or Denver, Colorado, convenient to the Denver Metro area, or via telehealth anywhere in Colorado. We look forward to meeting you!

Sources

https://www.nami.org

https://www.nimh.nih.gov/

https://www.samhsa.gov/

https://www.mentalhealth.gov/basics/mental-health-myths-facts

https://mhanational.org/mentalhealthfacts

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression