Treating Depression: Emerging from the Darkness

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By Mike DuBose with Dr. Surb Guram, MD

Millions of Americans will suffer from depression in their lifetimes. Whether you have experienced depression yourself or know someone who has, you likely understand what devastation it can wreak on individuals as well as those around them. When you’re in the grips of depression, you may not even have the energy to get out of bed. It seems like you’re stuck in a dark tunnel with no end in sight, and you wonder if you’ll ever feel “normal” again. Maybe, in a moment of despair, you might even become one of the 1.4 million U.S. adults who attempt suicide each year.

In addition to the emotional perils, untreated depression also takes a major toll on physical health. Individuals with depression may abuse alcohol and other drugs, lack the energy to exercise regularly, lose sleep, or fail to eat a healthy diet due to their disorder. Prolonged stress (like that suffered by many depressed individuals) can raise levels of cortisol in the blood, which has the dangerous effect of increasing blood cholesterol, triglycerides, and blood pressure. In fact, studies have linked depression to increased risk of serious health problems like heart disease, stroke, and Parkinson's disease, which can shave years off one’s lifespan!

The social stigma associated with depression can make acknowledging that you are depressed scary and embarrassing. But there is good news: you don't have to live under a dark cloud for your whole life! Depression is treatable, and you have tools in your arsenal to fight it. Just as everyone’s depression is different, some methods (or combinations thereof) work better for some people than others. It’s simply a matter of finding the motivation to seek help; working with high-quality doctors and mental health professionals to determine the best treatment plan for your unique needs; then, trying every day, little by little, to fight back against depressive disorders.

Getting Started

Your first move in identifying and treating depression is to see a skilled medical doctor (preferably, an internist who is a trained diagnostician) to rule out any physical or medical causes behind your mood. Supplements and medications, including some antivirals, acne drugs, corticosteroids, and other drugs, can have depression as a side effect. Problems in the body's endocrine system (like hypothyroidism, Cushing's syndrome, and Addison's disease), neurologic issues (such as multiple sclerosis and Parkinson's disease), and some infectious diseases like West Nile virus, Lyme disease, and Hepatitis C can induce a depressed mood. Recent studies have also found links between Vitamin D and Vitamin B12 deficiencies and depression.

Schedule time for a detailed discussion with your doctor, who will examine your health history, current illnesses, and any medications you are taking to determine if they could be causing your depression. He or she will also conduct a physical and a blood analysis to search for any nutrient deficiencies or other concerns. Come prepared to talk in detail about your symptoms, their severity, how long they have been occurring, and when they started; major stressors or life changes you have recently undergone; and whether you or anyone in your family has a history of depressive disorders. (See our previous article in this series at www.mikedubose.com/depressioncauses for detailed explanations of the most common depressive disorders and their causes.) Your physician may use a Patient Health Questionnaire (PHQ-9) to learn more about what you are experiencing and help diagnose your problem. Then, he or she will be able to treat and/or refer you to a mental health clinician with expertise helping patients in similar situations.

Most Common Treatments for Depression

Psychotherapy: A good start on your journey to wellness is to find a licensed, skilled counselor to administer “talk therapy” (also known as psychotherapy) with you on a regular basis. Therapy can help with a wide range of issues, including unresolved issues from your past, grief from losing a loved one or pet, relationship problems, work issues, loss of a business or employment, etc. The list of the problems we all face in life is endless, and we all sometimes need help to guide us through the storm.

We suggest visiting your insurance provider's online portal or calling them to conduct a search for mental health practitioners in your area that are covered by your policy (you can typically narrow the search results based on distance from your home or office). Then, examine the types of disorders that each doctor or master's level clinician specializes in treating. Once you have identified a list of several insurance-approved clinicians, review online patient ratings and ask friends and others if they know any of the counselors from the list. (If you’d like to maintain your privacy, you can always say that you are confidentially inquiring for someone else who needs their services!)

When you identify a professional skilled in your disorder, contact their office. Sometimes, there may be a lengthy wait to schedule an appointment or the clinician may not be accepting new patients. If you are set on visiting a specific professional, ask if there is a waiting list (some don’t have them), and if so, place your name on it. Regardless of whether there is a list or not, you should then call frequently to inquire if there have been any cancellations whose spot you might take (according to our research, Monday is the day most cancellations occur). You might also consider asking your doctor for help securing an appointment faster; sometimes hearing from him or her might convince the counselor’s office to expedite the process. Rather than selecting only one professional, however, we suggest considering several to find a good counselor.

Don’t worry if it takes some "trial and error" to locate a competent counselor. You need a good listener who makes you feel comfortable, whose treatment style meshes with your needs, and who does not rush to a diagnosis. Individuals’ preferences differ when it comes to counseling: some like a gentle therapist who focuses on soothing them, and others like to be challenged more during their sessions. If you and the first counselor you speak to don't mesh after a few sessions, seek another one and try again. You'll only benefit from talk therapy if you feel you can be truthful and open with an unbiased person whose opinions and suggestions you respect! As with any profession, there are competent, experienced counselors out there, as well as others who are not a good fit, despite their degrees.

During your therapy sessions, you won’t have to lay back on a leather couch and undergo Freudian analysis—today’s talk therapy is very different from the stereotype! Through conversations and gentle questions, your therapist can help you understand why you are depressed and the factors in your life that contribute to your depression, as well as potential changes you can make to improve your mood. Sessions will typically last about 45 minutes to an hour (depending on what your insurance will cover) and you will likely need to visit the therapist once to twice per week at the beginning, tapering off as your situation improves. Most therapists will also conduct appointments via telephone, and some even through online services like Skype. Many insurance companies now cover online sessions.

There are several types of psychotherapy, and each will vary in effectiveness based on the person. Cognitive behavioral therapy (CBT) aims to help individuals with depression reverse their patterns of negative thinking, understand the situations that contribute to their depression, and change behaviors to start acting in a more positive way. Interpersonal therapy (IPT) focuses on negative relationships that may be causing or exacerbating depression and works to change unhealthy behaviors. Problem solving therapy (PST) is a short-term therapy where patients identify a problem and realistic solutions in a step-by-step manner. Some forms of therapy may be helpful to one person with depression and not to another, and it may take experimentation to find the right therapist and format for you. If you are an older individual, the National Institutes of Health notes that PST is particularly helpful for your age. For all types of depression, Consumer Reports indicated that a combination of medications and therapy often results in the best outcomes.

There is no specific time frame required for talk therapy to be effective. Some will feel better over weeks or months, and others may take years to face their depression and begin the slow climb out of the pit. There is no right or wrong amount of time to attend psychotherapy sessions. In fact, some individuals who have overcome depression choose to make counseling appointments a few times per year just as “maintenance” to ensure they are staying on the right track.

Antidepressant medications: Although talk therapy is very helpful for many individuals with depression, there are also imbalances in brain chemicals that need to be considered. To address the physical causes behind depression, there are numerous antidepressant medications on the market, and they fall into different categories based on how they affect the brain. You must have a prescription from a medical physician or a psychiatrist to obtain these medications from a pharmacy (but keep in mind that most physicians are not trained in administering and monitoring antidepressants, whereas psychiatrists are). We recommend Dr. Josh Fowler, MD if you are seeking an excellent psychiatrist.

As with most medications and supplements, there could be side effects, so keep a list of any changes to your behavior or bodily functions while taking an antidepressant. While antidepressants can help improve some individuals’ moods, they can also make your depression worse if a certain drug is not suited for you. So, it’s very important to monitor mood and physical changes after beginning the medication and report any issues to the prescribing professional so adjustments can be made if negative issues arise.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant. According to the Mayo Clinic, SSRIs “generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are.” They work by blocking the brain from reabsorbing the brain chemical serotonin, leaving more serotonin available in the brain. Several varieties of SSRIs are marketed under the brand names Celexa, Lexapro, Paxil, Prozac, Luvox, and Zoloft. As noted in a WebMD article, “each SSRI has a different chemical makeup, so it’s possible that if you’re having side effects from one, you may not experience as many or any at all if you switch to another.”

Serotonin andnorepinephrine reuptake inhibitors (SNRIs) act similarly to SSRIs, but they also block the reabsorption of norepinephrine, another brain chemical, in addition to serotonin. Brand-name SRNIs include Cymbalta, Effexor XR, Pristiq, Khedezla, and Fetzima.

Tricyclic antidepressants and MAOIs (monoamine oxidaseinhibitors) are two other types of antidepressants that aren’t usually prescribed anymore due to their potential for side effects and negative reactions with other medications (and even foods). There are also other antidepressants that don’t fit into other categories and are called “atypical,” including Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL, Remeron, and Trintellix.

Regardless of the medication your clinician recommends, approach it with an open mind and monitor its effectiveness. Sometimes, a medication may take some dosage adjustments to work. Other times, your doctor may want you to try a different drug. Be aware that some insurance companies will try to steer you towards a lower cost drug or deny coverage for a certain medication that your doctor prescribes. If so, your physician can appeal to try to persuade the insurance company to cover their preferred medication.

Reactions to different types of antidepressants vary by individual. Some may see a significant improvement in their mood after taking SSRIs or SNRIs for 4-6 weeks (the amount of time it typically takes for the drugs to fully kick in), but others may need to add another type of medication to see results. Even medications within the same category can have different levels of effectiveness. You and your doctor and pharmacist will need to assess factors like potential side effects, possible interactions with other drugs or supplements you take, health issues you have, whether a drug is covered by your insurance, and family history (i.e., if a certain medication worked well for a relative with clinical depression). Even then, it may take trial and error to find the right medication and dosage for you. If you experience both depression and anxiety, the treatment can become even more complex. However, it’s worth the effort—in clinical studies of adults with moderate to severe depression, 40-60% of those who took antidepressants noticed improvement in their mood over 6-8 weeks!

Antidepressants should be taken daily, as prescribed by your doctor. According to the National Institutes of Health, the course of treatment usually lasts at least 4-9 months, and for some people, up to several years. It might be tempting to “go cold turkey” and quit your medications once you feel better, but don’t! Although they are not addictive, abruptly ceasing to take antidepressants can cause very serious mental and physical withdrawal problems, such as nausea, insomnia, digestive issues, restlessness, and worsening of your depression. It’s much wiser to (under the supervision of your doctor) gradually reduce your dosage over several weeks or transition to another medication instead.  

Brain-stimulating therapies: If therapy and medication (including trying several different drugs) make a significant impact on your depression, you might consider brain-stimulating therapy like electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or vagus nerve stimulation. Many insurance policies now cover ECT and TMS; some may cover vagus nerve stimulation, too. You may need to obtain prior approval from your insurance company by proving that you need these types of therapies, so check your coverage documents or contact your carrier before making an appointment.

Unlike the harsh, painful-looking scenes involving electroshock therapy that many of us have seen in movies, ECT involves gentle electrical pulses that stimulate the brain, performed while the patient is under anesthesia. The pulses are transmitted through electrodes that are attached to the scalp at specific locations on the head, and they actually cause a small seizure in the brain. Patients typically undergo 2-3 ECT treatments per week for 6-12 weeks, depending on the severity of the depression being treated and how their symptoms respond.

Other forms of brain stimulating therapies include transcranial magnetic stimulation (TMS) and vagus nerve stimulation. With TMS, no seizure is induced, and the patient remains awake while magnetic fields are rapidly altered to stimulate the brain. TMS therapy usually takes place 4-5 times per week for 4-6 weeks. TMS Columbia (www.tmscolumbiasc.com) is a well-reviewed provider in our area of Columbia, SC. Your insurance may require that you take an antidepressant before pursuing TMS, but you may ask your doctor to appeal the requirement.

Those who undergo vagus nerve stimulation have adevice surgically implanted under the skin on their chest with wires connecting it to the left vagus nerve. (The left vagus nerve runs between the brainstem and the chest through the neck; the right vagus nerve is not used because it contains fibers that carry nerves to the heart.) When the device is activated, it transports electric signals up the vagus nerve to the brainstem, which emits signals to certain parts of the brain.

Other Strategies That May Help

Depression is a serious illness, and it may require a significant amount of therapy and often medication to reach positive outcomes. Sometimes, that means there will be a trial and error period of experimentation to determine what works for you, so don’t give up! Provide ongoing feedback to your counselor and/or physician as you try different strategies to make sure you are pursuing the most effective treatment options possible.

Because depression is such a powerful disorder, depressed individuals should always rely on the advice of a medical professional when choosing treatment strategies. It’s unlikely that you can safely treat your depression using only non-conventional treatment methods, especially if your symptoms are moderate to severe. However, some alternative strategies may be helpful to incorporate as part of an overall treatment plan developed with the guidance of your clinicians, as outlined below.

Exercise: Based on several clinical studies, physical activity is scientifically proven to boost mood. It actually causes a chain reaction of processes in your body that result in increased brain power! According to Harvard University Medical School, “High-intensity exercise releases the body's feel-good chemicals called endorphins, resulting in the ‘runner's high’ that joggers report. But for most of us, the real value is in low-intensity exercise sustained over time. That kind of activity spurs the release of proteins called neurotrophic or growth factors, which cause nerve cells to grow and make new connections. The improvement in brain function makes you feel better.”

Swimming, dancing, running, jogging, brisk walking, biking, and participating in group exercise classes are all great ways to increase your heart rate and reap the emotional and mental benefits of exercise. To help prevent or manage depression (in combination with medication and therapy), you should eventually aim to experience 30-40 minutes of activity per day. However, many depressed individuals find it hard to get motivated to do things, so start off slowly. Setting small exercise goals (say, a 15-minute walk a few times per week) and then gradually increasing them to become daily habits as you feel better is a good strategy.

Diet: Eating a healthy, balanced diet consisting of lots of fruits and vegetables (especially leafy greens), lean protein, and whole grains is an overall health-booster. Unfortunately, the American diet is increasingly filled with processed, chemical-laden snacks, high carbohydrate foods, sugary soft drinks, and greasy fast foods—none of which provide our bodies the nutrients they need. This can lead to deficiencies in vitamins such as B-12 and D, which studies have linked to depression.

If a blood test shows that you are deficient in vitamin B12 or vitamin D, supplementing these nutrients may be part of your treatment plan for depression. Most people can absorb enough B12 by eating a healthy diet including fish, lean meat, eggs, and fortified breakfast cereals, but vegetarians or those over the age of 50 may need a dietary supplement. Vitamin D is naturally produced when your skin is exposed to the sun's UVB rays, but because Americans spend much more time indoors than they did in the past, many find it hard to get sufficient vitamin D. Fortunately, vitamin D is available as an oral supplement (we recommend the Nature Made brand, which can be found in most drugstores, for high-quality supplements). There is also a high-dose vitamin D supplement available by prescription only.

Sleep: Poor-quality sleep and depression are related issues; in fact, they seem to feed off of each other. Depressed people often have trouble sleeping, which means that their bodies and minds don't receive the restorative benefits of sufficient nightly rest, and inadequate sleep can make people feel tense and irritable. Bipolar individuals may even find themselves in cycles where they get very little sleep during manic periods, then "crash" and sleep excessively during depressed periods. Depression has also been linked to sleep apnea, which occurs when muscles in the back of the throat allow it to close during sleep, interrupting breathing—and preventing deep sleep.

To maximize your chances of getting good rest, optimize your sleeping environment. Eliminate light sources (including alarm clocks, which can promote worry and "clock watching") and install light-blocking curtains or blinds on any windows. Keep the room cool, but not too cold, and turn on a fan or obtain a white noise machine to provide soothing background noise. Use the bedroom only for sleeping and sexual activity; don't work on your laptop or play on your phone while lying in bed. In fact, it's a good idea to eliminate television, smartphones, gaming machines, and computer screens 1-2 hours before your nightly bedtime so your brain has time to unwind. Avoid caffeine after 2 PM, and try to eat dinner well before bedtime so your food has time to digest.

Many with depression (and/or anxiety, its cousin) find that worries and negative thoughts keep them up at night, and individuals with bipolar often find their mind racing. That's why many experts suggest instituting a routine before bed each night to "let go" of anxieties and relax. Some recommend mentally listing all the items you are worried about and then visualizing setting them aside; others suggest tensing and releasing muscle groups from head to toe, feeling the relaxation spreading throughout the body and pushing negative thoughts out. For some people, it may be just as simple as performing yoga stretches or reading an enjoyable book or magazine before bed. Strategies vary by individual; fortunately, there are many ideas for relaxing pre-sleep rituals available to peruse online! Consumer Reports also published an excellent article on sleep, bed types, and mattress brands in its February 2017 edition. If you find that you are having frequent episodes of insomnia, we recommend undergoing a sleep study conducted by a licensed physician trained in sleep disorders. We recommend internist, Dr. Joseph Gabriel, MD with SC Internal Medicine Associates and Rehabilitation in Columbia, SC.

Social interaction: Human beings are social creatures, and most of us need interaction with friends, family, and loved ones to feel good. In fact, a 2015 study published in the Journal of the American Geriatrics Society found that having limited in-person social contact (versus over the computer or phone) nearly doubled study participants' chance of having depression. It's also good to make sure that the people you are having social contact with are positive, happy persons. Individuals are empathetic, and emotions can pass from one person to another...so you don't want to surround yourself with negative people whose anger, bitterness, and meanness drag you down! Pursuing social relationships with positive and interesting people who listen as much as they talk (and limiting interactions with negative ones) will allow you to laugh, have fun, and feel better about yourself and others.

Mindfulness: This technique helps individuals become aware of their emotions, decrease stress, and stop negative thoughts before they spiral into deeper issues. Simply taking deep breaths and focusing the mind through meditation promotes a calmer mood, and yoga, which focuses on breathing deeply while performing stretches, has been indicated in several studies to reduce depression symptoms in individuals who practice it regularly. Another potentially helpful mindfulness practice is daily or weekly journaling (writing down happenings and feelings in a paper or online journal), which can help some individuals to emphasize positive events and put negative thoughts into perspective. According to some studies, hypnotherapy, such as that offered by Dr. Fredric Mau at Watermark Hypnosis in Columbia, SC (www.watermarkcolumbia.com), can also assist patients in controlling feelings of stress and anxiety associated with depression. 

Herbal remedies: The Mayo Clinic says, “So-called natural remedies for depression aren’t a replacement for medical diagnosis and treatment. However, for some people certain herbal and dietary supplements do seem to work well, but more studies are needed to determine which are most likely to help and what side effects they might cause.” Most researchers say that herbal supplements for depression, such as St. John’s Wort, SAMe, omega-3 fatty acids, and saffron, show some promise for people with mild depression, but are not sufficiently proven to aid those with moderate to severe depressive disorders. Also, recent studies suggest that too much St. John’s Wort may be dangerous, particularly if you take prescription medications. (Many supplements can interact with prescription drugs or may be harmful in large amounts; see www.mikedubose.com/supplements for a detailed article on the dangers of supplements.)  Always consult your doctor before beginning a supplementation regimen!

Acupuncture: More research is still needed on the true impact of acupuncture on depression, but some studies indicate that it shows promise when used in conjunction with other treatments. The Journal of Complementary and Alternative Medicine suggests that electroacupuncture can be as effective as Prozac for reducing symptoms of depression, and another study in the same journal found that acupuncture showed promise in reducing sexual dysfunction as a result of depression and the associated medications. However, as noted in Scientific American, acupuncture studies tend to have difficulties establishing a control group, so the placebo effect could cloud some results. Still, it is often worth trying for conditions that have not responded well to traditional western medication. We recommend Dr. Li Huang, a former ER surgeon from China, for acupuncture in Columbia, SC. Dr. Huang reported that it usually takes about 12 sessions of painless acupuncture for depression relief.

Treatments by Type of Depression

Talk therapy, medication, and (in severe or treatment-resistant cases) brain-stimulating therapies are the most popular, well-proven methods for battling depression. However, depending on what type of depression you have (see our previous article in this two-part series, “Understanding Depression: The Road to Darkness” for descriptions of each type and its causes), there may be other forms of treatment that you can add to your plan to improve your chances of feeling better. Here are the major types of depression, followed by the types of treatment recommended by researchers and medical professionals to treat them most effectively:

Major depression: Because major depression manifests itself differently in every individual it impacts, there is no standard, “one size fits all” treatment. Sufferers must work out a plan with the help of their doctors and/or therapists. Usually, clinical depression is treated with a combination of medication and psychotherapy. In situations where neither seem to be effective, or where a person suddenly declines and may become suicidal, brain-stimulating therapies are another option.

Some people with very severe depression who do not respond to medication or whose doctors, friends, or family fear they may harm themselves can also benefit from a stay at a hospital or mental health treatment facility, where they will be monitored for their safety and can learn ways to cope with their illness. One of the best programs in the nation is at McLean Hospital in Boston, MA. This program, called the Pavilion, provides intensive assessment and treatment by staff from Harvard University Medical School for up to eight individuals in a small group home setting. Unfortunately, it does not accept insurance.

Persistent depressive disorder: As with clinical depression, the two main methods of treating persistent depressive disorder, or dysthymia, are talk therapy and antidepressant medications. Since persistent depressive disorder is a long-term issue, patients may need to take antidepressants and/or attend therapy for an extended time period to best handle their illness. Although individuals with persistent depressive disorder must manage it throughout their lifetimes, education on the nature of the disorder and lifestyle efforts like healthy eating, regular exercise, and avoiding alcohol and other drugs can all help reduce the likelihood of a person re-entering a depressed state.

Seasonal affective disorder: One unique way that seasonal affective disorder is treated is through light therapy, which uses a brightly lit box (sometimes called a “phototherapy box”) that is intended to mimic naturally occurring outdoor light. Individuals with SAD can sit next to the box, absorbing the light and hopefully lifting their mood. Light therapy can be administered in a therapist’s office, but individuals can also buy their own light boxes for home use (unfortunately, they are rarely covered by insurance). Although no prescription is required, you should still consult with your doctor or therapist about using the box, perhaps as part of a larger treatment plan incorporating talk therapy and/or medication.

To decrease the negative effects of SAD, the Mayo Clinic recommends using a light box within an hour of getting up in the morning for 20-30 minutes. It should be positioned 16-24 inches from the face and should emit 10,000 lux of light with as little UV radiation as possible. Users should not look directly at the box, but should simply sit in its presence (maybe while reading a book or magazine, using a smartphone, making calls, etc.) to absorb the light from it.

If you purchase a light box to treat seasonal depression, make sure to buy one specifically designed for SAD, as other types of light boxes (including those for skin disorders) may emit too much UV light. A therapist we interviewed recommended purchasing a box-shaped light therapy device rather than a lamp-style one, citing better results from her clients. One highly-recommended light box is called the Aura Day Light Therapy Lamp. It is 100% UV ray free and emits 10,000 lux of light. The Verilux Happy Light Deluxe is also well-reviewed. Both are available on Amazon.com for less than $100.

Those with severe SAD may also be prescribed antidepressants, to be taken before the time of year their symptoms usually start and sometimes for a period after they end. The Mayo Clinic notes that the extended-release version of the antidepressant bupropion (Wellbutrin) seems to be particularly effective in stopping depressive episodes in people with seasonal depression. Talk therapy may also be beneficial, and some SAD sufferers find that mindfulness exercises like yoga and meditation help alleviate their symptoms as well.

Situational depression: Because situational depression, also known as adjustment disorder, is triggered by a life event (or series of serious problems occurring around the same time), treatment centers on equipping the person to return to their previously healthy emotional state and to cope in a healthier manner if similar issues arise in the future. Therapy—focusing on short-term goals and developing strong problem-solving skills—is the primary treatment, whether it’s one-on-one psychotherapy with a counselor, group therapy, or family therapy (this depends on the individual and the source of the situational depression). Medication is sometimes prescribed in combination with therapy. Healthy lifestyle changes, such as eating a balanced diet, performing regular exercise, sleeping well, and nurturing a strong support network of friends and family, can help prevent reoccurrence.

One major cause of situational depression is the death of a person (or even a pet) who is close to you. Therefore, grief and situational depression are often linked. For individuals who are having abnormal difficulty adjusting to life after their loss, counseling focusing specifically on grief can be very helpful. It can teach them to process the event, acknowledge their pain and grief, and cope in a healthier manner moving forward. Many therapists focus specifically on grief counseling, and there are also support groups for various losses (general, spouse, child, parent, pet, etc.) in many areas that can be found through a Google search, through a house of worship, or by asking a counselor. For example, St. Andrews Presbyterian Church in Columbia, SC offers free classes on dealing with grief.

Bipolar disorder: This inherited condition is often a lifelong illness, so people with it require long-term methods of treatment. According to the International Bipolar Disorder Foundation, a complete treatment plan for bipolar incorporates education about the disorder, medication, therapy, a support system, and lifestyle management (“maintaining a regular sleep schedule, avoiding alcohol and other drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year-round”). For some severe cases that do not respond well to medication and psychotherapy, ECT and TMS are recommended options.

Medications prescribed for bipolar disorder are often different from those used to treat depression; in fact, antidepressants are usually not recommended for bipolar because they may interfere with other, more effective medications (typically, mood-stabilizing drugs like valproic acid). Lithium carbonate is an antimanic agent that has been proven very effective in reducing manic episodes. Newer drugs are also showing promise for treating bipolar disorder, including an antiepileptic called lamotrigine, which helps prevent depression and mania. A psychiatrist may choose to add antipsychotic drugs to the mood stabilizers for patients who experience paranoia or hallucinations when they are in a manic state.

Premenstrual dysphoric disorder: For PMDD, antidepressants—specifically, those that delay serotonin reuptake, like SSRIs and SNRIs—are usually recommended. According to Harvard University Medical School, good options include citalopram, fluoxetine, venlafaxine, and clomipramine, a tricyclic antidepressant that significantly impacts serotonin. Because antidepressants work on PMDD faster than they do on major depression, women who treat PMDD in this way may not even have to take the drugs on a daily basis. In fact, they can practice “luteal phase dosing,” wherein they take antidepressants only for the 14 days or so in between ovulation and the beginning of menstruation.

Some doctors will also recommend hormone-based treatments for women suffering from PMDD; however, Harvard Medical School notes that this should be a “second-line” option due to the potential side effects. The most commonly prescribed hormone-based treatment is hormonal birth control, although only Yaz, a pill that combines ethinyl estradiol with drospirenone, has been clinically proven to help with PMDD. Another option is to block ovulation using estrogen, either in the form of an under-skin implant or a patch worn on the skin. For those women who have not responded to other treatments, gonadotropin-releasing hormone (GnRH) agonists may be prescribed. These medications, which suppress a woman’s hormonal cycle, are typically prescribed for issues like endometriosis and infertility, and they can potentially induce a menopausal state, so they are usually considered a last resort.

Perinatal depression: The disorder is treated much in the same way as clinical depression, with therapy and antidepressants (although doctors may advise against certain prescription drugs during pregnancy and breastfeeding). It has an even higher success rate—80 to 90% of women report feeling better with medication, talk therapy, or a combination of both, according to a Healthline.com article by Michael Kerr! Cognitive behavioral therapy and interpersonal therapy are specifically recommended by the National Institutes of Health. A therapist can also help connect new mothers to groups in their area where they can meet and talk with other women in similar situations, providing them with a sense of community that can also help raise their mood. Likewise, it is important for women suffering from perinatal depression to have strong support systems in place and for them to occasionally take time away from the baby to focus on their own needs.

The bottom line: Manifesting itself in a number of ways and through painful symptoms, untreated depression can steal the happiness from your world. It can also cause disease and shorten lifespans...but don’t despair! With the help of medical professionals such as doctors and counselors, you can seek effective treatments and begin retaking control of your life. If you think you may suffer from a depressive disorder, don’t prolong your misery. Seek help, and step out of the darkness and into the light of hope!

For more information about the various types of depression and their causes, visit www.mikedubose.com/depressioncauses.

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at katie@dubosegroup.com.

Mike DuBose,a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

© Copyright 2018 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at Katie@dubosegroup.com and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!

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