This blog post is meant to serve as a roadmap for anyone suffering from depression. We are going to talk about Wonder Medicine’s approach to recognizing and treating depression. After this we are going to talk about ketamine therapy, how it works, and who should consider it. If you are suffering from depression and do not feel like you are getting the care that you need, please consider joining Wonder Medicine clinic's direct primary care. Severe mental illnesses like major depression, require aggressive therapy, constant fine-tuning, and a clinic that has your back, whenever you need it.
Diagnosis of Depression
Depression can manifest in a number of ways. It is very important that everyone recognize the diversity of presentations that depression can have. I sometimes ask patients, are you depressed? They say no, but after digging deeper, it is clear that they are. Right now all of us are undergoing considerable stress. Our world has been turned upside down and it is harder than ever to find positive outlets for our stress. As a result, I am seeing unprecedented levels of mental illness, substance abuse, domestic violence, and other negative secondary health effects. If you are having any of the below symptoms, depression may be impacting your life.
1. Thoughts about hurting yourself or hurting other people
2. Lack of interest in things which you normally enjoy
3. Guilt about things in your life
4. Lack of energy
5. Poor concentration
6. Increased appetite or lack of appetite
7. Slowing or speeding up of your speech, movements, or actions
8. Problems sleeping
9. Pain in your head, abdomen, in the pelvic organs, or with sex that cannot be explained
Depression is debilitating and disabling. It can prevent us from even getting out of bed some days. However, it can also fly under the radar. I see many people who are depressed, living a suboptimal life, and hardly even realize it. It is important to remember that depression also runs along with other mental health problems like anxiety, post-traumatic stress disorder, and obsessive compulsive disorder. Often times, my patients do not even realize what they are missing until after they finally get some help. Below are the pillars of depression therapy.
Exercise Vigorously
The importance of exercise in the treatment of mental illness cannot be understated. Exercise triggers the release of natural endorphins, or happy substances, that make us feel better. Most of us have felt this after a workout or a run. Exercise also causes minute damage to our muscles and bones. Our bodies then repair this damage in a way that makes us more mobile and healthier. Exercise produces oxidative stress that helps our bodies fight disease and cancer as well. Regular cardiovascular and strength training helps us build healthy muscles, hearts, lungs, and every other major organ system. Without our health, most of us will become depressed. Exercise is a cornerstone of health. If we are not moving, we slowly stop moving. Many people live sedentary lifestyles. This is a recipe for disaster. Please get out there and start exercising. I promise it will make you feel better.
Eat a lot of Raw Vegetables and Fruits, Avoid Processed Foods
Most people eat a diet that primarily consists of meat, simple carbohydrates, and processed foods. These same people often eat very few vegetables and fruits. Particularly raw vegetables and fruits. Fresh produce, healthy fats like tree nuts, and healthy sources of protein are the key to nutrient success! Try and eat a variety of different types of fresh produce. Shoot for a rainbow of colors. This will provide essential vitamins, minerals, anti-oxidants, nutrients, and fiber. Fresh produce will keep your bowels working well, which will in turn keep you regular. Anyone who has not had regular bowel movements will understand the importance of this. The United States is currently experiencing a crisis related to low nutrient, high calorie, processed foods, and the subsequent development of obesity. If you are overweight or obese, losing weight will almost certainly help in managing your depression.
Prioritize Sleep
Getting enough sleep every night is so important for health and healing. Many people struggle to sleep at night. This leads to a cycle of badness. I find if I can improve a persons sleep, everything else get immediately better. So few people understand basic sleep hygiene, which is the first line treatment for problems with sleep. Below are the basics of sleep hygiene:
1. Avoid bright screens and bright lights for 1 hour before bedtime. Take the TV out of your bedroom.
2. Do not hang out in your bed throughout the day. Go to the bed when it is time to sleep or have intimate partner time.
3. Avoid caffeine or stimulants for 8 or more hours before bedtime.
4. Try and limit stressful interactions, stimuli, and thoughts in the hours leading up to bedtime.
5. Avoid strenuous exercise in the few hours before bed.
Recognize Addiction and Take Action Against It
If you suffer from problems with addiction this will make you depressed, anxious, and prevent you from enjoying the things in life which matter most. Addiction can come in many forms. Some chemicals like nicotine, hijack our bodies and make us dependent on them. Such chemical addictions essentially enslave us both physically and mentally. However anything which brings pleasure or removes displeasure, can potentially be habit forming and eventually cause addiction. I view addiction as anything a person cannot stop doing that is causing harm in their life. Addictions can be debilitating and are hard to break, but removing harmful behaviors from one’s life is one of the first steps toward mental health. If you are suffering from addiction, Wonder Medicine can help.
Cultivate Positive Personal Relationships
I truly believe that I am the wealthiest person in the world because I have been blessed with so many wonderful friends and a loving family. Having positive interpersonal relationships is so important to mental health. On the contrary, isolation and especially complete-isolation, can be extremely detrimental. The key to good relationships is finding good people, caring about them, and bringing joy to their lives. I find that when you give something, you almost always get paid back more. Put yourself out there, make friends, and have meaningful relationships. This is one of the keys to both happiness and longevity.
Detoxify
By exercising vigorously, eating healthy natural produce, avoiding processed foods, sleeping, avoiding harmful substances, and cultivating positive personal relationships our bodies can finally start to remove all of the toxins that keep us down and sad. The above steps alone, will cure the vast majority of mental health problems. If you have to choose between purchasing healthy food and joining a gym or utilizing healthcare, please choose the food and exercise! More to come on detoxifying your body. If you want to take detoxification to the next level, consider trying IV vitamin C and glutathione at our infusion clinic!
Have a Purpose
Everyone needs a reason to be alive; a goal, or a dream. The reason why so many people become so unhealthy and unhappy when they stop working and stop engaging in the community is because their lives become devoid of structure and purpose. Work is so important for the health of any human. Everyday people need to engage in activities which bring value to other people, society, and the environment. Having a purpose will bring value to your life, which will in turn drive healthiness. If you are struggling to find purpose, consider volunteering. The world needs all of our help!
Have a Positive Attitude and Leave Negative Thought Patterns Behind
Try and think positive. When you are depressed this can be very challenging. If you find yourself having recurrent negative thoughts and cycling through these negative thoughts endlessly, try and break away. Getting out and exercising or socializing are great ways to do this. Having a positive attitude and positive self-dialogues are so important. So far, everything mentioned has not required healthcare providers. Breaking away from negative thoughts and thinking positively can sometimes require the help of a therapist.
Mental Health Therapy
Having friends and family to talk to about your problems is so important. The importance of a professional therapist cannot be understated. If you have the time and money to see a therapist, and you suffer from a mental health illness, strongly consider at least trying a few sessions with a professional. It is important that any patient get along with and enjoy their particular therapist. If the relationship is not there, get a new therapist. Mental health therapists can help us recognize negative thought patterns, uncover hidden trauma, and help us navigate interpersonal relationships in more positive ways. They can also employ a number of therapeutic strategies like cognitive-behavioral therapy, which have proven efficacy in the treatment of mental health disease.
Medication Therapy
Quite frankly, the medications we use to treat depression are not as powerful as most providers would like. However, they do provide benefit and I have seen numerous people helped by them. The main medications used are selective serotonin reuptake inhibitors (e.g. sertraline), serotonin norepinephrine reuptake inhibitors (e.g. venlafaxine), norepinephrine dopamine reuptake inhibitors (e.g. buproprion), tricyclic anti-depressants (e.g. amitriptyline), and serotonin agonists (e.g. buspirone and low dose psilocybin [illegal currently]). All of these medications can work and many have other effects that can be beneficial such as pain relief and help with sleep. I find that people tend to have very different responses to medications. It is important to find a provider willing to get to know you and experiment. Depression medication titration is ongoing and can even be seasonal. Wonder Medicine can help you with depression medications as well as medications for any other mental health illness.
Electroconvulsive Therapy (ECT)
Believe it or not, this can work. Basically ECT is where a patient gets put to sleep and has their brain shocked. This treatment is utilized when the above treatments fail. However, in the last several years a new and more exciting treatment for refractory depression called ketamine has come on to the market.
Ketamine Therapy
Ketamine is a small molecule first synthesized in the 1960s. It blocks a receptor called NMDA present throughout the brain, spinal cord, and nerves of the body. It is known as a dissociative anesthetic. At high doses it puts people to sleep. Unlike most general anesthetics, it does not stop breathing. This makes it an excellent drug for performing procedures like surgeries in resource limited settings and modern hospitals alike.
More recently, ketamine has been found to produce remarkable and immediate reductions in both pain and depression at low doses. Strikingly, it also has the ability to stop suicidal ideation, nearly instantaneously. I have been using ketamine for pain, depression, and suicidal ideation, in my hospital practice for years. Wonder Medicine is proud to offer this therapy to outpatients with good indications. Please consider trying all of the above treatment (except ECT) prior to considering ketamine. Ketamine is given either through an IV or via an injection into the muscle. Ketamine does not cause chemical addiction, but remember, anything which makes us feel good can be habit forming.
I have seen so many “ketamine clinics” pop up all over the United States. These clinics usually charge way too much money for treatment. On top of this, having a clinic with just one therapy seems small minded and lazy. Having a “depression clinic” makes more sense, but as mental health is so multifactorial, visiting a comprehensive wellness clinic makes the most sense. At Wonder, we believe that anyone using ketamine to treat depression should be ready and willing to treat depression using a holistic approach. Unfortunately, no one treatment is enough to tackle the beast that is depression!
At Wonder Medicine, we take great pride in helping those with mental illnesses that wish to enjoy meaningful and productive lives. If you are struggling with mental illness, we would love to work with you!
Conflict of Interest
This article was written by the Owner of Wonder Medicine Clinic. Promotions for Wonder Medicine are present throughout the article.
Author
William Brandenburg, MD
Wonder Medicine’s Longevity and Performance Program improves your lifespan and healthspan with a research-driven proactive program that focuses on the big picture of your health so you can perform at your highest potential.