Depression

I have expertise treating all types of depression including seasonal affective disorder, major depressive disorder, bipolar Depression, dysthymia and treatment-resistant depression.

Evaluation and Treatment of Depression

Depression is typically multifactorial which means careful attention to the diagnosis and treatment is critical. I don’t focus on simply resolving the symptoms, but rather I strive to eliminate the underlying causes of the depression.

 

Although medication is an extremely valuable tool, simply prescribing a medication without exploring what is beneath the depression is the incorrect approach. 

Characterizing the type of depression is the first step and I look at the following pieces:

  • Length of current episode

  • Severity of the episode

  • History of recurrent episodes of depression vs. single episode vs. situational drive depression

  • Family history of depression or any psychiatric conditions

  • Specific set of symptoms

  • Previous response to medication, therapy, or nutritional supplements

  • Current diet, nutrition and physical health

  • Identifying any underlying medical conditions

  • Performing genetic testing when indicated

  • Evaluating current medication regimen of all medications, since many non-psychiatric medications can worsen depression

  • Evaluating seasonal components

  • Trauma history, relationship history, childhood history

  • Head injury and medical illness history

  • Birth history

  • Spiritual history and spiritual importance to you

Once I have developed a complete picture of your depression, I work with you to create a plan. I incorporate all the identified factors into formulating a comprehensive treatment plan, but I focus on attainable changes and goals. My end goal is always optimizing how you fee. I believe gradual and steady change is more successful and sustainable.

 

Medication is often the most straightforward first step addressing significant depression.  

Specifically, when someone is not functioning, struggling to get through the day or is suicidal. Typically I try a medication for 4 weeks before moving to another medication provided someone is tolerating it without side effects. l typically complete 2 trials of a traditional medication like an SSRI, SNRI (Effexor, Cymbalta), Remeron, or Pristiq.  I don’t hesitate to quickly move to a more potent medication like Parnate (An MAO-I.)  MAO-I’s are highly effective for all forms of depression, but especially in cases of treatment-resistant depression. They come with some mild dietary limitations, but otherwise are better tolerated than most other medications. These medications also come with certain drug interactions which is why it is not the first line therapy in most cases.

Another potent option for severe depression is ketamine.  Although often discussed as a treatment-resistant option, I view ketamine as a first line treatment for people who are severely depressed, not functioning, or suicidal. It is by far the most rapidly acting treatment for depression (sometimes within the first treatment). I view Ketamine and MAO-I’s as two life-saving treatments that are under-utilized. I provide ketamine therapy for my clients. I also collaborate with colleagues who specialize in ketamine infusion therapy to implement this option for my patients.

 

Psychotherapy is another critical element of successful treatment for depression.

Integration of Psychotherapy

Combining therapy with medication offers the best treatment outcome. Without a component of therapy, it is difficult to achieve an optimal result. Depression by nature negatively distorts our thoughts, feelings and behaviors. Medication alone cannot reverse this problem in most cases. Therapy also targets past child or adult traumas. Unresolved trauma wreaks havoc on the mind and fuels depression. I perform therapy as well as closely collaborate with my therapist colleagues to set up a treatment team and execute a collaborative plan. Most people thrive when supported by a team of people helping them to find healing. I will get to know you and find exactly what type of therapy you need to get relief from your symptoms. We will work together to implement the plan and continue to evolve the plan as necessary depending on what you are experiencing.

 

Nutrition, sleep, and physical activity represent the foundation for success in my experience.

Evidence shows that nutrition, sleep, and physical activity all are often more effective than medication in terms of treating depression. I have seen tremendous synergy in combining every treatment modality into a synergistic plan. This would ultimately include medication, therapy, nutrition, sleep and exercise into the plan. I am passionate about guiding motivated people through as many elements of positive change as they are wanting to take. I also will investigate your underlying health, labs and genetics when necessary. Addressing underlying medical causes are absolutely necessary.