Depression Psychiatrist Treatments: Ketamine, TMS & More

Millions of Americans suffer from some level of depression and while some depressive episodes are brief, for those that suffer from long-term depression, the effects can be devastating on one’s day-to-day life. Fortunately, an experienced depression psychiatrist can help, even with treatment-resistant depression. Let’s take a look at types of depression, symptoms and the many treatment options available.
 
It’s not uncommon for anyone to feel low or blue once in a while, even for a few days or a week or more. This is quite common after the loss of a loved one or perhaps in the aftermath of a divorce or another traumatic event, such as losing your job. Of course, many physical factors can contribute to depression, such as suffering from chronic pain, managing life with a disease such as cancer or even having a baby.
 
Reaching out to a trusted friend, a therapist or even a religious adviser can help during these times. However, when depression is constant and chronic and lasts for an extended period of time, it’s time to think about contacting a depression psychiatrist and finding treatment options that help you alleviate symptoms of depression or eliminate them altogether.
 
It is often hard for people to seek help for depression, but just like with physical pain, mental pain is a sign that something is wrong. As a depression psychiatrist, my philosophy is that psychiatric disorders are not a weakness, they are simply a biological disease that is often treatable.
 
Symptoms Of Depression
Again, most people have moments of sadness, loneliness and depression, but when depression lasts for several weeks or months, it is time to seek help. Here are a few symptoms you might notice that indicate you are clinically depressed:

• Fatigue
• Insomnia
• Irritability
• Feelings of hopelessness & pessimism
• Loss of interest in hobbies, work, relationships, etc.
• Chronic aches and pains (often headaches, as well)
• Persistent feelings of sadness and anxiety
• Feelings of guilt and helplessness
• Feelings of worthlessness
• Trouble concentrating & forgetfulness
• Suicidal thoughts (or attempting suicide)

 
If you are having suicidal thoughts, please call the National Suicide Prevention Lifeline at (800) 273-8255. While not everyone with depression will attempt suicide or have suicidal thoughts, please know that if you are feeling suicidal, help is available at any time of day or night.
 
What Causes Depression?
Many factors can cause depression, and in some cases, a combination of factors occurs. For instance, there is thought to be a genetic component with depression, so if your parent, grandparent or other relatives are prone to depression, this could be one of the causes of your depression.
 
For others, issues with brain chemistry might be an issue, such as lowered serotonin activity. Medical issues also can cause depression, and this can include conditions that cause chronic pain as well as diseases such as cancer, diabetes, Alzheimer’s disease, Parkinson’s disease and others. Of course, many women experience postpartum depression after giving birth. 
 
In some cases, drug or alcohol abuse can cause depression, but there are also some types of prescribed medications that can cause depression. A life-altering event also can trigger depression, and this can be anything from a death in the family to a car accident or some other type of traumatic event or just simply suffering from loneliness and feelings of isolation can cause depression.
 
Types Of Depression
There are several types of depression, and a depression psychiatrist will do a thorough evaluation to determine which type of depression is occurring, as treatment plans can vary based upon the type of depression.
 
Major Depressive Disorder (MDD) – With MDD, a person will experience a combination of the depression symptoms listed above for at least two weeks that mark a change from the person’s previous or usual mood.
 
The DSM-V, which is the classification system for mental disorders designed by the American Psychiatric Association, also states that for this diagnosis, these symptoms must be causing a significant amount of stress or reducing your ability to function. Perhaps your work suffers, or you have difficulty keeping your house clean or taking care of daily hygiene tasks.
 
These symptoms also must be independent of other disorders, such as schizophrenia or bipolar disorder. Additionally, the depression symptoms cannot be attributed to a medical condition or to drug or alcohol use.
 
Persistent Depressive Disorder (PDD) – While MDD is a type of depression lasting at least two weeks (or more), those with PDD have chronic depression lasting at least two years for adults and one year for children and teens. The symptoms of PDD often are milder than MDD, but the chronic nature of this depression obviously lessens one’s quality of life substantially. Again, the depression symptoms must be independent of disorders such as schizophrenia, bipolar disorder, medical conditions, etc.  
 
Postpartum Depression – While having a baby can be a wonderful event, a woman’s body goes through immense changes during pregnancy not to mention the huge changes that parenthood brings. Children are a blessing, but life does change signifcantly once they arrive, and it’s very common for women to experience depression and anxiety.
 
In fact, most women (as many as 70%) will experience what is known as the “baby blues.” This is a short-term issue that often causes women to feel anxious, irritable and perhaps very emotional, including bouts of crying for no specific reason. The good news is that the baby blues typically doesn’t interfere with daily life tasks and tends to resolve fairly quickly.
 
However, postpartum depression, also known as peripartum depression, is in a class by itself, so to speak. If you notice persistent feelings of depression, extreme sadness, anxiety or even feelings of indifference that last more than two weeks and prevent you from handling any normal activities, it’s important to seek help.
 
It’s also important to note that fathers also can suffer from this form of depression. While they don’t go through the same physical changes as mothers, the extreme changes and financial obligations of fatherhood can be daunting.
 
Premenstrual Dysphoric Disorder (PMDD) – While it’s not uncommon for women to experience mood changes as well as issues such as cramping, bloating, acne, headaches, etc. While this is certainly frustrating and uncomfortable, these issues rarely interfere with normal functioning at home, work or school.
 
For those with PMDD, the changes tend to occur about a week prior to menstruation and can last the duration of your period and the symptoms are severe enough to disrupt daily functioning. Symptoms of PMDD include severe fatigue and depression, anxiety, confusion, anger, crying spells, severe moodiness and sometimes even paranoia.
 
Many women with PMDD will experience headaches, dizziness, muscle spasms and heart palpitations.  Nausea and vomiting are other common symptoms as well as swelling of the ankles, feet and hands. In some cases, those with PMDD might experience vision changes and frequent eye infections. These are just a few of the severe symptoms a person with PMDD might encounter.
 
Seasonal Affective Disorder (SAD) – If you’ve ever had the winter blues for a few days, you are not alone. Many people tend to feel a bit down now and then during the winter, as there is less sunshine in our hemisphere. However, if you notice feelings of sadness, loss of energy, difficulty concentrating, oversleeping and the loss of interest in activities you previously enjoyed for a period of several weeks, this could be SAD, especially if these symptoms interfere with daily functioning.
 
With SAD, we might use some of the medications that are listed in the section below, but also light therapy and talk therapy, such as cognitive-behavioral therapy, have been shown to help lessen symptoms. With light therapy, the patient sits in front of a special light therapy box for about 20-30 minutes each day throughout the winter months.
 
Co-Occurring Disorders
As a depression psychiatrist, my job is not to simply diagnose depression, but also to look at the whole patient and determine all of the issues that you might be facing. For instance, it is not uncommon for people with depression to also suffer from anxiety. You might also suffer from addiction, OCD, PTSD or another mental health issue. Additionally, your depression could be caused by bipolar disorder or another mood disorder.
 
A depression psychiatrist must consider all of the possible diagnoses before setting on a course of treatment. We also must consider your general physical health. Is your body vitamin-deficient? Do you have diabetes? Are you suffering from chronic pain? Simply treating depression is often not enough, we need to treat all of the issues you are facing to improve your quality of life.
 
Depression Treatment Options
Many people with depression are hesitant to ask for help, but this is simply a biological disease, and it can be treated. Seeking help for depression is no different than seeking medical help for any other condition such as asthma or a broken bone.  It can, however, take some time to find the best treatment plan to fit your needs. Medications and therapy take time to work, so it’s important to have patience and keep taking medications and attending therapy as directed by your physician.
 
There are many treatment options to consider, including:
 
Selective Serotonin Reuptake Inhibitors (SSRIs) – This is often the first line of treatment for many types of depression, including MDD, PDD, postpartum depression, etc. These drugs tend to have fewer side effects and work for many people to lessen or eliminate symptoms of depression by boosting serotonin in your brain.
 
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) – These are similar to SSRIs, but they increase norepinephrine in the brain as well as serotonin. If you don’t respond well to SSRIs, your depression psychiatrist might try an SNRI instead.
 
Ketamine – Some patients will suffer from what is known as treatment-resistant depression. While this obviously can be frustrating and discouraging, ketamine is a medication that has shown some success with treatment-resistant depression as well as anxiety and PTSD.
 
Ketamine initially was used as an anesthetic, but interestingly, many EMTs and ER doctors would use it to calm agitated patients, especially those who had attempted suicide. While it did calm them initially, many of these patients would come back months later and state that they hadn’t felt suicidal or depressed since the ketamine treatment. Eventually, after much study, the FDA approved two types of ketamine as a treatment for depression, anxiety and PTSD.
 
Ketamine can be given either intravenously or as a nasal spray. After receiving the treatment, you need to wait at least two hours before heading home, and you will need to have someone drive you home as you might be drowsy.
 
Transcranial Magnetic Stimulation (TMS) – This is a non-invasive treatment that typically is used for people with treatment-resistant depression. For TMS, we place an electromagnetic coil by your forehead, and a magnetic pulse is delivered to nerve cells in your brain. This process is entirely painless for the patient and has been shown to stimulate the areas of the brain that control our mood. Often if TMS is unsuccessful, we will consider ketamine as our next approach.
 
Therapy – While medications certainly can be helpful, it is also wise to add some type of therapy to your treatment plan. Talking with a therapist or psychologist can help you work through problems and learn some tools to help you manage depression and anxiety. Some type of cognitive-behavioral therapy is usually always recommended in addition to medication.
 
Keep in mind, that if you have a co-occurring disorder, we may need to consider additional medications and treatments for those specific disorders. For instance, if your depression is caused by bipolar disorder, we might need to try more than one medication or perhaps other types of medications than those discussed above.
 
If you have depression caused by a physical medical condition, treating that condition can alleviate depression symptoms, so we might approach your depression treatment differently than for someone with MDD or PDD.
 
In addition, it is always recommended that you eat a healthy diet, and you consider daily exercise as these steps can help lessen symptoms and improve your overall health. Some patients, such as those with low levels of vitamin B12, iron and other vitamins or minerals also might need to consider taking vitamin supplements.
 
Contact A Depression Psychiatrist Today
As a depression psychiatrist, I can provide you with a thorough diagnosis as well as helping you find a medication or treatment plan that helps alleviate your symptoms. This thorough diagnosis is a crucial first step and it can take more than one session to determine the diagnosis and create a treatment plan, but it’s best to find ways to address all of the issues you are facing to achieve long-term success.
 
In addition to treating depression (including treatment-resistant depression), I also work as a bipolar disorder psychiatrist, ADHD psychiatrist, anxiety psychiatrist and can provide treatment for drug and alcohol addiction. While I have offices in Thousand Oaks, I also offer telepsychiatry services. Whether you live near my office or elsewhere in Southern California and beyond, I can provide you with quality virtual psychiatrist services.
 
If you need a depression psychiatrist, don’t wait another day to give me a call. No one should have to suffer from depression and there is hope. We have many treatment options that can help you live a healthier, happier life and you deserve to live your life to the fullest.