Patients who are treated for depression improve with treatment. However, there is a subset of them that are less depressed but still not able to function as well as they are expected. They feel better but are not well.
Wellness is a concept that is often times elusive. In my experience, this obstacle can most often be due to an anxiety disorder that has not been treated or has not been diagnosed.
Anxiety has many forms. I often categorize the symptoms into 2 categories: physical and emotional.
Physical symptoms can be the following:
Emotional symptoms of anxiety can include the following:
Many patients who have untreated anxiety disorders tend to have many of the above symptoms. They tend to live a life of fear, dread, frustration, with constant "worry". The cognitive impairment associated with the anxiety disorders tend to be severe enough that it prevents many from holding productive working lives and employment. Many self medicate with drugs, alcohol and marijuana.
The Jesalva Algorithm address this as a very important issue. Anxiety disorders need aggressive treatment in order to achieve wellness. This can be accomplished in several ways without the use of benzodiazepines. Using antidepressants at doses at the upper end of the therapeutic spectrum is a way that I advocate. Also, using gabapentin at high doses is another medication that I often use. Finally, second generation antipsychotics could be a 3rd line choice if the others fail.
Of course, non-medication modalities are also needed. Exercise is a tool that is most helpful especially cardio-oriented ones.
Dr Jesalva is a psychiatrist. He is in private practice in Thousand Oaks, CA since 1989. He successfully treats very challenging patients with varying co-occurring disorders with medications.