What Can Be Done for TRD
When a patient has their first, second and maybe even third major depression and they are placed on a good anti-depressant medication, 15% of patients can be expected to go all the way to normal within 6 weeks. As for the remaining 85% of the patients, as many as 80% may reach a normal mood if additional treatments are added.
The goal is to get everyone to feeling normal. This is done by adjusting dosages, adding treatments and changing the combinations until a good result is reached. It may take months or even years to reach the best possible results but alleviating a person from the symptoms is well worth the effort.
Here are a few of the augmentation treatments that are used and proven effective for many sufferers:
Transcranial Magnetic Stimulation (TMS)
If anti-depressant medication does not bring a person’s mood all the way to normal, TMS is one of the most beneficial augmentation strategies available.
This treatment relieves symptoms in 50% of the patients who try it and the benefits are long lasting, up to three or four years – even for people who have never had normal moods before. If a person has a relapse, just a few treatments will restore the good moods again.
TMS uses magnetic field pulses that stimulate or inhibits activity in the brain, depending on the setting and placement of the magnets. It is a comfortable treatment that does not interfere with a patient’s work or school schedule. The risks are minimal and there is no memory loss.
Robert D. McMullen has found that just 1/50 mg of lithium can give some people excellent results within one to two weeks. Some people, who have been treated for decades using other medications, have dramatic improvement with just this very small dosage of lithium.
People who don’t respond immediately, may respond if they take lithium over a long period of time. This low dose has no side effects at all and no monitoring of the blood is required.
Some people, such as those suffering from bi-polar disorder, need higher dosages of lithium. If they show relief but then have a relapse, the dosage can be increased. Many show improvement in just one week.
Other medication that people respond well to is N-acetylcysteine (NAC), a medication often used as an antihistamine. It is an amino acid. Four grams are taken per day.
It allows the body to make more of the main antioxidant needed to clear out poisonous free radicals.
Glutathione is made up of three amino acids – glycine, glutamine and cysteine. When you provide the body with this, including the cysteine, the body can make about 50% more glutathione than it normally makes.
Tests done by a psychiatrist in Austrailia showed that many people who were depressed either too many free radicals or too little glutathione. After giving them NAC for four and a half months and increasing the dosages from two grams to four grams, many people improved. Their bodies made more glutathione, which in turn cleaned up the free radicals.
EPA in Fish Oil
Another beneficial augmentation is fish oil, which is mainly composed to two types of fats – EPA and EHA. Patients usually take six to eight pills a day for a month to see if there is a benefit.
There are some new brands on the market with just EPA, which are smaller capsules with 500 mg. If a patient has to take a lot of EPA, he may prefer this brand.
What’s more, fish oil reduces inflammation, which has been shown to have a correlation to depression.
Another augmentation is taking statins, often used to reduce cholesterol. A test was done on patients who had suffered from heart attacks. Those on statins were 50% less likely to be seriously depressed after a heart attack.
The statins that seem to help the most are those that are lipid/fat soluble because they into the brain more easily, such as Zocor and Crestor. Robert D. McMullen is an advocate of taking statins because people with depression have a higher risk of heart attacks.
People with these factors are at a higher risk for heart attacks:
* Family history of heart attacks
* Having diabetes
* Having high cholesterol
So if you suffer from being depressed, you have an extra reason to take a statin. The modern theory is that a person with these factors should be on the highest dosage of statins that they can tolerate because the higher the dose, the fewer heart attacks occur.
Another augmentation strategy is diet. The vegan or the Mediterranean diet may be the best because it reduces inflammation. Since reducing inflammation is beneficial to people who are depressed, they should avoid white rice, white bread and white potatoes. The Mediterranean diet has been shown to reduces incidences of heart attacks.
Asprin – N-saids
NSAIDs are nonsteroidal anti-inflammatory drugs. Taking these is another augmentation measure people who are depressed can try. Mainly Celebrex has been used but not recommended for long-term use. However, if someone is extremely depressed, it is good in the short term.
Here are two non-medication strategies that have been shown to reduce symptoms – exercise and light therapy:
Exercise – One Hour a Day
Exercise reduces the incidences of heart attack, cancer, and other illnesses. Exercise is a tremendous anti-depressant. Studies have proven that if someone exercises vigorously for one hour a day, five days a week, they will get the same benefit as taking popular antidepressants, such as Prozac.
A person can receive significant anti-depressant effect if he gets up early in the morning, such as at 7:00 AM, and immediately goes outside for half an hour. It’s important to be under a full sky, even if the sun is not shining brightly.
In the winter, a depressed person can use a light box, which contains fluorescent lights. The amount of light that is needed is 10,000 lux. It’s necessary to sit really close to the box for half an hour when first getting up in the morning.
Machines and Parameter Used with TMS
Since transcranial magnetic stimulation therapy has been so successful, it deserves further mention. TMS has a 50% chance of bringing people who have never had normal moods in their lives all the way to normal.
Several TMS machines can be used. One has two copper coils that touch each other, making a figure-eight electromagnetic field. Different parameters can be use with TMS, such as adjusting the pulses and placements of the coils on the head. Various combinations can be tried until the individual get the optimal results.
There are other augmentation strategies that can be used. Trying one treatment after another can be frustrating and take a great deal of patience on the part of the individual who are depressed. He must trust his psychiatrist and be willing to wait a length of time to determine if a treatment is working or not. It may require trying many different treatments until the right combination is found.
Treating depression can be complicated but reaching 100% mood normal is well worth the effort.
Call (212) 362-9635 for an appointment in New York City. Offices in Manhattan and Mt. Kisco, NY, USA