Hope for Depression

Because depression is such a common disorder, I thought some of you might be interested in tidbits taken from the Carlat Psychiatry Report 16:6-7, July/August 2018 by Chris Aiken, MD. 

Dr. Aiken, a psychiatrist in Winston-Salem, NC, may be a good option for those who have difficultly finding psychiatrists in the Appalachian Mountains since he is only about a two-hour drive from this area. 

Dr. Aiken writes: 

• Failure of 2 full antidepressant trials lasting 6 weeks at a therapeutic dose is enough to qualify for a treatment resistant depression (TDR). 
• Nonresponse to antidepressants is not enough to diagnose bipolar disorder but up to 60% of TRD turn out to have a bipolar diagnosis. 
• Aripiprazole (Abilify) and risperidone (Risperdal) are the only two atypical antipsychotics that demonstrated improved functioning in a large study meta-analysis. 
• Abilify is preferred because it has more positive trials. 
• The therapeutic dose of Abilify ranges between 5-15 mg daily. 
• Overall tolerability was highest for risperidone. 
• After the atypical antipsychotics lithium is the second best studied augmentation option for TRD, but it would be considered first-line in patients who are at risk for suicide. 
• In a meta-analysis of 34 studies involving 110,000 person-years, lithium reduced the risk of suicide five fold in recurrent unipolar depression and sixfold in bipolar disorder. 
• Lamotrigine (Lamictal) has few long term side effects and works well for bipolar depression, but not unipolar depression.

Treatment–resistant depression patients can expect, a full recovery but they will need psychotherapy and life-style changes.

Animal and human studies consistently find that aerobic exercise; social interaction and a stimulating environment enhance both the clinical and biological effects of antidepressants, such as increasing neurotropic factors and synaptic plasticity. 

Dr. Aiken recommends the following lifestyle changes: 

1. Brisk walking 30 minutes daily of 45 minutes every other day. 
2. If a brisk walk is too intimidating a stroll in the woods provides similar relief. In one study, a 90-minute forest walk reduced depressive thinking more that a similar urban walk. Additionally walking in the woods improves cognitive performance better than a walk in the city or suburbs. 
3. Rise out of bed at the same time each morning. 
4. It often takes depressed patients a long time to feel fully awake in the mornings. This is called sleep inertia. Go watch the sunrise, use a dawn simulator or a light box to wake up faster. 
5. A Mediterranean diet enhances neuroplasticity and reduces inflammation. 
6. Mindfulness or meditation 
7. Antidepressant apps. 

I am going to add two more lifestyle changes: 

• 15-minute prayer daily. 
• 15-minute Bible reading and study daily