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:
- Brisk walking 30 minutes daily of 45 minutes every other day.
- 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.
- Rise out of bed at the same time each morning.
- 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.
- A Mediterranean diet enhances neuroplasticity and reduces inflammation.
- Mindfulness or meditation
- Antidepressant apps.
I am going to add two more lifestyle changes:
- 15-minute prayer daily.
- 15-minute Bible reading and study daily