Depression and anxiety treatments

v Always remember there is hope! One of the sinister elements of depression is how it can rob us of feeling like nothing can change or get better. Depression creates a veil around where all we see appears helpless and hopeless. It is important to remember that there is always hope, even when we can not see it. Sometimes we have to keep stumbling through the darkness in order to reach some light.

v This is a very incomplete and partial list. These are options that have at least some most scientific backing. Many of these newer ones need more time and research to tell how effective they truly are. That being said, most prescription anti-depressant medications are only marginally better than placebos.

v A combination of therapeutic lifestyle changes are the most effective, by far the healthiest and longest lasting means to help reduce depression and anxiety. (The most important lifestyle factors are in the NNEADSSSOME list below).

v If one is willing to trust, try and put forth effort, therapy works as well if not better than medication. Therapy is also longer acting and has fewer side effects than medication.

Environmental/ therapeutic factors that influence our physical and emotional health

Many of these lifestyle approaches have anti-depressant and anti-anxiety affects on their own. Together they can create a very powerful approach to overall physical and emotional well-being. Unlike so many other elements in our world, most of these NNEADSSSOME factors are all within your direct control!

·       If this list is too overwhelming, work on just one our two of these at a time.

N – Nature: spend more time in and around nature – household plants to trees to parks to wilderness areas

N – Natural light: Are you getting enough? Spend more time outside or get one or more full-spectrum lights

E – Exercise: The more you move your body, the better you will feel. Aerobic, weight training, yoga, HIT, whatever
A – Activity (meaningful ones): Should bring you joy, excitement, interest or are personally meaningful. *

D – Diet: Decrease consumption of all processed foods, especially processed foods high in sugar, fat and salt
S – Social connection: Grow your support web. Feeling isolated triggers activation of our stress response

S – Sleep: Get 7-9 hours a night. Sleeping too much or too little is harmful for our physiological functioning

S – Structure/schedule: Having some form of a routine helps our brains and body function better

O – Outlook: Intentionally and regularly challenge overly negative thoughts to create increased optimism

M – Meditation & mindfulness strengthen the brain’s ability to regulate attention, emotion and increase well-being

E – Existential meaning: Finding a purpose for ourselves in our community, society, (natural) world or universe.

       Connecting to something greater than ourselves brings our brains into an optimal state and promotes health

        and psychological well-being.

Whole-body physiological interventions

·        Exercise (this is the best researched and validated of all – it really helps!)

·        Ketogenic diets /diets creating increased ketosis and diets that cut out processed foods

·        Sleep deprivation therapy

·        Cold water immersion (can be as simple as turning the water to cold at the end of a shower)

Brain/mind interventions

·        Neurofeedback/biofeedback

·        Mindfulness meditation: See especially Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR).

·        TMC: Transcranial Magnetic Stimulation*

·        tACS transcranial alternate current stimulation*

·        Transcranial near infrared light stimulation*

·        Deep brain stimulation

·        (ECT) Electro-shock treatment

* research has shown these to be considerably more effective when applied only to the positive-

    dominant hemisphere

Psychotropic/psychadelic substances

·        Psychadelic guided therapy with psylocibin, MDMA, ayahuasca

o   Microdosing does not have much scientific backing as of yet

·        Ketamine

Antidepressants: Newest USA FDA approved medications and major classes

v Medication can make a huge difference for some, but for many it is not that effective. Sometimes meaningful changes can be brought about through the combination of two or more anti-depressants taken together (and/or mood stabilizers like Abilify).

Newest

·        Exxua (gepirone hydrochloride) 2023

·        Zurzuvae (zuranolone) 2023. Post-Partum Depression approval only

o   Brexanalone was original and IV version of Zurzuvae and was approved in 2019

·        Auvelity (combination of bupropion and dextromethorphan) 2022

·        Vraylar (cariprazine) 2022: Adjunctive to other antidepressants

·        Spravato (Esketamine) 2019 – This is an a nasally inhaled version of ketamine

·        Rexulti (brexpiprazole) – 2015: Adjunctive to other antidepressants and for schizophrenia

·        Trintellix/Brintellix (vortioxetine) 2013

·        Fetzima (levomilnacipran) 2013

·        Viibryd (Vilazadone) 2011

Major classes of anitdepressants: Approximately newest to oldest with brand name examples

·        Atypical (These do not fit neatly into the four classes below)

o   Remeron, Symbax, Trazadone, Trintellix, Wellbutrin

·        SNRIs – Serotonin and Norepinephrine Reuptake Inhibitors

o   Cymbalta, Effexor, Fetzima, Pristiq

·        SSRIs – Selective Serotonin Reuptake Inhibitors

o   Celexa, Lexapro, Luvox, Paxil, Prozac, Viibryd, Zoloft

·        TCAs - Tricyclic Antidepressants

o   Anafranil, Asendin, Elavil, Norpramin, Pamelor, Sinequan, Surmontil Tofranil, Vivactil

·        MAOIs – Monoamine Oxidase Inhibitors

o   Emsam, Marplan, Nardil, Parnate