Depression is one of the most common mental disorders in US. Depression is the leading cause of disability worldwide. It can happen at any age, but often begins in adulthood.
Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present, sometimes medications taken for these physical illnesses may cause side effects that contribute to depression.
When a person is struggling with depression, it is difficult for person to describe it. With depression even thought of facing yet another day is a daunting task. Person loses appeal to all the pleasurable activities in their life. Simple task of getting out bed becomes monumental task of the day. Even mundane small tasks seem impossible. At the same time it is difficult for others to understand. Friends and family, while trying to help, sometimes make it worse by encouraging them to snap out of depression, or cheer up, or stating their life is good. Major depression can be recurring illness where chance of having another episode increased with each depressive episode. Approximately 37% of adults with major depressive episode did not receive treatment, some lack access to care while other don’t recognize depression as a mental illness, thinking it is a weakness, or that it will simply go away.
An estimated 16.2 million adults in the United states suffer from at least one major depressive episode. Out of these, 4.5 million people in the United states do not respond fully to prescription antidepressants. Women are nearly twice as likely as men to be depressed.
Kessler RC, Berglund P, Demler O et al. JAMA. 2003;289(23):3095-105.
Risk Factors or Causes
It is usually personal or family history of depression.
Major life changes (both positive and negative)
Trauma or Abuse (past physical, sexual, and/or emotional abuse, chronic stress, family conflict or being raised in a household where there was addiction, mental or physical illness, neglect etc.)
Certain physical illnesses (heart disease, Parkinson's, any illness where someone is bedridden for a long time etc.) and medications (e.g. some blood pressure medications, acne medications etc.)
Signs and Symptoms
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest of pleasure in hobbies and activities
Decreased energy or fatigue
Moving or talking more slowly
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
Not everyone who is depressed experiences every symptom. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life.
Types of Depression
Other types of depression include:
Persistent depression disorder (also called dysthymia) is a depressed mood that lasts for at least 2 years. A person diagnosed with this may have episodes of major depression along with periods of less severe symptoms.
Postpartum Depression is much more serious than “baby blues” (relatively mild depression and anxiety symptoms within 2 weeks after delivery). Women with postpartum depression full-blown major depression during pregnancy or after delivery. The feelings of extreme sadness, anxiety, and exhaustion that accompany depression may make it difficult for those new mothers to complete daily care activities for themselves and/or for their babies.
Psychotic depression occurs when a person has severe depression plus some form of psychosis (e.g. false belief-delusion, hearing or seeing things that others can’t hear or see-hallucinations). Psychotic symptoms typically have a depressive “theme”, such as delusions of guilt, poverty, or illness.
Seasonal affective disorder is characterized by the onset of depression during winter months; usually accompanied by social withdrawal, increased sleep, and weight gain.
Bipolar depression, person with Bipolar disorder experiences episodes of extreme low moods that meets criteria for major depression.
Even though Depression can be devastating, it is also, thankfully, treatable condition. A variety of treatment options are available.
Medications: Antidepressants, mood stabilizers, and antipsychotic medications have been used for treatment of depression. At times, despite best efforts, significant percent of patients either do not respond to medications or could not tolerate their side effects.
Psychotherapy: also known at times as “Talk therapy” or counseling is offered by variety of professionals including counselors, therapists, and psychologists. Some psychiatrists offer psychotherapy as well but in US, typically, psychiatrist mostly offer prescribing medications, and other specialized treatments such as TMS or ECT. The most common forms of therapy for depressive illness are cognitive behavioral therapy, family or system focused, and interpersonal therapy.
Electroconvulsive Therapy (ECT): ECT uses electric currents in order to induce short seizures. It causes change in brain chemistry that help alleviate mental illnesses. It often works when other treatments have failed but is invasive, requires General Anesthesia, and can cause confusion and memory loss.
Transcranial Magnetic Stimulation Therapy (TMS): The gentle magnetic pulses, similar in strength to an MRI, are applied to strategic area of the brain, which reverses changes that happens when one is depressed. It is similar to ECT with regards to effectiveness, but it is far superior when it comes to side effects. It is performed in the doctor’s office, it is not invasive, and anesthesia is not needed.
Additional Treatments and Therapies: Self-management strategies are important to incorporate into treatment of depression. These include exercise, proper nutrition, proper sleep, meditation, faith, prayer, Acupuncture, and holistic treatment.
If you think you might suffer from depression, or are having difficulty managing depression, check with your doctor or give us a call for a depression treatment consultation at (520) 639-8576. If you need immediate help, please call 911. To talk with a crisis worker now, call the National Suicide Prevention Lifeline at 800-273-8255.
Many people have treatment resistant depression, where antidepressants have not helped or helped a little. Up to a third of patients do not respond to several attempts at treatment. Many people are unable to tolerate side effects of medications. Leaving depression in this partially untreated state damages the brain and perpetuates treatment resistance. In these patients, Transcranial Magnetic Stimulation (TMS) is an excellent new alternative treatment for resistant depression. Also, some people choose this as, not only it is effective, but has significantly less side effects (typically patient feel discomfort at the site of application) and has not systemic side effects (such as weight gain, dry mouth, nausea, decreased sexual drive etc.). Whether or not you have responded to antidepressants previously, TMS therapy can still be effective.
The goal of depression treatment is remission, which is absence of depression symptoms. With deep TMS, more than 50% of patients achieve remission and more than 70% have a significant response (50% or more improvement in depressive symptoms). (Add STAR*D slide here). Studies also show that concurrent use of antidepressant treatment with deep TMS may produce even greater results – 58% remission rate and 79% response rate. If you have undergone shock therapy or electroconvulsive therapy (ECT) unsuccessfully, or had significant side effects with it, or choose not to have it done even though it has been recommended, TMS therapy can help, without anesthesia or electrical currents being applied to your brain. In depression, certain parts of the brain are underacting. A gentle magnetic stimulation from the coil passes through the skull and creates stimulation of the brain neurons directly. Unlike antidepressants and other medications, TMS therapy has a long-lasting effect. Some people may need additional treatment months later, while others enjoy long-term relief from depression. TMS is FDA approved for treatment of depression since 2008. It also recently got FDA approval as an adjunctive therapy for Obsessive Compulsive Disorder.
In addition to FDA clearance for Major Depressive Disorder and Obsessive Compulsive disorder, the Brainsway system is currently approved (has CE mark) for several neuropsychiatric conditions in the European Union including:
(b) Major Depressive Disorder
(c) Bipolar Disorder
(e) Post-traumatic Stress Disorder
(f) Parkinson’s disease
(g) Chronic Pain
(h) Multiple Sclerosis
(j) Obsessive Compulsive Disorder
(k) Smoking cessation
Why Choose Deep TMS?
Currently five TMS systems are approved by the FDA for treatment of depression. In 2013 the FDA cleared Brainsway Deep TMS system for the treatment of Depression. Unique thing with this system is a revolutionary coil called “H” coil, invented at the National Institute of Health (NIH). The H coil, in contrast to figure-8 coil being used in all other TMS machines, is able to directly stimulate deeper into the brain (it can produce magnetic waves which reach deep brain structure at up to 1.6 inch below the skull surface while figure-8 coil usually reach 0.6 inch below skull surface. Thereby, “Deep TMS” or “dTMS” is able to distribute greater impulse to large area of the brain. A session of dTMS lasts typically 20 minutes, which is about the half the duration of figure-8 TMS session. Dr. Patel at Surya Psychiatric Clinic and Strive TMS Centers, is the first provider in Tucson to acquire and use Deep TMS.