Integrative Psychiatry and TMS

Even though the exact causes of depression are still not fully understood, a number of factors have been found to be responsible in precipitating depression:

Psychological stressor, such as personal loss, may frequently become a tiger. Many people suffering from depression during their adult lives have been neglected or abused as children. Postpartum depression may be related to the change in sex hormones following pregnancy. Many people with depression are found to have abnormalities in their levels of cortisol, thyroid and growth hormones. The brain aging process is another significant factor behind depression. The statistic shows that depression becomes more prevalent with age. In many cases a strong genetic predisposition can be traced.

​

In order to diagnose depression, five of the following symptoms must all be present during the same 2-week period:

1. Depressed mood most of the day, nearly every day

2. Markedly diminished interest or pleasure in all, or almost in all, activities

3. Significant decrease or increase of appetite and weight loss or gain (more than 5% a month)

4. Loss of sleep, or too much sleep

5. Agitation and restlessness, or markedly slowed mental and motor activity

6. Fatigue or loss of energy almost every day

7. Feeling of worthlessness or excessive/inappropriate guilt almost every day

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day

9. Recurrent thoughts of death (not just fear of dying), and recurrent suicidal ideations with or without plans

​

Treatment of Depression is a combination of lifestyle modifications, psychotherapy, and psychotropic medications.

The patient’s life style should become a healthy one, including a normal balance between work and rest, physical exercise, and proper nutrition.

​

When dealing with psychotherapy, three major approaches are used: Psychodynamic, Cognitive, and Interpersonal. The Psychodynamic approach promotes personality change through understanding of past conflicts. Cognitive psychology promotes symptomatic relief through alteration of self-destructive, “negative” thoughts and behavior. Lastly, the Interpersonal method promotes resolution of current interpersonal problems.

​

The most effective and frequently used anti-depressant medications today are: Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor, Luvox, Serzone (in its generic form), Cymbalta, Pristiq, Fetzima, Brintellix, Remeron, Viibryd, and Wellbutrin. These medications differ from each other by their effects on various receptors in the brain and body. The decision of which medication to prescribe often depends on the person’s tolerability, since the same medication can cause one patient to feel sick and no side effects in another patient. This is true since the human reaction to antidepressants, which is similar to the reactions to other medications, is highly individual. In addition to tolerability, the choice of which medication to use also depends on the type of depression the patient is suffering from. At times, it is a challenge to predict, without actually testing it out, which type of antidepressant will be the most effective and best tolerated by the patient.  In order to minimize probability of side effects, and improve effectiveness, we usually employ Medication Tolerance Genetic Test, and Brain Neurotransmitters’ Balance Analysis before starting or changing the medications. If insufficient amount of thyroid hormone or estradiol - progesterone imbalance is found in laboratory testing, it needs to be corrected, before psychotropic medications are introduced.