Best Treatments for DEPRESSION

Best Treatments for DEPRESSION

Yesterday, I went to a school meeting where many moms and dads were chattering away about how the school year has been going in their home. In the corner of a beautiful couch in the school’s living room, an old acquaintance was sitting staring into the distance, not talking to anyone but just wagging her long leg crossed over her other leg with her hand propping her sad, downcast face. She looked so sad and no one it seemed wanted to even talk to her as she looked so sad. She had been so nice to us when we first moved to the area but in the last few years has said they have been too busy to get together despite invitations for dinner and lunch. Gently I sat next to her to talk to her and it was clear that she very depressed. Her husband travels a great deal and she mentioned this fact multiple times in the short time we had to talk before a presentation began. I wanted so much to reach out and share with her some helpful options, but could not in such a public settings. Still even in private, I suspect she may not want to admit to a “semi-stranger” that she is struggling with depression and possibly deep resentments. All I could do is try to talk to her as best as I could and offer her a friendly smile trying to commiserate with the busy husband, busy household so common among women these days.

No one is immune from feeling down from time to time or from full blown depression. In medical school, as part of my 3rd year psychiatric rotation at Dartmouth, I was asked to interview a woman for our whole class who was admitted to the psychiatric ward at Dartmouth Hitchcock Medical Center for “Major Depression.” As I talked to this lovely 56 year old woman, I realized right then that no one was immune. She had lost her husband 5 months prior to a long and painful bout with lung cancer and then 3 months after that her teenage son was killed when a tractor flipped over upon him as it was climbing a gentle hill on their farm. She was completely physically and mentally “normal” aside from her admitting diagnosis.

At the time, all I could do was to offer my condolences. I don’t even think I told her that I would pray for her as that concept was likely not even on my radar screen. But now after years of seeing many people suffer through depression, it is clear that there is a better way.

Below are some great sites that have some good point from the medical perspective. Some treatment options are summarized below on my list as well. But all of them miss a key component which is the spiritual component of every human being which, in my opinion, needs to be addressed in most patients in order to help them presently and more importantly eternally. 

C. G. Jung, an agnostic if not atheist psychiatrist who was a contemporary and colleague of Sigmund Freud noted in a published interview that if everyone went to confession weekly, he would be out of a job. He saw the healing power of confession and studied it for for this reason. 
J Relig Health. 1985 Mar;24(1):39-48. doi: 10.1007/BF01533258.
The value of confession and forgiveness according to Jung.
Todd E.
Author information
This article represents a broad survey of the views of C. G. Jung regarding confession and forgiveness. Man, a naturally religious being, has a need to confess his wrong and to gain forgiveness of one sanctioned to absolve. The curative effect of confession has been known for centuries. Without confession, man remains in moral isolation. Priests, ministers, and rabbis, as well as psychotherapists, attest to the universality of this human phenomenon.
Aside from the biases one might have from “rotten apple” priests, which unfortunately in any profession do exist, there is an inherit benefit to weekly confession. If you have not tried it, you should: with a good Catholic priest (a list of favorite confessors of all times is below). A friend once went into a random Catholic confessional and said something to the effect, “Father, forgive me, I don’t believe all this crap.” It changed her life for the better, forever she says.
Why not try it? Is it embarrassing and humiliating? How much more embarrassing is going to a shrink who charges a lot of money? Confession is free. Confession will not cure all types of depression or mental health issues if there is a hormonal or neuro-chemical or brain issue, but it has helped so many people I know personally that I feel compelled to mention it precisely because no physician, especially no surgeon,would publicly mention it or ever prescribe it.  Yet we prescribe billions of dollars worth of prescription medicines which also do not have a 100% guarantee and have numerous potential side effects. Is there a side effect of weekly Confession? Not really. Maybe time could be an issue, but I would not say it is wasted time since going to a wise Catholic priest is priceless. There is reason why thousands would fly all over the world to visit with Padre Pio. Also the time you spend in confession is paid back I would argue 7 fold in getting the wisdom to avoid the traps that lead many into the pit of depression and despair.  
More on Padre Pio Below. But if you want to skip to my list of Best Treatments for DEPRESSION, please scroll down to ***.

in a small, hard to get to town called San Giovanni Rotondo, Italy before his death in 1968.
After his death, millions still flock to see the remains of St. Padre Pio who was an incredible confessor. 

Most of my list may sound like “common sense,” but I would argue that if you follow this list well, you might have many new natural options that might help keep you stay away from prescription drugs which each have a long list of potential side effects. 

Dr. Cremers’ Best Treatments for DEPRESSION
1. Be sure you are getting plenty of sleep: avoid tv, ipads, cell phones after 8pm (ideally earlier); especially avoid tv, ipads, or cell phones in bedroom. Getting enough sleep is essential in getting the right neurotransmitters to work in your brain properly when you wake up. If you do not get enough sleep, your brain cannot be happy! (see references below). Sleep should be sacred in your house unless you are a true saint and can cheerfully offer up a bad night of sleep.
2. Drink plenty of water: at least 64oz per day. Eat plenty of green leafy vegetables ideally 2-3x per day to increase the antioxidants and vitamins needed to produce “happy feeling” hormones such as oxytocin. 
3. Get some direct sunlight safely at least 2 hrs per day. Natural sunlight increases one’s Vitamin D levels which are the backbone to key hormones in our body which we need to have the feeling of “happiness” or “contentment.”
4. Get more exercise: yes, this it seems is on any list having to do with any health issue. But it is true. Even standing at an elevated desk instead of sitting can help improve the stress hormone/ relaxation hormone ration in the long run. Park farther away from the entrance. Take 1 flight of stairs a day and increase it each week. Talking the long way around the 1st floor kitchen island and picking more things off the floor can build your “happy hormones” especially when done with love and purpose. In the Christian relm, we say to sincerely “Offer Up” that little inconvenience of that extra exercise or effort for someone you love or for a soul in purgatory. Science is now finally showing that these little “Oferrings” actually help the person doing the “Offering Up” chemically as well.
5. Learn to say “I am sorry” and “I forgive you” at least 7 times a day with a sincere heart and mind. This might be the hardest thing on the list. One has to start small: saying “I am sorry” to your dog for stepping on his tail may be much easier than saying “I am sorry” to your spouse who you have a mountain of resentments towards. But learning to say you are sorry and also learning to FORGIVE your enemy and saying you FORGIVE your enemy has been proven to decrease stress hormones in the body and increase happy hormones. At the base of this is an act of humility which the body is pre-programmed to help us physically if done with gentle charity and cheerfulness. An “I forgive you” or “I am sorry” while gritting one’s teeth with anger at the max, does not have this effect. Thus taking this “I am sorry” and “I forgive you.”slowly but surely is worth the effort and pain it takes. This point is the bases for the next:
5. Weekly confession. Find a great Catholic priest who walks the walk & lives a virtuous life. A wise, holy priest is worth more than 1million psychiatrists. It is not easy to find a holy, wise priest in some locations, but there are thousands around the world and well worth a plane ticket.
6. Daily Mass: this takes a leap of faith, it is true, but just going to daily mass even as someone who does not believe God at all, likely would prove to decrease stress levels in an NIH sponsored study. Mass is a very peaceful place and time in most cases and a time to reflect on one’s life and decisions at the very least. It is “mindfulness” on steroids. And if you believe all that is purported to occur at Mass: if you could even imagine a world where such was possible, then the power of Daily Mass, has the power to cure eternally. A friend used to sit in the very back pew at Daily Mass for months, criticizing all he herd and saw: the old women & men there. “Likely on death’s door anyway. What do THEY have to loose. They have nothing better to do anyway. What a waste of time, this nonsense.”  Yet, he found a peace there that he could not explain and kept returning. He soon was blown away by “something” (he now recognizes it as the Holy Spirit) and he was transformed into a new man who goest to Daily Mass out of pure love of God. 
Similarly we have a friend who was a world-touring executive for a big TV network in LA. He found himself one day waking up and finding no real meaning in his life: “what’s all this money and power for anyway?” He started feeling called to stroll at a nearby cemetery near his work frequently during lunch when his colleagues would go out for drinks. There he was faced with his mortality and that he would die someday and wondered what he would have to show for his life. Soon he felt called to go to Daily Mass at a nearby Catholic Church. He says he was drawn to it but could not explain why initially. Now he is able to explain that he found a meaning and peace there he could not find any where else in the world. He is now in the seminary to become a priest. 
Give it a try for 2 weeks: Daily Mass. It takes about 20-30 minutes in most good parishes. Just ask God to help you see if you should be going to Daily Mass. Just try it.
7. Pray frequently throughout the day. My favorite prayers are the Rosary and the Angelus. Since many may have stopped reading this “religious stuff” already, I’ll leave it at that. But prayer and meditation has been proven in scientific studies to increase oxytocin levels in the brain and decrease stress hormone levels.
8. Call a friend at least once per week. Ideally once per day if you can. This is often the hardest thing to do when you are in the pit of despair. There has been many papers reporting that the reason women are happier than men over time is because women in general at better at making and maintaining friendships. Still I have many friends who begin to isolate themselves in their resentments and depression and will not answer a friend’s call because they are so deeply depressed. By getting into the habit of calling a good friend frequently when things are stable or not too bad, this good habit will help you in the end conquer the turning in of depression and help you reach out for help.
9. Find a trusted, wise mentor, spiritual director. This is a must for everyone. In the professional world, many of the most successful people have a trusted advisor or mentor. The same should be true in the mental health world and I would say in the spiritual world as well. Find someone who lives a life of virtue and ideally practices the above 7 points and is a happy, cheerful, deep person. Wise mentors are priceless.
10. Follow a Plan of Life: have a schedule that keeps you busy and focused on serving others and not serving yourself. Thinking about yourself is a recipe for disaster and despair. Here is a sample Plan of Life of a friend who is trying to be a saint.
1) Wake up, saying a prayer called the Morning Offering, and pray to God thanking Him for your life and happiness you have had and will have.
2) Bit of exercise, jumping, high steps, stationary bike riding or climbing up stairs.
3) Daily Mass before breakfast ideally.
4) Wash hands & have Breakfast: full of Omega 3, anti-oxidants; limit carbs as much as possible. Don’t over-eat. 
5) Start the day: ie, Get kids off to school. Get off to work. Help spouse get off to work. Start home-school. Clean house. Do chores, errands. Plan meals. Start cooking. Delegate when can. Call friends. Go out for coffee with friend. Exercise. Frequently imagine you are the child of God who loves you. Try to say “I am sorry” and “I forgive you” at least once a day to start with cheerful affection.
6) Say Angelus Prayer at noon
7) Wash hands & Have lunch
8) Wrap up work day: ie Pick up kids from school. Get home from work. 
9) Make a visit at a tabernacle to pray. Say aspirations of love to God” “I love you, God Almighty.”
10) Read a few minutes of the bible and another good book.
11) Get a bit more exercise in. Go for a walk & call a friend.
12) Wash hands and have dinner: full of green leafy veggies; low carbohydrate best; high Omega 3s
Pray rosary after dinner or as everyone helps clean up. 
13) Start winding down: ie, help kids with homework, finish chores after dinner, get kids to bed, hug your kids, hug your spouse; many hugs and kisses increase Oxytocin which makes brains happy!
14) End of evening: get more exercise in if possible; Attend a stimulating talk or take a course on something new. Do cross word puzzles or brain teasers to keep your mind fit and off your problems until you can process them together with a wise mentor. 
15) Say evening prayers. Finish the rosary if have not already. 
16) Avoid computers in bedroom. 
11. Read good books: there are hundreds of good books out there on how to get one out of depression. Here are my favorites.
a. Hell and How to Avoid It. Still a miracle working- book for me. Usually takes me a few pages to read but after that I am cured of all anger, resentment, depression…at least for a few days.
b. Fascinating Womanhood: a must read for all women: just don’t read the Amazon reviews until after you have read the book and have implemented at least 15 points. 
For Men: If He Only Knew: a must read for all men!
c. The New Testament: just read a couple of lines a day going through the New Testament slowly but surely. Jesus did cure many people and I believe He has the power to cure us to TODAY.
d. The Way, by St. Josemaria. So simple but can be helpful.
12. A Personal Diary: this has many benefits but also some risks. If one feels they cannot talk to anyone, not even a priest about very painful, depressing issues, then writing in a diary is a good idea. Throwing it all out there can be very cathartic. But re-reading a diary or ruminating on past hurts has been shown to create a viscous cycle of stress hormones in the brain that can physically lead to despair. Write it all down & then chuck it out! It is like trash that you have to get rid of from your brain, heart, mind, and soul! Get rid of it.
13. Consider Natural Lithium Water: few risks and helps in some patients.
14. Over the counter vitamin D and other herbs and roots may help.
 15. Lastly, prescription medications: more below. List of possible risks is high. 

 2004;65 Suppl 16:4-7.

The neurotransmitters of sleep.


The part of the brain most important in regulating sleep duration is the hypothalamus. Certain groups of hypothalamic neurons and adjacent groups of basal forebrain neurons produce the neurotransmitter gamma-aminobutyric acid (GABA). Projections of these GABA neurons inhibit the firing of cells involved in wakefulness. Several groups of neurons have been shown to be inhibited by this action–including neurons containing histamine, norepinephrine, serotonin, hypocretin, and glutamate–and this inhibition promotes sleep. Hypocretin (also called orexin) was discovered in 1998, and its role in sleep and narcolepsy was identified in 2001. Other as-yet undiscovered transmitters are undoubtedly involved in sleep control. The transmitters discussed in this article have been the most thoroughly studied, and many aspects of the role of each of these transmitters in relation to sleep are reasonably well understood.

1.  Dr. Donald Jacobson answered:
From Healthtap MD: 

Why is Abilify (aripiprazole) a $6+billion per year #1 blockbuster drug? Is it worth $25 each for the lowest strength pill? And why so heavily used?
Depression &  disability

Depression is one of the most disabling conditions there is. The total economic loss due to loss of productivity, loss of life, work disability, and presenteeism is virtually impossible to establish. Once a person goes on disability from depression which happens in approximately 50% of major depression recurrent cases, it is very difficult to ever get them off of the disability rolls. Having treated over 200 people with Abilify and having the great pleasure of watching them stabilize, normalize, going to full remission, and return to work has been nothing short of amazing and something that i never expected to see during my career working with particularly depressed individuals.While the cost is high, the company is generous in samples, it’s co-pay cards, and it’s patient assistance programs.I have had the pleasure of watching Abilify prevent marital breakup, child abuse, verbal and physical abuse, and a tremendous number of hospitalizations. It is on this basis that i feel it’s cost is justified.Having previously suffered subdural hematoma, i don’t know that i would’ve been able to rehabilitate to return to work without the addition of Abilify to my medication regimen. It has also saved lives of several very close friends and relatives as well. It’s contribution should not be underestimated.

10 Natural Depression Treatments
WebMD Feature
Reviewed by Joseph Goldberg, MD
Best Depression Treatment: The One You Want
Antidepressants or Therapy? Patient’s Preference Most Effective
WebMD Health News
Reviewed by Michael W. Smith, MD
WebMD News Archive
Being depressed can make you feel helpless. You’re not. Along with therapy and sometimes medication, there’s a lot you can do on your own to fight back. Changing your behavior — your physical activity, lifestyle, and even your way of thinking — are all natural depression treatments.
These tips can help you feel better — starting right now.
1. Get in a routine. If you’re depressed, you need a routine, says Ian Cook, MD. He’s a psychiatrist and director of the Depression Research and Clinic Program at UCLA.
Depression can strip away the structure from your life. One day melts into the next. Setting a gentle daily schedule can help you get back on track.
2.Set goals. When you’re depressed, you may feel like you can’t accomplish anything. That makes you feel worse about yourself. To push back, set daily goals for yourself.
“Start very small,” Cook says. “Make your goal something that you can succeed at, like doing the dishes every other day.”
As you start to feel better, you can add more challenging daily goals.
3. Exercise. It temporarily boosts feel-good chemicals called endorphins. It may also have long-term benefits for people withdepression. Regular exercise seems to encourage the brain to rewire itself in positive ways, Cook says.
How much exercise do you need? You don’t need to run marathons to get a benefit. Just walking a few times a week can help.
4. Eat healthy. There is no magic diet that fixes depression. It’s a good idea to watch what you eat, though. If depression tends to make you overeat, getting in control of your eating will help you feel better.
Although nothing is definitive, Cook says there’s evidence that foods with omega-3 fatty acids (such as salmon and tuna) and folic acid (such as spinach and avocado) could help ease depression.
5. Get enough sleep. Depression can make it hard to get enough shut-eye, and too little sleep can make depression worse.
What can you do? Start by making some changes to your lifestyle. Go to bed and get up at the same time every day. Try not to nap. Take all the distractions out of your bedroom — no computer and no TV. In time, you may find your sleep improves.
6. Take on responsibilities. When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don’t. Staying involved and having daily responsibilities can help you maintain a lifestyle that can help counter depression. They ground you and give you a sense of accomplishment.
If you’re not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work.
7. Challenge negative thoughts. In your fight against depression, a lot of the work is mental — changing how you think. When you’re depressed, you leap to the worst possible conclusions.
The next time you’re feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the planet, but is that really likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control.
8. Check with your doctor before using supplements. “There’s promising evidence for certain supplements for depression,” Cook says. Those include fish oil, folic acid, and SAMe. But more research needs to be done before we’ll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications.
9. Do something new. When you’re depressed, you’re in a rut. Push yourself to do something different. Go to a museum. Pick up a used book and read it on a park bench. Volunteer at a soup kitchen. Take a language class.
“When we challenge ourselves to do something different, there are chemical changes in the brain,” Cook says. “Trying something new alters the levels of [the brain chemical] dopamine, which is associated with pleasure, enjoyment, and learning.”
10. Try to have fun. If you’re depressed, make time for things you enjoy. What if nothing seems fun anymore? “That’s just a symptom of depression,” Cook says. You have to keep trying anyway.
As strange as it might sound, you have to work at having fun. Plan things you used to enjoy, even if they feel like a chore. Keep going to the movies. Keep going out with friends for dinner.
When you’re depressed, you can lose the knack for enjoying life, Cook says. You have to relearn how to do it. In time, fun things really will feel fun again.

3. Also from WebMD
Sept. 15, 2005 — If you are suffering from depression, the most effective treatment may be the one you most want.
Many experts agree that a combination of antidepressant medicationand psychotherapy is the best treatment for severe clinical depression. But not everyone wants or needs both kinds of treatment.
So can there be a “best” treatment for depression? Yes, say researchers at the VA Puget Sound Health Care System and the University of Washington in Seattle. It tends to be what patients prefer.
Edmund F. Chaney, PhD, University of Washington associate professor of psychiatry and behavioral sciences, is a member of the research team.
“In chronic illnesses like depression and diabetes, treatment is more than just taking medicine,” Chaney tells WebMD. “A lot of the work that has to be done is with lifestyle change. So if patients are active participants in the treatment and have some choice in what they are doing, it becomes something they find much easier to do and to follow through with.”

Chaney and colleagues studied 335 patients with depression. Nearly all of them were male, ranging in age from 24 to 84.
All patients were asked what kind of treatment they preferred. Fifteen percent preferred medication, 24% preferred psychotherapy, and 61% preferred both. Most of this latter group, Chaney says, actually had no strong preference and were considered “matched” with their preferred treatment if they received either antidepressants or psychotherapy.
All patients’ depression improved after treatment.
But after three months of treatment, the 72% of patients matched with their preferred treatment were significantly less depressed than those not matched. Patients who got their preferred treatment also tended to be less depressed after nine months.
The study appears in the October issue of Annals of Behavioral Medicine.

Psychotherapist Andrew Elmore, PhD, assistant clinical professor at New York’s Mount Sinai School of Medicine, is an expert in the behavioral treatment of depression. He says “patients’ theory of their illness” makes a difference in how well their therapy works.
“If they have a theory of their illness that it is an inherited biological problem or whatever, they are likely to do better on medication,” Elmore tells WebMD. “And even if it is an illusion, those who want the feeling of being more in charge of their lives prefer psychotherapy.”

Treatment is more than just antidepressant medications or psychotherapy, Elmore says; it’s really about people making an effort to combat their depression by controlling it and making themselves feel better.
“What this study is about is something profound: The phenomenology of the patient has an impact on the way treatment works,” Elmore says. “There are issues with any treatment for depression. With behavior therapy, there is homework. With drugs you have to take them. If you don’t like homework, or if you do not like taking pills, you will not do it and you will not benefit.”
Chaney says that patients who choose a particular treatment have expectations it will work. Those expectations may boost the treatment’s effect.
“If, because of their own experience or that of family members or significant others, a patient has the expectation that medication is going to help, then they may well prefer that and get a benefit. On the other hand, if they think psychotherapy may help, that has a big impact on whether that is successful for them or not.”
There’s a lesson here for primary-care doctors — usually the first health-care professional a person with depression sees.
If their doctor merely refers them to a mental health specialist, Chaney says, many patients will simply fail to seek further help. But when doctors ask about patients’ treatment preferences, they are more likely to end up with a helpful prescription or referral. That’s especially true if a trained nurse practitioner or physician assistant follows up the visit with a call.
Medical education is moving in the direction of helping primary-care doctors deal with the mental-care issues that come to them,” Chaney says. “One part of this skill set is listening to the patient’s preference and taking this into account.”

My favorite confessors:
Father Jordi: Georgia
Father Frank: Houston, Texas
Father Joe: Boston, MA
Father Cavanaugh: Boston, MA
Father Bob, NY, NY
Father DeoGracias: NY, NY
Father Paul: Washington DC
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