Depression Treatments - Covering Depression Treatments

Written by HealthyPlace.com Staff Writer

Ablueyed: I've been reading this self help book called "You Can Feel Better" and it describes our feelings as being caused by our thoughts, and that if you can think differently, this will change your mood. Do you believe in this?

Dr. Cady: To an extent, Ablueyed, this is true. One participant had mentioned cognitive therapy. Aron Beck, who founded cognitive therapy, noted that some of his patients who had undergone ECT (electroconvulsive therapy, electro-shock therapy) were simply not getting better. He determined that their problem was their thinking processes. Hence, he set about reversing their depressions by changing their thinking processes.

So the quick answer is, "I believe this" - that is, what you think about determines your reality. Earl Nightingale called this his "strangest secret" and sold a platinum 78 rpm vinyl recording (and later, a book) called "The Strangest Secret" based on this principle: "we become what we think about." On the other hand, to take a seriously depressed, imminently depressed patient and say, "see here, madame (or sir): your only problem is you've not selected the right things to think about" won't get the job done. There's a biological problem there. (See above). In that case, the combination of psychotherapy (to deal with "what they're thinking about") as well as medication therapy should be used. Hope this answers your question accurately and completely.

David: For everyone's info, Dr. Cady's website is: http://www.drcady.com.

Here's the link to the HealthyPlace.com Depression Community. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this. There's a lot of info there on depression and antidepressant medications.

AnnFP: So, in your experience, what happens as people try to rebuild their lives and climb out of a major clinical depression. How do they judge whether they are being successful at combatting their depression?

Dr. Cady: Most people, in my experience, and if they are truly getting better, have some idea that they are making process. This is tremendously exciting and motivating for them, because they can see a causal link between the medications and the psychotherapy they are using and the mental adjustments they are making correlated with their progress. This is "positive reinforcement." Also, the psychotherapeutic process facilitates pointing out to patients - if they are not yet aware - the subtle yet distinct changes that they are making in their lives as they get better.

Riki: What do you do if you have tried all the depression medications out there and still don't get any results from the depression lifting?

Dr. Cady: Riki, at this point, I have only one patient that I'm getting close to "trying all the medications out there" who hasn't significantly improved. The problem with "trying all the medications out there" is that, frequently:

1. they are not pushed up to the maximum dose;
2. they are changed too soon;
3. they are never tried in what Stahl calls "heroic combination pharmacotherapy."

If you consider, for example combining one of two SSRI's with Remeron, with Effexor, and with Wellbutrin, you have literally dozens of permutations of what could be tried. I'm not suggesting, willy nilly, simply putting people on a bunch of medications without thought of what you're doing. But, logically, trying someone on Prozac, then Zoloft, then Paxil, then Luvox, then Celexa (five SSRI's in their order of market appearance) and saying, "we've tried five things and they haven't worked" is not a logical way to do things. That was probably at least three or four too many in the SSRI class before trying something a little more creative. This is simply an example of the thought process I encourage clinicians to consider.

topsy: I have seldom felt anger during my life, and my psychiatrist has said that depression is "anger turned inward". He has mentioned "constructive anger". What does he mean by constructive anger?

Dr. Cady: "Anger turned inward" was Freud's classical psychoanalytic concept of where depression came from. "Constructive anger" - which your therapist has mentioned, could refer to the fact that he/she perceives you as legitimately and appropriately angry at something or someone who traumatized you or did you an injustice. This would be appropriate anger, and could be "constructive" in the sense that it clues you into things in your life that you need to look at or change per se, however, free-floating, non-specific, uncontained, non-directed , and inwardly corrosive can be a terribly disempowering thing to deal with. You might want to check out "Dr Weisinger's Anger Work Out Book" and examine your anger through the lens that this particular author suggests. Good luck.

Alan2: Can I ask Dr. Cady to comment on the medications, Depakote and Risperdal, as they are used for Bipolar Disorder?

Dr. Cady: Great question, Alan2. Old style way to treat bipolar disorder: one mood stabilizer; if that didn't work, add a second mood stabilizer. New way to treat: one mood stabilizer and an "atypical antipsychotic." That is exactly the combination you mention with Depakote and Risperidal, respectively. It's a good combo. Here are some caveats. Depakote should be dosed up to the level where you either have side-effects or are better. The blood level numbers for this may range between 100 - 150 on the lab test. These are higher numbers than are typically seen in the use of Depakote for seizures. Also, periodic liver function tests should be obtained - every three months is a good idea - to make sure that your liver is still happy with the Depakote. In rare cases, it can cause your liver to become upset and you to become sick if it continues. Risperidal is one of those atypical antipsychotics about which we talked earlier which can contribute to weight gain. Watch out for that. But, if one is feeling great on this combination, it's a good one. Certainly it's logical and appropriate for bipolar disorder.