From the Desk of Dr. Kent
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“Happiness is the meaning and purpose of life, the whole aim and end of human existence.”
It would seem this may be the most important pursuit we strive for. Books, songs, movies, plays all depict the struggle to find it. People will pay any price to get it. This is likely the reason depression is such a serious illness. It is the opposite of happiness. It is anti joy.
For the purposes of rigorous study and collaboration among researchers depression has been defined using strict criteria. In the US, the most widely accepted criteria is contained in The Diagnostic and Statistical Manual or DSM. The DSM has undergone multiple revisions based on ever evolving research. The latest edition is DSM V. The DSM V criteria for diagnosing major depressive disorder require that the symptoms last 2 weeks or more and have at least 5 of the following symptoms: a low mood or a loss of interest (anhedonia), significant weight loss or weight gain, insomnia or hypersomnia (excessive sleep), subjective feelings of restlessness or being slowed down, fatigue, feelings of worthlessness or guilt, poor concentration, recurrent thoughts of death, suicidal thoughts. The criteria also state that symptoms cause significant impairment in social, occupational and other areas of functioning (1). Understandably, every type of discipline, religion and philosopher has tried to find remedies for depression. Some of these do work or provide some relief. People who are depressed will feel stress about many things that may not normally bother them. Since in some cases, major depression is persistent and recurrent, it leads to despair and eventually to hopelessness. Individuals cannot tolerate this for long and end up becoming suicidal and prone to suicide attempts and hospitalizations. In some cases they complete suicide.
Seeing how the pursuit of happiness seems be an instinctual drive, depression is something everyone would like to avoid. There are many established treatments backed by research data that are effective for depression, which include antidepressants, certain well defined psychotherapies (cognitive-behavioral or CBT, interpersonal psychotherapy, psychodynamic therapy, problem-solving therapy, in individual and group formats ) (2), electroconvulsive therapy and transcranial magnetic stimulation (TMS). All of these forms of treatment have value and are effective for depression.
Combining medications with psychotherapy has been shown to be more beneficial than either one alone. TMS and ECT currently come into play when medications and psychotherapy are failing. Due to its very safe profile, TMS may be considered earlier in the treatment of depression. Third party payor such as Medicare and Blue Cross still won’t cover TMS until there are at least 4 medication failures + psychotherapy.The only treatment besides psychotherapy that doesn’t have any systemic side effects is TMS. Medications drop off in effectiveness with each successive trial and show diminishing returns, so some patients are opting to forego their insurance coverage to try TMS earlier. Electroconvulsive treatment is still a viable options in patients who have lost hope after many failed attempts with different treatment options (see my blog on TMS vs ECT).
Happiness is attainable, but recognizing and treating one of its worst enemies, depression, is paramount.
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The Diagnostic and Statistical Manual or DSM V
The American Psychiatric Association’s Practice Guideline for the treatment of patients with
major depression, third edition.
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