Depression Treatment: An Integrative Approach Combining Psychotherapy and Novel Psychopharmacological Options
I offer a unique approach to depression treatment in Scottsdale, AZ. Successful treatment for depression requires a thorough understanding of the psychopharmacology involved in the involved brain circuitry as well as the integration of the involved psychological factors. The first step in severe depression treatment is ensuring an accurate diagnosis which is why I spent a lot of time with every patient. There are often factors involved in treating depression that are neglected such as undiagnosed medical conditions, side-effects of medication and psychological trauma which are not recognized. I am able to address all of those components with an integrated using psychotherapy, medication and advanced medical knowledge.
From a medication standpoint, my general approach to the treatment of depression is to utilize 2 newer classes of medications such as SSRI’s, Wellbutrin, Effexor, Cymalta or Remeron. If a full response is not seen, than I proceed to more complex pharmacological regimens. I am one of the only Scottsdale psychiatrists and psychiatrists in the country who has extensive experiencing utilizing the following treatments:
1. MAO-I’s- The oldest, yet most effective class of anti-depressants such as Parnate and Nardil offer extremely effective results for treatment resistant depression (especially of the bipolar type). They essentially increase all three monoamines: Dopamine, Serotonin and Norepinephrine by blocking their break-down in the synaptic cleft of the neuronal circuits. While some diet restrictions are required, I have used these medications with great success is over 50 patients and no patient has had a problem following the diet restrictions which are frankly quite reasonable. Diet information can be found at MAOI diet.
2. Ketamine- Although I rarely do not have success with MAO-I medications, there are occasions when they do not work or are not a good fit. I have been utilizing oral and sublingual Ketamine to attack treatment resistant depression (as well as my latest trials with treatment resistant PTSD.) Ketamine is a potent NMDA antagonist as well as being responsible for modulating a wide range of neuro-circuitry involved in mood regulation.
3. Low-dose Naltrexone- (LDN) The mechanism of LDN is largely unknown and is completely different than the regular dose Naltrexone (which is 50mg) which fully blocks endogenous opioid receptors which does not have positive mood benefits. Side-effects are extremely low and it is very well tolerated. This is my third line approach typically unless someone has co-occurring auto-immune disorders that may be complicating the mood disorder. Its mechanism in auto-immune treatment. More information on the mechanism of action can be found at Low-dose naltrexone mechanism of action
4. Tricyclic anti-depressants- Tricyclic anti-depressants such as Nortriptyline and Clomipramine increase Norepinephrine and Serotonin as well as modulating the up-regulation of several gene’s and importantly suppresses REM sleep in a potent way that is thought to have significant benefit to mood.
I also offer genetic testing in certain cases where information regarding the patient’s metabolic pathways involving certain medications become important for treatment decisions.