Transcription
Okay, so we recently had a comment about what are some good alternatives to antidepressant medications. So I'm going to start with probably the simplest and then kind of work up in severity. And, you know, a lot of this depends on how depressed you are. So I'm going to start by saying this is for people who probably have mild and more contextual depression. And by that, I mean your life is hard. You know, there's things going on at the moment that are difficult. You can clearly identify them. And so for these individuals, I mean, the safest alternative to using an antidepressant is simply to wait. You know, you want to give yourself enough time to get through it.
If time is not going to improve this, you know, say, you know, time may improve something like a breakup or bereavement or going to a new town. But maybe there's something about you that is causing, you know, these repeated depressive episodes. And some things can be like maladaptive personality traits. I mean, you may be getting into unhealthy relationships. You may be having a hard time at having boundaries with those around you. And that's leading you to constantly have some, you know, resentment, to watch yourself resentment towards others. And that's weighing on you. That's, you know, for those types of problems, you want to be looking at psychotherapies. And so that would be the main, probably the least invasive ways to treat depression.
Other things you want to look at is obviously, are you on anything that's potentially making you worse? I mean, we know that there's a huge list of other medications out there, not just psychiatric ones, but even simple medications like Singulair for asthma and seasonal allergies. You want to have a full review of your medication list just to make sure that you're not in some kind of chemical depression.
Now that those kind of, you know, those lower risk ones are out of the way, what do you do if maybe you've got just chronic depression? You know, it's, it's not easily treated by changing things in your life, or maybe it's just come straight out of the blue. Now, the way to think about when to start antidepressants for this is, do I really want to risk making things worse? Because that's the same conversation I have with myself when I need to think about starting these meds. And so now that we know about things such as PSSD and protracted withdrawal injury and difficulty coming off these medications, even though they are fairly uncommon side effects, they still weigh heavily on my decision to prescribe. And so if I see someone and they're still functioning fairly well despite this, I may encourage them to not take those medications.
But if it's now gotten to the point where maybe we've waited for a long time and it's still getting worse and it's building on itself, it's going to cross that tipping point of risk and benefit where I say, well, I should try this because the chances of making this person worse than they already are are pretty low. And it's a risk that I'm willing to take with that person, and they're willing to take it with me. And then so you could try antidepressant medications at that time.
Now, not everyone wants to be on a daily medication like an SSRI. And there's a lot of reasons for this. You know, one, it can blunt your emotions a lot. They may make it more difficult to have fulfilling relationships. There's sexual problems with there. There's weight gain. And so if you don't want to be on one of these medications long-term, what do you do? You could look at other alternatives. I know ketamine therapy has become increasingly popular. And here's the thing that I really like about ketamine. The thing I like about it is it's not a medication that you take every day. And so the chance of building up this kind of dependence and tolerance on it is a lot less. Sure, you have to go through a lot more hoops to get it. Either go to a ketamine clinic and get infusions, or you have to go and find a doctor who could give you Spravato. Or you go and find Mindbloom and they send you ketamine sublingual in the mail. Like these are big steps. They're usually quite expensive, but you at least minimize the risk of having this kind of daily burden of this medication in your body. So I'm actually okay with ketamine. You know, I think it's pretty good. Probably what I would want if I was having severe depression, something that's not every day.
Now, there's a lot of alternatives to ketamine which are kind of coming out now. And so probably the main ones would be MDMA and magic mushrooms or psilocybin, you know, the chemical ingredient from magic mushrooms. These aren't FDA approved at the moment. You cannot buy them anywhere. But in a lot of cities, they're decriminalized now. I mean, a lot of West Coast cities. I know it's decriminalized in Denver. And so you can find therapists that will actually work with you to do the depression treatment. And this is a whole new philosophy on how to treat depression with these drugs because you do these preparatory meetings where you meet with someone and they ask you what's going on in your life, what are you wanting to get out of this experience. And then when you take your trip with your therapist, they kind of help you work on those things. And then afterwards, you do these integrative sessions to kind of keep those insights that you learned from those psychedelic experiences and help integrate them into your life. That is a completely new paradigm than just taking a medication that has these mood constricting and emotion constricting effects. You know, that's almost like a psychotherapeutic paradigm on sort of like steroids. So I really like that. Again, that would be something that I would be more interested in personally. Knowing what I know about the drugs, obviously they're not without their own risks and complications, but to me, in general, it seems safer.
Other treatments are things like TMS. TMS has its risks as well. I've heard horror stories with TMS, but again, it's, it's this course of treatment that you do. It's not every single day. And that may be useful for some people. Some people have huge effects on it, but for a lot of people I see, it's really not that dramatic. And then ECT is the one that is probably the most potent, but also the most dangerous. You know, for some people who have severe depression to the point where maybe they stop eating and they don't even leave their bed anymore, and, you know, they've failed other other drugs. That's when something like ECT can be really useful. So that's my overview of antidepressants and antidepressant modalities. I, I hope that helps.