Checklist of Simple Treatments For Depression – including in Pregnancy

I have compiled a simple list of measure known to help depression that can be given to patients. It was initially compiled with pregnancy in mind but concerning herbals, there  are Pregnancy issues. However here are suggestions from a recent obstetrical review:

Obstet Gynecol Clin North Am. 2009 Dec;36(4):789-807,
Update and critique of natural remedies as antidepressant treatments.
Mischoulon D abstract here

  • If there is significant depression, then traditional antidepressants are necessary
  • St. John’s Wort: “One small prospective study found no significant differences in fetal malformations in women exposed to St John’s wort during pregnancy, compared with pregnant women on other antidepressants and pregnant women with no teratogen exposure.49 Studies examining hyperforin and hypericin levels in breast milk have suggested safety for children and mothers,50,51 and one small prospective study suggests no increase in adverse events in children exposed to St John’s wort in mother’s milk, though cases of lethargy and drowsiness were reported.52 The data, however, are scant and long-term studies of safety are required.53 In the absence of safety data, it is recommended that women who are pregnant or intend to become pregnant avoid St John’s wort. “
  • SAMe – “As with St John’s wort, there is a lack of data regarding safety during pregnancy and lactation. Some studies have found that pregnancy may result in impaired methylation and lower levels of SAMe,73 suggesting a potential benefit from SAMe administration in pregnant women. SAMe supplementation in pregnant women with intrahepatic cholestasis has been associated with beneficial effects.74 Although SAMe seems to be a mostly safe over-the-counter agent (ie, a chemical that humans already manufacture,with no drug-drug interactions, and minimal and mild adverse effects), consideration for SAMe administration in selected cases may be reasonable. ” [but if significant depression then traditional better]
  • Omega 3 – beneficial in pregnancy [but it is not safe to leave a lady depressed in pregnancy that could otherwise be better on traditional antidepressants.]- Just taking excessive fish or cheap fish oil might lead to mercury poisoning so needs to be tested.
  • Nuts: recent study found walnuts, lamonds and hazelnuts high in serotonin (walnuts highest) and associated with increased excretion of serotonin metabolities – study implied 1 handful/day might help depression – (they used mix –  1/2 walnuts and 1/4 other two)
    Metabolomics Unveils Urinary Changes in Subjects with Metabolic Syndrome following 12-Week Nut Consumption
    Sara Tulipani,†,‡ Rafael Llorach,†,‡ Olga Jauregui,‡,§ Patricia Lopez-Uriarte,||,^ Mar Garcia-Aloy,†,‡ Monica Bullo,||,^ Jordi Salas-Salvado,||,^ and Cristina Andres-Lacuev
    J. Proteome Res. 2011, 10, 5047–5058  abstract here
    A discussion of nuts and mood here
  • Calm abiding meditation – focusing on breathing and more time breathing out than in for 20 minutes – asssociated with elevated serotonin levels, activation of Prefrontal cortex and improved mood:
    Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices
    Xinjun Yu, Masaki Fumoto, Yasushi Nakatani, Tamami Sekiyama, Hiromi Kikuchi, Yoshinari Seki, Ikuko Sato-Suzuki, Hideho Arita
    International Journal of Psychophysiology 80 (2011) 103–111  abstract hereAnother study found remaining mindful of their breathing for 18 minutes was associated with improved mood:
    The Healthy Quality of Mindful Breathing: Associations With Rumination and Depression
    Cognitive Therapy and Research Volume 35, Number 2, 179-185,
    Jan M. Burg and Johannes Michalak    abstract here

Below is the list:

Stop Drinking

Proper Diet – notice what foods make you sick

Sleep Hygiene –Tums or Milk of Magnesia at bed if heartburn; don’t sleep in on weekends; no caffeine
Outdoor exercise/phototherapy – walk around block during day
Regular Exercise
Relaxation exercises , Yoga,  Mediation,  Taped sounds
Time management –  make lists,  Set a goal daily
Late night sleep deprivation – bed 9:00 PM, up by 1:00 AM; next night sleep recovery – 10:30 PM to 6:30 am
Adopt a support person
Omega 3 – max of EPA 1.7 gm; average ~1.2 gm EPA (plus whatever amount DHA)
 Folic acid 0.5 – 5 mg /day
B12 – 1000 mcg shot /wk or 1000 – 2000 mcg orally/day
Bright Light – 10,000 LUX; ½ -1 hour in AM; consider more in PM too
SAMe [S-adenosylmethionine] 600 mg twice daily – up to 1600 mg/day
St. John’s Wort [Hypericum] 300-600 mg – 3 times a day

DHEA (adrenal hormone) – if levels low, then DHEA 100 mg three times daily can help mood (doctor can order it through ebay…
Testosterone levels are (often non-existent in women with chronic pain) – Testim gel 0.2-0.3 daily for women helps
Get any pains treated

Books – Feeling good, Ten Days to Self Esteem by David Burns

Online manual: http://www.gpscbc.ca/system/files/MH_CBIS_manual.pdf

Online manuals for teens:

Teaching manual
http://www.kpchr.org/public/acwd/CWDA_workbook.pdf

Parent manual
http://www.kpchr.org/public/acwd/CWDA_parent_manual.pdf

online manual for adults:

https://www.rand.org/content/dam/rand/pubs/monograph_reports/2005/MR1198.6.pdf

Online resources

Support Groups
Know that this, too, shall pass

Psychological support

——————————

Regina Counseling services:

Family Service Regina
2020 Halifax Street
Regina, SK S4P 1T7

Tel: (306) 757-6675
Fax: (306) 757-0133
E-mail: fsr@sasktel.net

http://www.familyserviceregina.com/whoarewe.html

Mental Health Clinic: (306) 766-7800
Fax: (306) 766-7811
Manager: (306) 766-7841

Catholic Family Services
974 Albert Street
Phone: (306) 525-0521
Fax: (306) 522-3775
Email: cfsregina@sasktel.net

http://www.cfsregina.ca/contact.html

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Behavioural Issues:

 

Depression Behavioural Fields

1.Family Relationships

(e.g., What type of brother/sister, son/daughter, father/mother do you want to be? What qualities are important in your relationship with those in your family?)

2.Social Relationships

(e.g., What would an ideal friendship be like to you? What areas could be improved in your relationships with your friends?

3.Intimate Relationships

(e.g., What would your role be in an intimate relationship? Are you currently involved in this type of relationship, or would you like to be?)

4. Education/Training

(e.g., Would you like to pursue further education or receive specialized training? What would you like to learn more about?)

5. Employment/Career

(e.g., What type of work would you like to do? What kind of worker would you like to be?)

6. Hobbies/Recreation

(e.g., Are there any special interests you would like to pursue, or new activities you would like to experience?)

7. Volunteer Work/Charity/Political Activities

(e.g., What contribution would you like to make to the larger community?)

8. Physical/Health Issues

(e.g., Do you wish to improve your diet, sleep, exercise, etc.?)

9. Spirituality

(e.g., What, if anything, does spirituality mean to you? Are you satisfied with this area of your life?)

10. Psychological/Emotional Issues

(e.g., What are your goals for this treatment? Are there other issues besides depression that you would like to explore?)

scratch pad of issues:

dietary factors
herbal factors
enjoyment – pleasure
goal fulfilling
clutter helping
sleep enhancing
exercise
relaxation training
compassionate giving – who would you like to help
getting outside
socializing
mindfulness

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One Response to Checklist of Simple Treatments For Depression – including in Pregnancy

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