Alternatives and Complements To Psychotherapeutic Medication in Depression
Updated: Feb 13
Antidepressant medications have helped millions of patients worldwide since the discovery of iproniazid, a monoamine-oxidase inhibitor, in the 1950’s. The introduction of fluoxetine aka Prozac, the first SSRI, in the late 1980’s further revolutionized the care of depressive patients. Recent evidence suggests these medications alone may improve the symptoms of depression in up to 60% of patients. That relieves a large amount of burden placed on the nearly 1.2 million individuals living with major depression here in the United States. Unfortunately, these same studies highlight the fact that around 40% of patients may be non-responders to these first line treatments. They continue to struggle with the life interrupting symptoms of depression regardless of appropriate dosages of pharmaceutical drugs. These patients experience loss of interest, sadness, sleep disturbance, sexual dysfunction and many other debilitating symptoms. Another issue that often keeps people from finding satisfaction with their drugs are the slew of side effects that can occur. Weight gain and sexual trouble are not uncommon, and lead many patients to discontinue their meds. So, what options do they have? Where do you turn if need answers outside the conventional pharmacy?
We have compiled a list of several therapies that can help patients in addition to their medication, or in place of it. This list in not all encompassing, and must be met with the caveat that they are supported by varying levels of evidence. It is suggested that, like pharmaceutical options, these treatments will have greater efficacy if used in combination with psychotherapy such as cognitive behavioral therapy (CBT). We do our best to provide a snapshot with the most pertinent information below:
Neurofeedback is used to “retrain” the brain in conditions ranging from depression to ADHD, sleep disorders, or migraine headaches. Small sensors are placed on the outside of the patients head that measure brain waves while the practitioner delivers a predetermined stimulus. Patients get real-time feedback in the form of audio or visual responses based on the type and frequency of brainwaves elicited. Over multiple sessions patients can retrain their brains to respond more appropriately when they are met with difficult triggers in their everyday lives. Each treatment session lasts 20-30 minutes with patient response ranging from as little as a single session up to 20 or more.
Where to find Neurofeedback in Portland
Hive Mind Medicine (cost-free treatment for veterans)
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) involves stimulating targeted brain areas using strategically placed magnetic coils. It differs from transcranial electrical stimulation in that the patient does not experience pain or seizures, and no anesthesia is required. The procedure utilizes magnetic frequency similar to that in an MRI (1.5-3 Tesla). The patient will be seated in a chair and will feel a tapping sensation on their scalp as the magnetic arc is applied. Currently, the FDA has cleared TMS for treatment of depression and OCD but it has also been applied for anxiety and PTSD. The current theory is that repetitive magnetic stimulation of underactive brain regions can help with mood control and treatment resistant depression. Early observations have indicated that high-rate TMS applied to the left dorsolateral prefrontal cortex may improve depression, giving hope that this might replace electroconvulsive shock treatment. Conversely, low-rate TMS delivered to the right dorsolateral prefrontal cortex may also be helpful. Therapeutic effectiveness depends on the exact site of stimulation, intensity and the precise pattern of pulses. In one neuroimaging study of depressed patients, a prefrontal serotonin deficiency at baseline normalized after treatment with repetitive TMS. These treatments are typically given daily, five times a week for 4-6 weeks to achieve results. Most trials indicate that patients will start to experience improvement by the 4th week of treatment, with 45% of responders maintaining remission at 12 month follow-up.
Where to find TMS in Portland
The Hakomi Method of Experiential Psychotherapy was developed by Ron Kurtz in the 1970’s as a body-centered approach that combines somatic awareness with experiential techniques to promote psychological growth and transformation. The five core principles of Hakomi are drawn from Eastern philosophy and include mindfulness, organicity, nonviolence, mind-body integration, and unity. Sessions follow a sequence of contact, accessing, processing, and integration. Unlike traditional psychotherapy, sessions may involve the use of encouragement in the form of consensual light touch from the therapist. Kurtz’s book, Body-Centered Psychotherapy: The Hakomi Method, describes the method in detail and the various ways its principles can be applied. Evidence is still limited regarding the efficacy of Hakomi therapy, but it has been reported to aid in the treatment of depression, anxiety, and ADHD, as well as cultivate personal growth for those without specific mental health concerns.
Where to find Hakomi in Portland
Psychedelic Assisted Psychotherapy
The acceptance of Oregon’s Measure 109 means that psilocybin therapy may be available in our state as early as 2023. A 2021 trial found that 67% of PTSD sufferers given MDMA in coordination with psychotherapy no longer qualified for a PTSD diagnosis, compared to 32% in the comparison group who received placebo with psychotherapy. These treatments aren’t yet widely available to patients, however, there is a promising alternative that can aid in treatment of depression, anxiety, PTSD, end of life care, OCD, and addiction. Although less research is available currently, practitioners have utilized ketamine assisted therapy (KAT) to facilitate altered states with a strong record of success for over 20 years. Patients report greater connection to one’s own life, greater mindfulness and presence, as well as increased confidence following ketamine sessions. Therapy is typically initiated prior to any consumption of the substance, and integration sessions are performed as follow-up to the psychedelic experience. Ketamine is legal when prescribed by a doctor and has a long history of safety with little to no risk for adverse effects. At the right dose, it can help patients access the deep rooted unconscious emotions and beliefs that may be contributing to their disease state. KAT utilizes this uncovering of the unconscious mind in combination with talk therapy to promote a level of personal discovery you wouldn’t otherwise achieve.
Where to find Ketamine Assisted Psychotherapy in Portland
To learn more about ketamine assisted psychotherapy you can schedule a free 15-minute consultation with one of our providers on our scheduling page.