Treating Depression

A treatment that focuses on the present and a specific goal, and is usually short-term. The treatment is based on the assumption that our thoughts and feelings affect behavior, and therefore the focus is on the patient's thinking and behavior. In depression, treatment focuses on identifying and changing automatic thoughts, ineffective interpretations and beliefs, identifying challenging points throughout the day and returning to enjoyable and meaningful activities. For example: Automatic negative thoughts, such as: "I am worthless, I am nothing, the world is a bad and cruel place, there is no chance that anything will ever change"; cognitive biases, such as overgeneralizing and extrapolating from a single event, for example: After failing one test, thinking that I will fail the entire degree and will not be able to graduate. All or nothing – if I failed at something, I am a total failure in all areas. The work in this case is to challenge automatic thoughts and the way of thinking, and to provide tools on how to successfully replace thinking with more flexible and adaptive one, and to examine whether it stands the test of reality.

The emphasis in the treatment is on the patient's interpersonal and social relationships, which may cause or worsen depression. For example, the experience of loss or mourning of a loved one, ongoing conflicts with the environment, misinterpretation of social interactions. The idea in the treatment is to process and examine the current events that constitute a trigger for the onset of depression, while providing tools for developing social skills and building more adaptive life roles.

Short-term psychodynamic therapy that includes 12 sessions. This therapy focuses on working on four types of conflicts: Between independence and dependence, activity and passivity, normal self-esteem versus low self-esteem, and unprocessed grief and loss. The therapy is time-limited and focuses on thought patterns, behaviors, and coping styles related to one or more conflicts. It is based on an active approach and is suitable for focused work aimed at achieving change.

The therapy focuses on the deep layers of the psyche, assuming that depression stems from unconscious conflicts, unprocessed experiences, or patterns of thinking and behavior that developed in the past (usually in childhood). The goal of the therapy is to understand the source of the depression, and thus lead to deep and long-term treatment.

• SSRI drugs: The most common drugs, which are used as first-line treatment. Their mechanism of action is by increasing serotonin levels in the brain.
• SNRI drugs: Usually used as second-line treatment. Their mechanism of action is based on increasing serotonin and noradrenaline levels in the brain.
• Atypical and other drugs: Drugs that are mostly newer, work by different mechanisms and often have a different side effect profile than SSRI and SNRI drugs.

The current common approach to treating depression is to tailor medication therapy to the individual. Since there is a wide variety of antidepressants, with the difference between them being the symptoms they treat and the side effect profile, it is important to tailor the medication to the symptoms of the disorder and the individual needs and limitations of the patient. Sometimes, a specific medication is used precisely because of its side effects, which may be helpful for treatment – for example, when you want to help improve sleep, reduce anxiety or increase appetite.

It is important to be careful and complete the duration of treatment and the dosage of the medication according to medical instructions. For most medications used to treat depression, the time it takes for the medication to work is at least 3 weeks, and it reach up to 6 weeks. By then, the side effects may actually appear. This situation, in which you do not yet feel the benefits of the medication, but are dealing with the side effects – can be frustrating. It is important to note that in rare cases, especially in young people and especially at the beginning of treatment, there may be an increase in suicidal thoughts and the risk of suicide. The reason for this is not yet sufficiently clear, but it is important to be aware of this and in the event of an increase in suicidal thoughts, one should immediately seek help and treatment.

Every medication has a side effect profile that often changes over time, depending on the dose and may differ from person to person. It is important to report side effects to the treating party. Often, in order to reduce these effects, changes can be made to the dose or type of medication. A particularly disturbing side effect is impairment of sexual function. The typical impairment is a delay in the time required to reach orgasm. Another phenomenon can be urinary retention, that is, a delay in the ability to urinate. Even in these situations, it is recommended to consult with the treating party, and remember that in most cases, it is possible to manage drug treatment better by changing the dose, replacing or adding a medication.

We have mentioned only some of the common side effects here, but it should be remembered that each drug has its own unique mechanism of action and side effects. Therefore, it is important to carefully read the leaflet that comes with the drug, and to make sure that upon receiving the drug, you receive the necessary guidance, support and monitoring from your treating physician.

It should be emphasized: In about a third of cases, the initial drug or initial dose does not produce a sufficient response. In these situations, it is important not to despair and to consult with your treating physician about the possibility of increasing the dose or changing the drug, until the optimal dose or the appropriate drug is found.

Antidepressants are not addictive and can be stopped, but it is important to remember that the decision to stop the medication is important and complex. It is commonly thought that after one depressive episode, treatment should be continued until the symptoms disappear and then continued for an additional 6 months. In the case of multiple depressive episodes, sometimes the recommendation is for long-term medication. Along with this approach, it is worth examining the intensity of the symptoms that appeared, and examining what significant processes the person underwent during the treatment period. In any case, a decision to end treatment, after successful treatment, is a decision that depends on many questions, such as the effectiveness of the medication, the disappearance of symptoms, the intensity of suffering, and more.

However, even when a decision is made to attempt to stop medication, it is important that this be done in dialogue and coordination with the treating party, and that the reduction in the medication dose be done gradually until complete cessation. Since the body has become accustomed to operating under the influence of the drug, immediate discontinuation may cause a "rebound" reaction – that is, an immediate and disproportionate return of the symptoms of depression and even the development of anxiety and restlessness. In contrast, gradual discontinuation allows the body to adapt to the new situation in moderation and find the appropriate balance even without the presence of the drug (if it is not required).

In light of all this, it is recommended to consider a joint decision with the treating party whether to discontinue or reduce drug treatment.

An innovative drug treatment based on the anesthetic ketamine, which works on the neurotransmitter glutamate, with an innovative chemical mechanism. Esketamine treatment is approved by the FDA and the Ministry of Health and is available in hospitals and specialized clinics in Israel. It is a series of treatments administered via nasal spray, with varying frequency – from twice a week to once a month. It is an effective and relatively safe treatment. All possible side effects may occur in the hour or two following treatment, and include a feeling of disorientation, nausea, vomiting and a temporary increase in blood pressure. It is important to note that this is a drug that can have additional mind-expanding effects (psychedelic effect). This phenomenon can have a positive effect on the course of treatment, especially when it is accompanied by complementary psychotherapy.

Treatment using a special helmet that creates deep magnetic brain stimulation, which targets areas of the brain responsible for depression. The treatment is effective and safe, with no significant side effects beyond a feeling of discomfort during the stimulation. The stimulation is usually given in a series of daily treatments, for several weeks. You can receive the treatment as part of the Healthcare Basket, at several designated clinics in Israel.

Implantation of a pacemaker or generator in the chest connects to the vagus nerve that runs through the neck. This nerve is responsible, among other functions, for transmitting messages of peace and calm from the body to the brain. The pacemaker stimulates the vagus nerve in a controlled manner using electrical signals, thereby stabilizing neural activity. It harnesses the natural neural impulses of the vagus nerve to activate centers responsible for mood regulation and to release neurotransmitters such as serotonin, noradrenaline, dopamine, and BDNF, which promote nerve cell growth. After implantation, the pacemaker operates regularly within the body, necessitating periodic psychiatric evaluations to monitor its effectiveness. This treatment has been shown to effectively reduce symptoms of depression, alter the disease's progression over the years, and improve quality of life. While generally safe, the treatment may lead to complications from surgery, hoarseness, and discomfort at the stimulation site in the neck. Currently, this treatment is not included in the Healthcare Basket.

This is the most effective treatment for depression available today, with high success rates, even for patients who haven't responded to any treatment for many years. The procedure is done under short anesthesia, during which an artificial seizure is triggered using an electric current. It involves a series of treatments given twice a week. Side effects can include symptoms from recovering from anesthesia and temporary memory loss. Unfortunately, this treatment has a bad reputation that makes patients fearful and reluctant to try it, even though it can sometimes save lives. It is offered in most hospitals on an outpatient basis and is included in the Healthcare Basket.