Depression is very common among my patients with chronic pain.
And chronic pain is very common among people with depression. It is hard to know what cames first,
the chronic pain or the depression? The most important is to identify
that the person is depressed and start treatment as soon as possible.
There are various available effective strategies to treat depression.
And to remember we will talk about the 5 Ps: plate, pillow, physical, pills and psychology.
So, today I’ll explain the 5 strategies to treat depression
There are various available effective strategies to treat depression.
I always tell my patients that we have groups of strategies. We have 5 groups. And it is good to combine them in order to treat
depression. The sooner the patient is diagnosed and start treatment, the better.
The 5Ps represents 5 strategies, and it is easier to remember:
The first P is for your plate, what you eat influence your mood,
The second P is for your pillow, how you sleep influence your mood,
The third P is for Physical exercises,
The fourth P is for pills, in this case, antidepressant medications.
And the fifth is for psychology, that is mind-body therapies.
Your plate Have you heard this
“We are what we eat”? Well, that is also true for “We think what we eat”.
If we feed our body with junk food, our mind will have to find nutrients in the junkyard.
Briefly, I’ll give you 3 reasons why you need to improve your nutrition to treat your depression:
1) Our brain needs fuel to produce the neurotransmitters, especially serotonin,
in the case of depression. 2) There is evidence that
if we anti-inflammatory diet, we have less inflammation, and therefore, better mood.
3) Your mood is linked to the bacteria that lives in your guts. It takes time to replace the bad
bacteria for the good bacteria in your guts, so, it is important to stick to a healthy diet
for a long time. So, here is the recipe:
Reduce sugars and increase fruits Eliminate pops and drink water
Reduce white flour and increase whole wheat flour Replace white rice with brown rice
Reduce animal fat and increase fat from seeds and nuts
Reduce red meat and increase fish Reduce bacon and increase olive oil
Eliminate hot dogs and eat more vegetables
Eliminate cookies and eat more beans Reduce butter and increase yogurt
Your pillow Sleep problems can lead
to depression, and depression can lead to sleep problems. So, they go hand and hand.
Improving your sleep efficiency will help to reduce the depression symptoms,
and one way to improve sleep efficiency is by changing some habits and routines
around sleep, we call this “Sleep hygiene”. Having healthy sleep habits will make a big
difference in your mood. Here are some tips:
Exposure to bright light in the morning and darken your bedroom at night,
Eat and drink in moderation before bedtime,
Do not get up at night to go to the washroom, Get tired during the day,
Occasionally may take a short nap in the afternoon,
Have the same bedtime routine everyday,
Reduce the noise of your bedroom, Reduce the temperature of your bedroom,
Reduce distractions in your bedroom, Relax your mind and body before bedtime,
You may use natural medicines like melatonin or magnesium.
I have another video about sleep efficiency that you can watch
and I show more details about these sleep recommendations.
Physical Exercise
When we exercise, our body releases endorphins, that is the feel-good
hormones, or our endogenous opioids. Also, when we exercise, we distract
our mind with our movements, counting the repetitions, choosing the equipment,
preparing the positions, and all of that is good to distract our mind from our worries.
The more we exercise, the more we gain confidence and self-esteem.
Exercises are also excellent for social interaction, for
going outdoors, and for meeting people who are interested healthy lifestyle.
Any exercise will work, try to do what is more pleasant to you, what you enjoy.
I love dancing, I like the music and the rhythm. I made a video about dancing for arthritis,
and you may watch. There are a lot of online classes for dance, yoga, pilates, stretching, etc.
Try to practice everyday, even if it is just for 5 minutes. Start slow and
increase by 5 minutes every day. You may want to find a partner
in the beginning to do these exercises with you, so you can get motivated and stick to your plan.
Don’t push yourself too hard in the beginning. Allow yourself some rest days. Maybe you want
to set some goals to start exercising 2 days a week for 5 minutes. Then increase gradually
up to 5 days a week, 30 minutes each day. You may need to buy some simple equipment, such
as an elastic band, or free weights. Don’t spend too much money, but if you invest a little bit
you will feel more compelled to use the equipment and adhere to your plan.
Antidepressant pills
There are a variety of antidepressant medications that can be used.
There are different groups of drugs, and within each group, there are various drugs.
So, for example SSRI are selective
serotonin reuptake inhibitors. Some examples are fluoxetine (Prozac),
paroxetine (Pail), Sertraline (Zoloft), Citalopram (Celexa) and escitalopram
(Lexapro). These medications are
usually the first line that we try, and they are very effective. It may take a few weeks
until the person notices the first effects in the mood. And they need to be taken everyday.
The SNRIs are good to treat depressive mood and chronic pain. So, I tend to
use these medications a lot. Examples are the duloxetine (Cymbalta), venlafaxine (Effexor), and
desvenlafaxine (Pristiq). The tricyclic antidepressants are
also my favourites, they are excellent for treatment of neuropathic pain
and sleep disturbances associated with fibromyalgia. Examples are amitriptyline (Elavil),
nortriptyline (Pamelor), Imipramine (Tofranil) and Desipramine (Norpramin).
Then, there are other types of antidepressants that are prescribed by psychiatrists for more
severe or treatment resistant depression. A treatment resistant depression is a
depression that has not improved after a trial of 6 weeks of two antidepressants.
But it is important to use the therapeutic dose for 6 weeks. I see a lot of people who
don’t stay in the therapeutic dose for 6 weeks and they want to change the antidepressant.
You need to talk to a psychiatrist because about 40% of treatment resistant depressants
are due to bipolar disorders or other medical conditions. A medical condition that is commonly
associated with depression is hypothyroidism, and I have another video about that. Check here.
And sometimes treatment resistant depression is treated with atypical anti-psychotics
like Aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal),
and olanzepine (Zyprexa) . There are other kinds of
antidepressants like trazodone, mirtazapine, vortioxetine (Trintelix) and
Buproprion (Wellbutrin). And also the monoamine oxidase inhibitors (MAOIs) such as phenelzine
(Nardil) and tranylcypromine (Parnate). It is important to get a consult with a psychiatrist
to make the proper diagnosis of the type of depression and the best antidepressant medication.
Although most antidepressants are generally safe, they should be prescribed with caution
in people under 25 years of age as they may increase the risk of suicidal thoughts.
And the last letter P, is for psychological therapy.
Psychologists can help the person in a variety of ways. They will use different techniques
to help patients to deal with symptoms of sadness, hopelessness, guilt, anger,
restlessness, difficulty concentrating, fatigue, sleep, appetite changes, chronic pain, loss of
interest in activities, withdrawal from friends and family and thoughts of suicide or death.
The counsellor may use techniques like cognitive behavioural therapy, or CBT.
This is a psychotherapy that involves learning to identify and manage negative thoughts
and behaviour patterns that can contribute to their depression.
The therapist will work with the patient to identify unhelpful or negative thoughts,
and help them to change inaccurate beliefs with more positive and realistic thoughts.
Mind-body therapy can be delivered in person, by videoconference, by telephone or even
by certain electronic methods on computer or apps. So, in summary, depression is a serious mental
health disorder that affects a lot of people with chronic pain. These 5P strategies can be used
in combination to provide a faster method to improve symptoms and restore function.
Remember plate, pillow, physical, pills and psychological therapies.
Please, don’t forget that this video is for educational purpose only.
If you have a condition that needs medical advice, please talk to your doctor.
And if there is an emergency, go to the nearest emergency department.
Use the comments below to suggest topics for future videos.
Below, there is a link to a document that you can download
and it summarizes all the content of this video.
If you like this video, give a thumbs up here, turn on the
notifications and don’t forget to subscribe to this channel.
There is a “share” button here too, and you can send this video to your friends.
I have many other videos on this channel, check here for other topics.
You can also find me on twitter, facebook and Instagram.
Thank you for watching. Good bye