Depression

Depression is considered to be one of the most complex mental disorders due to the incredible variance in physical, psychological, and behavioral symptoms. While this mental illness varies greatly in presentation, it is commonly characterized by sad mood, lack of interest and motivation, hopelessness, fatigue, irritability, social isolation, sleep issues, and more. The conditions under which depression emerges vary widely, and no core cause has been identified. Due to such variance in presentation and cause, the low levels of clinical remission when brain function analysis has not been performed is not surprising.

The Alpine Approach:

At Alpine, we do not have a “one size fits all” approach to your treatment. Based on your brain activity and specific needs, we develop a plan that is specific to you. This plan could involve one or more of the following modalities: Amplitude neurofeedback training, tDCS, tACS, pEMF, ILF neurofeedback, and Alpha/Theta training. We often utilize multiple modalities to allow for quicker and more effective symptom reduction.

Why NF Works for Depression:

A qEEG assessment allows for the identification of phenotypes, or divergent patterns in the qEEG. There are several EEG phenotypes commonly observed in depression, including an asymmetry in left and right frontal activation.  This asymmetry results in a bias towards negative emotions, withdrawal, weakened ability to feel a sense of social belonging, low motivation, and low mood.

Deficits in accessing, engaging, and disengaging neurocognitive networks leads to significant distress. The mind’s environment should be constructed and under your control, not imposed. Neurofeedback trains the brain to self regulate, unlocking an ability to control thought process and regulate emotional states. Instead of feeling stuck in the imposed environment of your mind, you can gain control over subtle brain wave fluctuations with real time rewards for target brain frequencies at specific cortical locations,.  Over time, you will be in  control of your emotions, ruminative thoughts, and mood.

In addition to neurofeedback, ​tDCS is another modality that can help unstick brain patterns and increase neural plasticity.  Abnormalities in glutamate and GABA, principal excitatory and inhibitory neurotransmitters of the central nervous system are observed in depression. tDCS addresses this dysregulation by supporting glial cells in the brain, which are essential for brain plasticity. tDCS combats this decline in glial cell support, resulting in a clinically potent remedy for depression.

Treatment Efficacy

Following are statistics from several randomized controlled trials and clincial trials determining treatment efficacy. The Hamilton Depression Rating Scale, or HDRS, is one of the most widely used depression assessment scales. This scale is used to determine the efficacy of a treatment. This scale goes from 0 to 52 with 0 indicating no depression and scores above 24 indicating severe depression. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSRI vs. Placebo Treatment

Clinical trials of SSRIs are shockingly unsuccesful - the remission rate in these trials is barely higher than the placebo effect, and adverse side effects are noted in a substantial number of subjects: 

  • "During the treatment phase, treatment-related adverse events were noted in 68.8% of subjects taking zoloft and 74% of subjects taking paroxetine. 20% of sertraline subjects discontinued and 30.5% of paroxetine subjects discontinued the medication before clinical trials were complete" (Cascade et al., 2009).

  • Zoloft is commonly the first antidepressant prescribed to patients, however national library of medicine facilitated clinical trials for zoloft show a large placebo effect: 


















     

Misconceptions about mental health are getting in the way of successful treatment, however, don't be discouraged! Relief from depression is possible.  Reaching out and asking for help can be a difficult first step, at Alpine we encourage you to begin your journey to happiness.

 

 

 

Learn more:

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1   Transcranial direct current stimulation (tDCS) in the treatment of depression: systematic review and meta-analysis of efficacy and tolerability, Neurosci. Biobehav. Rev., 57 (2015), pp. 46-62

2 Boggio et al., 2008, A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression, International Journal of Neuropsychopharmacology, Volume 11, Issue 2, March 2008, Pages 249–254

3 Appl Psychophysiol Biofeedback (2016) 41:103–110

4 Jakobsen, J.C., Katakam, K.K., Schou, A. et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry 17, 58 (2017).

5 Barber, J., (June, 2017) Treatments for Depression: Drug Versus Psychotherapy. Identifier NCT00043550

Cascade, E., Kalali, A. H., & Kennedy, S. H. (2009). Real-World Data on SSRI Antidepressant Side Effects. Psychiatry (Edgmont (Pa. : Township)), 6(2), 16–18.

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