Dr. Robert Pitts speaks about Depression

Another thing that we deal with a lot, you know, and which is omnipresent in our society, just like stress and anxiety, is depression. I mean, it's. Now, there is normal depression that most. We all have our ups and downs, but clinical depression is extremely common. That 70%, 70 to 75 5% of all of the general public have had at least one clinical depression in their life. That's a lot. And that means severe depressive features, which last for more than two weeks, and sometimes it last for many months. Some of the classic symptoms of depression are you can have either a sad mood, the blues, but really beyond the blues, where you're feeling deep in a sad hole, and it can be just a sense of blackness that's suffocating, feels like it's pulling you deeper and deeper.

There's also a lack of energy and fatigue. Like I said, insomnia or hypersomnia. It can interfere with your appetite. Now, other people have what we call, can have what we call an irritable depression, or an agitated depression, where they're really not as sad and dysphonic, but they're more agitated and irritable, easily angered. So depression can present itself that way. Now, some people have what we call a major depression, where they perhaps can't get out of bed. It's like their system is turned down from ten to two or one, and they just don't have the energy to move. Oh, I didn't mention also there's a lack of motivation. So depression is a nasty animal because it takes away the two things that you need to get yourself out of it, which are energy and motivation. So clinical depression is devastating, and it kills many people, millions, tens of thousands of people, millions around the world, from suicide. And it is also not just suicide, but severe depression lowers your immunities. It can play into physical illnesses and make them worse. So it's a devastating disorder in its severe forms. But the good news is we have some exciting new treatments for severe depression, severe treatment-resistant depression that didn't exist until about ten or 15 years ago. One of the examples is called transcranial magnetic stimulation, TMS.

We actually have a TMS chair in this practice. It looks kind of like a dentist chair, but there's an MRI strength magnet that is placed over the middle of the head, and a psychiatrist maps it and gets it right to the right spot. And there's a way that they can tell when it's right at the right spot. And then the person comes in for 36 treatments that are about a half-hour long, over eight weeks. Now, that sounds like a lot, and it is. But the other treatment that we have had for many years for severe, treatment-resistant depression is ECT, electroconvulsive therapy, or shock therapy. Now ECT gets a bad rap. ECT has saved many, many lives. And up until we had TMS, ECT was it when people had severe treatment-resistant depression. And so ECT is still a good option for people who have tried dozens of antidepressants, and nothing has helped. And those people are out there.

There are many misconceptions about ECT, dating back to the movie One Flew Over the Cuckoo's Nest and other movies. It is very carefully done. It does cause you to have a seizure that resets the brain, but you're not convulsing. They give you a muscle relaxant. They sedate you. So the seizure that you have, I've watched an ECT treatment, and it looks about like this, like, twitch, twitch, twitch, twitch, twitch, and then it's done. That's it. You're laying there sedated, barely twitching, and that's your seizure. But it resets the brain in a good way. And if someone is severely depressed, or suicidal, really, ECT is a better thing because it can be done immediately, and now somebody has to drive you to the hospital.

Often people start ECT when they're in the hospital, but it can help you kind of take you back from the edge of the cliff if you have severe, treatment-resistant depression and you're suicidal. But the nice thing about TMS is that it's much less invasive. You're not sedated. There are a lot of 30-minute treatments. So it's five days a week for six weeks and then two weeks of three times a week. So that's the eight weeks. But there are people that come in the morning, and then they go to work. Some people come during their lunch hour. Some people come at the end of the day, and so listen. For people who have struggled with major depression for this long, they're happy to have this inconvenience, if you will. In addition to TMS, there are exciting new treatments that are in clinical trials, including with ketamine. Ketamine trials. Often it's a nasal spray where the person stays in the doctor's office for 20 or 30 minutes just to make sure they don't have a reaction.

There are also very exciting clinical trials with substances such as psilocybin, which is a hallucinogenic drug. But it appears to have remarkable capabilities to help people with the worst of the worst people with severe, treatment-resistant depression. Often people with depression just need counseling. If counseling is not enough, getting on some kind of antidepressant can help. But if you've tried one after another after another and it's not getting better, we have treatments now, and we have other treatments that will be available after these clinical trials that are really spelling relief for people for the first time in my career. So it's so encouraging to me late in my career to see these wonderful treatments for people that we have only been able to help this much in the past, and now we can help them this much. So.