【10000 Lux Full Spectrum Light】Delivering the medically recommended 10000 Lux for effective light therapy
HBOT=Hyperbaric Oxygen Treatment
| Integrative Treatment: Depression | |||
| Assessment | Multiple factors: leaky gut, inflammation, NT function, oxidation, mitochondrial, co-occuring TBI, PTSD, ACE's | Herbs | St. John's Wort, rhodiola & coffee, increase dopamine |
| Herbal | |||
| Digestion | Assess for GERD, hypoactive elimination | Detoxification | Liver flushes, coffee enemas |
| Digestion and Mental Health | Detox and Handouts | ||
| Culinary Medicine | Green papaya salad, chocolate, raw butter, raw soaked almonds, fermented foods, Spinach (lutein), figs | Yoga & Exercises | Aerobic exercise, Yoga, Emphasize right nostril, pranayama |
| Culinary Medicine | Yoga, Sound, Oxygen and Handouts | Mind, Body, Spirit interventions | |
| Nutritional Therapies | Refer to Nutritional Therapist table, Amino acid, adrenal support | Somatics | Stimulating pressure, deep reflexology, abominal, rocking, 10th cranial nerve, HBOT/ Ketamine therapy |
| Nutritional Therapies | Nutrition Essentials | Somatic, Energy Therapies | |
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| Treatment Resistant Depression: TRD | |||
| Option | Rationale | Limitation | |
| Extending Antidepressant Trial | Delayed time to response amongst populations with TRD | Modest evidence base supporting the strategy. Unlikely to be acceptable to most patients with TRD. | |
| Switching antidepressants | Mechanistically dissimilar antidepressants from different classes may offer improved health outcomes for TRD in some cases. Especially appropriate when index antidepressant class is poorly tolerated. | Modest evidence base supporting the strategy. Newly initiated antidepressant will require at least 4 weeks before outcome can be assessed. | |
| Combining antidepressants | May target symptoms not responding to index antidepressant (e.g. fatigue, cognitive, impairment, sleep problems). May improve tolerability via antidote of emergent adverse events (e.g. buproprion for antidepressant-induced sexual dysfunction) | Limited evidence in TRD. Potential for drug-drug interactions. Decreased adherence with polypharmacy regim. Greater cost of treatment. | |
| Ketamine | Acute efficacy established in TRD. Beneficial effects on suicidality. Rapid onset of symptomatic improvement. Greater efficacy in TRD with higher number of prior antidepressant failures. | Insufficient long-term efficacy, tolerability and safety data. Access to treatment limited in many jurisdictions. Specialized personnel required for safe administration. Long-term safety profile in TRD not established. | |
| Esketamine (Spravato blog post) | Acute and maintenance efficacy established in TRD. Beneficial effects on suicidality. Rapid onset of symptomatic improvement. Greater efficacy in TRD with higher number of priror antidepressant failures. Superiority of SGA (i.e. quetiapine XR) in acute and maintenance. | Access to treatment limited in many juridisctions. Acquisition cost. Recommendation to co-prescribe with newly initiated antidepressant in TRD. | |
| McIntyre et al World Psychiatry 2003 | |||
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| Treatment Resistant Depression: TRD | |||
| Option | Rationale | Limitation | |
| Second- generation antipsychotics (SGAs) | Scalable and accessible treatments. Evidence established for olazapine-fluoxeine combination. (Zyprexa-Prozac) | With the exception of olanzapine-fluoxetine combination, studied in partial responders than TRD. Short and long-term tolerability concerns. | |
| Electroconvulsive therapy (ECT) | Highly effective in acute and maintenance treatment of TRD. Superiority to IV Ketamine suggested by available evidence. Efficacy in TRD across the span. | Relative lack of availability in many jurisdictions. Stigma and lack of acceptability to many patients with RD. Tolerability concerns (e.g. memory deficits). | |
| Repetitive transcranial magnetic stimulation (TMS) | Shown to be effective in TRD. More acceptable to patients than ECT. Accelerated protocol demonstrates significant remission rates within 1 week. Tolerability advantages compared to ECT (.e. persisting cognitive deficits not observed). | Relative lack of availability in many jurisdictions. Inferiority to ECT in TRD with non-accelerated protocols. Insufficient long-term data in TRD. | |
| Vagus nerve stimulation | Proven efficiency in TRD in persons with extensive antidepressants failure histories. Treatment does not need to be administered ona daily basis. | Not available i most countries globally. Complexity of procedure limits scalability. Complications of implant. Cost of treatment. | |
| Psychotherapies | Evidence supports efficacy when used adjunctively in TRD. Opportunity to target commorbidities. Facilitate coping strategies with improved effects on patient-reported outcomes. Highly acceptable to persons with lived experience of TRD. Opportunity to tailor treatment targeting specific therapeutic outcomes. | Lack of availability of treatment or adequately trained provider. Low adherence to therapy. Lack of evidence as standalone treatment in TRD. | |
| McIntyre et al World Psychiatry 2003 | |||
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