Treating the energy loss associated with depression withOUT medication

[amo_mea_filiis.]

My dd is going through some stuff. She has a psychiatrist and is currently on lithium. We will be weaning it in October. She does not tolerate meds well, and already has a yacht-load for her asthma and allergies, which likely contribute to her anxiety and depression. There's way more than "just" depression going on, but that'll be my focus.

 

She has the potential for a good therapy team, but I have to be lead because not much action has been taken (lots of praise for having small goals, small walks for treats, etc).

 

Starting in September, she'll have a huge team consisting of: 2 "intensive" family based therapists (lacking intense, but we're getting there), DBT group and possible individual sessions, a BCBA (applied behavior analysis), OT, and a school counselor (cyber school).

 

I've been reading up on behavioral techniques for treating depression, but haven't gotten very far yet.

 

My biggest questions...

 

How in the world do behavioral methods, specifically behavioral activation, lead to increased energy?

 

How do I set her up to contact high value rewards when most of her teen years involved very destructive, very high value reward methods (light drugs, poor peer models, very poor internet buddies, etc.)?

 

How do I get her sleep and meals normalized?

 

(We have a LOT of specialist appointments coming up to rule out or treat a few medical things. 1st appt is in November. She'll be seeing a new allergist as well for shots to eventually, hopefully, come off those meds.)

 

Anyone have any recommended books, sites, or articles about treating depression without meds?

 

Anything that worked for you?

 

I know meds are gold standard, and that depression can be chemical, but both of my kids don't respond as expected to a host of medication and it's caused many problems. Otherwise I'm not anti-med or anti-dr in any way. I wish a pill or cocktail of pills and a little therapy were the answer here.

[bettyandbob]

Exercise helps. It must be consistent and for many people it needs to be vigorous. You have to build up, but regular exercise makes helps a lot with sleep and as you get stronger you can increase intensity.

 

The big problem you have in starting is getting a teen to do something daily and helping that teen find an outlet she likes. Maybe start with walking and later try dance classes, martial arts or Cross fit. If the teen is unwilling that's may be impossible. Depression makes it very hard to do anything.

[amo_mea_filiis.]

She's willing to an extent. Thank you!

 

She likes yoga, swimming (but our indoor pool access outside summer is too high in chlorine. I'll have to find another), walking, hiking, and a few other things. Do I just drag her out? She will go, but will crash hard later, but too early to be effective for bed. But it not being a regular thing could contribute I guess.

 

What's hardest for me (should get easier in Sept) is that she's behind in her summer classes, and she sleeps all day. So when she's up, I'm gently getting up her rear about school. (With her constellation of difficulties, not all written here, school focused shows best long term outcomes)

 

Summer school ends this Friday though. So I can shift gears for a month. Come September, other people will be up her butt for academics and I can focus on BA/DBT, and exercise.

[amo_mea_filiis.]

She'd probably love cross fit. I can't afford the local gym, but can call and see if there's a way to barter at all (very small town!).

[JFSinIL]

How many other meds have been tried so far?  I would hesitate to only use therapies w/o med or meds.   One twin of mine, years ago, only started to respond to an intense ABA program once we had him on meds that let his brain respond to the therapies.  His fraternal twin is now on six (or is it seven?) different meds, under his THIRD psychiatrist in as many years, to control his bipolar/depression (to extent of suicide talk)/insomnia/anxiety attacks.  He can now drive safely to his part-time job and back (if he ever feels unsafe to drive I step in and drive him). is taking another class in the fall, and most days feels almost "normal".   He also has a great psychotherapist he can talk to...but he will be first to admit, without the right meds, no amount of non-med therapy or exercise etc can get and keep his brain/though processes on-track to enable him to function.

 

Depression is a medical disorder.  If lithium isn't helping, what else can the doc try...or does she need a new doctor?  There has to be a way to balance asthma meds and brain meds.

 

You have two years left before she can refuse to cooperate.  Do keep trying to find a med or meds that will help her, in addition to all the therapies etc. you have lined up.  Ok, now I will shut-up about meds, since you obviously know this already.

 

Have you been in contact with your local chapter of NAMI or looked for support on their website?  They may have some good ideas, too.

 

Is there an outside person (not a parent) who can reliably get dd out exercising or ? a few times a week? She may take prodding to participate better from a non-parent (perhaps a local college student?)  We hired local college students to be trained as therapists in our son's ABA program eons ago.  I stayed out of the way, I prepared props, etc for the program. 

 

 

Edited July 29, 2017 by JFSinIL

[JFSinIL]

She'd probably love cross fit. I can't afford the local gym, but can call and see if there's a way to barter at all (very small town!).

 

Maybe some of us could help pay for a few months of Cross Fit ....would that help?  When a kid of the Hive is ill, we step in, right?

[amo_mea_filiis.]

She's been on a lot of other meds over the years. It takes time to see the negatives, and by then behaviors have worsened and stick. I will ask psych about possible genetic testing for meds.

 

My son is either allergic to or intolerant to 15 meds, both psych and non psych. He reacts almost immediately, so it's easier to see, but he also comes off the meds fine (poor stuff doesn't stick). I only mention his reactions since because of him, none of our docs are shocked that dd has difficulties as well.

 

I applied for disability for dd, and if she qualifies, I'd throw every dime into the positive stuff (exercise, bike repairs, allergy products for her room, art classes).

[amo_mea_filiis.]

We don't have a local NAMI.

 

She's fine with me prodding over getting out. She hates me prodding over school, but she'll literally ignore all courses. It's a hard balance that I'm not balancing.

 

She can actually refuse to cooperate with mental health now, and since she was 14. Mental and sexual health can be controlled by the teen at 14.

[Soror]

I would say read the book Spark if you want to learn about how exercise helps with depression, it is impressive.

 

I'd also add have you checked d3, iron, and b12 levels? I'd want to make sure those are optimal, not just acceptable, all those things have a huge bearing on your energy level.

 

I'd aim for a min. of 60 d3- I feel best at 80.

b12- upper range of chart- use a good sublingual

iron- ferritin at least 50- ideally 60-70

[amo_mea_filiis.]

For the most part, her labs are good. Her D, early spring, was in the 50's. It'll be checked again today with her lithium levels, along with thyroid, and regular stuff. She takes 2k D daily. I'll ask psych to check other levels at our next appt.

 

Crossfit is EXPENSIVE! And she wants to do these activities with me. $220 a month is crazy! I might just have her use a YMCA trainer for a while. Trainers for kids at the Y are only $10 for an hour. Granted, if she saw a trainer for the same time you get at crossfit, it'd be a lot more, but I'll start simple right now.

[maize]

I second the book Spark. Will your dd read it or listen to the audio book?

 

A partner to exercise with can make a big difference.

[LarlaB]

I would say read the book Spark if you want to learn about how exercise helps with depression, it is impressive.

 

 

Agreed. I just started reading this book last night after seeing it mentioned here a few weeks ago. I'm only half way thru but pretty impressed at the brain chemistry changes made by vigorous exercise.

 

For me it's obvious why I didn't struggle with depressive episodes during the 10+ years of running and training. I really really wish treatment plans would include exercise BUT I understand the demotivation aspects of depression in the brain. Practically it's very hard to motivate a depressed person.

[amo_mea_filiis.]

https://www.amazon.com/gp/aw/d/B000SFD21Q/ref=mp_s_a_1_2?ie=UTF8&qid=1501333477&sr=8-2&pi=AC_SX236_SY340_QL65&keywords=spark

 

Is this the book? If so it's in my cart and will be had shortly. :)

[maize]

https://www.amazon.com/gp/aw/d/B000SFD21Q/ref=mp_s_a_1_2?ie=UTF8&qid=1501333477&sr=8-2&pi=AC_SX236_SY340_QL65&keywords=spark

 

Is this the book? If so it's in my cart and will be had shortly. :)

Yes, that is the book.

[JumpyTheFrog]

"Spark" is a great book. It convinced me that all the hassle of having my probable ADHD son in competitive gymnastics is worth it for helping his brain.

[JumpyTheFrog]

https://examine.com/topics/depression/

 

Examine.com goes through the evidence for and against various supplements for various conditions. If you want to see the list for depression in one spot, you have to pay. But you can click each supplement in the list individually and read which conditions it has been tested for. For example, fish oil has been found in 23 studies to be very helpful.

[JumpyTheFrog]

I'd also have her eat her breakfast outside every morning. The sun will make it easier for her circadian rhythm to normalize (if it is off).

[amo_mea_filiis.]

I'd also have her eat her breakfast outside every morning. The sun will make it easier for her circadian rhythm to normalize (if it is off).

I don't even attempt to bother her until noon! Lmao! And she's picky with her routines so this could actually be an issue. I will put steps in place to give this a try. :)

[JumpyTheFrog]

I don't even attempt to bother her until noon! Lmao! And she's picky with her routines so this could actually be an issue. I will put steps in place to give this a try. :)

https://www.amazon.com/Chronotherapy-Resetting-Inner-Alertness-Quality/dp/1583334726/ref=sr_1_1?ie=UTF8&qid=1501335638&sr=8-1&keywords=chronotherapy

 

This book has info on using bright light therapy/the sun for dealing with sleep disorders. I wonder if she has a sleep disorder making the depression worse. In any case, have her go outside for 30 minutes after she wakes up. See if you can slowly move the wake time back by five or ten minutes per week.

[gardenmom5]

how is her diet?  

has she ever been evaluated for food sensitivities? 

has she ever been evaluated for MTHF mutation? 

how about her thyroid and adrenals with the stop the thyroid madness protocols/numbers for free t3, free t4, etc. (they have whole page on what tests to run - which include hormones, iron, vitamins, etc. because imbalances in them can undermine energy - and even cause depression.)

 

those things can not only cause depression - they can undermine energy.

 

I have been on ndt for a year - and was still struggling with fatigue.   I went back to limiting bread - and noticed I felt awful when I had some of dh's rolls.  (cry.). . . then I wasn't eating any - hey, I'm feeling better (re:: more energy).  knew I probably shouldn't eat bread, but was hungry so I made half a pbj sandwich.   ate it - felt like garbage and was knocked off my feet for the rest of the day.  ooookkkkkaaaayyyy - no bread it is.   (which is weird, becasue pasta doesn't affect me that way.  dh suggested it might be because they're different kinds of wheat.  or maybe it's the amount of folic acid used to fortify it. . . those with mthf mutations should NOT have folic acid.)

 

avoiding added sugars (of all kinds.  even the so-called "healthy" sugars should be avoided) is another biggie.  among other things - it can cause depression and undermine energy.

 

does she exercise?   at a level and type appropriate for her?

 

 

eta: about vitamin d3. . I was just talking with one of my drs, who was diagnosed with mthf.  before, her d3 level was 12 (should be 50+), and 10K IU's a day was not raising it.   after she started taking mthf - d3 came up with no effort.

Edited July 29, 2017 by gardenmom5

[amo_mea_filiis.]

https://www.amazon.com/Chronotherapy-Resetting-Inner-Alertness-Quality/dp/1583334726/ref=sr_1_1?ie=UTF8&qid=1501335638&sr=8-1&keywords=chronotherapy

 

This book has info on using bright light therapy/the sun for dealing with sleep disorders. I wonder if she has a sleep disorder making the depression worse. In any case, have her go outside for 30 minutes after she wakes up. See if you can slowly move the wake time back by five or ten minutes per week.

For treatable reasons, I do hope (kind of) that her sleep study shows obstructive sleep apnea. She had it as a kid, had tonsils and adenoids removed, but has never slept well.

 

I was going to do the opposite and push her sleep time later by an hour or so for a couple weeks.

 

It may just be fixable with her therapists coming a bit earlier.

[regentrude]

Have you looked into light therapy? 

As mentioned by pp: vigorous exercise, preferably outside.

[StephanieZ]

Outdoor exercise. 

 

Good sleep (ideal 10, but at least 8, hours of sleep daily, on a regular schedule).

 

Vitamin D. 

 

 

[SparklyUnicorn]

I don't have advice, but it is not uncommon for medication to not work the same on younger people and not uncommon for it to take a lot of trial and error to find what combination does help. 

 

 

[JumpyTheFrog]

I was going to do the opposite and push her sleep time later by an hour or so for a couple weeks.

That chronotherapy book I linked to also has info about changing the sleep schedule by pushing sleep back every so often until the person is eventually waking up at a more normal time.

[JumpyTheFrog]

If she has had long term sleep problems, I'd be inclined to think the sleep trouble is causing the depression, instead of assuming it is the other way around. (That is assuming sleep problems happened noticably before depression.)

[amo_mea_filiis.]

If she has had long term sleep problems, I'd be inclined to think the sleep trouble is causing the depression, instead of assuming it is the other way around. (That is assuming sleep problems happened noticably before depression.)

I do (again, sort of!) hope she has a treatable sleep disorder.

 

This is also why I let her sleep. I don't want to add serious sleep deprivation on top of everything. I know she needs to sleep.

[amo_mea_filiis.]

Have you looked into light therapy?

As mentioned by pp: vigorous exercise, preferably outside.

I really should. We're in northeast PA and sunlight is poor year round.

[SparklyUnicorn]

Sleep issues are common too.  All three of my family members have or have had sleep issues. 

 

If she is hardly sleeping, did they offer something for sleep? 

[amo_mea_filiis.]

Sleep issues are common too. All three of my family members have or have had sleep issues.

 

If she is hardly sleeping, did they offer something for sleep?

She is on light stuff for sleep and her psych would give us anything. However, until we get a physical disorder (OSA, etc) ruled out or treated, in not going to hit her hard.

 

My doc did sleep studies as standard work up for patients asking for sleep meds. I was sent for a study and found OSA (at barely 100lbs!). I'm so glad he didn't just drug me through my lack of breathing!

[MBM]

There are two newish treatments being used now for the toughest cases of depression and certain types of bipolar.

 

Repetitive transcranial magnetic stimulation (rTMS or just TMS) works well but takes a number of sessions before changes are seen and felt. The Neurostar is the machine used for rTMS. If you google Neurostar, you can find articles.

 

Low frequency magnetic stimulation (LFMS) is also showing promise in treating depression and certain kinds of bipolar. It uses a lower frequency and patients often feel relief quickly. It was developed at Harvard.

 

http://news.harvard.edu/gazette/story/2014/07/new-treatment-for-depression-shows-immediate-results/

 

 

Your daughter's allergies and asthma suggest a problem in her gut which could very likely be causing problems with certain neurotransmitters. About 90% of your body's serotonin is made in the gut. I don't know if her health care team is working on that but it would be something to look into if they haven't already.

[JumpyTheFrog]

Maybe she could try an elimination diet to see if any foods are contributing to allergies, asthma, or depression. Gluten intolerance runs in my family. Sinus congestion/infections (and eventually GI problems) were my biggest symptom. My dad and brother's seasonal allergies were reduced almost completely when they went gluten free. They also discovered that gluten made them irritable and they felt happier when off of it (even outside of allergy season).

 

I know this would be a lot of work, but it sounds like you will be spending a ton of money and time on various therapies. If her diet is making things worse, it would be nice to know.

[displace]

The author of the Depression Cure book claims decrease in depression by similar rates as people taking meds. Helping depression = helping energy.

 

Most of the cures are easy (getting into natural light daily, exercise or even walking daily, fish or other oil supplements- dose recommended in book, stop ruminating on negative thoughts- advice given).

 

Worth a check from the library. No risk.

[SparklyUnicorn]

There are two newish treatments being used now for the toughest cases of depression and certain types of bipolar.

 

Repetitive transcranial magnetic stimulation (rTMS or just TMS) works well but takes a number of sessions before changes are seen and felt. The Neurostar is the machine used for rTMS. If you google Neurostar, you can find articles.

 

Low frequency magnetic stimulation (LFMS) is also showing promise in treating depression and certain kinds of bipolar. It uses a lower frequency and patients often feel relief quickly. It was developed at Harvard.

 

http://news.harvard.edu/gazette/story/2014/07/new-treatment-for-depression-shows-immediate-results/

 

 

Your daughter's allergies and asthma suggest a problem in her gut which could very likely be causing problems with certain neurotransmitters. About 90% of your body's serotonin is made in the gut. I don't know if her health care team is working on that but it would be something to look into if they haven't already.

 

huh...very interesting

[Ottakee]

My daughter needs yet lithium levels in the very low end to not quite therapeutic....but they are effective there. Above that she gets too tired.

[MamaBearTeacher]

Is she doing Cognitive-Behavioral Therapy? This is very different from ABA and it has been shown to be very effective for depression.

 

Is there a reason, you cannot get her up at 7 or 8 am? The first few days might be tough.

 

Is she happy with her social life? Her relationships? Can she exercise with her peers? Do you think that would help?

[amo_mea_filiis.]

Is she doing Cognitive-Behavioral Therapy? This is very different from ABA and it has been shown to be very effective for depression.

 

Is there a reason, you cannot get her up at 7 or 8 am? The first few days might be tough.

 

Is she happy with her social life? Her relationships? Can she exercise with her peers? Do you think that would help?

 

We're doing Dialectical Behavior Therapy, which is a spin off of CBT, and actually goes well with ABA. With the combo of ABA and DBT, I'll be pulling in behavioral activation, which seems like it can be accomplished through the ABA. (remember that it's not just the depression going on)

 

I can't get her up early because she will continue staying up late at night and adding sleep deprivation on top of everything is not the way to go. I can't get her sleeping at night because her online world is her only known coping skill. I'm not taking that before learning and practicing appropriate replacement skills.

 

Socially, at the moment, she doesn't have much. A recent stupid behavior led to the (hopefully temporary) loss of a local friend. We're in a very small town and it's very hard to find decent influences, so until we find good stuff I'm not pushing her going out much. Because she doesn't have much, she isn't currently sneaking out which is great, even if the only reason for her not sneaking out is the depression squashing the motivation for social interaction.  

 

None of her peers intentionally exercise unless they're hiding from the police at 2am trying not to get caught doing something.

 

Dd also has autism. So on top of normal teen not fitting in stuff, she truly doesn't fit in. I'm pretty sure her short time with pot was for an accepting social group. You smoke, even a teeny tiny bit, you're in, you know? Maybe this fitting in was also where at least the idea of crossfit was nice. I know it can be cult-ish, but it can be very family like as well. 

 

She gets out of the house with me a little bit. Last week we met with her teacher, then had DBT, so that was an 8ish hour day. She'll come to the store with me. I can sometimes get her in the pool. Her family based therapists take her for a walk.

 

She did eat breakfast outside today, then went back to sleep, but got up for a walk with me and to pick up her brother from the pool. She has 5 more days on steroids for her allergies, so I'm hoping to keep her getting up a little in the morning once meds are done (I give her her meds at 8, but don't expect more at that time).

 

So it's as dire as I'm posting, but not. I know, makes no sense. Lol.

 

She's currently watching spongebob eating homemade creamed spinach while avoiding her gothic lit essay. 

[amo_mea_filiis.]

My daughter needs yet lithium levels in the very low end to not quite therapeutic....but they are effective there. Above that she gets too tired.

 

I'm very iffy on the lithium. She's on it after a single, *possible* manic episode, which was likely brought on by a combination of meds, sleep deprivation, a UTI, and the autism and depression. I don't think she's bipolar, though the genetics are there. She's only on 450mg/day.

[Ottakee]

I'm very iffy on the lithium. She's on it after a single, *possible* manic episode, which was likely brought on by a combination of meds, sleep deprivation, a UTI, and the autism and depression. I don't think she's bipolar, though the genetics are there. She's only on 450mg/day.

Is the fatigue worse in the lithium? If it is not clearly needed then it might be worth stopping it. I use meds here and they are life savers but I am also less meds is best

[amo_mea_filiis.]

Is the fatigue worse in the lithium? If it is not clearly needed then it might be worth stopping it. I use meds here and they are life savers but I am also less meds is best

 

(bolding mine)

 

I don't know. I don't feel the lithium is clearly needed at all. A single manic/depersonalization episode does not scream lithium to me, know what I mean? 

 

I tried getting her off of it when she'd been on it only a few days, but that doc was refusing to communicate. At this point she's been on almost 4 months. *IF* it's controlling any manic behavior, it's not touching the depression for sure. 

 

I just don't like using meds without clear benefits.

 

My son is on prozac. Very low dose. We weaned off twice just to be sure it was helping, and it absolutely is. He takes it for anxiety, and his anxiety presents as anger. On it, his tantrums are much calmer (haha! a calm tantrum!), and he's much quicker to see his part and apologize. Off it and he still has 2+ hour destructive tantrums. The goal of his behavior therapy is to eventually come off meds, but he's not complaint enough yet.

 

I see absolutely no difference from before the lithium in my daughter, unless it's doing something minimal that we'd have to wean off to see. 

[Ottakee]

Then Prozac might be an option for her if it works well for your son. Often med responses are similar for family members.

 

Lamictal is great for depression and is a mood stabilizer.

[amo_mea_filiis.]

Sadie, that explanation sounds to fit right in with what I'm hoping to do with the ABA/BA/DBT mix.

 

I'm tracking mood and energy in observable ways. I want her therapists (September team) getting her productively out more, and hopefully by forcing some of this, she'll see the gains and start to take over (and I'll have the data to support!). Eventually I want her to track her anxiety, but right now there's no motivation. I can only track what I see, which doesn't track her feelings of anxiety very well.

 

She still hasn't written a letter she needs for summer school. I'll get her doing that tomorrow. I gently tried today, but we went for 2 short walks and she helped make dinner, in between naps. She effectively avoided her non preferred demand.

[amo_mea_filiis.]

Then Prozac might be an option for her if it works well for your son. Often med responses are similar for family members.

 

Lamictal is great for depression and is a mood stabilizer.

My SSRI fear is that while the former Zoloft and celexa did cure her anxiety, it also eliminated her inhibitions, which led to her engaging in behaviors that her anxiety was preventing. Now that she's engaged in them with minimal consequence, she's not afraid of them.

 

I don't want to try a 3rd med that would target the anxiety even though it could help the depression. At least not before getting behavioral support in place.

 

We actually went to the psych asking for Prozac back in January (or a little earlier?) since ds tolerates it. But he said he's had more success with celexa in teen girls.