Treatment for Depression in Dubai

Treatment for Depression in Dubai. Introduction

Everyone has days of sadness and low mood. These phases usually pass quickly. However, if the low mood persists for more than two weeks, it might indicate a depression.

Clinical depression also known as Major Depressive Disorder (MDD) is a psychiatric condition characterized by persistent feelings of sadness, fatigue, loss of interest in activities and sleep deprivation.

Depression can affect anyone, with the risk varying based on triggers. When depression strikes, the reasons are often elusive. Depression symptoms can seemingly appear out of nowhere, leaving many feelings guilty and perplexed, thinking, “Everything is fine, so why do I feel so awful?” Accepting the illness can be challenging initially, with sufferers often feeling misunderstood. Well-intentioned advice like “snap out of it” or comforting words like “cheer up, it’ll get better” are unhelpful.

Depression can take a severe toll on one’s life, leading to feelings of persistent sadness, exhaustion, and disinterest in activities and social withdrawal. Untreated depression has devastating impact on people individual’s well-being, including decreased quality of life and increased suicide risk. People with depression are mor likely to die on high blood pressure, diabetes, stroke, or heart attack.

Therefore, understanding the symptoms, levels of severity, and available depression treatment in Dubai is essential for effective management and recovery. With a proper care and knowledge, treatment for depressive disorders can aliavate the symptoms leading to a full recovery.

Symptoms of Depression

Depressive symptoms include:

Main symptoms:

• persistent low mood
• loss of interests or pleasure
• lack of energy

and

Secondary symptoms:

• Poor concentration and attention
• Low self-esteem and self-confidence
• Feelings of guilt and worthlessness
• Excessive worry about the future
• Thoughts or acts of self-harm or suicide
• Sleep disturbances
• Decreased appetite

Physical discomfort can contribute to diagnosis. Headaches, back pain, breathing difficulties, dizziness, and digestive issues might be the somatic symptoms resulting from depression.

Severity Levels of Depression

Each depression is unique. It differs in intensity and course. Severity levels can be mild, moderate, or severe, based on the number and duration of main and secondary symptoms:

Mild

Two main and two secondary symptoms for over two weeks.

Moderate

Two main and three to four secondary symptoms for over two weeks.

Severe

Three main and four or more secondary symptoms for over two weeks.

The therapy of depression should be adjusted to the level of severity. While mild depression can be treated only with psychotherapy, the more server grades require the use of medication.

Steps in Diagnosing Depression

Depression requires proper diagnosis which can be secured by the psychiatrist. The diagnosis is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), mostly used in the US, or the International Classification of Diseases (ICD-10) deployed worldwide, among others in Europe.

Based on the initial evaluation the psychiatrist will first make the diagnosis and then develop an individualized treatment plan tailored to patient’s specific needs.

The psychiatric interview can start with “Two-Questions Test” giving the physician basic information about patient’s status.

The “Two-Question Test” assessment:

• Did you often feel down, sad, or hopeless last month?
• Did you have significantly less interest or pleasure in things you usually enjoy last month?

1. Anamnesis (Medical History Review)

If both questions are answered with “Yes,” the mental health professional determines the diagnosis via conversation, called anamnesis focusing on:

• patient’s personal and family medical history to rule out any possible genetic or environmental factors contributing to depression.

• assessing the severity and duration of symptoms such as persistent sadness or empty mood, loss of interest or pleasure, fatigue, difficulty sleeping or sleeping too much, feelings of worthlessness or guilt, and thoughts of suicide.

2. Physical Exam consist of

• General physical exam: assessment of patient’s general health status (depression may be linked to an underlying physical health problems).

• Neurological exam: allows to roll out major problems of the central nervous system.

3. Laboratory tests

Evaluating the status of the patient before starting the treatment excluding different health issues. In case of starting treatment with medication the initial result is a benchmark for further controls.

4. ECG (Electrocardiogram)

By using ECG, we exclude pre-existent heart problems. A “native” ECG is also a point of reference for further controls under medication.

5. Additional Diagnostics

A more profund investigation will be needed in case of severe mental disorders like psychosis or bipolar disorder. Such diagnostic includes brain scan (CT-scan or MRI) and the record of the brain generated electrical activity EEG (Electroencephalogram).

Objectives in Treatment for Depression

Depression is a treatable condition. The treatment objectives are:

• initially symptom reduction and then full disappearance
• initially improving and then restoring daily routine
• preventing relapse after patient’s full recovery

Treatment Options for Depression (Major Depressive Disorder) in Dubai

The treatment of depression needs time and requires a close cooperation with the psychiatrist and psychologist. The goal of the preliminary visit is to identify the problems and to decide which treatment method would be the most suitable.

The therapy of depression consists of two main methods such as psychotherapy and use of antidepressants, and can be supported by complementary treatment methods.

In case the symptoms are mild the treatment with psychotherapy would be the first choice. However, if the symptoms are more severe the combination of medication and psychotherapy will be necessary.

Other treatment options are reserved for severe or chronic course of the illness. This could be ECT (electroconvulsive therapy), TMS (Transcranial Magnetic Stimulation) or light therapy.

Older and today rarely used treatments methods are hormonal therapy with L-Thyroxine and using controlled sleep deprivation.

Treatment for Depression with Psychotherapy

In patients treated only “biologically”, i.e. with medication, the symptoms can appear again despite of using the same dosage of the medication. Consequently, adding the psychotherapy is a necessary part of an effective treatment improving by several times the chance for a full recovery.

Clinical psychologists offer psychotherapy, or “talk therapy”, and have degrees in psychology and significant postgraduate training. Psychologists avail themselves of evidence based psychotherapeutic treatment methods.

There are variety of psychotherapeutic methods. The majority of them belong to two psychotherapeutic branches: psychodynamic and behavioral therapy.

Cognitive-Behavioral Therapy in Treatment for Depression

Cognitive behavioral therapy combines two therapeutic approaches:

Cognitive Therapy

According to cognitive therapy, it is often not the things and situations themselves that cause problems, but rather the meaning we attach to them. Our personal perspective can be a crucial starting point for change.

Behavioral Therapy

Behavioral therapy is based on the assumption that behaviours can be learned and unlearned. The therapeutic goal is to identify problematic behavioral patterns, work with them, and bring about change.

The core approach of CBT (Cognitive Behavioral Therapy) is based on the idea that problems are the result of the way people interpret situations, thoughts, and feelings. CBT addresses the symptoms giving the patient insight about the triggers in “hier and now.” This allows the patient to control the patterns of his thinking and behaviour causing the symptoms. It helps the individual identify thoughts that make them feel bad (e.g. I am not good enough).

Treatment with Psychodynamic Psychotherapy for Depression

Psychodynamic psychotherapy relates to several methods of in-depth psychotherapy. These are classical psychoanalysis, psychoanalytical psychotherapy, and different modifications of this methods.

Despite the different approach, just as cognitive-behavioral therapy, psychodynamic therapy also wants to bring about changes in behaviour. Unlike CBT, psychodynamic psychotherapy places a large emphasis on the psychic layer not accessible to the consciousness, especially on the unresolved conflicts. Conflicts are upsetting contents such as aggressive impulses and anti-social desires “stored” in the unconscious. However, even though they are not accessible to our conscious perception, they influence our feelings and behaviour.

A key requirement for psychoanalytic-based therapy is a willingness to engage deeply with past, such as early childhood experiences, current relationships and current defence mechanisms.

Reducing the intensity of the conflict, creating the underlying tension, leads to symptom reduction. Making unbearable feelings conscious and employing the Ego (the conscious part of the psyche) in understanding cause and effect brings about healing.

Efficacy of Psychodynamic Psychotherapy in Treatment for Depression

Psychodynamic psychotherapy has not been studied as extensively as behavioural therapy in the treatment for depression. Even though psychodynamic psychotherapy, including the eldest technique called “psychoanalysis”, has a long-standing history, the empiric research on its effectiveness is less large. Despite the higher number of studies referring to behavioral methods those done for psychodynamic psychotherapy prove its efficacy. The main reason for the lower volume of research related to psychodynamic methods is explicable by the therapy setting. The psychodynamic psychotherapy done by an analyst in his private practice, is less accessible for empiric evaluation.

Treatment with Interpersonal Psychotherapy

Interpersonal Psychotherapy involves meeting with a group of other people who have been through the same, or a similar traumatic event. It can be easier to talk about what happened if you are with other people who have been through a similar experience. An open trial of interpersonal psychotherapy reported high rates of remission from symptoms.

Treatment with Systemic Therapy

Systemic therapy places great importance on social relationships, such as those within the family, circle of friends, or workplace, as they can contribute to the development of depression. During therapy, efforts are made to improve communication within a family, for example. This is intended to help alleviate depressive symptoms.

EMDR in Treatment of Depression

Francine Shapiro developed and studied EMDR (Eye Movement Desensitization and Reprocessing) which is a form of psychotherapy. This is a technique which uses eye movements to help the brain access and integrate the traumatic events “pushed” by sudden trauma (for example by war trauma or accidents) in the unconscious in their row unprocessed shape. Psychologists use the eye movement to facilitate emotional processing of memories to attend to more adaptive information.

Treatment of Depression with Medication

Medication is the fastest method of treatment of depression. However, the best long-term effect can be achieved by combining medication with psychotherapy.

Brain nerve cells use various neurotransmitters to transmit signals. While not all details are known, experts believe that in depression, the balance of certain neurotransmitters, such as serotonin, noradrenaline, dopamine or, glutamate are altered and some nerve connections are inhibited. They are different groups of medication influencing the neurotransmitters and used in treatment of depression. However, the main medication used in the treatment are antidepressants.

Depression Treatment with Antidepressants

Antidepressants aim to improve the availability of these neurotransmitters in the brain. Modern research has developed several antidepressants with different courses of action. The two biggest and the most frequently used groups of antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

While there are many different antidepressant drugs, it is difficult to predict how well a specific medication will help an individual. Therefore, at the beginning of treatment, doctors often suggest a medication that they consider effective and well-tolerated. If the medication does not work as expected, it is possible to switch to another one. Sometimes, various trials with medications are necessary to find the most suitable substance. 

Studies show that the benefit depends on the severity of depression: the more severe the depression, the more the benefits outweigh the drawbacks. This means that antidepressants are effective for chronic, moderate, and severe depression. They use is less successful for treatment of mild depression or dysthymia.

Course of Treatment with Antidepressants

Antidepressants are taken daily. In the first weeks and months, the goal is to alleviate symptoms and ideally make the depression disappear. Once this goal is achieved, the treatment is continued for at least 6 to 9 months. This so-called maintenance therapy is important to prevent relapses. Sometimes the medications are taken for even longer to avoid relapses (relapse prevention).

The duration of intake depends, among other things, on how the symptoms develop and whether there is an increased risk of relapse. Some people make need antidepressants for many years.

Monitoring Depression Treatment with Medication

Regular psychiatric visits are important during the treatment with medication. The psychiatrist will ask whether the symptoms have improved and if any side effects have occurred. If necessary, the medication type and dosage will be adjusted.

Under no circumstances the patient should medicate himself. This can result in insufficient effectiveness, more side effects or even in overdosing. Unlike many sleep aids and tranquilizers, antidepressants need weeks to develop the full efficacy. Abruptly discontinuation of antidepressants leads often to sleep disturbances, nausea, or restlessness. It can also happen, that few days later the patient might feel better. This leads him to the conclusion that he is healed and/or that the medication wasn’t effective. However, days or weeks later the depression can reoccur even more pronounced then at the beginning.

Towards the end of the treatment, the medication dosage should be gradually reduced over several weeks under strict psychiatric monitoring.

Treatment for Depression According to Severity Level of Depression

Psychiatrist and patient decide together, which therapy method can be used considering personal wishes and preferences, medical history, and the illness severity:

• Mild depression: Education, support, self-management, psychotherapy; cautious antidepressant use.
• Moderate depression: Psychotherapy or medication.
• Severe depression: Medication combined with psychotherapy.

Treatment for Depression of Suicidal Patients

Suicidal thoughts can appear in severe episodes of depression. Such patients should be immediately hospitalized and treated under close supervision by a psychiatrist and nurses.

Suicidal ideations can appear at every age but the most vulnerable group are older adults facing isolation, physical ailments and partner loss.

Successful treatment is key to suicide prevention.

Adjusting Therapy to the Course of Depression

Depression often occurs in phases, called depressive episodes. They can be solitary or recurrent. Prolonged episodes, exceeding two years, are classified as chronic. Approximately two out of ten patients experience chronic depression.

In some cases, recovery occurs within weeks or months, while half of patients experience recurring episodes, known as recurrent depression. The interval between episodes can be years or mere weeks.

Acute phase

Quick symptom relief, enabling normal life; usually 6-12 weeks.

Maintenance therapy

When symptoms ease, treatment continues in maintenance therapy. It stabilizes the condition and reduces relapse risk. Medication lasts about four to nine months; psychotherapy, eight to twelve months.

Relationship with Therapist

The warranty of a successful psychiatric and psychotherapeutic treatment is a trustworthy relationship with the therapist. psychiatrist and/or psychologist.

The patient should be transparent with the psychiatrist reporting honestly about your worries, work, and private circumstances, as well as possible side effects of the medication. Based on the feedback the psychiatrist can adjust the medication.

One of the common reasons for failing the therapy is changing or discontinuing the medication by the patient himself. Firstly, the risk of uncontrolled stopping the medication can be the reappearance of the depression. Secondly, by sudden discontinuation of the medication will trigger unpleasant symptoms such as mood swings, dizziness, or nausea. Needless to say, that any changes of medication should be discussed and implemented by the psychiatrist.

Relapse Prevention of Depression

Depression is well treatable condition but requires professional help. An early visit by the psychiatrist and/or psychologist and early therapeutic intervention shortens the treatment and improves its long-term outlook.

Untreated depression rarely resolves on its own. Therapy shortens episodes, reduces the risk of relapses and disrupts the vicious circle of depression. The treatment of depression is not a “quick fix.” The process of healing takes time.

The patients should be careful while judging the therapeutic progress without overestimating the temporary improvement. It’s not uncommon to experience setbacks during the recovery process.

Discontinuing the medication on one’s own as soon as one feels better also increases the risk of the depression recurring.

Apart of psychiatric monitoring and psychotherapy the involvement of family and friends in the treatment, patient’s self-education, self-care are important factors in preventing depression.

Self-Support in Treatment for Depression in Dubai

If you suffer of depression follow the below guideline:

• The most crucial step is consulting a psychiatrist or psychologist to recognize depression.
• Overcome shame. Be open and honest for accurate assessment.
• Seek support. Take a trusted person to appointments. Their perspective aids symptom communication.
• Practice patience. You’re in treatment; remember progress takes time and the symptoms improve first after few weeks.
• Stay active. Set small goals like limited physical activities for positive impact.
• Engage in activities. Meet a friend, visit a stylist, cook; small steps toward success.
• Accept help. Family and friends are you first line of support. Discuss with them what helps and bothers you.
• Connect with peers. Self-help groups offer understanding. Embrace conversations to ease crises.

Treatment for Depression in Dubai. Summary

Remember, depression is well treatable condition. Untreated depression affects individual’s well-being, decreases their life quality and increases suicide risk. The early diagnoses and therapy can restore individual’s performance, their life their general health condition and life quality.

Depression treatment at CHMC in Dubai includes psychotherapy, medication, or combination of both. The most effective, evidenced based treatment is the combination of medication and psychotherapy (counselling).

The effect of medication appears after few days to a few weeks. In contrary the benefits of psychotherapy unfold over a longer period and have much deeper impact on your life.

The treatment for depression is essential for restoring individual’s performance, life quality and general health outcome. Thus, it’s crucial for to be treated by an experienced psychiatrist and/or psychologist while having a supportive social network foremost family and friends.