Interventional Psychiatry by Dr. Bermudes - Depression, Anxiety, PTSD, OCD Treatments

Depression

Definition: Depression, or major depressive disorder, is a mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities, causing significant impairment in daily life.
Prevalence & Impact: Affects around 7% of adults in the United States, with a considerable impact on work productivity, relationships, and overall quality of life.
First-line treatments: Psychotherapy (e.g., cognitive-behavioral therapy or interpersonal therapy), antidepressant medications (e.g., selective serotonin reuptake inhibitors or SSRIs), and lifestyle changes. There is evidence that TMS is effective and safe as a first line treatment.
Second-line treatments: repetitive transcranial magnetic stimulation (rTMS), FDA cleared in Adult Patients who have failed to achieve remission from one or more antidepressants.

Definition: Treatment-resistant depression is a form of major depressive disorder that does not respond adequately to at least two different trials of antidepressant medications.
Prevalence & Impact: Affects around 10-30% of individuals with depression, leading to chronic symptoms and increased risk of suicide.
First-line treatments: Augmentation or combination strategies with different antidepressants, psychotherapy, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and ketamine or esketamine treatment.

Definition: GAD is a mental health condition characterized by excessive, chronic worry and anxiety about various aspects of life, causing significant distress and functional impairment.
Prevalence & Impact: Affects around 3-4% of adults in the United States, impacting work productivity, relationships, and overall well-being.
First-line treatments: Psychotherapy (e.g., cognitive-behavioral therapy), medications (e.g., SSRIs, SNRIs), and lifestyle modifications.
There are clinical studies indicating repetitive transcranial magnetic stimulation (rTMS) can be effective and safe in GAD especially when co-occurring with Major Depression. TMS is not FDA cleared for this condition. We will be offering this treatment at our Lake Tahoe Clinic.

Definition: Bipolar disorder is a mental health condition marked by extreme mood swings, including periods of intense mania (elevated mood and energy) and depression.
Prevalence & Impact: Affects around 2.8% of adults in the United States, often causing disruptions in work, relationships, and daily functioning.
First-line treatments: Medications (e.g., mood stabilizers, antipsychotics, or antidepressants), psychotherapy (e.g., cognitive-behavioral therapy or family-focused therapy), and psychoeducation.
Second-line treatments: There are clinical studies indicating repetitive transcranial magnetic stimulation (rTMS) can be effective and safe in Bipolar Depression. TMS is not FDA cleared for this condition. We will be offering this treatment at our Lake Tahoe Clinic.

Definition: PTSD is a mental health condition that develops after experiencing or witnessing a traumatic event, characterized by intrusive memories, avoidance, negative mood and cognition, and hyperarousal.
Prevalence & Impact: Affects around 3.6% of adults in the United States, with a significant impact on daily functioning, relationships, and overall quality of life.
First-line treatments: Psychotherapy (e.g., trauma-focused cognitive-behavioral therapy, prolonged exposure therapy, or eye movement desensitization and reprocessing), medications (e.g., SSRIs or SNRIs), and support groups.
There are clinical studies indicating repetitive transcranial magnetic stimulation (rTMS) can be effective and safe in PTSD especially when co-occurring with Major Depression. TMS is not FDA cleared for this condition. We will be offering this treatment at our Lake Tahoe Clinic.

Definition: OCD is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions) aimed at reducing anxiety.
Prevalence & Impact: Affects around 1-2% of adults in the United States, causing significant distress and impairment in daily functioning.
First-line treatments: Psychotherapy (e.g., exposure and response prevention), medications (e.g., SSRIs or clomipramine), and self-help strategies.
Second-line treatments: repetitive transcranial magnetic stimulation (rTMS) is FDA cleared as adjunctive treatment with a SSRI in adult patients with OCD.

Definition: Panic disorder is a mental health condition characterized by recurrent, unexpected panic attacks, along with persistent worry about future attacks and significant changes in behavior to avoid triggering them.
Prevalence & Impact: Affects around 2-3% of adults in the United States, causing considerable distress and interference with daily functioning, relationships, and work.
First-line treatments: Psychotherapy (e.g., cognitive-behavioral therapy), medications (e.g., SSRIs, SNRIs, or benzodiazepines), and self-help strategies (e.g., relaxation techniques, deep breathing exercises).