Major Depressive Disorder

Therapy for Life

Feeling depressed and having depression is not the same. Sadness is short term and can wane suddenly. Depression is an illness characterized by persistent sadness and a loss of interest in activities that are normally enjoyed, accompanied by an inability to carry out daily activities for at least two weeks (WHO, 2017). Depression can be long-lasting or recurrent. It can greatly impair an individual's ability to function at work or school, or the ability to cope with daily life.

People suffering from depression usually take 10 years to ask for help. Treatments include: taking medications (which may start working in 6 to 8 weeks), psychotherapy, or ketamine infusions (which start working in 24 hours). ECT and transcranial magnetic stimulation are other treatment forms. 

The diagnosis is based on symptoms that should last at least 2 weeks and must cause distress. The symptoms include a depressed mood every day for most of the day; loss of interest on activities that used to be pleasurable; feelings of worthlessness or guilt; hard time focusing or concentrating; inability to make decisions; though of death or possible suicidal ideation; physical signs like change in weight (loss or gain); sleep changes (too much or too little); psychomotor agitation or retardation; fatigue or loss of energy.

Major depression is one of the most common mental disorders in the US. In the US 10% struggle with depression, which, if left intreated or is resistant to treatment, significantly increases the risk of suicide. Ketamine infusion however is successful in up to 80% of the cases.

Forms of depression include: Major Depression Disorder (MDD), persistent depressive disorder, seasonal affective disorder, postpartum depression, bipolar disorder (BPD), cyclothymia, among others. Bipolar disorder is one that consist of both maniac and depressive episodes, separated by periods of normal mood. Dysthymia is a persistent form of mild depression; symptoms are similar but tend to be less intense and last longer. 

Chronic stress plays a major role in depression and is associated with reduction in synaptic plasticity, connectivity, and neuronal atrophy in certain areas of the brain. Neuroplasticity is the brain's ability to respond to its environment by changing, reorganizing, and restructuring neural networks in the brain. Stress may impede neuroplasticity and decrease neurons in the mood centers of the brain, leading to slower reactivity and symptoms.

When treatment for depression are not working, many individuals turn to substance abuse to numb and manage their symptoms, Sadly, this alternative is dangerous and more destructive. More than 20 million in America aged 12 and older have a substance abuse problem. Almost half of them have a serious mental illness. The most common drugs abuse in order of prominence include: marijuana, prescription drugs, cocaine, hallucinogens, inhalants, methamphetamines, and heroin. Alcohol is the most widely abuse substance (approx. 75%). Serious mental illnesses in young adults continues to rise and only 51.5% receive treatment. One in three adults who struggle with drugs and alcohol abuse also suffer from depression. Depression and substance abuse create a downward spiral, intensifying symptoms and feeding thoughts of suicide.

When treatment fails and loss of hope persists, suicidal ideation unfortunately becomes an option for many. The number of young adults having suicidal ideation and attempting suicide has increased over the last decade. There is a significant link between suicide a those experiencing severe depressive episodes with no symptom relief. Providing prompt relief and support for those struggling with major depression is important in helping to prevent suicide and improve quality of life. Studies have shown that ketamine is effective in up to 80% of the cases in reducing at least 50% of the symptoms within 24 hours after infusion.

Ketamine is a general anesthetic that may reverse the symptoms of Major Depressive Disorder with minimal, if any, long term side effects within 24 hours. However, the administration of the infusion requires strict and close monitoring of the patient because administration can have several severe side effects that requires the presence of a Board Certified and experienced Anesthesiologist to be immediately available. I, Dr. Leano, am Board Certified Anesthesiologist/Pain Management with more than 30 years of experience using Ketamine.

The most basic requirements for this treatment are the need of an IV insertion, the time of treatment (about 2 to 3 hours), and the need of a companion to stay with the patient during treatment and drive the patient back home every day after the therapy. Another requirement is the need of several treatment at the beginning of the therapy, follow for a maintenance treatment every 4 to 6 weeks.

Our goal is to bring joy back to patients and their families. If you, a friend, a family member or any person you know is battling with Major Depressive Disorder, Bipolar Disorder, alcohol/substance abuse, PTSD, OCD, anxiety, intractable migraine, CRPS, or severe chronic pain, call Palm Beach Pain at (561) 248 1166


Interventional Pain Management Ricardo Leano, MD Ricardo Leano, MD, is a pain management and regenerative medicine specialist at Palm Beach Pain, LLC, in Palm Beach Gardens, Florida. Dr. Leano is committed to alleviating pain and maximizing the mobility and quality of life for his patients with the lightest touch of medicine, with the goal of avoiding all side effects in the process and making life as great as it should be. He values getting to know his patients and learning about their interests, goals, and concerns.

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Ketamine is a “rapid acting antidepressant” that can terminate suicidal ideation and is effective in up to 80% of the most difficult-to-treat cases of depression.

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