THE ROLLER COASTER

Remember your first roller coaster ride, when no one warned you? That first dip sucked marrow from your bones and you wondered what was supposed to be fun about it. Approaching next dip, your more-experienced buddy (if you were lucky) yelled, “Laugh! Laugh!” and you did, and it was all manageable.

Letting air in, letting air out.

IN-SPIRATION

The word “inspiration” comes from Greek for “breathing in.” When we breathe in, we bring in oxygen that feeds cells and allows us to think clearly.

Breathing air in, in-spires us and we function better. Letting it out gets rid of toxins, and movement also prevents “the bends” from those roller-coaster moments we have.

We are spirits in corporeal world. “we” live in bodies that are composed of elements and need basics of air and water.

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Fourth, psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within same class (e.g. SSRI to another SSRI) is just as effective.

Fifth, Maria’s psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria’s compliance to drug should be addressed promptly.

Lastly, if despite above measures Maria doesn’t respond to antidepressants, then electroconvulsive therapy should be entertained. Of course, this procedure should be done with her consent.

In summary, Maria’s psychiatrist can optimize dose, augment or combine treatment, switch medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression.