Depression rehab provides structured, intensive support for individuals battling severe or treatment-resistant depression. These programs combine 24/7 care with therapy, medication, behavioral interventions, and holistic healing practices. Clients receive a safe, nurturing environment where they can rebuild emotional resilience and regain control of their lives.
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DEPRESSION-
7 Habits That Could Cut the Risk of Depression in Half.
A healthy lifestyle is good for your brain.

KEY POINTS-
New research makes it clear that daily habits can boost or diminish mental health.
A healthier lifestyle can ward off depression, even in those with genetic predisposition.
“We are what we repeatedly do.” —Aristotle

Your answers to these seven questions have serious implications for your mental health:
Do you get between 7 and 9 hours of sleep a night?
How much junk food do you consume?
Do you make time for friends and family?
Do you exercise regularly?
How many hours a day do you sit at your desk?
Do you smoke cigarettes?
How much alcohol do you consume?
A new study published in Nature Mental Health found that a healthy lifestyle can prevent depression, even in those who have a genetic predisposition.

While pharmaceutical advertisements have led many to believe that major depressive disorder is caused by a lack of neurotransmitters, it has become increasingly clear that depression is much more than a chemical imbalance. Remember the classic Zoloft commercial from the early 2000s showing a sad blob with a cloud following it around?

The voiceover explains: “While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance.”

Zoloft transforms the sad blob into a smiling blob and the cloud literally dissipates. More recent evidence paints a more complicated picture that debunks this model: Antidepressant medications work for some people, but not because they correct a chemical imbalance. What remains unclear is exactly how they work.

What is clear is how daily habits can boost mental health. Researchers examined data from almost 290,000 people—of whom 13,000 had depression—over a nine-year period, and identified seven healthy lifestyle behaviors linked with a lower risk of depression:

1. Prioritize sleep. Sleeping seven to nine hours per night reduced the risk of depression including single depressive episodes and treatment-resistant depression by 22 percent. Of all the depression-reducing factors, getting a good night’s sleep on a regular basis made the biggest difference.

2. Cultivate connections. Frequent social connection reduced the risk of depression by 18 percent and was the most protective against recurrent depressive disorder. Put simply, happiness doesn’t only come from within, it also comes from “with.”

3. Drink less. Moderate alcohol consumption decreased the risk of depression by 11 percent. Less is clearly more. Greater than one drink a day for women and two drinks a day for men can actually increase the risk of depression.

4. Eat well. Refined carbs, processed foods, and sugary drinks are bad for the body and the brain. People who maintained a healthy diet were 6 percent less likely to report an episode of depression. Increasing evidence shows that the Mediterranean diet can boost mood and dial down symptoms of depression and anxiety.

5. Move regularly. Frequent exercise can improve daily mood and also cut one's risk of depression by 14 percent. A related study published in the British Journal of Sports Medicine found that physical activity was 1.5 times more effective than medication in reducing depression. Not surprisingly, the sports that give people the biggest boost typically involve others—tennis, soccer, and other team-related activities.

6. Don’t smoke. Never smoking decreased the risk of depression by 20 percent. Enough said.

7. Get up, stand up. A sedentary lifestyle was considered independent of exercise. Taking breaks and stepping away from screens regularly reduced the chances of depression by 13 percent. If you’re reading this sitting down, please stand up and stretch.

These lifestyle factors are more than icing on the cake. I would argue that they are the cake. People who maintained most of these seven healthy habits—five or more—had a 57% lower risk of depression. We all know that a healthy lifestyle is important for our physical health. It’s just as important for our mental health.

Bottom Line: While many with depression benefit from medication and therapy, lifestyle medicine can make a meaningful difference in reducing symptoms and preventing them altogether.

DEPRESSION-
Depression, Serotonin, and the Gut.
New findings explore SSRI efficacy and dysbiosis in major depressive disorder.
Reviewed by Hara Estroff Marano

KEY POINTS-
A new report indicates a direct correlation between gut dysbiosis, major depressive disorder, and SSRI efficacy.
Although the gut makes more than 90% of the body's serotonin, gut-derived serotonin does not cross the blood-brain barrier.
Instead, a related metabolic pathway producing kynurenine is associated with decreased serotonin, increased inflammation, and depression.
The gut microbiota may serve as a prognostic indicator and a treatment target for major depressive disorder.
By: Nicole Cain, ND, MA

In a report scheduled for publication in the June 2023 issue of the Journal of Affective Disorders, researchers explore the association between the gut microbiome and the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD). Their findings indicate that an increase in specific microbial genera (Blautia spp., Coprococccus spp., and Bifidobacterium spp.) may be useful as markers predicting treatment efficacy. They also help lay to rest the notion that low serotonin is a causative factor in depression

A 2022 systematic umbrella review published in Molecular Psychiatry examined the breadth and quality of evidence behind that once-popular theory. After reviewing 17 studies involving more than 150,000 individuals, they concluded that “the main areas of serotonin research provide no consistent evidence of there being an association between serotonin (5-hydroxytryptamine, or 5-HT) and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.” Their review also revealed evidence that long-term antidepressants may actually reduce serotonin concentration.

Serotonin Production
L-Tryptophan, an essential amino acid and building block of serotonin, is not produced by the body. Humans thereby rely primarily on dietary intake to provide tryptophan. The metabolism of tryptophan within the human body can follow one of two pathways, toward serotonin or toward production of kynurenine, a substance that plays a role in niacin production. Serotonin is the main focus here, but it's noteworthy that the kynurenine pathway definitely plays a role in mood.

Tryptophan Pathways
Tryptophan is metabolized into serotonin in the central nervous system by the brain’s neurons.1 It is also metabolized by specific gut microbes (e.g., Lactococcus, Lactobacillus, Streptococcus, Escherichia coli, and Klebsiella species)2 and specialized intestinal epithelial cells known as enterochromaffin cells.3 More than 90% of the body’s serotonin (5-HT) is produced in the gut. But gut-derived, peripheral serotonin typically does not cross the blood-brain barrier.4-6 Rather, it is associated with digestive activity including nutrient absorption and transport.7 Gut-derived serotonin is also involved with inflammatory response8 and glucose and lipid homeostasis,9 among other effects. A deficit of 5-HT in the gut is also associated with irritable bowel syndrome (IBS).10

Although peripheral serotonin produced by the gut cannot directly enter the brain,11 it can influence blood-brain barrier permeability.7 Furthermore, vagus nerve stimulation by the gut microbiota can alter concentration of serotonin, GABA, and glutamate within the brain—all known to influence mood.12

Additionally, peripheral serotonin itself plays a role in stimulation of the hypothalamic-pituitary-adrenal (HPA) axis, via neuroendocrine interaction.13 Notably, stress-induced hyperactivation of the HPA axis is associated with a dysregulation in the serotonergic system, including a chronic increase in the stress hormone cortisol, which is associated with both depression and suicidal ideation.14,15

The gut clearly plays a significant role in serotonin production, and peripheral serotonin does influence the brain directly and indirectly through immune function, vagal nerve stimulation, neuroendocrine feedback, and the HPA axis. But the larger question surrounding the relationship between serotonin levels in the brain and mood, specifically depression, remains unclear.

The Difference a Pathway Can Make
As shown in the illustration above, enzymes are vital to the metabolism of serotonin from L-tryptophan and its metabolite, L-5-hydroxytryptophan (5-HTP). Evidence suggests that the transport of 5-HTP across the blood-brain barrier is deficient in depressed individuals.16 As such, the most commonly prescribed antidepressant medications, SSRIs, block the serotonin transporter (SERT) in the brain, allowing more serotonin to remain in the synaptic cleft between neurons; blocking the reuptake of serotonin ostensibly keeps it active, in theory, to promote antidepressant effects.17,18 But as the 2022 review reports, the relationship between serotonin levels and depression is not clearly established.

With this in mind, it's worth taking a look at the alternative, much more common, pathway for tryptophan metabolism. In normal human physiology, more than 90% of 5-HTP is metabolized via the kynurenine pathway. But overactivation of this busy pathway in the brain results in increased production of neurotoxic compounds and lower neuroprotective compounds as well as reductions in mood-balancing neurotransmitters including dopamine, choline, and GABA.19,20

This excessive kynurenine pathway activity also happens to be correlated with exaggerated inflammation, which is itself associated with decreased levels of serotonin in the brain.21 Moreover, inflammation alone is implicated in mood disorders, with increased levels of proinflammatory proteins (cytokines) a well-established marker of major depressive disorder and treatment-resistant depression.22,23

Perhaps serotonin as a marker of depression is something of a canary in the coal mine. It may be possible that addressing serotonin reuptake between neurons is not the most efficient path toward healthy brain function, neurotransmitter optimization, and mood balance. Perhaps the root cause of depression may be better addressed with a focus on the so-called second brain: the gut microbiome.

This aligns with the findings reported in the Journal of Affective Disorders in June 2023 in which the authors conclude that the gut microbiome of patients with major depression is distinct and changes with SSRI treatment. They believe that gut dysbiosis offers a prognostic tool and therapeutic target for individuals with major depression.

KETAMINE-
Update on Ketamine via Telemedicine Delivery.
A breakthrough treatment for depression or a risky precedent? Here’s the latest.
Reviewed by Tyler Woods

In 2020, the federal government changed the rules to make it easier for providers to treat patients via telemedicine. One rule change allowed providers to prescribe controlled substances like ketamine without first seeing the patient in person.

The thinking was that, because the pandemic was raging, it was too dangerous for people to go to doctor’s offices for visits and to get their prescriptions.

Since that time, the number of people receiving ketamine via telemedicine has soared. The reason is clear. Several studies, as well as anecdotal evidence, in the last few years have shown ketamine to be highly effective for some people with treatment-resistant depression (TRD). It is also showing efficacy for bipolar disorder, PTSD, and certain other mental illnesses.

But depression seems to be the sweet spot. Many who have been suffering from debilitating TRD for years, and who have tried other medications with no success, are finally seeing their symptoms improve with ketamine. Some see a dramatic improvement over a period of days or even hours.

Another positive development? Ketamine obtained in this way—it usually gets sent in the mail in lozenge or tablet form when the prescription is filled—often costs far less than when a person receives the medication in person at a clinic.

So far, so good. However.
The risks of ketamine via telemedicine delivery
There are several serious downsides to this development. For one, when ketamine is taken chronically in high doses (which can happen when it’s taken at home in an unsupervised manner), it can cause severe bladder damage. In some cases, the damage requires surgical reconstruction of the bladder.

Ketamine can also be highly addictive for some individuals, and you can overdose on it. It can also dramatically raise heart rate and blood pressure when you take it, and it’s risky for those who live with certain kinds of psychiatric illnesses.

Maybe the biggest downside of all is that there is virtually no data on the long-term health effects of taking ketamine daily or every other day, as many who get it delivered via telemedicine do. (Many people receive their monthly dose of lozenges or tablets, take more of the medication each day than is prescribed, and run out early.)

Compare that lack of oversight to ketamine’s FDA-approved nasal spray form, called esketamine or Spravato. This is normally taken in a controlled clinical setting only once or twice a week for a set number of weeks under medical supervision.

Given all these upsides and downsides, what’s the best way forward with ketamine? Let’s start with the basics.

What is ketamine?
A synthetic substance, ketamine (pronounced “KEH-ta-meen”) was developed in the early 1960s as an anesthesia treatment to keep people from feeling pain from injury or during surgery. It’s still used today and is especially common in veterinary hospitals.

Classified as an anesthetic, ketamine causes feelings of dissociation and sedation in higher doses. It gained notoriety in the 90s as a club drug—people inject it, snort it, or add it to marijuana or cigarettes. Nicknames include "K," "Special K," and "Super K." Ketamine has also shown benefits in pain management for both chronic pain and acute pain in emergency room settings.

When taken to combat depression and other mental illnesses, ketamine can produce hallucinatory effects, visual and sensory distortions, out-of-body experiences, and euphoria or a “buzzed” state. Often, a ketamine “trip” lasts about two hours, though occasional side effects, such as unconsciousness and high blood pressure can be severe.

Many ketamine patients say that their sessions with the drug can act as a reset button for the brain. The drug allows them to detach from themselves, and many report profoundly pleasant thoughts and visualizations. Afterward, your daily problems can feel less oppressive, and the improved mood can last for weeks or longer.

A few cautionary words on telemedicine as a delivery method
As an addiction treatment clinician, I am wary of working remotely with patients, prescribing medications to them via telemedicine, and monitoring their progress and recoveries via videoconference. Why? Because it’s harder to do all those things remotely than if you’re seeing someone in person and can assess body language, attitude, hygiene, and other behaviors. It’s also easier for patients and providers to abuse the “virtual” delivery system.

So yes, in a perfect world where quality in-person care was available to everyone, that delivery method would win every time. But that’s not the reality. To extend our health and medical reach to those who otherwise wouldn’t access it, telehealth is vital, and it’s here to stay. On balance, that’s a great thing.

Telemedicine and ketamine
Here’s my take: Telehealth-based care (usually via video) works well for physical ailments like strep, skin rashes, or sinus infections. But things get more difficult with mental health because there are fewer physical symptoms to guide you. It gets dicier still when the medication that is prescribed for the illness is itself risky, as is the case with ketamine, because it’s harder to monitor remotely.

That said, the answer isn’t to shut down this delivery method for ketamine. Rather, we need to create regulations and safeguards that allow for the medication to be prescribed and monitored by a certified provider in a safe manner.

With that goal in mind, I offer the following.
4 recommendations on ketamine
Put clear, enforceable rules around that first visit with the provider. If the government doesn’t require a return to an in-person visit before prescribing controlled substances like ketamine, that first virtual visit must be comprehensive, recorded, and trackable by an oversight body. I hear all the time that these initial visits are as short as 30 minutes, and I can say with certainty that it is impossible to do a thorough mental health assessment with a patient in that amount of time.
Require certification of all providers and companies that offer ketamine via telemedicine delivery. This is how it works now with clinics that offer in-person FDA-approved Spravato nasal spray. Similar regulations need to be in place for the new providers offering ketamine via telemedicine.

Require addiction screening for all patients. Because ketamine can be addictive, providers and patients are playing with fire if patients aren’t thoroughly screened (this takes more than 30 minutes!) for addiction use past or present. This needs to happen, no exceptions. My recommendation is that a patient must be sober from drugs or alcohol for at least six months, if not a year, before a ketamine prescription is considered.
Make it mandatory that providers do frequent video checkups with their patients who take ketamine. This oversight is vital. Providers need to see how the patient is doing in order to make dosage adjustments. Video chats also allow for visual evidence to be shared, for example, the provider can ask to see a patient’s remaining dosages.

Key advice for patients
Always advocate for yourself, and remain vigilant about fraudulent or suspicious activity by your provider.

Remember, providers are not infallible. They sometimes make mistakes in judgment—or worse. There’s money to be made in this new-frontier area of medicine at the moment, which means you’re always going to get some bad characters involved.

If something smells fishy about the way medications are being prescribed by your provider, ask about it. Push back. Ask direct questions. Make inquiries. Do your due diligence. Google your provider to check on their credentials.

Bottom line: Be careful. Hold your provider to the highest possible standard. This is your (or a loved one’s) mental health we’re talking about, and there’s nothing more important than that.