Best Depression Treatment in Cardiff

It is important to differentiate sadness from different stressful life situations or unfulfilled expectations from a more intense alteration in mood and behaviors secondary to Grief from the bereavement or loss of someone vs Clinical Depression which is a clinical syndrome with core features of a persistent and pervasive low mood and/or anhedonia (inability to experience pleasure). There are many other characteristics features that together as a cluster help in diagnosing clinical depression. These can include:

Emotional symptoms

  • Low mood, sadness (pervasiveness) 
  • Tearfulness
  • Loss of interest in activities that would normally be pleasurable (motivational problems)
  • Anhedonia (inability to feel pleasure in normally pleasurable activities)
  • Change in reactivity of mood to external events
  • Irritability
  • Anxiety
Cognitive symptoms
  • Changes in the form of thought such as reduced speed of thought, reduced speed and volume of speech, reduced expression in speech
  • Subjective impairment in concentration, registration, and recall, increased time to process information, impairment in decision making in the routine day-to-day tasks or memory disturbance
  • Alteration in the content of thoughts with the classic triad of negative views of the self (self-blame), the world (negativism), and the future (pessimism)
  • Suicidal thoughts and/or plans with intent
Behavioral symptoms (what others can observe)
  • Altered facial expression with reduced or loss of facial expressivity
  • Slowed up demeanor or agitation (Psychomotor retardation or agitation)
  • Self-neglect
  • Social withdrawal
Biological symptoms 
  • Variation in mood through the day (typically, but not always, diurnal variation such that the mood may be worse in the mornings)
  • Sleep disturbance- Classically it is Early morning waking (late insomnia) but maintenance of sleep or delayed onset may also be present
  • Loss of appetite
  • Weight Loss (if 5% in the last month, then it is significant)
  • Loss of Libido
  • Anergia- easy fatigability and generalized lassitude
  • Constipation and/or Amenorrhoea

In severe depression- psychotic features such as delusions and hallucinations may be present.

How is it diagnosed?

It is normally diagnosed by the professional by getting information from the patient in a Psychiatric interview, using relevant questionnaires, getting collateral information from family/carers/friends, and carrying out a complete mental state examination. 

The severity of depression is based on the number and the quality of the range of symptoms that a person is suffering from and is part of the clinical interview and assessment.

How is it treated?

A multidisciplinary treatment approach is the best depression treatment in Cardiff, provided at Wales Psychiatry Centre. It includes the use of pharmacology, psychological interventions, social interventions, brain stimulation techniques as well as management of risks associated with the illness. 

Newer ways of treating depression include Neuromodulation approaches such as rTMS(Repetitive Transcranial Magnetic Stimulation) and others. 

Mild cases of depression may best respond with the psychosocial interventions that may include certain lifestyle changes, exercising, stress-reducing strategies, and the use of Cognitive Behavioural Therapy (CBT). 

In cases of moderate to severe depression, Antidepressants can be helpful pharmacological interventions. SSRIs (Selective Serotonin Reuptake Inhibitors) are considered the first line of medication option. There are many other medications as well and it's best to consult with your prescriber regarding the timing and suitability of other medications. That involves the Psychiatrist considering different Neuropharmacological approaches depending upon the needs of the individual.

What is Treatment-Resistant Depression? Or is it Difficult to Treat Depression?

Whilst the first-line of treatments that include psychological and pharmacological therapies are effective in many cases, it is well recognized that almost a 3rd of the patients fail to respond to two or more trails of first-line antidepressant medications. These people are deemed to have a Treatment Resistant Depression (TRD). 

STAR-D was the largest study done on Depression management and it further highlighted that with each addition of medication strategy, roughly a 3rd may respond further and with each new step added in, the depression becomes more and more difficult to treat. The new way of looking at this is to consider it being a Difficult-to-Treat Depression (DTD).

How is TRD or DTD then treated? What is New in the treatments of depression?

Newer advancements in Neurophysiology using EEG (Electro-Encephalography) have begun to show us that certain parameters detected in people with depression can act as a Biomarker for treatment resistance and more specifically, a more likelihood for someone to not respond to the first-line medication. This can help in the treatments to be individualized and tailored to the individual. 

Similarly, there is a role for newer neuromodulation techniques early on in the treatment of depression.The best depression treatment in Cardiff also includes a Repetitive Transcranial Magnetic Stimulation (rTMS). With this treatment, an improvement in response rates can be enhanced and sustained.

Other pharmacological interventions that modulate monoamines differently- Vortioxetine; Psychedelic drugs like Psilocybin, Ketamine, Esketamine; Brexanolone in Post-Partum Depression are some newer drugs that have begun to be used in research and clinical settings. It is advisable to consult with your treating Psychiatrist regarding these new strategies. 


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