Depression
Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.
Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.
More than 17 million U.S. adults—over 7% of the population—had at least one major depressive episode in the past year. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does affect some groups more than others.
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Symptoms
Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks.
Common symptoms include:
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Changes in sleep
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Changes in appetite
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Lack of concentration
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Loss of energy
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Lack of interest in activities
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Hopelessness or guilty thoughts
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Changes in movement (less activity or agitation)
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Physical aches and pains
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Suicidal thoughts
Treatment
Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:
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Psychotherapy including cognitive-behavioral therapy (CBT), dialectical-behavioral therapy (DBT), family-focused therapy, and interpersonal therapy.
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Medications including antidepressants, mood stabilizers and antipsychotic medications.
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Exercise can help with prevention and mild-to-moderate symptoms.
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Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
Types of
Depression
Some forms of depression are slightly different, or they may develop under unique circumstances. The most common types of depression include:
Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
Co-Occurring
Mental Illness
A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin at the same time, or one may appear before or after the other.
Medication
Guide
(Prescription, Experimental, &
Natural Herbs and Medicines)
Traditional Prescription Drugs:
Antidepressants and anti-anxiety pharmaceutical medications are frequently prescribed by Psychiatrists to treat depression and anxiety. For some people, antidepressant medications may help reduce or control symptoms. Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to reach full effect. Most people will have to try various doses and/or various medications to find what works for them. Here are some antidepressants commonly used to treat depression and anxiety:
Selective serotonin reuptake inhibitors (SSRIs) act on serotonin, a brain chemical. They are the most common medications prescribed for depression.
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Fluoxetine (Prozac)
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Sertraline (Zoloft)
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Paroxetine (Paxil)
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Citalopram (Celexa)
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Escitalopram (Lexapro)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most common antidepressants. These medications increase serotonin and norepinephrine.
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Venlafazine (Effexor)
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Desvenlafazine (Pristiq)
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Duloxetine (Cymbalta)
Norepinephrine-dopamine reuptake inhibitors (NDRIs) increase dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes fewer (and different) side effects than other antidepressants. For some people, bupropion causes anxiety symptoms, but for others it is an effective treatment for anxiety.
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Bupropion (Wellbutrin)
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Mirtazapine (Remeron)
Second-generation antipsychotics (SGAs), or “atypical antipsychotics,” treat schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental illnesses. SGAs can be used for treatment-resistant depression.
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Aripiprazole (Abilify)
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Quetiapine (Seroquel)
Tricyclic antidepressants (TCAs) are older medications, seldom used today as initial treatment for depression. They work similarly to SNRIs but have more side effects. They are sometimes used when other antidepressants have not worked. TCAs may also ease chronic pain.
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Amitriptyline (Elavil)
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Desipramine (Norpramin)
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Doxepin (Sinequan)
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Imipramine (Tofranil)
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Nortriptyline (Pamelor, Avantyl)
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Protriptyline (Vivactil)
Alternative Drug Therapies:
Alternative medicines to traditional pharmaceutical drugs include man-made drugs (such as Ketamine and MDMA) and plant based drugs (such as Psilocybin and Ayahuasca), and have been gaining increased exposure and availability as treatments for mental illness in recent years. Some of these medicines have shown promising results towards treating various forms of mental illness, including depression, anxiety and substance abuse. This form of therapy is generally described as "Psychedelic Therapy", and is featured in this 2022 story by the New York Times: https://www.nytimes.com/2022/01/05/well/psychedelic-drugs-mental-health-therapy.html
Below are brief introductions to some of the "alternative drugs" that are currently being used to treat mental illness in certain countries. Please consult with your doctor before using any traditional or alternative medicines.
Plant-Based Psychedelic Drugs Used to Treat Mental Illness:
Plant based drugs have been used by some cultures for hundreds of years and are currently available to the public in certain countries around the world, but are generally restricted in the U.S.
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Psilocybin (aka "magic mushrooms")- https://asm.org/articles/2023/february/psilocybin-and-mental-health-the-magic-in-the-mush Use of psilocybin for treating mental illness is currently legal in only two states, Colorado and Oregon, but is now being considered by several more. The US has granted research licenses to several universities in the US, including Johns Hopkins, NYU and the University of Michigan to do more clinical testing on the use of psilocybin for treating mental illnesses.
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Ibogaine- https://www.usatoday.com/story/news/health/2024/01/05/study-ibogaine-combat-veterans-brain-ptsd/72083144007/ Ibogaine is a cheical derived from the root bark of the African plant, Iboga. Ibogaine is available in some countires, but is illegal in the US due to its high potential for abuse. Ibogaine has shown promising results for treating opiod addiction and for treating post-traumatic stress disorder from brain trauma. Clinical research is underway in the U.S.
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Ayahuasca - https://www.webmd.com/mental-health/addiction/what-is-ayahuasca Ayahuasca is a psychoactive Amazonian plant-based brew which has emerging data indicating that it has antidepressant properties. Ayahuasca is not legally available anywhere in the US, but has been available for supervised use in certain countries, particularly Peru.
Man-Made Drugs Psychedelic Drugs Used to Treat Mental Illness:
Ketamine -Ketamine is a hallucinogenic anesthetic drug that has been used by doctors and veterinarians in surgeries in the U.S. for several decades. More recently, it is being used by hospitals to treat suicidal depression. Ketamine is currently available in many states in the US, and there are hundreds of Ketamine clinics across the country, providing supervised ketamine infusions for depression and anxiety.
https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain.
MDMA (aka "ecstasy" or "Molly")- According to WebMD: MDMA is a psychoactive drug that acts as a stimulant. The drug releases chemicals in your brain to give an energizing effect, heighten your senses, and boost emotions like self-awareness and empathy. MDMA is legally available for mental health therapy in a small number of countries, including Australia and Canada, but it is not legal in the US. However, it has gained much attention in recent years for its positive results in treating PTSD (post traumatic stress disorder), which has generated significant support for its legalization for PTSD therapy. https://www.nytimes.com/2023/09/14/health/mdma-ptsd-psychedelics.html MDMA
LSD:
Non-Psychedelic Natural Herbs and Medicines Used to Treat Anxiety and Depression:
Plant based medicines have been used for centuries to support mood and treat mild forms of anxiety and depression. These medicines have research supporting their benefits: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500625/
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St. John’s wort has become known as less of a treatment for nerve pain and more so for depression, with multiple double-blind, placebo-controlled trials confirming its antidepressant properties. Authors typically compare St. John’s wort with mainstream anti-depressant drugs and find it has a preferable side effects profile. It is not without its downsides, however, as excessive use has been linked to serotonin syndrome, sun sensitivity, and easy skin burning, and more generally with increased pharmaceutical drug metabolism by the liver.
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Lemon balm is mainly known as an anxiolytic (reduces anxiety), nootropic, anti-depressant, and carminative (reduces excess gas). Double-blind placebo-controlled human studies have shown positive results for lemon balm extracts in the improvement of mood, reduction of anxiety, and improvement of cognitive abilities.
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Rhodiola rosea may help improve moods in the treatment of mild to moderate depression.
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Kava Root is most commonly used to calm anxiety, stress, restlessness and treat insomnia.
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Minchex - It is said to help keep the nervous system healthy. The ingredients found in Min-Chex are said to induce a natural calming effect by exerting their individual influence on specific parts of the central nervous system.
Medical
Procedures
for Treating
Mental Illness
There are a number of medical procedures that may be prescribed by a doctor to treat mental illness, particularly depression and severe anxiety. Some of the more common procedures include:
Vagus Nerve Stimulation (VNS)- VNS uses a pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses.
Electroconvulsive Therapy (ECT)- ECT is a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. This results in a brief, controlled seizure that affects neurons and chemicals in the brain. It is most often used to treat severe depression and depression with psychosis that has not responded to medications.
Deep Brain Stimulus (DBS) - Deep brain stimulation is currently being studied as treatment for Tourette’s syndrome and major depression. DBS involves two electrodes put surgically directly in the brain and a pulse generator put in a person’s chest.
Transcranial Magnetic Stimulation (TMS) - TMS is a procedure that creates magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS should not be used to treat anyone experiencing depression with psychosis or bipolar disorder or having a high risk of suicide.
Systematic Treatment Enhancement- The NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a long-term outpatient study designed to find out which treatments, or combinations of treatments, are most effective for treating episodes of depression and mania and for preventing recurrent episodes in people with bipolar disorder.
Meditation, Yoga
& Other
Self-Directed
Therapies
Sleep, Diet and Exercise for Better Mental Health
Good sleep, a heathly diet and regular exercise are all proven to support your menatl health and overall wellness. Start today, get into a good routine and stay with it. You're sure to feel better, both mentally and physically.
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Sleep and Mental Health https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health
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Diet and Mental Health https://nutrition.org/how-to-boost-mental-health-through-better-nutrition/
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Exercise
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How Exercise Can Be As Effective As Antidepressants from Harvard Health
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7 Great Exercises To Ease Depression from Everyday Health
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Half an Hour of Walking a Day Can Ease Symptoms of Depression from Science Alert
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Massage Therapy
Additional
Resources
Support Programs
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The Support Network - Address and promote student mental health and well-being through peer support initiatives in high schools and colleges.
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The Jed Foundation - Protects emotional health and prevents suicide for our nation’s teens and young adults
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Peer-to-Peer - Depression awareness and suicide prevention education, training, and support for middle and high school students
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The Mighty - A community to share and interact with others going through mental health issues
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You Are Not Alone from NAMI - A forum for users to read and share their personal stories
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Stigma-Free Society - A resource for parents, guardians, and caregivers to talk to their teens about mental wellbeing
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The 7 Best Online Therapy and Mental Health Support Options for Teens for 2022
Blogs
Videos
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How to Repair the Brain Through Healthy Living from Dr. Daniel Amen
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7 Best TED Talks on Mindfulness https://www.happierhuman.com/ted-talks-mindfulness/
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The Power of Exercise on Your Brain https://www.ted.com/talks/lauren_parsons_snack_on_exercise_boost_your_mind_body_and_mood
Books
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The Anxiety and Depression Workbook: Simple, Effective CBT Techniques to Manage Moods and Feel Better Now by Michael A. Tompkins PhD ABPP
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The Listening Cure: Healing Secrets of an Unconventional Doctor
Articles
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3 Things Your College Kid Must Know About Mental Health from Anxiety And Depression Association of America
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What It's Really Like to Struggle with Anxiety and Depression from The Independent
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12 Surprising Facts About Depression from Everyday Health
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The Benefits of Tai Chi - See how tai chi boost your health and wellbeing from VeryWell Health
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Friendship Bench—A Model for Accessible Mental Health Care from BrainBlogger.com
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Stress, Inflammation, and Microbes: A Moody Trinity Psychological stress leads to physical stress, anxiety, and depression.
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Mental Illness: Brain Disease or Gut Disease? by Psychology Today
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Nutritional Psychiatry: The Gut-Brain Connection from Psychiatric Times
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Foods to Help Fight Depression from Verywell Mind
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The Power of Positive Thinking from Harvard Health Publishing
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Little Treatments Show Big Promise for Youth Psychiatric Problems from MDEdge
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Can Vitamin D Help Treat Depression? from Everyday Health
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Quick Facts on Disruptive Mood Dysregulation Disorder (DMDD) from The Child Mind Institute
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What is Cognitive Behavior Therapy? from Good Therapy
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How to Sleep: Cognitive Behavior Therapy for Insomnia from Psych Education
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What is Dialectical Behavior Therapy (DBT)? from Good Therapy
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Relieving Anxiety: Meditation Neutralizes Thought Polarity from EOC Institute
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Using Hallucinogens as Therapeutic Drugs from VeryWellMind
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Ibogaine for Opiod addiction: https://www.nbcnews.com/health/health-news/little-known-psychedelic-drug-treat-opioid-addiction-kentucky-wants-fi-rcna124062
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https://www.nih.gov/news-events/nih-research-matters/how-psychedelic-drugs-may-help-depression#:
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Ibogaine for Bipolar https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375667/
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963252/
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I Was Paralyzed by Severe Depression. Then Came Ketamine from NYT OpEd
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Psilocybin and Depression from Johns Hopkins
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Psychedelic Ayahuasca Works Against Severe Depression from CNN
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Peer-to-peer Counselors - Demand for college peer counselors is booming from NPR
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Pandemic leads colleges to revise, and improve mental health efforts from The Washington Post
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5 Reasons Group Therapy Is the Best Choice Struggling Teens from Psychology Today
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NYU Langone Health Establishes Center for Psychedelic Medicine
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Could Psilocybin Be Helpful In Bipolar Depression? Is it Safe?
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Evaluating the risk of psilocybin for the treatment of bipolar depression
Websites
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DBSA Wellness Toolbox to help you better communicate with your doctor from DBSA
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Moodgym - An online self-help program designed to help users prevent and manage symptoms of depression and anxiety which teaches skills based on cognitive behavior therapy
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Mental Health Online - Free self-help resources and therapist support
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ThisWayUp - Offers self-paced online courses that teach clinically-proven strategies to help you improve the way you feel
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myCompass - A personalized self-help tool for your mental health
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MindSpot - A digital mental health clinic
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10 Centers for Psychedelic Healing, Therapy, and Exploration
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Healing Maps - A source for accurate and honest information about psychedelic-assisted therapy and qualified providers
Podcasts
Handouts
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Information Sheets & Worksheets from The Centre for Clinical Interventions
Apps
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Headspace - Guided meditations, animations, articles, and videos