It makes sense to split depression off into categories for various reasons. A woman whose mother encouraged her stepfather to rape her for years is depressed for an entirely different reason from someone who has a problem with inflammation.

The rape victim needs trauma informed therapy with a therapist, neurofeedback, meditation training or mechanically assisted meditation. That process will go on for years as she is gradually assisted into a new kind of adulthood that isn't so reactive and has more shades of grey. After significant progress is made and she is at least into Response, then it's time to think about an SSRI and the tiny little bit of good it will do that would otherwise have been completely lost in the noise of therapy.

The inflammation patient should have an anti inflammatory treatment including diet, possibly antibiotics, possibly probiotics, possibly have their dental work looked at to see whether there is a pocket of infection somewhere buried in a root canal or a bridge. Or it could be perfectly obvious rheumatoid arthritis. Or it could be something else, but I would be looking at medical causes for the inflammation rather than life history.

Another possibility for the depressed and anxious patient is a problem with methylation. Methylation problems are solved with methylation solutions, such as niacin or SAMe. There is also Deplin and a couple other prescription medical foods, but I'm not so sure of the research behind them.

In terms of EEG usage, the Antidepressant Treatment Response Index is good at separating people who are responding medically to a medication vs the placebo response, and can pick out people who are not responding and who should switch medications to a completely different mechanism of action.

Another EEG solution is to take an rEEG of a patient and ship it to MYnd Analytics to have it matched against a database of past scans to see what medications worked for people with a very similar scan.

Some people would rather make lifestyle modifications rather than take a medication for the rest of their lives. For them, try Steven Ilardi's six step plan and see whether they can get going that way.

I have had some success with cranial electrotherapy, heart rate variability training, audio-visual entrainment, strategic use of light, far infrared sauna, mineral water (which contains a bit of lithium and boron). I've gotten a lot more mileage out of vitamins than I thought was possible. Vitamin C, D3, magnesium, fish oil, and a B complex do a lot of good for depression. I've had that combination do great things for the negative symptoms of schizophrenia as well.

Sleep maximization is globally helpful. Blue blocker sunglasses worn after dark help the body cope with the abundant artificial blue light all around us and helps us use our natural melatonin for sleep. Using sleep tracker apps on pt's phones is helpful.

There are a lot of ways to go at it.

Most of the time, I wish primary care would just refer instead of figuring citalopram probably wouldn't hurt. The odds of that one being the right one are kind of slim.