5 Lessons You Can Learn From Latest Depression Treatments
Latest Depression Treatments
The good news is that, if your depression does not improve after treatment with psychotherapy or antidepressants, the latest fast-acting medications offer promise in treating depression resistant to treatment.
SSRIs which are also known as selective serotonin-reuptake inhibitors, are the most frequently prescribed and well-known antidepressants. They work by altering the way that the brain processes serotonin, a chemical messenger.
Cognitive behavioral therapy (CBT) helps you change negative thoughts and behaviors like hopelessness. The NHS offers 8 to 16 sessions.
1. Esketamine
The FDA approved a new treatment for depression in March of 2019 nasal spray known as esketamine (brand name Spravato). It is created from the anesthetic drug ketamine which has been proven to help in severe cases of depression. The nasal spray works alongside an oral antidepressant to treat depression that hasn't responded to standard medication. In one study 70% of patients with depression that was resistant to treatment received this medication were able to respond well, which is a significantly higher response rate than just taking an oral antidepressant.
Esketamine acts differently than conventional antidepressants. It increases the levels of neurotransmitters in the brain that transmit messages between brain cells. The effects aren't immediately apparent. Patients typically feel better within a few days, but the effects last longer than SSRIs and SNRIs.
Researchers believe that esketamine helps alleviate depression symptoms by strengthening the connections between brain cells. In animal studies, esketamine reversed the breakdown of these connections that could be found in depression and chronic stress. It also seems to promote the development of neurons which can decrease suicidal feelings and thoughts.
Esketamine differs from other antidepressants in that it is administered via nasal spray. This allows it to reach your bloodstream much faster than pill or oral medication. The drug has been proven by studies to reduce depression symptoms within a few hours. In some cases the effects may be immediate.
However the results of a study that followed patients over 16 weeks showed that not all who began treatment with esketamine remained in the remission phase. This is a bit disappointing, but not surprising according to Dr. Amit A. Anand, a ketamine expert who was not part of the study.
Esketamine is currently only available through a clinical trial program or private practice. Esketamine isn't a first-line option for treating depression. It is prescribed when SSRIs and SNRIs don't work for a patient with treatment-resistant depression. A patient's doctor can determine if the condition is resistant to treatment and determine if it is possible to use esketamine for treatment.
2. TMS
TMS utilizes magnetic fields to stimulate nerve cells in the brain. It is noninvasive, doesn't require surgery or anesthesia and has been proven to reduce depression for people who do not respond to psychotherapy or medication. It can also be used to treat obsessive compulsive disorder (OCD) and tinnitus.
TMS treatment for depression is typically delivered in a series 36 daily treatments spread over six weeks. The magnetic pulses can feel like pinpricks in the scalp. It could take some time to become used to. Patients are able to return to work and home immediately following a treatment. Based on the type of stimulation used and the stimulation pattern used, each TMS session lasts between 3.5 and 20 minutes.
Scientists believe that rTMS changes the way neurons communicate. This process is known as neuroplasticity, and it allows the brain to form new connections and change the way it functions.
Presently, TMS is FDA-cleared to help with depression when other treatments like talk therapy or medications, haven't succeeded. It has also been proven be effective in treating tinnitus as well as OCD. Researchers are also looking into the possibility of using it to treat Parkinson's disease and anxiety.
Although a number of different studies have found that TMS can improve depression but not everyone who gets the treatment will experience a positive effect. Before you embark on this treatment, it is essential to undergo a thorough mental and medical evaluation. If you have a history of seizures or are taking certain medications, TMS may not be right for you.
A conversation with your doctor could be beneficial if you're struggling with depression but not seeing any benefits from the treatment you are currently receiving. You may be a candidate for a trial of TMS or other forms of neurostimulation, however, you must test several antidepressants before insurance coverage covers the cost. Contact us today to arrange a consultation to learn more about. Our experts can assist you in the process of deciding if TMS is the best option for you.
3. Deep brain stimulation
A noninvasive therapy that resets the brain circuitry could be effective in just one week for those suffering from treatment-resistant depression. Researchers have developed new methods that deliver high-dose electromagnetic waves to the brain faster and at a time that is more manageable for the patients.
Stanford neuromodulation therapy, now available in the Advanced Psychiatric Therapeutics Clinic at the UC Davis Department of Psychiatry and Behavioral Sciences, uses MRI images to direct electrodes to send magnetic impulses to specific areas of the brain. In a recent study, Mitra and Raichle found that in three-quarters (75%) of patients who suffer from depression, the typical flow of neural activity from the anterior cingulate cortex and the anterior insula was interrupted. SNT restored that flow to normal within a couple of days, which coincided perfectly with the easing of their depression.
A more invasive technique called deep brain stimulation (DBS) may produce similar results for some patients. Neurosurgeons will perform a series tests to determine the ideal placement before implanting one or more leads into the brain. The leads are connected to a neurostimulator that is implanted under the collarbone, which looks like a heart pacemaker. The device is able to deliver an ongoing electric current through the leads. This alters the brain's natural circuitry, reducing depression symptoms.
Some psychotherapy treatments may also help alleviate depression symptoms, including cognitive behavioral therapy and interpersonal therapy. Psychotherapy can be done in groups or in one-on-one sessions with an experienced mental health professional. Some therapists also offer the option of telehealth services.
Antidepressants are still the cornerstone of depression treatment. In recent times, however there have also been notable advancements in the speed at which they can relieve symptoms of depression. Newer drugs, such as gepirone (Exxua), esketamine (Spravato), brexanolone (Zulresso) and dextromethorphan-bupropion (Auvelity), all have been shown to work faster than older antidepressants.
Other therapies, such as electroconvulsive treatment (ECT) or repetitive transcranial magnet stimulation (rTMS), use magnetic or electric stimuli to stimulate the brain. These are more complicated procedures that require a doctor's supervision. In some cases they can trigger seizures or other serious side effects.
4. Light therapy
Bright light therapy, which involves working or sitting in front of an artificial light source, has been known for a long time to treat major depression disorder through seasonal patterns (SAD). Studies show that bright light therapy can decrease symptoms like fatigue and sadness by improving mood and controlling circadian rhythm patterns. It can also help those suffering from depression that is intermittent.
Light therapy mimics the sun, which is a major component of a biological clock referred to as suprachiasmatic (SCN). The SCN is associated with mood, and light therapy can rewire misaligned circadian rhythm patterns that may contribute to depression. Light therapy can also lower melatonin and restore the function of neurotransmitters.
Some doctors use light therapy to combat winter blues. This is a milder form of depression that is similar to SAD, but only has fewer people affected and is more prevalent during the times of year that have the least amount of daylight. They recommend sitting in the light therapy box every morning for 30 minutes while awake to get the maximum benefits. Light therapy can produce results within the space of a week, unlike antidepressants which can take a long time to kick in and may cause adverse effects like nausea or weight gain. depression treatment plans 's also safe to use during pregnancy and in older adults.
However, some research experts warn that a person should never experiment with light therapy without the guidance of psychiatrists or a mental health professional, because it can cause a manic episode in those with bipolar disorder. It may also make some people feel tired during the first week of treatment because it can reset their sleep-wake patterns.
PCPs should be aware of the new treatments that have been approved by the FDA, but they shouldn't neglect tried-and-true methods like antidepressants or cognitive behavioral therapy. "The quest for newer and better is exciting, but we must keep focusing on the most effective treatments," Dr. Hellerstein tells Healio. He suggests PCPs should educate their patients on the benefits of new treatments and aid them in sticking with their treatment plans. This can include offering transportation to the doctor's office or setting reminders to take medication and attend therapy sessions.