Latest Depression Treatments
If your depression doesn't get better through psychotherapy and antidepressants new medications that work quickly may be able to treat treatment-resistant depression.
SSRIs, or selective serotonin reuptake inhibitors, are the most commonly prescribed and well-known antidepressants. They work by altering how the brain processes serotonin, an important chemical messenger.
Cognitive behavioral therapy (CBT) assists you in changing negative thoughts and behavior like hopelessness. It is available on the NHS for 8 to 16 sessions.
1. Esketamine
The FDA approved a new treatment for depression in March 2019 nasal spray known as esketamine (brand name Spravato). It is derived the anesthetic ketamine. This has been shown to be effective in severe depression. The nasal spray works with an oral antidepressant in order to treat depression that hasn't responded to standard medication. In one study 70 percent of patients with depression that was resistant to treatment treated with the drug showed good results with a much higher response rate than with just an oral antidepressant.
Esketamine is different from standard antidepressants. It increases the amount of neurotransmitters in the brain that transmit messages between brain cells. The results aren't immediate. Patients typically feel a little better after a couple of days however, the effects last for a longer time than SSRIs or SNRIs. Those can take weeks to months to show results.
Researchers believe that esketamine reduces symptoms of depression by enhancing the connections between brain cells. In animal studies, esketamine reversed the breakdown of these connections that can be found during depression and stress. In addition, it seems to boost the development of neurons that aid in reducing suicidal thoughts and feelings.
Another reason esketamine is different from other antidepressants is the fact that it is delivered via an nasal spray, which allows it to reach the bloodstream faster than pills or oral medication would. It has been demonstrated by studies to reduce depression symptoms within a matter of hours. In some cases the effects may be immediate.
A recent study that tracked patients for 16 weeks found that not all patients who started treatment with esketamine were in Remission. This is disappointing, but not surprising, according to Dr. Amit A. Anand, a ketamine expert who was not involved in the study.
For now, esketamine is only available through the clinical trial program or private practice. It is not considered a first-line treatment for depression and is typically prescribed only when SSRIs or SNRIs haven't worked for a person with treatment-resistant depression. The doctor can determine whether the disorder is resistant to treatment and then decide whether esketamine may be beneficial.
2. TMS
TMS uses magnetic fields in order to stimulate brain nerve cells. It is non-invasive, doesn't require surgery or anesthesia and has been proven to improve depression in those who don't respond to medication or psychotherapy. It is also used to treat the disorder of obsessive compulsiveness and tinnitus (ringing in the ears).
TMS therapy for depression is usually delivered in a series 36 daily treatments spread out over six weeks. The magnetic pulses feel similar to pinpricks that are placed on the scalp, and may require some time to get used to. After the treatment, patients are able to return to work or go home. Based on the stimulation pattern employed, each TMS session can last between 3.5 and 20 minutes.
Researchers believe that rTMS can alter the way that neurons communicate. This process is known as neuroplasticity and allows the brain to form new connections and change how it functions.
Presently, TMS is FDA-cleared to treat depression when other therapies such as talk therapy and medication, have not worked. It has also been proven be effective in treating tinnitus as well as OCD. Scientists are currently examining whether it can be used to treat anxiety and Parkinson's disease.
TMS has been shown to help with depression in a number studies, however not all who receives it will benefit. Before attempting this type of treatment, it is essential to undergo a thorough mental and medical evaluation. If you have any history of seizures or are taking certain medications, TMS may not be the best option for you.
A visit to your doctor can be beneficial if suffering from depression, but are not seeing any benefits from the treatment you are currently receiving. You could be a good candidate to try TMS or other forms of neurostimulation but you need to try several antidepressants first before insurance coverage covers the cost. Contact us today to set up an appointment to learn more. Our experts will assist you through the process of determining if TMS treatment is right for you.
3. Deep stimulation of the brain
For people with treatment-resistant depression, a noninvasive therapy that resets brain circuitry can be effective in just one week. Researchers have devised new methods that permit them to deliver high-dose magnetic pulses to the brain in a shorter amount of time and on a schedule that is more suitable for patients.
Stanford neuromodulation therapy, which is currently available in the Advanced Psychiatric Therapeutics Clinic at the UC Davis Department of Psychiatry and Behavioral Sciences utilizes MRI images to guide electrodes to send magnetic impulses to targeted areas of the brain. In a study conducted recently, Mitra and Raichle observed that in three-quarters of people with depression, the usual flow of neural activity from the anterior cingulate cortex and the anterior insula was reversed. With SNT this flow was restored to normal within a week, which coincided with a reduction in their depression.
Deep brain stimulation (DBS) is an invasive procedure, may produce similar results in some patients. Neurosurgeons will perform a series tests to determine the most appropriate placement before implanting one or more leads into the brain. The leads are connected to a nerve stimulator implanted beneath the collarbone, which looks like a heart pacemaker. The device provides continuous electric current to the leads which alters the brain's circuitry and reduces depression symptoms.
Some psychotherapy treatments may also aid in reducing depression symptoms, including cognitive therapy for behavioral disorders and interpersonal therapy. Psychotherapy can be conducted in a group setting or in one-onone sessions with a mental health professional. Some psychotherapists provide the option of telehealth.
Antidepressants remain a cornerstone of treatment for depression, and in recent times there have been significant advances in how quickly these medications can work to lift depressive symptoms. 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 use magnetic or electric stimulation to stimulate the brain, like electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). These are more involved procedures that require a doctor's supervision. In some instances they can trigger seizures or other serious side effects.
4. Light therapy
Bright light therapy consists of sitting or standing in front of an artificially bright light source. This therapy has been used for a number of years to treat seasonal depression and major depressive disorder (SAD). Research has shown that it can ease symptoms like fatigue and sadness by regulating the circadian rhythm and improving mood. It can also help people who experience depression that comes and goes.
Light therapy mimics sunlight, which is an essential element of a biological clock referred to as suprachiasmatic (SCN). The SCN is linked to mood, and lighttherapy can alter circadian rhythm patterns that can cause depression. Light therapy can also decrease melatonin and restore the function of neurotransmitters.
Some doctors use light therapy to combat winter blues. This is a milder version of depression that is similar to SAD however it affects fewer individuals and occurs during the seasons that have the least amount of sunlight. To achieve the best results, they suggest you sit in front of the box for 30 minutes every morning while awake. Light therapy can produce results within a week, unlike antidepressants that can take weeks to kick in and may cause negative side effects, such as nausea or weight gain. It's also safe to use during pregnancy and for older adults.
However, some researchers warn that one should not attempt light therapy without consulting of a psychiatrist or mental health professional, as it could cause a manic episode in bipolar disorder sufferers. advanced depression treatment may feel tired within the first week due to the fact that light therapy can alter their sleep-wake cycle.
PCPs must be aware of any new treatments that have been approved by FDA. However they shouldn't be ignoring tried-and-true methods like antidepressants or cognitive behavioral therapy. "The pursuit of newer and better treatments is exciting, but we must continue to focus on the most well-established therapies," Dr. Hellerstein informs Healio. He suggests that PCPs should concentrate on informing their patients about the benefits of the latest treatments and help them stick to their treatment plans. This can include arranging for transportation to their doctor's office or setting up reminders to take medications and attend therapy sessions.