Latest Depression Treatments
The good news is that, if your depression doesn’t improve with psychotherapy and antidepressants, new fast-acting drugs show promise for treating depression treatment-resistant depression.
SSRIs, or selective serotonin reuptake inhibitors, are the most commonly prescribed and well-known antidepressants. These antidepressants work by altering the way the brain uses serotonin.
Cognitive behavioral therapy (CBT), also known as cognitive behavioral therapy assists you in changing negative thoughts and behavior such as despair. The NHS offers 8 to 16 sessions.
1. Esketamine
The FDA approved a new treatment for depression in March of 2019, a nasal spray called esketamine (brand name Spravato). It is derived from the anesthetic ketamine, which has been shown to help in severe cases of depression. The nasal spray is used in conjunction alongside an oral antidepressant to treat depression that has not responded to standard medications. In one study, 70 percent of people with depression that was resistant to holistic treatment for depression given the drug responded well — a far more rapid response rate than the use of an oral antidepressant.
Esketamine is different from standard antidepressants. It boosts the levels of naturally occurring chemical in the brain, referred to as neurotransmitters. These chemicals transmit messages between brain cells. The effects aren’t immediate. Patients usually feel better after a couple of days, but the effects last much longer than SSRIs or SNRIs, which may take weeks or even months to take effect.
Researchers believe that esketamine reduces depression symptoms by enhancing connections between brain cells. In animal studies, esketamine reversed the breakdown of these connections that could be found in chronic stress and depression. It also appears to boost the growth of neurons that can aid in reducing suicidal thoughts and feelings.
Esketamine is distinct from other antidepressants because it is delivered via nasal spray. This allows it to get into your bloodstream faster than pill or oral medication. It has been demonstrated in studies to lessen depression symptoms within a few hours. In some cases, the effects can be immediate.
A recent study that tracked patients for 16 weeks found that not all who began treatment resistant anxiety and depression with esketamine had reached Remission. This is disappointing but not surprising, according to Dr. Amit Anand, an expert on ketamine, who was not part of the study.
Esketamine is only available in clinical trials or in private depression treatment practice. Esketamine is not a first-line treatment for depression. It is prescribed when SSRIs and SNRIs fail to help a patient suffering from treatment-resistant depressive disorder. A patient’s doctor will determine if the disorder is not responding to treatment and determine if it is possible to use esketamine for treatment.
2. TMS
TMS employs magnetic fields to stimulate brain nerve cells. It is non-invasive, doesn’t require surgery or anesthesia and has been shown to improve depression for people who do not respond to medication or psychotherapy. It’s also been used to treat the disorder of obsessive compulsiveness and tinnitus (ringing in the ears).
For depression, TMS therapy is typically administered as a series of 36 daily treatments over six weeks. The magnetic pulses feel similar to pinpricks that are placed on the scalp and can take a bit of getting used to. Patients can return to workplace and go home straight after a treatment. Depending on the stimulation pattern employed the session TMS session lasts between 3.5 and 20 minutes.
Scientists believe that rTMS changes the way neurons communicate. This process, referred to as neuroplasticity, allows the brain to establish new connections and change its function.
At present, TMS is FDA-cleared to treat depression when other therapies such as talk therapy and medications, haven’t succeeded. It has also proven to be effective in treating tinnitus as well as OCD. Scientists are currently examining whether it could be used to treat Parkinson’s disease.
Although a number of different studies have shown that TMS can improve depression however, not everyone who receives the treatment will experience a positive effect. It is important that you have a thorough psychiatric and medical evaluation before trying this treatment. If you have any history of seizures or are taking certain medications, TMS might not be suitable for you.
A visit to your doctor can be beneficial if you’re struggling with depression but not seeing any benefits from your current treatment. You could be a good candidate for a trial of TMS or other forms of neurostimulation, however, you must test various antidepressants before insurance coverage will cover the cost. If you’re interested in knowing more about these life-changing treatments, contact us today to schedule a consultation. Our experts will assist you through the process of determining if TMS treatment is right for you.
3. Deep brain stimulation
A non-invasive therapy that rewires the brain’s circuitry could be effective in as little as one week for people with depression that is resistant to treatment. Researchers have devised new methods that allow them to deliver high-dose magnetic impulses to the brain in a shorter time and on a schedule that is more adaptable for patients.
Stanford neuromodulation therapy (SNT) SNT, which is now offered at the UC Davis Department of Psychiatry and Behavioral Sciences’ Advanced Psychiatric Therapeutics Clinic makes use of MRI imaging to guide electrodes which send magnetic pulses to targeted areas of the brain. In a recent study, Mitra and Raichle discovered that in three-quarters of patients suffering from Depression treatment without Medication, the normal flow of neural activity from the anterior cingulate cortex to the posterior insula was disrupted. With SNT, that flow returned to normal within a week, and coincided with a lifting of their depression.
A more invasive procedure called deep brain stimulation (DBS) can yield similar results in some patients. Neurosurgeons perform a series of tests to determine the ideal place to implant one or more leads into the brain. The leads are connected to a nerve stimulator implanted beneath the collarbone, which appears like a heart pacemaker. The device provides an uninterrupted electric current through the leads. This alters the brain’s natural circuitry, reducing depression symptoms.
Some psychotherapy treatments may also help relieve depression symptoms, such as cognitive therapy for behavioral disorders and interpersonal therapy. Psychotherapy can be done in a group setting or in one-onone sessions with a mental healthcare professional. Some therapists also offer telehealth services.
Antidepressants are still the cornerstone of depression treatment. In recent years, however, there have been significant improvements in how quickly they can alleviate 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, for example electroconvulsive therapy (ect treatment for depression and anxiety) and repetitive transcranial magnetic stimulation (rTMS). These are more involved procedures that require under the supervision of a physician. In some instances they may cause seizures or other serious adverse side effects.
4. Light therapy
Bright light therapy consists of sitting or standing in front of a bright light source. This therapy has been used for a number of years to treat seasonal depression as well as major depressive disorder (SAD). Studies have shown that it can ease symptoms like sadness and fatigue by regulating circadian rhythm patterns and improving mood. It is also a great option for those who suffer from depression that is intermittently present.
Light therapy works by mimicking sunlight, a key element of the biological clock referred to as the suprachiasmatic nucleus (SCN). The SCN is associated with mood, and lighttherapy can alter circadian rhythm patterns that can cause depression. Light can also reduce the production of melatonin and improve the function of neurotransmitters.
Some doctors are also using light therapy to treat a less severe form of depression known as winter blues, which is similar to SAD but is less common and only happens in the months with the least daylight. They suggest sitting in the light therapy device each morning for 30 minutes while awake to get the most benefit. In contrast to antidepressants that can take weeks to begin working and often cause side effects such as nausea or weight gain light therapy can provide results within a week. It’s also safe to use during pregnancy and for those who are older.
Researchers advise against using light therapy under the supervision of a mental health professional or psychiatrist, since it can cause manic episodes in those who suffer from bipolar disorders. It can also make people feel tired in the first week of treatment due to the fact that it can alter their sleep and wake patterns.
PCPs need to be aware of any new treatments approved by the FDA. However they shouldn’t dismiss the tried-and-true techniques like antidepressants or cognitive behavioral therapy. “The quest for newer and better is exciting, but we must continue to focus on the most well-established treatments,” Dr. Hellerstein informs Healio. He says PCPs should focus on educating their patients about the benefits of the latest treatments and help them adhere to their treatment strategies. This could include arranging transportation to the doctor’s office, or setting reminders for patients to take their medications and attend therapy sessions.
