5 Clarifications On Latest Depression Treatments
Latest Depression Treatments
If your depression doesn't get better by taking antidepressants or psychotherapy new medications that work quickly may be able treat depression resistant to treatment.
SSRIs are the most common and well-known antidepressants. They affect the way that the brain processes serotonin.
Cognitive behavioral therapy (CBT) is also referred to as cognitive behavior therapy, assists you in changing negative thoughts and behavior such as hopelessness. It's available on the NHS for 8 to 16 sessions.
1. Esketamine
In March 2019 the FDA approved a new nasal spray for depression, called esketamine. (Brand name Spravato). It is derived from the anesthetic, ketamine. This has been shown to be effective in severe depression. The nasal spray is applied in conjunction with an oral antidepressant to treat depression that isn't responding to standard medication. In one study 70% of patients with depression that was resistant to treatment received this medication did well - a more rapid response rate than taking an oral antidepressant.
Esketamine acts differently than conventional antidepressants. It raises the levels of neurotransmitters in the brain that transmit messages between brain cells. The results aren't immediate. Patients typically feel better after a few days, but effects last longer than SSRIs and SNRIs.
Researchers believe that esketamine helps reduce depression symptoms by strengthening brain cell connections. In animal studies, esketamine reversed the breakdown of these connections that can be found during depression and stress. It also appears to stimulate the growth of neurons that can help reduce suicidal thoughts and feelings.
Another reason why esketamine is distinct from other antidepressants is the fact that it is delivered via nasal sprays, which allows it to get into the bloodstream much faster than a pill or oral medication would. It has been proven to decrease depression symptoms within a matter of hours, and in certain individuals the effects are nearly instantaneous.
A recent study that tracked patients for 16 weeks found that not all patients who began treatment 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.
For now, esketamine is only available through an experimental clinical trial program or private practices. Esketamine is not a first-line option to treat depression. It is prescribed when SSRIs and SNRIs don't work for a patient with treatment-resistant depressive disorder. A doctor for a patient can determine if their condition is not responding to treatment and determine if the use of esketamine is beneficial.
2. TMS
TMS uses magnetic fields to stimulate neurons in the brain. It is noninvasive, does not require anesthesia or surgery and has been shown to improve depression for people who are not responding to medication or psychotherapy. It's also been used to treat obsessive-compulsive disorders and tinnitus (ringing in the ears).
TMS treatment for depression is usually delivered in a series of 36 daily treatments spread over six weeks. The magnetic pulses feel like pinpricks that are placed on the scalp and can take a bit of getting used to. Patients can return to their work or home after a treatment session. Each TMS session lasts between 3.5 minutes and 20 minutes, depending on the stimulation pattern.
Researchers believe that rTMS works by changing the way neurons communicate with one another. This process is referred to as neuroplasticity. It allows the brain to form new connections and change how it functions.
At present, TMS is FDA-cleared to treat depression when other treatments, including talk therapy and medications, haven't succeeded. It has also been shown to help people with tinnitus, OCD and pain. Scientists are currently examining whether it could also be used to treat anxiety and Parkinson's disease.
TMS has been shown to reduce depression in numerous studies, however not all who receives it benefit. It is important that you undergo a thorough psychiatric and medical examination prior to attempting this kind of treatment. If you have an history of seizures or are taking certain medications, TMS might not be the best option for you.
A conversation with your doctor can be beneficial if struggling with depression but not seeing any benefits from your current treatment. You may be a suitable candidate for a trial of TMS or other forms of neurostimulation but you need to try various antidepressants before insurance coverage can cover the cost. If you're interested in learning more about these life-changing treatments, call us today for a consultation. Our specialists will guide you in the decision of whether TMS treatment is right for you.
3. Deep brain stimulation
A noninvasive therapy that resets the brain's circuitry may be efficient in just one week for people with depression that is resistant to treatment. Researchers have developed new techniques that enable them to deliver high-dose magnetic impulses to the brain in a shorter amount of time and at a frequency that is more adaptable for patients.
Stanford neuromodulation therapy (SNT) SNT, which is now available 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 in the brain. In a recent study, Mitra & Raichle found in three quarters of patients suffering from depression that the normal neural activity was reversed from the anterior cortex to the anterior cortex. SNT returned the flow back to normal within a couple of days, and it was perfectly timed with the end of depression.
A more in-depth procedure known as deep brain stimulation (DBS) can yield similar results in certain patients. After an array of tests to determine the most appropriate location, neurosurgeons insert one or more wires, referred to as leads, in the brain. The leads are connected to a neurostimulator that is implanted under the collarbone, which appears to be a heart-pacemaker. The device delivers continuous electrical current to the leads which alters the brain's natural circuitry and reduces depression symptoms.
Certain psychotherapy therapies, such as cognitive behavioral therapy and inter-personal therapy may also relieve depression symptoms. Psychotherapy can be provided in one-on-one sessions with a mental health professional, or in a group setting. Some therapy providers offer the option of telehealth.
Antidepressants remain the primarystay of depression treatment. In recent times, however, there have also been notable improvements in how quickly 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 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 need to be performed under a physician's care. In some cases they may cause seizures or other serious adverse effects.
4. Light therapy
Bright light therapy, which is sitting or working in front of an artificial light source, has been proven for many years to treat major depression and alcohol treatment disorder through seasonal depression treatment patterns (SAD). Research has shown that bright light therapy can decrease symptoms such as sadness and fatigue by improving mood and controlling circadian rhythms. It also aids those who suffer from depression that is sporadic.
Light therapy works by mimicking sunlight, a key component of the biological clock called the suprachiasmatic nucleus (SCN). The SCN is linked to mood, and light therapy may rewire circadian rhythm patterns which can cause depression. Light can also reduce melatonin and restore the function of neurotransmitters.
Some doctors are also using light therapy to treat a less severe form of depression referred to as winter blues. It is similar to SAD but is less common and is only seen in months when there is the least amount of daylight. They recommend sitting in the light therapy device each morning for 30 minutes while awake to get the maximum benefit. Contrary to antidepressants, which may take weeks to work and can often cause side effects like nausea or weight gain, light therapy can produce results in just one week. It's also safe during pregnancy and for older adults.
Researchers caution against using light therapy under the supervision of an expert in mental health or psychiatrist, as it can trigger manic episodes in people who suffer from bipolar disorders. It may also make some sufferers feel tired during the first line treatment for depression and anxiety week of treatment due to the fact meds that treat anxiety and depression it could alter their sleep-wake patterns.
PCPs must be aware of new treatments that have been approved by the FDA however, they shouldn't neglect tried-and-true methods such as antidepressants and cognitive behavioral therapy. "The pursuit of newer and better is exciting, but we should keep focusing on the most effective treatments," Dr. Hellerstein says to Healio. He says PCPs need to educate their patients on the benefits of new treatments as well as aid them in sticking with their treatment plans. This may include providing transportation to the doctor's office, or setting reminders for patients to take their medications and attend therapy sessions.
