Latest Depression Treatments
The good news is that if your depression does not improve after psychotherapy and antidepressants, new fast-acting drugs are promising for treating depression that is resistant to treatment.
SSRIs are the most popular and well-known antidepressants. These antidepressants work by altering the way the brain uses serotonin.
Cognitive behavioral therapy (CBT) assists you in changing negative thoughts and behaviors like hopelessness. It's available through the NHS for 8 to 16 sessions.
1. Esketamine
The FDA approved a new treatment for depression in March of 2019 which is a nasal spray dubbed esketamine (brand name Spravato). It is created from the anesthetic drug ketamine that has been proven to help in severe cases of depression. The nasal spray works with an oral antidepressant in order to treat depression that hasn't responded to standard medications. In one study 70% of patients with depression that was resistant to treatment were given this drug were able to respond well, which is a significantly higher response rate than just taking an oral antidepressant.
Esketamine is different from standard antidepressants. It boosts the levels of naturally occurring chemicals in the brain, referred to as neurotransmitters, that relay messages between brain cells. The results aren't immediate. Patients usually feel better after a couple of days, but the effects last longer than SSRIs and SNRIs.
Researchers believe that esketamine reduces depression symptoms through strengthening connections between brain cells. In animal studies, esketamine reversed these connections that can be broken down due to depression and stress. Additionally, it appears to boost the growth of neurons that can help reduce suicidal thoughts and feelings.
Esketamine differs from other antidepressants due to the fact that it is administered via nasal spray. This allows it to reach your bloodstream faster than pill or oral medication. It has been demonstrated by studies to decrease depression symptoms within a matter of hours. In some cases the effects can be immediate.
However, the results of a recent study that tracked patients for 16 weeks showed that not all patients who began treatment with esketamine remained in Remission. This is a bit disappointing, but not surprising according to Dr. Amit A. Anand, a ketamine expert who was not involved in the study.
At present, esketamine is only available through an experimental clinical trial program or private practice. Esketamine is not a primary option to treat depression. It is prescribed when SSRIs and SNRIs fail to help a patient suffering from treatment-resistant depression. Doctors can determine if the condition 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 noninvasive, doesn't require surgery or anesthesia and has been proven to reduce depression in those who don't respond to psychotherapy or medication. It is also used to treat obsessive-compulsive disorder (OCD) and tinnitus.
For depression, TMS therapy is typically given as a series of daily treatments spread over six weeks. The magnetic pulses feel similar to a series of pinpricks on the scalp, and may be a little difficult to get used to. After the treatment, patients are able to return to work or home. Based on the type of stimulation used, each TMS session can last between 3.5 and 20 minutes.
Researchers believe that rTMS alters the way that neurons communicate. This process is known as neuroplasticity. It allows the brain to form new connections and alter the way it operates.
TMS is FDA approved for treating depression in cases when other treatments like talk therapy and medication have not worked. It has also been proven to aid people suffering from tinnitus, OCD and pain. Researchers are examining whether it can be used to treat Parkinson's disease.
While a variety of studies have proven that TMS can improve depression but not everyone who gets the treatment will experience a positive effect. Before attempting this type of treatment, it's important to undergo an exhaustive medical and psychiatric evaluation. TMS is not for you if you have a history or certain medications.
If you've been suffering from depression and aren't experiencing the benefits of your current treatment plan, a chat with your psychiatrist may be helpful. You may be a suitable candidate to try TMS or other forms of neurostimulation, however, you must test various antidepressants before insurance coverage can cover the cost. If you're interested in learning more about these life-changing treatments, call us now for a free consultation. Our specialists can help you through the process of determining whether TMS is the right option for you.
3. Deep brain stimulation
For people suffering from depression that is resistant to treatment, a non-invasive treatment that rewires brain circuits can be effective in less than one week. Researchers have developed new techniques that allow them to deliver high-dose magnetic pulses to the brain in a shorter period of time and at a frequency that is more adaptable 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, uses MRI images to guide electrodes to deliver magnetic pulses to targeted areas of the brain. In a study conducted recently, Mitra & Raichle found that in three quarters (or more) of patients suffering from depression, the normal neural activity was disrupted, shifting from the anterior cortex to the anterior isola. With SNT the flow of neural activity returned to normal within a week, coinciding with a reduction in their depression.
A more invasive technique called deep brain stimulation (DBS) can produce similar results in some patients. After several tests to determine the best location, neurosurgeons insert one or more wires, known as leads, into the brain. The leads are connected by the neurostimulator. It is inserted beneath the collarbone and looks like a pacemaker. The device delivers continuous electrical current to the leads, which alters the brain's circuitry and reduces depression symptoms.
Some psychotherapy treatments may also help alleviate depression symptoms, such as cognitive behavior therapy and interpersonal therapy. Psychotherapy can be provided in one-on-one sessions with an expert in mental health or in group settings. Some therapists also offer telehealth services.
Antidepressants are still the cornerstone of treatment for depression. In recent times, however there have been significant improvements 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 employ magnetic or electric stimulation to stimulate the brain, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). These are more complex procedures that must be done under the supervision of a doctor. In some instances, they could cause seizures and other serious adverse side effects.
4. Light therapy
Bright light therapy consists of sitting or standing in front of a bright light source. depression counseling www.iampsychiatry.com has been used for a number of years to treat seasonal depression and major depressive disorder (SAD). Research suggests that bright light therapy can decrease symptoms like fatigue and sadness by boosting mood and regulating the circadian rhythms. It is also a great option for those who suffer from depression, which is intermittently present.
Light therapy mimics sunlight, a key element of the biological clock referred to as the suprachiasmatic nucleus (SCN). The SCN is linked to mood, and light therapy may alter the patterns of circadian rhythms that can contribute to depression. Additionally, light therapy can reduce melatonin levels and restore the function of neurotransmitters.
Some doctors utilize light therapy to treat winter blues. This is a milder type of depression that is similar to SAD but affects fewer individuals and is more prevalent during the times of year when there is the least amount light. To achieve the most effective results, they suggest that you sit in front of the light therapy box for 30 minutes every morning while awake. Light therapy can produce results within a week, unlike antidepressants, which can take a few weeks to begin working and can cause negative side effects, such as nausea or weight increase. It is also safe for pregnant women as well as older adults.
However, some research experts warn that one should never try light therapy without consulting of psychiatrists or a mental health professional, as it could cause a manic episode for people with bipolar disorder. Some people may experience fatigue in the first week because light therapy can reset their sleep-wake patterns.
PCPs must be aware of the latest treatments that have been approved by the FDA. However they shouldn't dismiss tried-and-true methods like antidepressants or cognitive behavioral therapy. Dr. Hellerstein told Healio that while the search for newer and better treatments is exciting, we should focus on the most well-established treatments. He suggests PCPs should educate their patients on the advantages of new treatments and help them stick with their treatment plans. This could include offering transportation to the doctor's office or setting reminders for them to take their medication and attend therapy sessions.