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Latest Depression Treatments

The good news is that, if your depression does not improve after psychotherapy and antidepressants, new drugs that are fast-acting show promise for treating depression that is resistant to treatment.

SSRIs, or selective serotonin-reuptake inhibitors, are the most commonly prescribed and well-known antidepressants. These antidepressants work by altering the way that the brain utilizes serotonin.

Cognitive behavioral therapy (CBT) assists you in changing negative thoughts and behavior, such as hopelessness. It is available on the NHS for 8 to 16 sessions.

1. Esketamine

In March 2019 the FDA approved a brand 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 used in conjunction with an oral antidepressant for depression that isn't responding to standard medications. In one study, 70% of people with treatment resistant depression who received this medication were able to respond well, which is a significantly higher response rate than just using an oral antidepressant.

Esketamine is different from conventional antidepressants. It increases levels of naturally occurring chemical in the brain, referred to as neurotransmitters. These chemicals transmit messages between brain cells. The results don't come immediately. Patients usually feel better after a couple of days, but the 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 these connections that are damaged by chronic stress and depression. Additionally, it appears to stimulate the development of neurons that could aid in reducing suicidal thoughts and feelings.

Another reason esketamine stands out from other antidepressants is that it is delivered via a nasal spray which allows it to reach the bloodstream more quickly than a pill or oral medication could. The drug has been proven by studies to decrease depression symptoms within a matter of hours. In some instances the effects can be immediate.

However, the results of a study that followed patients over 16 weeks showed that not all who began what treatment for depression with esketamine continued to be in Remission. This is a bit disappointing, but not surprising, according to Dr. Amit A. Anand an expert in ketamine who was not involved with the study.

For now, esketamine is only available through an experimental clinical trial program or private practice. Esketamine is not a first-line option to treat depression. It is prescribed when SSRIs and SNRIs don't be effective for a patient suffering from treatment-resistant depression. The doctor can determine whether the disorder is resistant to treatment and then discuss whether esketamine may be beneficial.

2. TMS

TMS uses magnetic fields in order to stimulate brain nerve cells. It is noninvasive, does not require surgery or anesthesia and has been proven to improve depression in people who don't respond to psychotherapy or medication. It's also been used to treat obsessive-compulsive disorder and tinnitus (ringing in the ear).

For depression, TMS therapy is typically delivered as a series of daily sessions spread over six weeks. The magnetic pulses can feel like pinpricks in the scalp. It may take some time to become accustomed to. After a treatment, patients can return to work or home. Based on the type of stimulation employed and the stimulation pattern used, each TMS session lasts between 3.5 and 20 minutes.

Researchers believe that rTMS works by altering the way neurons communicate with each other. This process, also known as neuroplasticity, enables the brain to form new connections and to change its function.

TMS is FDA approved for treating depression in cases where other therapies such as medication and talk therapy have not worked. It has also been shown to aid people suffering from tinnitus, OCD and pain. And scientists are exploring whether it could be used to treat anxiety and Parkinson's disease.

TMS has been proven to improve depression in numerous studies, however not every person who receives it will benefit. It is crucial to have a thorough psychiatric and medical evaluation prior to beginning this kind of treatment. If you have any history of seizures or are taking certain medications, TMS might not be suitable for you.

If you have been suffering from depression and are not seeing the benefits of your current treatment plan, a chat with your psychiatrist may be helpful. You may be eligible for a TMS trial or other forms neurostimulation. However, you need to first test several antidepressants before your insurance company will cover the cost. If you're interested in learning more about these life-changing treatments, call us today to schedule a consultation. Our specialists can assist you in the process of determining if TMS is the right option for you.

3. Deep stimulation of the brain

A non medical treatment for depression-invasive treatment that resets the brain's circuitry could be effective in just one week for people with treatment resistant depression. Researchers have devised new methods that permit them to deliver high-dose magnetic impulses to the brain in a shorter period of time and on a schedule that is more manageable for patients.

Stanford neuromodulation therapy, which is now available in the Advanced Psychiatric Therapeutics Clinic at the UC Davis Department of Psychiatry and Behavioral Sciences, uses MRI images to guide electrodes to send magnetic impulses to targeted areas of the brain. In a recent study, Mitra & Raichle found in three quarters of patients with depression that the normal flow of neural activity was reversed from the anterior cortex to the anterior isola. SNT returned the flow back to normal within a couple of days, coinciding perfectly with the easing of their depression.

Deep brain stimulation (DBS), a more invasive procedure, can cause similar results in some patients. After several tests to determine the optimal placement, neurosurgeons implant one or more wires, called leads, into the brain. The leads are connected to a neurostimulator that is implanted under the collarbone. It appears to be a heart-pacemaker. The device delivers an ongoing electric current through the leads. This alters the brain's natural circuitry, decreasing depression symptoms.

Certain psychotherapy therapies like cognitive behavioral therapy and inter-personal therapy, can also help alleviate depression symptoms. Psychotherapy can take place in a group setting or in one-onone sessions with a mental healthcare professional. Therapists may also offer the option of telehealth services.

Antidepressants remain a cornerstone of treatment for depression. However, in recent times, there have been remarkable advances in how quickly these medications 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 treatments, such as electroconvulsive treatment (ECT) or repetitive transcranial magnet stimulation (rTMS), use magnetic or electric stimuli to stimulate the brain. These are more involved procedures that require the supervision of a physician. In some cases they can cause seizures or other serious adverse side effects.

4. Light therapy

Bright light therapy involves sitting or standing in front of a bright light source. This therapy has been used for many years to treat seasonal depression as well as major depressive disorder (SAD). Studies show that it can alleviate symptoms such as fatigue and sadness by controlling circadian rhythm patterns and boosting mood. It can also help people who suffer from depression that comes and goes.

Light therapy mimics sunlight, which is a major component of a biological clock referred to as suprachiasmatic (SCN). The SCN is associated with mood, and lighttherapy can rewire circadian rhythm patterns which can trigger depression treatment ect. In addition, light therapy can reduce melatonin levels and restore the functioning of neurotransmitters.

Some doctors utilize light therapy to treat winter blues. This is a milder type of depression that is similar to SAD however it affects fewer individuals and is most prevalent in the months that have the least amount light. They suggest sitting in front of a light therapy box every morning for 30 minutes while awake to get the most benefit. Light therapy can produce results within the space of a week, unlike antidepressants, which can take a few weeks to begin working and may trigger adverse effects like nausea or weight gain. It's also safe to use during pregnancy and for those who are older.

However, some researchers warn that one should never attempt light therapy without the guidance of psychiatrists or a mental health professional, as it can cause a manic episode for people with bipolar disorder. It could also make people feel tired in the first week of treatment due to the fact that it can alter their sleep deprivation treatment for depression and wake patterns.

PCPs should be aware of the new treatments that have been approved by the FDA However, they shouldn't overlook tried-and-true techniques like antidepressants and cognitive behavioral therapy. Dr. Hellerstein told Healio that while the search for better and newer treatments is exciting, we should be focusing on the most established treatments. He says PCPs need to educate their patients about the advantages of new treatments and assist them in sticking to their treatment plans. This may include providing transportation to the doctor's office or setting up reminders for them to take their medication and attend therapy sessions.