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Latest Depression Treatments

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

SSRIs are the most well-known and well-known antidepressants. These antidepressants work by altering the way the brain uses serotonin.

Cognitive behavioral therapy (CBT) helps you change negative thoughts and behaviours such as despair. It's available through the NHS for 8 to 16 sessions.

1. Esketamine

The FDA approved the new treatment for depression in March 2019, a nasal spray called esketamine (brand name Spravato). It is derived from the anesthetic ketamine treatment for depression which has been proven to help in severe cases of depression. The nasal spray is used in conjunction with an oral antidepressant to treat depression that has not responded to standard medications. In one study, 70 percent of people suffering from treatment-resistant depression treated with the drug had a positive response -- a far higher response rate than with the use of an oral antidepressant.

Esketamine is different from conventional antidepressants. It increases the amount of neurotransmitters in the brain that transmit messages between brain cells. The effects aren't immediately apparent. Patients generally feel better after a couple of days but the effects last much longer than with SSRIs or SNRIs. Those can take weeks to months to take effect.

Researchers believe that esketamine improves depression symptoms by strengthening connections between brain cells. In animal studies, esketamine reversed the breakdown of these connections which can be found in depression and chronic stress. It also appears to stimulate the growth of neurons that can help reduce suicidal thoughts and feelings.

Esketamine is distinct from other antidepressants in that it is delivered via nasal spray. This allows it to enter your bloodstream much faster than pills or oral medications. The drug has been proven by studies to reduce depression symptoms within a few hours. In certain instances the effects can be almost immediate.

A recent study that followed patients lithium for treatment resistant depression 16 weeks found that not all patients who began treatment with esketamine were actually in the remission phase. This is disappointing but not surprising, according to Dr. Amit Anand, an expert on ketamine, who was not involved in the study.

At present, esketamine is only available through a clinical trial or private practice. It is not considered a first-line treatment for depression and is typically prescribed when SSRIs or SNRIs have not been effective for a patient suffering from treatment-resistant depression. The doctor can determine whether the disorder is resistant to treatment, and then determine whether esketamine might be beneficial.

2. TMS

TMS uses magnetic fields to stimulate neurons in the brain. It is non-invasive, doesn't require surgery or anesthesia and has been shown to improve depression in people who are not responding to medication or psychotherapy. It is also used to treat obsessive compulsive disorder (OCD) and tinnitus.

TMS treatment for depression is typically delivered in a series of 36 daily treatments spread out over six weeks. The magnetic pulses feel like a series of pinpricks on the scalp, and may require some time to get used to. After the treatment, patients are able to return to work or at home. 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 each other. This process, known as neuroplasticity, enables the brain to form new connections and to modify its function.

At present, TMS is FDA-cleared to treat depression when other therapies like talk therapy or medication, have not worked. It has also been shown to help people with tinnitus, OCD and pain. And scientists are exploring whether it could be used to treat anxiety and Parkinson's disease.

Although a number of different studies have shown that TMS can improve depression but not everyone who gets the treatment will experience a positive effect. It is important that you undergo a thorough psychiatric as well as medical examination prior to attempting this kind of treatment. TMS is not suitable for you when you have a history of or certain medications.

Talking to your doctor may be beneficial if you are suffering from depression, but are not experiencing any positive results from the treatment you are currently receiving. You may be a suitable candidate to try TMS or other forms of neurostimulation but you should try several antidepressants before insurance coverage covers the cost. Contact us today to arrange a consultation to learn more. Our specialists can assist you in the process of determining if TMS is the best natural treatment for depression option for you.

3. Deep brain stimulation

For people with treatment-resistant depression, a noninvasive therapy that resets brain circuitry can be effective in less than a week. Researchers have come up with new methods that allow them to deliver high-dose electromagnetic pulses to the brain in a shorter period of time and on a schedule that is more manageable for patients.

Stanford neuromodulation therapy (SNT), that is now available at the UC Davis Department of Psychiatry and Behavioral Sciences' Advanced Psychiatric Therapeutics Clinic makes use of MRI imaging to direct electrodes that transmit magnetic pulses to the targeted brain regions. In a study conducted recently, Mitra and Raichle discovered that in three-quarters (75%) of patients with depression, the usual flow of neural activity from the anterior cingulate cortex and the anterior insula was interrupted. SNT restored that flow back to normal within a few days, which coincided perfectly with the end of their depression.

Deep brain stimulation (DBS) is an even more extensive procedure, can cause similar results in some patients. After a series of tests to determine the most appropriate place for the implant, neurosurgeons can insert one or more wires, referred to as leads, in the brain. The leads are connected with a neurostimulator, which is inserted under the collarbone and appears like an electronic pacemaker. The device provides an uninterrupted electric current through the leads. This alters the brain's natural circuitry, which reduces depression symptoms.

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

Antidepressants are still the cornerstone of depression treatment. In recent times, however there have been significant advancements in the speed at which 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 treatments employ magnetic or electric stimulation to stimulate the brain, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). These are more complicated procedures that need to be performed under the supervision of a physician. In some instances, they could cause seizures or other serious adverse effects.

4. Light therapy

Bright light therapy, which is sitting or working in front of a bright artificial light source, has been used for a long time to treat major depressive disorder with seasonal patterns (SAD). Studies have shown that it can ease symptoms such as fatigue and sadness by controlling circadian rhythm patterns and enhancing mood. It is also a great option for those who experience depression that is intermittently present.

Light therapy mimics sunlight, which is a major component of a biological clock known as suprachiasmatic (SCN). The SCN is linked to mood, and lighttherapy can rewire circadian rhythm patterns which can cause depression. Light can also reduce Melatonin levels and help 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's similar to SAD but is less common and is only seen in months when there is the least amount of daylight. They suggest sitting in front of a light therapy device each morning for 30 minutes while awake to get the maximum benefits. Light therapy produces results in a week, unlike antidepressants that can take a few weeks to begin working and can cause adverse effects like nausea or weight gain. It is also safe for pregnant women as well as older adults.

However, some research experts warn that one should not try light therapy without consulting of psychiatrists or a mental health professional, because it can trigger a manic episode in bipolar disorder sufferers. It can also make people feel tired in the first week of treatment as it can reset their sleep-wake patterns.

PCPs need to be aware of new treatments that have been approved by the FDA. However they shouldn't be ignoring tried-and-true methods like antidepressants or cognitive behavioral therapy. "The quest for more effective and innovative treatments is exciting, but we should keep focusing on the most effective treatments," Dr. Hellerstein informs Healio. He suggests PCPs must educate their patients on the benefits of new treatments and help them stick with their treatment plans. This could include arranging for transportation to their doctor's appointment or setting up reminders to take medication and attend therapy sessions.