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Latest Depression Treatments

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

SSRIs are the most well-known and well-known antidepressants. They work by altering the way that the brain processes serotonin, the chemical messenger.

Cognitive behavioral therapy (CBT), also known as cognitive behavioral therapy helps you to change negative thoughts and behaviors such as despair. The NHS offers 8 to 16 sessions.

1. Esketamine

The FDA approved the new treatment for depression in March of 2019, a nasal spray called esketamine (brand name Spravato). It is created from the anesthetic drug ketamine for treatment resistant depression that has been proven to help in severe cases of depression. The nasal spray is applied in conjunction with an oral antidepressant in cases of depression that hasn't responded to standard medication. In one study 70% of patients with treatment resistant depression who received this medication were able to respond well, which is a significantly more rapid response rate than taking an oral antidepressant.

Esketamine is different from traditional antidepressants. It boosts the levels of naturally occurring chemical in the brain, called neurotransmitters, that relay messages between brain cells. The effects aren't immediate. Patients generally feel better after a few 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 the breakdown of these connections that could be seen in chronic stress and depression. In addition, it seems to stimulate the growth of neurons that can help to reduce suicidal ideas and feelings.

Another reason esketamine stands out from other antidepressants is the fact that it is delivered through a nasal spray, which allows it to get into the bloodstream much faster than pills or oral medication would. The drug has been proven by studies to decrease depression symptoms within a few hours. In some cases the effects may be instantaneous.

A recent study that followed patients for 16 weeks revealed that not all patients who started treatment with esketamine had reached the remission phase. This is not surprising, according to Dr. Amit Anand, an expert on ketamine who was not part of the study.

Esketamine is currently only available in private practice or in clinical trials. It isn't considered a first-line treatment option for depression, and is usually prescribed only when SSRIs or SNRIs haven't worked for a person with treatment-resistant depression. The doctor can determine whether the condition is resistant to treatment and then discuss whether esketamine may be beneficial.

2. TMS

TMS makes use of magnetic fields to stimulate neurons in the brain. It is noninvasive and does not require anesthesia or surgery. It has been proven to aid people suffering from depression who haven't responded to medications or psychotherapy. It is also used to treat obsessive-compulsive disorder 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 can feel like pinpricks in the scalp. It can take time to get used to. Patients can return to work or home after a treatment session. Each TMS session lasts between 3.5 minutes and 20 minutes, based on the stimulation pattern.

Researchers believe that rTMS functions by altering the way neurons communicate with each other. This process is referred to as neuroplasticity, and it lets the brain form new connections and change how it functions.

At present, TMS is FDA-cleared to treat depression when other therapies, including talk therapy and medication, have not worked. It has also been proven to aid people suffering from tinnitus, OCD and pain. And scientists are exploring whether it can be used to treat anxiety and Parkinson's disease.

TMS has been shown to reduce depression in numerous studies, however not every person who receives it will benefit. Before you embark on this treatment, it is important to undergo a thorough medical and psychiatric examination. If you have any history of seizures or are taking certain medications, TMS may not be right for you.

If you have been struggling with depression treatment during pregnancy but aren't experiencing the benefits of your current treatment plan, a chat with your psychiatrist might be helpful. You could be eligible for the TMS trial or other forms neurostimulation. But, you must first try a variety of antidepressants before your insurance will cover the cost. If you're interested in learning more about these life-changing treatments, call us today for a consultation. Our experts will guide you through the process of the decision of whether TMS treatment is right for you.

3. Deep brain stimulation

A non-invasive treatment that resets the brain's circuitry could be effective in as little as one week for people with treatment resistant depression. Researchers have come up with new methods that allow 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 (SNT), that is now available at the UC Davis Department of Psychiatry and Behavioral Sciences' Advanced Psychiatric Therapeutics Clinic, uses MRI imaging to guide electrodes which send magnetic pulses to the targeted brain regions. In a recent study, Mitra & Raichle found that in three quarters (or more) of patients with depression the normal neural activity was reversed from the anterior cortex to the anterior cortex. SNT returned the flow back to normal within a few days, and it was perfectly timed with the end of their depression.

A more invasive procedure called 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 an electrical stimulation device, which is inserted beneath the collarbone. It appears like an electronic pacemaker. The device provides an ongoing electric current through the leads. This alters the brain’s natural circuitry, which reduces depression symptoms.

Certain psychotherapy treatments can aid in reducing depression symptoms, such as cognitive behavior therapy and interpersonal therapy. Psychotherapy can be offered in one-on-one sessions with an expert in mental health or in group settings. Some therapists also provide the option of telehealth services.

Antidepressants remain a cornerstone of treatment for depression, and in recent years, there have been remarkable advances in how quickly these drugs can 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 employ electric or magnetic stimulation to stimulate the brain, for example electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). These are more involved procedures that require the supervision of a doctor. In some instances, they could cause seizures and other serious adverse side effects.

4. Light therapy

Bright light therapy involves sitting or standing in front of an artificially bright light source. This treatment has been used for many years to treat seasonal depression and major depressive disorder (SAD). Studies show that bright light therapy can reduce symptoms like fatigue and sadness by improving mood and controlling the circadian rhythms. It can also help people who suffer from depression, which occurs and disappears.

Light therapy mimics sunlight, a key element of the biological clock known as the suprachiasmatic nucleus (SCN). The SCN is linked to mood, and lighttherapy can alter circadian rhythm patterns that 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 only happens in the months with the least daylight. They recommend sitting in front of a light therapy device each morning for 30 minutes while awake to reap the maximum benefits. Unlike antidepressants, which can take weeks to work and often cause side effects like nausea or weight gain light therapy can provide results in just a week. It is also safe for pregnant women and older adults.

Researchers advise against using light therapy without the supervision of an expert in mental health or psychiatrist, since it may cause manic episodes in those with bipolar disorders. It could also make people feel tired in the first week of treatment because it could alter their sleep-wake patterns.

PCPs should be aware of the new treatments that have been approved by the FDA, but they shouldn't be ignoring tried-and-true approaches like antidepressants and cognitive behavioral therapy. "The pursuit of more effective and innovative treatments is exciting, but we should continue to prioritize the best-established treatments," Dr. Hellerstein says to Healio. He says that PCPs should focus on teaching their patients on the benefits of new options and helping patients adhere to their treatment plans. This may include providing transportation to the doctor's appointment, or setting up reminders to patients to take their medications and attend therapy sessions.