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Latest Depression Treatments The good news is that, if your depression doesn't improve after treatment with psychotherapy or antidepressants, new drugs that are fast-acting offer promise in treating treatment-resistant depression. SSRIs, or selective serotonin-reuptake inhibitors, are the most frequently prescribed and well-known antidepressants. They affect the way that the brain processes serotonin. Cognitive behavioral therapy (CBT) assists you in changing negative thoughts and behavior such as despair. The NHS offers 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 the ketamine. It has been proven to be effective in severe depression. The nasal spray is used in conjunction with an oral antidepressant to treat depression that isn't responding to standard medication. In one study 70% of patients suffering from treatment resistant depression who were given this drug responded well – a much greater response rate than using an oral antidepressant. Esketamine is different from conventional antidepressants. It increases levels of naturally occurring chemical in the brain, known as neurotransmitters. They transmit messages between brain cells. The results are not immediate. Patients usually feel better after a few days, but the effects last longer than SSRIs and SNRIs. Researchers believe that esketamine reduces depression symptoms by enhancing connections between brain cells. In animal studies, esketamine reversed these connections that can be broken down by chronic stress and depression. It also appears to stimulate the growth of neurons that can decrease suicidal feelings and thoughts. Another reason esketamine stands out from other antidepressants is that it is delivered through a nasal spray that allows it to reach the bloodstream much faster than pills or oral medication can. The drug has been shown in studies to lessen depression symptoms within a matter of hours. In some cases the effects may be immediate. However the results of a recent study that followed patients over 16 weeks showed that not everyone who started treatment with esketamine continued to be in the remission phase. This is disappointing, but not surprising according to Dr. Amit A. Anand an expert in ketamine who was not involved in the study. For now, esketamine is only available through a clinical trial program or in private practice. Esketamine isn't a first-line option for treating depression. It is prescribed when SSRIs and SNRIs don't help a patient suffering from treatment-resistant depressive disorder. The doctor can determine whether the condition is resistant to treatment and then discuss whether esketamine might be beneficial. 2. TMS TMS uses magnetic fields to stimulate neurons in the brain. It is non-invasive, doesn't require anesthesia or surgery, and has been shown to improve depression for people who don't respond to psychotherapy or medication. It's also been used to treat the disorder of obsessive compulsiveness and tinnitus (ringing in the ear). For depression, TMS therapy is typically delivered as a series of 36 daily treatments over six weeks. The magnetic pulses are similar to a series of pinpricks on the scalp and could be a little difficult to get used to. After a treatment, patients can return to work or at home. Each TMS session can last between 3.5 minutes and 20 minutes, based on the pattern of stimulation. Researchers believe that rTMS alters the way that neurons communicate. This process, referred to as neuroplasticity, allows the brain to form new connections and to modify its function. Currently, TMS is FDA-cleared to treat depression when other therapies such as talk therapy and medications, haven't succeeded. It has also been proven to help people with tinnitus, OCD and pain. Researchers are also investigating the possibility of using it to treat Parkinson's disease as well as anxiety. While a variety of studies have proven that TMS can improve depression, not everyone who receives the treatment experiences a benefit. It is crucial to undergo a thorough psychiatric and medical evaluation before trying this treatment. TMS is not suitable for you when you have a history of or certain medications. A visit to your doctor may be beneficial if you're suffering from depression, but are not experiencing any positive results from your current treatment. You may be a candidate for a trial of TMS or other forms of neurostimulation, but you need to try various antidepressants before insurance coverage covers the cost. If you are looking to learn more about these life-changing treatments, call us today to schedule a consultation. Our experts can assist you in the process of deciding if TMS is the right option for you. 3. Deep stimulation of the brain A non-invasive therapy that rewires the brain's circuitry could be efficient in just one week for people with treatment resistant depression. Researchers have developed new methods that deliver high-dose magnetic waves to the brain more quickly and on a schedule that is more manageable for patients. depression treatment strategies I Am Psychiatry (SNT) SNT, which is now available at the UC Davis Department of Psychiatry and Behavioral Sciences' Advanced Psychiatric Therapeutics Clinic, uses MRI imaging to guide electrodes that send magnetic pulses to targeted areas of the brain. In a recent study, Mitra and Raichle observed that in three-quarters of people who suffer from depression, the typical flow of neural activity from the anterior cingulate cortex to the anterior insula was reversed. With SNT this flow was restored to normal within a week, which coincided with a reduction in their depression. A more in-depth procedure known as deep brain stimulation (DBS) may produce similar results in certain patients. After a series of tests to determine the most appropriate placement, neurosurgeons implant one or more wires, called leads, inside the brain. The leads are connected to a neurostimulator that is implanted beneath the collarbone, which appears like a heart pacemaker. The device delivers an uninterrupted electric current through the leads. This alters the brain’s natural circuitry, reducing depression symptoms. Some psychotherapy treatments may also help alleviate depression symptoms, including cognitive therapy for behavioral disorders and interpersonal therapy. Psychotherapy can take place in a group setting or in one-on-one sessions with a mental health professional. Some psychotherapists provide online health. Antidepressants are still the primary treatment for depression. However, in recent times there have been some remarkable advances in how quickly these medications can work to alleviate depression 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 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 require a doctor's supervision. In certain instances, they can cause seizures or other serious adverse side effects. 4. Light therapy Bright light therapy, which is sitting or working in front of a bright artificial light source, has been used for years to treat major depressive disorder with seasonal patterns (SAD). Research has shown that it can relieve symptoms like fatigue and sadness by regulating the circadian rhythms and boosting mood. It can also help those suffering with depression that is not a continuous one. Light therapy mimics sunlight, a key element of the biological clock known as the suprachiasmatic nucleus (SCN). The SCN is associated with mood and light therapy may alter the circadian rhythms that may contribute to depression. Light can also reduce the production of melatonin and improve the function of neurotransmitters. Some doctors use light therapy to treat winter blues. This is a milder type of depression that is similar to SAD but is more common and occurs during the times of year when there is the least amount light. They suggest sitting in the light therapy box each morning for 30 minutes while awake to gain the most benefit. Unlike antidepressants, which can take weeks to begin working and often cause side effects like nausea or weight gain light therapy can provide results in a matter of one week. It is also suitable for pregnant women and older adults. However, some researchers warn that a person should never try light therapy without the advice of psychiatrists or a mental health professional because it can cause a manic episode in bipolar disorder sufferers. It can also make people feel tired during the first week of treatment as it can reset their sleep-wake patterns. PCPs should be aware of new treatments approved by the FDA. However, they shouldn't ignore traditional methods such as antidepressants and cognitive behavioral therapy. Dr. Hellerstein told Healio that although the quest for newer and better treatments is exciting, we should prioritize the most well-established treatments. He says PCPs should concentrate on teaching their patients about the advantages of the latest treatments and help patients adhere to their treatment strategies. This could include offering transportation to the doctor's office or setting up reminders to take medication and attend therapy sessions.