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Latest Depression Treatments If your depression doesn't get better by taking antidepressants or psychotherapy, new drugs that act quickly may be able treat depression resistant to treatment. SSRIs are the most popular and well-known antidepressants. They affect the way the brain uses serotonin. Cognitive behavioral therapy (CBT) helps you change negative thoughts and behaviours, such as hopelessness. The NHS offers 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 made from the anesthetic ketamine that has been proven to aid in the treatment of severe cases of depression. The nasal spray is utilized in conjunction with an oral antidepressant to treat depression that hasn't responded to standard medications. In one study, 70 percent of people with treatment-resistant depression who were treated with the drug had a positive response which was a greater response rate than the use of an oral antidepressant. Esketamine is different from traditional antidepressants. It raises levels of naturally occurring chemical in the brain, referred to as neurotransmitters, that relay messages between brain cells. The results aren't immediate. Patients typically feel a little better after a couple of days however, the effects last longer than with SSRIs or SNRIs. Those can take anywhere from weeks to months to show results. Researchers believe that esketamine reduces symptoms of depression by strengthening connections between brain cells. In animal studies, esketamine reversed the breakdown of these connections that could occur in depression and chronic stress. Additionally, it appears to stimulate the growth of neurons that can aid in reducing suicidal thoughts and feelings. Esketamine is different from other antidepressants in that it is administered via nasal spray. This allows it to reach your bloodstream more quickly than pills or oral medications. It has been demonstrated by studies to reduce depression symptoms within a matter of hours. In some cases the effects may be almost immediate. However, the results of a study that followed patients for 16 weeks showed that not all who began treatment with esketamine was in the remission phase. 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 the clinical trial program or in private practice. It isn't considered a first-line treatment option for depression, and is typically prescribed only when SSRIs or SNRIs haven't performed for a person suffering from treatment-resistant depression. The doctor will determine if the condition is resistant to treatment and then decide whether esketamine may be beneficial. 2. TMS TMS employs magnetic fields to stimulate brain nerve cells. It is non-invasive, doesn't require anesthesia or surgery and has been proven to reduce depression in people who are not responding to medication or psychotherapy. It can also be used to treat obsessive compulsive disorder (OCD) and tinnitus. For depression, TMS therapy is typically delivered as a series of 36 daily sessions spread over six weeks. The magnetic pulses are similar to pinpricks that are placed on the scalp, and may take a bit of getting used to. After the treatment, patients are able to return to work or go home. Each TMS session lasts between 3.5 minutes and 20 minutes, based on the pattern of stimulation. Scientists believe that rTMS changes the ways that neurons communicate. This process, also known as neuroplasticity, enables the brain to establish new connections and modify its function. At present, TMS is FDA-cleared to help with depression when other treatments, including talk therapy and medication, haven't worked. It has also proven to be effective in treating tinnitus and OCD. Researchers are also looking into the possibility of using it to treat Parkinson's disease and anxiety. TMS has been proven to reduce depression in several studies, but not everyone who receives it benefits. Before beginning this treatment, it is important to undergo an extensive medical and psychiatric examination. If you have a history of seizures or are taking certain medications, TMS might not be suitable for you. If you have been struggling with depression and aren't seeing the benefits of your current treatment plan, a conversation with your psychiatrist may be helpful. You may be eligible for an TMS trial or other forms neurostimulation. But, you must first try several antidepressants before your insurance company will cover the cost. If you are interested in learning more about these life-changing treatments, call us today for a consultation. Our specialists can help you through the process of deciding whether TMS is the best choice for you. 3. Deep brain stimulation A noninvasive therapy that resets the brain circuitry could be effective in as little as one week for those suffering from treatment-resistant depression. Researchers have devised new methods that permit them to deliver high-dose magnetic pulses to the brain in a shorter amount of time and at a frequency that is more manageable for patients. Stanford neuromodulation therapy, now available in the Advanced Psychiatric Therapeutics Clinic at the UC Davis Department of Psychiatry and Behavioral Sciences utilizes MRI images to guide electrodes to deliver magnetic pulses to specific areas of the brain. In a recent study, Mitra and Raichle observed that in three-quarters (75%) of patients who suffer from depression, the typical flow of neural activity from the anterior cingulate cortex to the anterior insula was interrupted. With SNT, that flow returned to normal within a week, and coincided with a reduction in their depression. Deep brain stimulation (DBS), an invasive procedure, may produce similar results in certain patients. Neurosurgeons perform a series of tests to determine the most appropriate place to implant one or more leads in the brain. The leads are connected to a nerve stimulator implanted under the collarbone. It appears like a heart pacemaker. The device delivers a continuous electric current through the leads. This alters the brain's natural circuitry, decreasing depression symptoms. Certain psychotherapy therapies, such as cognitive behavioral therapy and inter-personal therapy, can also help with depression symptoms. Psychotherapy can be delivered in one-on-one sessions with an expert in mental health or in a group setting. Some therapy providers offer online health. Antidepressants are still the primary treatment for depression. However, in recent years there have been significant improvements 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 electric or magnetic stimulation to stimulate the brain, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). www.iampsychiatry.com are more complex procedures that require the supervision of a doctor. In some instances they may cause seizures or other serious adverse 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 a number of 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 circadian rhythm patterns. It can also help those who suffer from depression that is intermittent. Light therapy works by mimicking sunlight, which is a crucial element of the biological clock known as the suprachiasmatic nucleus (SCN). The SCN is connected to mood and light therapy may change the patterns of circadian rhythms 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, which is similar to SAD but is less common and only happens in the months when there is less daylight. To get the best results, they suggest that you sit in front of the box for 30 minutes each morning while you are awake. Unlike antidepressants, which can take weeks to begin working and can cause adverse effects such as weight gain or nausea light therapy can provide results within one week. It's also safe to use during pregnancy and for those who are older. However, some researchers advise that one should never experiment with light therapy without consulting of a psychiatrist or mental health professional, as it can trigger a manic episode in people with bipolar disorder. It could also make people feel tired in the first week of treatment due to the fact that it can reset their sleep-wake patterns. PCPs should be aware of the new treatments that have been approved by the FDA, but they shouldn't neglect tried-and-true methods like antidepressants and 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 therapies. He says PCPs should concentrate on informing their patients about the benefits of the latest treatments and help them adhere to their treatment strategies. This may include providing transportation to the doctor's appointment, or setting up reminders for patients to take their medication and attend therapy sessions.