Advances in Treating Depression

laboratory-testing-406 courtesy CDC.jpg

There are a variety of medications that have treated the symptoms of depression for many decades. Back in the 1950s, the advent of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants revolutionized the treatment of depression. The 1980s saw the advent of Prozac, the first of many selective serotonin reuptake inhibitors (SSRIs). Building on this were the serotonin-norepinephrine reuptake inhibitors (SNRIs). Both of these offered similar control with greater safety.

The golden age of depression treatment was upon us. Unfortunately, that is where we peaked.

The fact is these drugs cannot resolve depression in everyone. As many as 10% to 20% of depression patients treated with these options fail to get any resolution of their symptoms; up to 2/3 of patients get only varying degrees of resolution of their symptoms.

All of these existing treatment types target the monoamine systems in the brain. The fact that the newest drugs on the market these days are all variations on existing drugs is because that is the only cause of depression that is currently well understood.

New Treatments

The biggest recent change in depression treatment has been combining existing antidepressants with atypical antipsychotics, like Abilify and Seroquel, which are commonly prescribed to treat bipolar disorder and schizophrenia. Several research studies have supported this approach, saying that those patients who receive only partial relief from antidepressants alone often do much better when prescribed the combination.

Valdoxan has been approved in Europe for the treatment of major depressive disorder. It is unique in that it targets the melatonin system in the brain. Melatonin is more commonly used to regulate sleep patterns, something that often accompanies depression. Valdoxan is the first melatonergic antidepressant. Clinical trials are underway in the United States.

Current Research

Researchers are looking at Ketamine, a well-used anesthesia and analgesic (and illegal rave drug), as a possible treatment for acute, emergent depression. Doctors have had little recourse for treatment when acutely depressed patients arrive at emergency rooms, especially when they are suicidal, because typical antidepressants can take up to six weeks to work. Ketamine, on the other hand, can reduce depression symptoms in as few as a few hours, up to a day. Researchers have started looking at this as a possible treatment for such situations, although the research is preliminary.

Ghrelin is a natural antidepressant hormone. It is also known as the “hunger hormone” as it is implicated as a factor in increasing appetite. Researchers have been looking into ways to safely harness the effects of ghrelin and produce a reliable depression treatment.

Another possible treatment under review is not a drug. Instead, it is low-field magnetic stimulation (LFMS), as reported by researchers at McLean Hospital in the August 1, 2014 issue of Biological Psychiatry. LFMS uses low strength, high frequency electromagnetic fields to stimulate the brain. Relief from depression is immediate, making it a highly valuable tool in the instance of suicidal ideations resulting from severe depression. Additional studies will need to happen to determine the parameters for use of this technology.

Sources: PsychCentral.com , Medical News Today and Harvard University
Image courtesy CDC

 
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