Advances in scientifically based treatments
Drug therapy has made great progress in recent years. We have improved the scope and focus of drug therapy by developing more selective or specialized antidepressants and combining them in new ways with fewer side effects.
Today's drug treatments may include newer drugs such as citalopram (Celexa) and escitalopram (Lexapro) as well as existing drugs such as fluoxetine (Prozac) and sertraline (Zoloft).
As supported by ample evidence, it tends to be most effective when combined with psychotherapy. Currently, the most effective and efficient treatments have been found to be cognitive behavioral therapy and psychodynamic therapy.
Doctors may use electroconvulsive therapy (ECT) for people whose depression resists psychotherapy or drug therapy. Current versions of his ECT are more specific and have fewer side effects. This is usually reserved for people with severe drug-resistant depression that has features of bipolar disorder.
new treatment
Many new treatments have been introduced that have brought significant improvements to patients.
Ketamine
New treatments include a drug called ketamine, which has been used as an anesthetic in the past and is highly effective. This is a relatively new approach. It's been around for about 5 years.
Ketamine therapy resets connections in the brain's nodes and networks, reducing, if not eradicating, many signs and symptoms of depression. Many patients experience long-term symptom relief and, in some cases, recovery.
Ketamine therapy requires only one dose. Alternatively, multiple doses may be given over a short period of time. However, it must be done under the supervision of a doctor. Although it is usually an outpatient treatment, proper administration of ketamine and support for the patient are important.
This is not the first drug of choice as it has quite serious effects on the brain and should be used with caution. It is currently used for severe, treatment-resistant depression. However, there is ongoing discussion that patients with severe depression may be successful if they use it early in their treatment.
In the future, I think we will see an increase in the use of ketamine, especially for people who cannot get help from other treatments.
psychedelic
Evidence is accumulating for the use of psychedelics in the treatment of major depression.
Drugs such as psilocybin, commonly known as mushrooms, and LSD (lysergic acid diethylamide) can alter the properties of brain chemistry involved in depression.
Microdoses or milli-doses of these drugs are highly effective when used alone or in combination with antidepressants. Symptoms, behavior, and function can be improved. They tend to have immediate effects, but the effects may not last long for some people.
Psychedelics are still relatively stigmatized and are controlled substances. For best effects, you need to find the right microdosing and schedule. Not all clinicians are skilled or comfortable providing psychedelic drugs.
Another drawback is that people may try to self-medicate, which is very difficult. This is a very specialized method that requires clinical skills.
Further research is needed. Medically based evidence is needed for the use and value of psychedelics in treating certain types of depression.
Transcranial magnetic stimulation (TMS)
TMS, which sends a very weak magnetic current through the skull, is interesting. It works like a dimmer switch to change the electrical activity of the brain and reduce the signs and symptoms of depression.
There is very promising research that repetitive TMS may be highly effective in treating certain treatment-resistant depressions. It is very simple, can be tailored to each patient's needs, and often provides a rapid and durable response. It can be used alone or in combination with psychotherapy or drug treatment.
However, while the effects of TMS are strong, they can diminish over time. Multiple sessions may be required, and you will need to find a clinician who is trained and skilled in administering TMS.
Deep brain stimulation (DBS)
Deep brain stimulation is a new treatment that involves implanting electrodes that target specific areas of the brain. It can be tailored to each individual patient to most effectively control the symptoms and signs of depression.
DBS was first attempted in 2005. Since then, science has advanced significantly with support from his BRAIN Initiative, his NIH program aimed at revolutionizing our understanding of the human brain. We now have a better understanding of how to target the brain more precisely, which may lead to better results. Further research would be even more helpful.
DBS is thought to reset brain network activity. Over time, brain activity associated with depression may be turned off, meaning patients remain in remission. There is evidence that DBS has long-term effects.
The interesting effect that we've seen in some patients is how significantly it changes their outlook. Some people appear to be more sociable and active, have renewed vigor, and even have changing interests. It is difficult to determine whether these changes are a side effect of DBS or a result of people feeling less burdened by depression. That's very interesting.
The disadvantage of DBS is that it is a neurosurgical procedure, so there is a risk of infection and bleeding. Although rare, there is also the risk of electrode misalignment or electrode displacement.
Other disadvantages include side effects and cost. Insurance companies will not cover her DBS across the board. As technology advances, maintenance and upkeep may be required and costly.
I believe DBS is the future. When it works, it really works.
on the horizon
New technologies are moving towards minimally or non-invasive DBS.
There are state-of-the-art techniques that include non-surgical implantation of electrodes. A program at DARPA, the agency behind the BRAIN initiative, is looking at small transmitters and stimulators that can be delivered into the bloodstream, inhaled or swallowed and guided to the brain.
Other groups are looking at less invasive approaches that can be done in the clinic. All it takes is a very small hole in the scalp, into which a doctor inserts a fluidic electrode that is guided electromagnetically to the brain. Once it reaches the brain, it hardens.
I believe this is the future. It may be completed in some form within 5 to 10 years.