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iampsychiatry.com If your depression doesn't get better by taking antidepressants or psychotherapy, new drugs that act quickly could be able to treat depression resistant to treatment. SSRIs are the most popular and well-known antidepressants. They work by altering the way the brain uses serotonin, the chemical messenger. Cognitive behavioral therapy (CBT), also known as cognitive behavior therapy, assists you in changing negative thoughts and behaviors such as hopelessness. It's available through the NHS for 8 to 16 sessions. 1. Esketamine In March 2019, the FDA approved a new nasal spray for depression called esketamine. (Brand name Spravato). It is created from the anesthetic drug ketamine that has been proven to be effective in cases of severe of depression. The nasal spray is used in conjunction with an oral antidepressant to treat depression that has not responded to standard medication. In one study, 70 percent of people suffering from treatment-resistant depression treated with the drug had a positive response with a much higher response rate than with only an oral antidepressant. Esketamine is different from conventional antidepressants. It increases the amount of neurotransmitters that transmit messages between brain cells. The effects aren't immediately apparent. Patients generally feel better after a few days, but the effects last longer than SSRIs and SNRIs. Researchers believe that esketamine helps reduce depression symptoms by enhancing brain cell connections. In animal studies, esketamine reversed these connections that are damaged through depression and chronic stress. It also seems to promote the development of neurons, which can reduce suicidal feelings and thoughts. Another reason esketamine is different from other antidepressants is the fact that it is delivered via nasal sprays, which allows it to reach the bloodstream much faster than pills or oral medication could. It has been proven to decrease symptoms of depression within hours, and in certain individuals the effects are immediately. A recent study that followed patients for 16 weeks found that not all who began treatment with esketamine were in remission. This is disappointing, but not surprising, according to Dr. Amit A. Anand, a ketamine expert who was not involved in the study. Esketamine is currently only available through an experimental clinical trial program or in private practice. Esketamine is not a primary treatment for depression. It is prescribed when SSRIs and SNRIs do not work for a patient with treatment-resistant depression. The doctor will determine if the condition is not responding to treatment and then discuss whether esketamine may be beneficial. 2. TMS TMS utilizes magnetic fields in order to stimulate brain nerve cells. 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 has also been used to treat obsessive-compulsive disorders and tinnitus (ringing in the ear). TMS treatment for depression is usually given in a set of 36 daily treatments spread over six weeks. The magnetic pulses can feel like pinpricks on the scalp. It can take time to get used to. After an appointment, patients can return to work or home. Based on the stimulation pattern used, each TMS session can last between 3.5 and 20 minutes. Researchers believe that rTMS works by changing the way neurons communicate with one another. This process, also known as neuroplasticity, allows the brain to create new connections and alter its functions. TMS is FDA approved to treat depression in situations when other treatments like medication and talk therapy have not worked. It has also been proven to aid those suffering from tinnitus, OCD and pain. Researchers are also looking into the possibility of using it to treat Parkinson's disease and anxiety. TMS has been shown to help with depression in a number studies, however not all who receives it benefit. It is important that you have a thorough psychiatric and medical examination prior to attempting this treatment. TMS is not suitable for you when you have a history of or a history of certain medications. A visit to your doctor can be beneficial if struggling with depression but not experiencing any positive results from the treatment you are currently receiving. You may be a suitable candidate to try TMS or other forms of neurostimulation but you should try various antidepressants before insurance coverage will cover the cost. If you're looking to learn more about these life-changing treatments, contact us now for a free consultation. Our experts can assist you in the process of determining if TMS is the best option for you. 3. Deep brain stimulation For those suffering from treatment-resistant depression A non-invasive treatment that rewires brain circuits can be effective in just a week. Researchers have developed new methods that deliver high-dose electromagnetic waves to the brain quicker and at a time that is more manageable for the patients. Stanford neuromodulation therapy (SNT) SNT, that is now available at the UC Davis Department of Psychiatry and Behavioral Sciences' Advanced Psychiatric Therapeutics Clinic utilizes MRI imaging to guide electrodes which send magnetic pulses to specific areas of the brain. In a recent study Mitra and Raichle discovered that in three-quarters (75%) of patients with depression, the usual flow of neural activity from the anterior cingulate cortex and the anterior insula was reversed. With SNT, that flow returned to normal within a week, which coincided with the lifting of their depression. A more in-depth procedure known as deep brain stimulation (DBS) can produce similar results in certain patients. After several tests to determine the most appropriate location, neurosurgeons insert one or more wires, called leads, into the brain. The leads are connected to a neurostimulator that is implanted under the collarbone. It appears to be a heart-pacemaker. The device provides a continuous electric current through the leads. This alters the brain's natural circuitry, which reduces depression symptoms. Some psychotherapy treatments may also help alleviate depression symptoms, including cognitive behavioral therapy and interpersonal therapy. Psychotherapy can take place in a group setting or in one-onone sessions with a mental health professional. Some therapists also offer telehealth services. Antidepressants remain the primarystay of treatment for depression. In recent years, however, there have been significant advancements in the speed at which they can alleviate 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 magnetic or electric stimulation to stimulate the brain, for example electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). These are more complex procedures that must be done under a physician's care. In certain instances they may cause seizures or other serious adverse effects. 4. Light therapy Bright light therapy consists of sitting or standing in front of an artificially bright light source. This therapy has been used for many years to treat seasonal depression as well as major depressive disorder (SAD). Studies show that it can ease symptoms such as fatigue and sadness by regulating the circadian rhythms and boosting mood. It also aids those suffering with depression that is not a continuous one. Light therapy mimics sunlight which is a major element of a biological clock referred to as suprachiasmatic (SCN). The SCN is associated with mood and light therapy has the ability to alter the circadian rhythms which can cause depression. In addition, light therapy can lower melatonin levels, and restore the functioning 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 is only seen in months when there is less daylight. To achieve the best results, they recommend that you lie in the box for 30 minutes each morning while awake. Unlike antidepressants, which can take weeks to begin working and can cause adverse effects such as nausea or weight gain the light therapy method can deliver results within one week. It's also safe during pregnancy and for those who are older. However, some research experts warn that a person should never attempt light therapy without the advice of psychiatrists or a mental health professional because it could cause a manic episode in bipolar disorder sufferers. It could also make people feel tired during the first week of treatment as it could alter their sleep-wake patterns. PCPs should be aware of new treatments that have been approved by the FDA however, they shouldn't overlook tried-and-true techniques like antidepressants or cognitive behavioral therapy. “The quest for newer and better treatments is exciting, but we must continue to focus on the most well-established treatments,” Dr. Hellerstein informs Healio. He says PCPs should be focusing on educating their patients on the benefits of new options and helping patients adhere to their treatment plans. This can include arranging for transportation to their doctor's office or setting up reminders to take medications and attend therapy sessions.