Depression Treatment Breakthroughs
Researchers are tackling depression from different ways than they did before. These strategies are designed to help you avoid relapses, and identify the appropriate medication.
Psychotherapy is an option if antidepressants do not work. This includes cognitive behavior therapy as well as psychotherapy with others.
Deep Brain Stimulation
Deep brain stimulation is a surgical method where electrodes inside the brain are placed to target specific regions of the brain that cause disorders and conditions such as depression. The electrodes are connected to an instrument that emits pulsing electric pulses to treat the disease. The DBS device, also referred to as a neurostimulator is used to treat other neurological conditions like Parkinson's disease and epilepsy. The pulsing of the DBS device can "jam" circuits that cause abnormal brain activity in depression, while keeping other circuits in place.
Clinical studies of DBS have demonstrated significant improvements for patients suffering from treatment resistant depression (TRD). Despite the positive results, the path to stable recovery from TRD looks different for every patient. Clinicians rely on the subjective reports from patient interviews and psychiatric ratings scales that are difficult to interpret.
Researchers from the Georgia Institute of Technology, Emory University School of Medicine and the Icahn School of Medicine at Mount Sinai, have developed an algorithm that detects subtle changes in brain activity patterns and can differentiate between stable and depressive recovery states. The study was published in Nature Human Behaviour, exemplifies the importance of combining neuroscience, medical and computer engineering fields to develop potentially life-changing treatments.
In DBS, doctors insert a thin, wire-like lead into the brain through a tiny hole in the skull. depression treatment for adults is equipped with a variety of electrodes at its tips that transmit electrical signals to the brain. The lead is connected to an extension cable that extends from the head, through the ear and down to the chest. The extension and lead are connected to an implanted battery-powered stimulator that is placed under the skin of your chest.
The programmable neurostimulator generates electrical impulses to regulate abnormal brain activity in the regions targeted by DBS devices. In the study, researchers employed DBS to target a particular region of the brain known as the subcallosal cingulate cortex (SCC). The researchers discovered that when SCC was stimulated, it led to an increase in the levels of dopamine, which can improve symptoms of depression.
Brain Scanners
A doctor may use a variety of tools and techniques to diagnose depression, but the best one currently available is brain scans. This technique uses imaging in order to monitor changes at the functional and structural levels of brain activity. It can be utilized by a patient to pinpoint the affected areas of their brain, and then determine what's happening in these regions in real-time.
Brain mapping can help to predict the type of treatment is most effective for a particular person. For example, some people are more responsive to antidepressant medication than others, but this isn't always situation. By using MRI to evaluate the effectiveness of a drug psychologists and doctors can be more accurate when prescribing it for their patients. Knowing how their treatment is progressing can also increase compliance.
The difficulty in measuring mental health has hampered research despite its widespread prevalence. Although there is a wealth of information on depression, anxiety and other disorders, a clear understanding of the causes behind these issues has been elusive. However, new technology is beginning to uncover the mechanisms behind these conditions.
A recent study published in Nature Medicine, for example, classified depression into six distinct subtypes. This will lead to customized treatment.
Researchers employed fMRI technology to examine brain activity of 801 people with depression, as well as 137 others without. Researchers looked at the activation of brain circuits that are affected by depression, for instance those that regulate emotions or cognition. They looked at a participant's brain scan during the time of rest as well as while performing specific tasks.
A combination of resting-state and task-based measures was able to predict if someone would respond or not to SSRIs. This is the first time that a predictive test has been developed in psychiatry. The team is currently working on the development of an automated test that will give these predictive results.
This is particularly helpful for those who don't respond to standard treatments such as therapy and medication. In fact, more than 60 percent of those suffering from depression don't respond to the initial form of treatment they receive. Some of these patients are referred to as treatment-resistant and are difficult to treat with the standard treatment regimen However, there is hope that new technologies will help to improve treatment options.
Brain Implants
Sarah suffered from a debilitating type of depression. She described it as a blackhole that pulled her down. It was a force so powerful that she could not move. She tried all kinds of drugs however none of them had given a lasting lift. She also had undergone other treatments, such as electroconvulsive therapy and ketamine infusions but both did not work. Finally, she was able to undergo a procedure which would allow researchers to implant electrodes in her brain to send her a targeted jolt every time she was about to suffer from a depressive attack.
The process, also known as deep brain stimulation, is widely used to treat Parkinson's disease and has been shown to help some people with treatment-resistant depression. But it's not an effective treatment, it just assists the brain in coping with the illness. It is based on a device which implants tiny electrodes in certain areas of the brain. It's like a brain pacemaker.
In a study that was published on Monday in the journal Nature Medicine, two researchers at University of California at San Francisco (UCSF) explain how they utilized the DBS device for the first time to customize the treatment for depression for a patient. They called it an "revolutionary" new approach that could open the door for customizable DBS therapies for other patients.
For Sarah the team traced her brain's circuitry and found that her amygdala was the trigger of depression episodes. They found that a spot deep in her brain -the ventral striatumis responsible for calming her amygdala's overreaction. They then placed the matchbox-sized device in Sarah's head, and then strung its electrode legs shaped like spaghetti to the two brain regions.
When a depression symptom occurs the device transmits a small electrical charge to Sarah's amygdala, as well as ventral striatum. This jolt is intended to stop the development of depression and nudge her to a more positive state of mind. It is not an effective treatment for depression, however, it can make a huge difference for those who need it most. In the future, it could be used to detect an indicator of a biological sign that indicates a depression is on the way and allows doctors to prepare by increasing the stimulation.
Personalized Medicine
Personalized medicine is a way to create a custom-made prevention, diagnosis and treatment strategies to particular patients, based upon the data gathered from molecular profiling. Medical imaging, lifestyle information, etc. This differs from traditional treatments, which are designed to meet the needs of an average patient.
Recent studies have revealed various factors that contribute to depression in different patients. These include genetic variation and neural circuitry dysfunctions and biomarkers, psychosocial markers and others. The goal of psychiatry that is personalized is to integrate these findings into the clinical decision-making process for optimal care. It also aims to facilitate the development of individualized treatment approaches for psychiatric disorders such as depression, with the aim of achieving better utilization of resources and improving the outcomes for patients.
The field of individualized psychiatry continues to grow, but several obstacles are still preventing its clinical application. For instance many psychiatrists aren't familiar with the various antidepressants as well as their chemical profiles, which could result in a suboptimal prescription. Additionally, the complexity and cost of the integration of multiomics data into healthcare systems as well as ethical considerations have to be taken into account.
Pharmacogenetics could be a promising approach to improve the effectiveness of personalized psychiatry. It uses the patient's genetic makeup in order to determine the appropriate dosage of medication. This can help reduce the side effects of medications and improve treatment effectiveness, especially with SSRIs.
However, it is important to note that this is only a potential approach and requires more research before it is widely adopted. Other factors, including lifestyle choices and environmental influences, are also important to think about. The integration of pharmacogenetics in depression treatment should therefore be carefully balanced.
Functional neuroimaging may also be utilized to aid in the choice of antidepressants and psychotherapy. Studies have shown that the pretreatment levels of certain neural circuits (e.g. ventral and pregenual anterior cingulate cortex) determine the response to psychotherapeutic and pharmacological treatments. Certain clinical trials have utilized these findings as a basis to select participants. They focus on those who have higher activation and, therefore more favorable responses to treatment.