Depression Treatment Breakthroughs
Scientists are taking on depression from more angles than ever before. These strategies will help you locate the right medications and prevent repeat relapses.
Psychotherapy is an option when antidepressants do not work. This includes cognitive behavior therapy and psychotherapy for interpersonal relationships.
Deep Brain Stimulation
Deep brain stimulation is a surgical technique where electrodes inside the brain are placed to target specific regions of the brain that are responsible for conditions and diseases such as depression. The electrodes connect to a device that emits pulsing electrical pulses to treat the disease. The DBS device, also known as a neurostimulator, is used to treat other neurological disorders like epilepsy and Parkinson's disease. The DBS device's pulsing can "jam up" circuits that trigger abnormal brain activity during depression, but leave other circuits unaffected.
Clinical trials of DBS for depression have shown significant improvement in patients suffering from treatment-resistant depression (TRD). Despite the positive results, the path to stable recovery from TRD differs for each patient. Clinicians have to rely on self-reported subjective information from patient interviews and psychiatric rating scales, which can be difficult to interpret.
www.iampsychiatry.com 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 them from depressive versus stable recovery states. The researchers' research, published by Nature Human Behaviour in Nature emphasizes the importance of combining neuroscience and medical disciplines with computer engineering to develop potential life-changing treatments.
During the DBS procedure, doctors place a small wire-like lead into the brain through a hole within the skull. The lead has a number of electrodes on its tip that send electrical impulses to the brain. The lead is connected to an extension cable that runs from the head, through the ear and then down to the chest. The lead and extension are connected to an implanted battery-powered stimulator that is placed under the skin of your chest.
The programmable neurostimulator produces pulses of electricity to control abnormal brain activity in areas targeted by DBS devices. The team employed DBS in their study to target a specific brain region called the subcallosal cortex (SCC). Researchers discovered that when SCC was stimulated, it led to an increase in dopamine levels which may improve symptoms of depression.
Brain Scanners
A doctor may employ a variety methods and tools to diagnose the depression, but a brain scan is the most effective method. This technology utilizes imaging to observe changes at structural and function levels of brain activity. It can be used to identify the areas of a client's brain that are affected by the disorder and determine what is happening in those areas in real time.
Brain mapping can also assist to determine which treatment will be the most effective for an individual. For instance, certain people are more responsive to antidepressant medication than others, however this isn't always the situation. Psychologists and physicians can prescribe medications more accurately by using MRI to assess the effectiveness. Monitoring how their treatment progressing can also aid in ensuring better compliance.
Despite its widespread use the research on mental health has been hampered by the difficulty in measuring it. There is a wealth of information on depression as well as anxiety illnesses. However it's been a challenge to pinpoint the causes. New technology is now revealing the mechanisms behind these conditions.
A recent study published in Nature Medicine, for example classified depression into six distinct subtypes. This opens the doorway to personalized treatment.
Researchers used fMRI technology to analyze the brain activity of 801 individuals who suffer from depression, and 137 people who are not. They studied the activation and connectivity of brain circuits affected in depression, including those which regulate cognition and emotions. They examined a person's brain scans during rest and while completing specific tasks.
The results showed that a combination of resting state and task-based measures could be used to determine whether or not a person would react to SSRIs. This is the first time a predictive test has been created in psychiatry. The team is currently developing an automated tool that can provide these predictions.
This is especially useful for those who don't respond to conventional treatments such as therapy and medication. As high as 60% of people with depression don't respond to their first treatment. Some of these patients are referred to as resistant to treatment and are difficult to treat with standard treatment, but the hope is that new technology will aid to optimize treatment options.
Brain Implants
Sarah suffered from a debilitating form of depression. She described it as a dark hole that dragged her down. It was a force so powerful that she was unable to move. She tried all kinds of medications, but none had provided an enduring lift. She also had undergone other treatments like electroconvulsive therapy and ketamine infusions however, they failed to work. Finally, she agreed to undergo a procedure which would allow researchers to implant electrodes in her brain to send her a specific jolt every time she was about to have a depressive episode.
The method, also known as deep brain stimulation, is widely used to treat Parkinson's disease. It has been proven to aid some people with treatment-resistant depression. It is not an effective treatment, but it aids the brain in coping. It makes use of a device to implant small electrodes in specific brain regions, like a pacemaker.
In an article published in Nature Medicine on Monday, two researchers at the University of California at San Francisco explain how they utilized a DBS to customize the treatment for depression for a specific patient. They called it an "revolutionary" new approach that could open the way for a more flexible DBS treatments for other patients.
The team looked into Sarah's brain's circuits, and found that her amygdala is the cause of her depression episodes. They found that a spot deep within her brain -the ventral striatumwhich was responsible for calming her amygdala's excessive reaction. They then implanted the matchbox-sized gadget in Sarah's head and strung its electrode legs shaped like spaghetti to the two areas.
If a symptom of depression occurs the device sends an electrical signal to Sarah's amygdala, and ventral striatum. This jolt is meant to stop the development of depression and help her into a more positive mood. It's not a cure, however, it can make a big impact for those who require it the most. In the future, it could be used to determine 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 method to create a custom-made prevention, diagnosis and treatment strategies for particular patients, based upon the information gathered through molecular profiling. Medical imaging, lifestyle data, etc. This differs from conventional treatments, which are designed to meet the needs of an average patient.
Recent studies have uncovered several factors that contribute to depression in different patients. These include genetic variation, neural circuitry dysfunctions biomarkers, psychosocial markers and biomarkers, among others. Personalized psychiatry seeks to integrate these findings in the clinical decision-making process for the best treatment. It is also designed to aid in the development of individual treatment strategies for psychiatric disorders like depression, aiming for more efficient use of resources and improving the outcomes for patients.
While the field of personalization in psychotherapy is growing, several obstacles hinder its clinical implementation. Many psychiatrists are not acquainted with the pharmacological characteristics of antidepressants. This can lead to suboptimal prescribing. It is also crucial to think about the cost and complexity of integrating multiomics into healthcare systems and ethical issues.
Pharmacogenetics is a promising way to advance the field of personalized psychiatry. It utilizes the genetic makeup of a patient in order to determine the appropriate dosage of medication. This could reduce side effects of drugs and increase treatment effectiveness, especially with SSRIs.
It is important to note that this is a possibility solution, and further research is needed before it is widely used. Additionally, other factors like environmental influences and lifestyle choices are essential to consider. Therefore, the integration of pharmacogenetics in depression treatment should be carefully and balanced.
Functional neuroimaging is a further promising method for guiding the selection of antidepressants and psychotherapy. Studies have demonstrated that the levels of pretreatment activation in specific neural circuitries (e.g. ventral and pregenual anterior cingulate cortex) determine the response to both pharmacological and psychotherapeutic treatments. Additionally, certain clinical trials have already utilized these findings to guide their selection of participants, focusing on those with greater levels of activation and thus having more favorable responses to therapy.