Depression Treatment Breakthroughs
With the new generation of breakthroughs in depression treatment, scientists are targeting this disease with greater precision than ever before. These treatments are designed to aid in avoiding relapses and find the right drug.
Psychotherapy is an option if antidepressants do not work. This includes cognitive behavioral therapy and psychotherapy with others.
Deep Brain Stimulation
Deep brain stimulation is a surgical method in which 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 a device which emits electric pulses to treat the disease. The DBS device, also referred to as a neurostimulator, can be used to treat other neurological conditions like Parkinson's disease and epilepsy. The DBS device's pulsing could "jam up" circuits that cause abnormal brain activity in depression, while leaving other circuits unaffected.
Clinical trials of DBS for depression have demonstrated significant improvement in patients with treatment-resistant depression (TRD). Despite the positive results however, the path to steady recovery from TRD differs for each patient. Clinicians rely on the subjective reports from patient interviews and psychiatric ratings scales that can be difficult for them to interpret.
Researchers from the Georgia Institute of Technology and Emory University School of Medicine have developed an algorithm to detect subtle changes in the brain's activity patterns. This algorithm can differentiate between stable recovery and depressive states. The study was published in Nature Human Behaviour, exemplifies the importance of combining neuroscience, medicine and computer engineering disciplines to develop potentially life-changing therapies.
During the DBS procedure, doctors place a thin wire-like lead in the brain through a hole within the skull. The lead is equipped with electrodes 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 the lead are connected to a stimulator powered by batteries implanted beneath the skin of the chest.
The programmable neurostimulator generates electric pulses to regulate abnormal brain activity in the regions targeted by DBS devices. In the study, researchers utilized DBS to target a specific region of the brain called the subcallosal cingulate cortex (SCC). The researchers found that when SCC was stimulated, it led to an increase in dopamine levels which can improve symptoms of depression.
Brain Scanners
A doctor may employ a variety tools and techniques to identify depression, however a brain scan is the most effective method. This technology makes use of imaging to monitor changes in brain activity at the functional and structural levels. It can be used by a client to determine the affected regions of their brain and to determine what's happening in these regions in real-time.
Brain mapping can help determine the kind of treatment that is most effective for an individual. Some people respond better antidepressant medications than others. However this isn't always the situation. With the use of MRI to assess the effectiveness of a medication, psychologists and physicians are more precise in prescribing it to their patients. It can also help to improve compliance by allowing patients to see how their treatment is progressing.
Despite its widespread use, research in mental health has been hampered by the difficulty in measuring it. While there is a plethora of data regarding depression and anxiety, as well as other conditions, a complete understanding of the causes behind these disorders has been difficult. Technology is now uncovering the underlying causes of these disorders.
For instance, a study published in Nature Medicine sorts depression into six distinct biological subtypes. This paves the way toward customized treatment.
Researchers employed fMRI technology in order to study the brain activity of 801 individuals with depression, and 137 others without. They studied the activation and connectivity of brain circuits that are affected by depression, including those which regulate cognition and emotions. They looked at the brain scans of a person at rest and during specific tasks.
A combination of resting-state and task-based tests could predict whether an individual would respond to SSRIs. This is the first time a predictive test has been created in the field of psychiatry. The team is now working on a computerized tool that can provide these predictions.
I Am Psychiatry is especially beneficial for people who are not responding to the standard type of treatment like therapy and medication. About 60% of people suffering from depression are not responding to the first treatment they receive. Some of these patients can be difficult to manage with a standard treatment regimen.
Brain Implants
Sarah was afflicted with a debilitating depression that she described as a black hole that pulled her down to a gravity force that was so strong, she couldn't move. She had tried all sorts of medicines, but none had provided an indefinite lift. She also tried other treatments like ketamine infusions and electroconvulsive therapy, but they too did not work. She was willing to undergo surgery in order to implant electrodes in her brain, which would give her a specific shock every time she was about have a depressive attack.
Deep brain stimulation is a procedure that is widely used in the treatment of Parkinson's disease. It has also been shown to be helpful for some people who are unable to respond to treatment. It's not an effective treatment, but it assists the brain to cope. It utilizes a device that can implant tiny electrodes into specific brain regions, like the pacemaker.
In the study published in Nature Medicine on Monday, two researchers from the University of California at San Francisco describe their experience using the DBS to customize treatment for depression in a specific patient. They called it a "revolutionary" approach that could open the way for a more flexible DBS treatments for other patients.
For Sarah the team traced the circuits in her brain and discovered that her amygdala was a trigger of depression episodes. They discovered that the ventral region, an area of her brain, was responsible for calming her amygdala overreaction. They then implanted the matchbox-sized device in Sarah's brain and attached its electrode legs that resembled spaghetti to the two brain regions.
If a symptom of depression occurs the device transmits an electrical signal to Sarah's amygdala and ventral striatum. This jolt is intended to prevent the onset of depression and nudge her to a more positive state of mind. It's not a cure however, it can make a significant impact for those who require it the most. In the future it may be used to determine an indicator of a biological sign that indicates a depression is on the way, allowing doctors to prepare by increasing the stimulation.
Personalized Medicine
Personalized medicine is an approach to customizing diagnosis, prevention and treatment strategies to individual patients based on information gathered through molecular profiling, medical imaging, lifestyle data and more. This differs from conventional treatments that are designed for the average patient. It is one-size-fits-all solutions that isn't always effective or efficient.
Recent studies have revealed a variety factors that contribute to depression in a variety of patients. These include genetic variations and neural circuitry disorders as well as biomarkers, psychosocial markers, and many more. Personalized psychiatry aims to integrate these findings into clinical decision-making process to ensure the best treatment. It also aims to facilitate the development and implementation of individualized treatment for psychiatric disorders such as depression.
Personalized psychiatry continues to progress however, there are many obstacles still hindering its use in clinical settings. Many psychiatrists are not acquainted with the pharmacological profiles of antidepressants. This can lead to suboptimal prescribing. In addition, the complexity and cost of integrating multiomics data into healthcare systems as well as ethical considerations must be taken into account.
Pharmacogenetics is a promising way to improve the effectiveness of personalized psychiatry. It utilizes the genetic makeup of a patient order to determine the correct dose of medication. This can reduce the adverse effects of medications and boost the effectiveness of treatment, especially with SSRIs.
It is important to recognize that this is a possible solution and further research is needed before it can be widely used. Other factors, such as lifestyle choices and environmental influences are also important to take into consideration. The integration of pharmacogenetics in depression treatment must therefore be carefully balanced.
Functional neuroimaging is a further promising method to guide the choice of antidepressants as well as psychotherapy. Studies have demonstrated that the levels of activation in certain neural circuits (e.g. The response to pharmacological or psychotherapeutic treatment is determined by the pregenual and ventral cortex. Certain clinical trials have utilized these findings as a basis to select participants. They focus on those who are more active and, therefore more favorable responses to treatment.