Depression rates, which were already on the rise before the pandemic, appear to be higher than ever.
Depression also has a high recurrence rate.
After treatment of the first episode of depression, around 50% will experience relapse.
The risk for relapse increases for every subsequent episode.Research also suggests that 30.9% of people havetreatment-resistant depression.
This means an estimated 8.9 million Americans will try one or more treatments for depression without achieving remission.
With this combination of factors, its more crucial than ever to find treatments that are effectiveandwork quickly.
Its a time of hope for many people who havent been helped by current treatments.
Since the first antidepressants were introduced in the 1950s, more and more options have continued to emerge.
Today, there is an increasing interest in the use of psychedelics and ketamine for depression relief.
Other fast-acting options include recently introduced antidepressants and transcranial magnetic stimulation (TMS).
Options that show promise as future treatments include optogenetics and stem cells.
The patients showed a marked improvement in mood.
They work by inhibiting the absorption of serotonin and norepinephrine, and blocking acetylcholine, another neurotransmitter.
This was the first SSRIthat is, the first antidepressant to work exclusively on blocking the reabsorption of serotonin.
Increasing serotonin levels is thought to regulate mood.
Additionally, SSRIs carry far fewer side effects than the earlier MAOIs/TCAsthough they are not without side effects.
Stress is linked to both an increased risk of major depressive episodes andtreatment resistance.
This dysregulation causes impairment in the hippocampus, which controls memory and emotion.
This leads to the neuroplasticity hypothesis of depression.
Those with depression show significantly lower levels of neuroplasticity and a decreased ability to adapt to stress.
It also helps nerve cells better communicate with each other.
The experience may give people relieffrom more existential aspects of depression.
It is estimated that by 2027, psychedelics will be a multibillion-dollar industry.
However, some safety concerns do exist.
MDMA works by rapidly releasing and increasing levels of serotonin and dopamine in the brain.
This may lead to greater self-compassion and stay with these memories safely in therapy without getting overwhelmed.
IV ketamine uses a different part of the molecule and is currently used off-label for depression.
It has demonstrated a more significant overall response rate than intranasal ketamine but is more complicated to use.
It also may quickly reducesuicidal ideationin some cases.
Auvelity
One of these treatments is the oral antidepressantAuvelity, approved by the FDA in August 2022.
Auvelity may work within a week and targets the glutamate system, similarly to ketamine.
Its approval may fire up the door for a new class of medications that work to increase glutamate.
TMS therapy involves using magnetic pulses on the head to treat depression.
Typically, TMS treatment takes six weeks of once-daily sessions, a major time commitment.
“The patients had remission of depression after a few days, which is tremendous,” says Borenstein.
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