Depression: Current Treatment Protocols

Depression | May 6, 2014 | Author: The Super Pharmacist

Phsychological, Brain, Nervous system, depression

Depression: Current Treatment Protocols

DepressionDepression is much more than just sadness. It can destroy an entire personality, leaving an angry, helpless, lonely person in its wake. Unlike some other disorders, though, the treatment for depression isn't always clear-cut. Depressed patients may have to try several medications or therapeutic modalities before something works. About 50% of depression patients spontaneously recover for no apparent reason at all, making it even more challenging for doctors to measure what works and what doesn't. For patients who don't get better on their own, though, there's plenty of hope. About 80 percent of depressed patients ultimately find a medication that works, though the journey to such a remedy may be difficult.

Antidepressant Medications

For the majority of patients struggling with depression, medication is the first line of defence. Current research indicates that depression's primary cause is an imbalance in brain chemicals called neurotransmitters. Neurotransmitters help carry a nerve signal across a synapse. If a person's brain can not effectively send signals associated with feelings of happiness and pleasure, depression may result. Doctors currently rely on several different classes of antidepressants:

Selective Serotonin Reuptake Inhibitors (SSRIs)

These are among the most popular antidepressants, and this class includes drugs such as Fluoxetine, Fluvoxamine, and Sertraline. SSRIs work on a brain chemical called serotonin that is associated with mood regulation and feelings of happiness. Side effects with these drugs are mild but very common, with the majority of people who take SSRIs experiencing sexual side effects. Other common side effects include weight gain and emotional blunting.

Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)

These medications are among the newest antidepressants, and are a popular choice for people with treatment-resistant depression. SNRIs work on serotonin as well as noradrenaline, a brain chemical associated with feelings of stress. This group of drugs includes medications such as Duloxetine and Venlafaxine. Common side effects include changes in blood pressure and dry mouth.

Tricyclic antidepressants

These medications are part of a much older group of antidepressants, and are no longer the preferred first line of defense for the disorder. This class of drugs includes medications such as Clomipramine and Doxepin. For people with treatment-resistant depression, tricyclics can be a powerful antidote. However, these drugs carry a high risk of overdose – much higher than other antidepressants. The side effects of tricyclics are similar to SSRIs, and include problems such as sexual dysfunction and weight gain. However, people taking tricyclics typically notice more severe, pronounced side effects than those taking SSRIs.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are older antidepressants that have been in use for decades, and include drugs such as Resagaline and Moclobemide. However, they are not an ideal first choice for depression treatment because of the serious side effects of these drugs. Such side effects include sexual dysfunction, dizziness, difficulty urinating, and nausea. MAOIs also have negative interactions with a variety of other drugs, rendering it critically important to tell your doctor about all other medications you take.

Atypical antidepressants

These drugs aren't really a class of drugs; instead, they simply fail to fit neatly into other classes. Drugs such as Bupropion and Agomelaton fall into this class. The specific side effects of the drug you choose depend on the neurotransmitter it acts upon and your individual biochemistry.

  • Agomelatine is an antidepressant that acts on neurotransmitter receptors for both melatonin and serotonin. Melatonin is a hormone that is important for regulating sleep. Agomelatine is the only antidepressant available to modify the actions of melatonin in the body. It is a relatively new medicine, but data available suggests it may be equally effective as other anti-depressants which provides a new option for patients unable to find an effective and well-tolerated option.
  • Bupropion has a reduced risk of sexual side effects but can induce mania in some people. It's also occasionally used as a stop smoking supplement.

Some people with depression find that atypical antidepressants are more effective at regulating their symptoms. These drugs, in some cases, can also be combined with other antidepressants to amplify the effects and reduce the severity of side effects.

Counselling and Cognitive Behavioural Therapy

Counselling can be highly effective at treating depression, and studies suggest that patients who combine counselling with medication have a higher rate of improvement. Although any type of counselling may be helpful, cognitive-behavioral therapy (CBT), and variants of this modality, have been clinically proven to help combat depression. CBT is designed to be a short-lived treatment, and helps patients detect, understand, and counter negative thoughts while remedying problematic behaviours. The most important components of effective counselling are a good relationship with a licensed counsellor and a clear treatment plan. Effective counsellors discuss treatment options with their patients, modify treatment plans based upon results, and give patients a clear idea of what they can expect from treatment and how long treatment will take.

Alternative Interventions

Depression is a highly personal condition, which means that what works for one person might not work for another. In the most serious of depression cases, doctors sometimes recommend electro-convulsive therapy (ECT). Formerly known as electro-shock treatment, this therapy involves the direct administration of an electric current to the brain. Such a procedure induces a seizure that appears to help “re-wire” the brain. About 80 percent of people who undergo ECT report improvements, but the treatment can have serious side effects, most notably memory loss. Some patients are afraid to try ECT because of the stigma and because in generations past, the treatment was painful and often administered without consent. But under current treatment protocols, ECT is much safer and patients never undergo the treatment against their will. They're also fully sedated during the procedure.

Lifestyle factors

Lifestyle remedies can help amplify the effects of other treatments while remedying problematic lifestyle choices that contribute to depression. Such remedies include:

  • Regular aerobic exercise, which studies show can be as effective at treating depression as SSRI medications
  • Creating a healthy home environment and addressing any relationship problems
  • Eating a healthy, balanced diet
  • Establishing a regular schedule that allows for healthy sleep habits
  • Meditation and mindfulness tactics that can help patients combat and redirect negative thoughts

Future Treatments and Developments

Ketamine, a veterinary drug sometimes used for illicit purposes, has shown promise in clinical research. In one study, for example, depressed patients administered a single dose of Ketamine showed remission within a few hours. Another treatment, trans-cranial magnetic stimulation  (TMS), has already been approved by the FDA. An alternative to electro-convulsive therapy, this relatively non-invasive treatment stimulates the brain and has shown significant promise in remedying depression. Some doctors also rely on off-label usage of popular prescriptions. Patients with treatment-resistant depression sometimes benefit from Amphetamine and other stimulants that act on dopamine. Doctors still must do significant research to gain an understanding of why a particular depression treatment works in one patient but not another. As researchers gain more insight into the chemical underpinnings of depression, they may be able to customize treatments to a patient's particular manifestation of the disease.

References:

  1. "Antidepressants: Selecting One That's Right For You." Mayo Clinic, n.d. Web. 18 Apr. 2014.
  2. Daley, A., and K. Jolly. "Exercise to Treat Depression." Bmj 344.Jun06 1 (2012): E3181. Print.
  3. "Experimental Medication Kicks Depression in Hours Instead of Weeks." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 18 Apr. 2014.
  4. Hautzinger, M. "Cognitive Behavioral Therapy of Chronic Depression." European Psychiatry 23 (2008): S59. Print.
  5. “Agomelatine” http://www.nps.org.au accessed May 2014
  6. Rossi S, ed. eAMH [online]. Australian Medicines Handbook, 2012. www.amh.net.au.
backBack to Blog Home