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Depression Treatment Advancements Researchers are constantly striving to improve the treatment for depression. This special Research in Context feature will explore some of these breakthroughs in treatment for depression. Psychotherapy helps alleviate depression symptoms by teaching people how to manage negative thoughts and emotions. Talk therapy can take place in an environment of group or one-on-one with a mental health professional. Precision mental healthcare Precision refers to the ability to be more precise or precise in the prevention, diagnosis, and treatment methods. In the context of mental health, it could encompass a variety of strategies, from medication to psychotherapy. However, many of these strategies tend to focus on the effects of the disorder rather than its root causes. This can result in treatments that do nothing more than ease symptoms but do not address the root causes that contribute to mental illness in the initial place. Fortunately, the field of precision mental health is rapidly evolving. It's a similar approach to that that's been taken in other areas of healthcare by incorporating continuous monitoring of important indicators into the clinical setting (e.g. fever, ailment or blood pressure). It also involves combining multiple sources of data and applying machine learning to aid physicians better understand a patient's individual needs and formulate more effective treatment plans. One example of precision psychiatry involves using EEG to measure brain activity and help doctors determine whether a patient is able to engage in cognitive behavior therapy. A new class of drugs referred to as NMDA receptor inhibitors can alleviate depression symptoms by blocking the neurotransmitter glutamate from reaching certain brain cells. The test can be used to detect interactions between genes and drugs, and to prevent undesirable effects. A number of companies are also looking into digital precision medicine, which makes use of objective digital technology to monitor patients remotely and collect real-time information that can help guide their treatment. One example is that a company is using artificial intelligence to track adherence and optimize medication dosages for patients suffering from depression. These solutions have the possibility of improving accessibility and effectiveness in mental healthcare as well as improving the adherence to treatment. Digital precision psychiatry, in particular, can help people with mental illness overcome the barriers to treatment, particularly those who are working. For example one Johnson & Johnson initiative in Singapore is working with other organizations to aid in the reintegration of people recovering from depression into their workplaces and communities. This will allow them to keep their jobs, which are essential to a successful recovery. Medication Many people suffering from depression discover that medication can relieve their symptoms, especially if they're experiencing severe or disabling symptoms. Antidepressants help restore the balance of neurotransmitters which are chemical messengers in the brain that regulate mood and emotions. Most current antidepressants target one of these neurotransmitters, increasing levels of serotonin and norepinephrine as well as dopamine. Selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft boost the levels of serotonin's chemical in the brain. the SNRIs, such as Cymbalta and Effexor which focus on both dopamine and norepinephrine; and monoamine oxidase inhibitors, such as Wellbutrin which targets only norepinephrine and dopamine. The majority of doctors recommend antidepressants as the first option of treatment for depression, along with some kind of therapy for talk. Some of these therapies include cognitive therapy that helps improve thoughts and feelings by teaching specific skills, or psychotherapy for interpersonal relations, which is focused on improving relationships. Other treatments, such as electroconvulsive (ECT) therapy and transcranial magnet stimulation (TMS) have also proven to be effective in treating depression. However, some people do not respond to the initial medications prescribed by doctors. About a third of people suffering from depression do not see any improvement from their first medication and around 40 percent of those who begin taking antidepressants cease within three months. Recent research has enabled doctors to predict which medications will work best for a person through blood or MRI testing to determine which receptors are most affected by depression. The way we treat depression has improved over the last few years, with more options and better dosages that help reduce side effects. Newer antidepressants like esketamine, brexanolone, and Nefazodone are effective in reducing depression symptoms. Other medications are undergoing clinical trials that could alter the ways they're used. A drug called vorapaxar, that is currently being tested in humans, targets a different brain region that's associated with depression, by blocking NMDA receptors. It's scheduled to be available by 2024. Another drug that has shown promise is a combination of ketamine and bupropion, which could be more effective at treating depression that is resistant to treatment. Psychotherapy Researchers in psychiatry have been able to pinpoint certain factors that cause depression, for instance, problems with the neurotransmitters serotonin and norepinephrine. These chemicals play a vital function in regulating mood emotions, moods and overall brain function. Medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors are the main treatment options. They can ease many of depression-related symptoms such as depressed feelings and fatigue, and improve sleep, appetite and energy levels. They are not without side effects, which can make them unsuitable for certain people. Psychotherapy can help address the root causes and assist people to overcome depression. Different types of therapy have been shown to reduce symptoms, including cognitive behavior therapy and the ketamine infusion therapy. Psychotherapy can also help patients to develop a healthier way of coping and help them manage stressors. Cost, scheduling limitations and a lack of mental health providers can limit access to psychotherapy. Telehealth services have improved access for many people. Finding the right treatment combination is essential to overcome depression. Medication alone may not be enough to alleviate all your symptoms. It may take between 6 and 12 weeks before you are able to tell whether a medication is working. There are also several nonpharmacologic treatments that are available like transcranial magnetic stimulation and vagus nerve stimulation. These therapies employ electromagnetic fields to improve mood and increase the brain's chemistry. If you're considering psychotherapy or medication it is essential to work closely with your provider. Discuss depression management strategies and thoughts as well as the risks and side effects that come with each choice. Find a provider that will meet your needs in case you're having difficulty building trust with your doctor or therapist. A clinic that offers a free trial period could be a great choice, as it gives you the opportunity to try out different approaches before committing. You'll eventually find a treatment that works best for you and allows you to feel your most at your best. Brain stimulation In a few short years, scientists have come up with new techniques to target specific regions of the brain, and rapidly change how they function. These techniques can be utilized to treat physical ailments and some mental disorders. rTMS is a technique that utilizes electromagnetic pulses to stimulate brain activity. It is similar to the magnetic pulses that are used in MRIs, but is not powerful enough to cause a seizures. The technique is based on stimulating a specific brain region with an uninvolved magnet. The pulses alter the way that the brain communicates which allows you to feel better. The therapy can take as little as 3.5 minutes and isn't a problem with your normal activities. There may be a slight headache afterward. Another treatment involves putting electrodes in the brain to send painful electrical impulses. This treatment is also known as deep transcranial magnetic stimulation (deep TMS) and is employed to treat OCD and to quit smoking cigarettes. Early research suggests that it can alleviate depression symptoms in certain individuals. It's unclear what the effect of this treatment is, but it does appear to alter the balance of certain neurotransmitters. Other noninvasive brain stimulation techniques are also improving. In a recent study patients with severe depression and intolerance to antidepressants responded well to a treatment using magnetics called SAINT. It is individualized to each patient's specific brain anatomy, and uses high-dose magnetic pulse patterns. The treatment can be delivered within a few hours while previous treatments required daily sessions over several weeks or months. Researchers employed fMRI technology to pinpoint precisely the brain region being stimulated by each patient. They also examined the small variations in the way that brain's different regions activated, which helped them discern the direction of the signals. They discovered that in patients suffering from depression, the brain's anterior cingulate cortex sent signals to an area known as the subgenual cingulate cortex. However, these signals were often misdirected, and the more severe the depression, the greater number of these wrong-way signals there were.