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Treatment Of Depression: Seeking The Magic Bullet

“Study Suggests New Target for Treatment of Depression”

At the time of writing this page, the above headline was hot off the press, together with the rest of the news story from the University of Iowa and the Iowa City Veterans Affairs Medical Center. The story in the Journal of Neuroscience was sub-headed, “Disrupting a brain protein produces antidepressant-like effect in mice.” The treatment of depression is important in the US for the medical profession and for the researchers in academic institutions because “depression affects at least 14 million American adults and can be severely disabling” according to the article.

It continued to explain that the causes of depression are not well understood and says that up to “half of people diagnosed with depression are not helped by current therapies because either the drug is not effective for them, or the side effects are intolerable.”

Research related to the treatment of depression is important because “if a patient doesn’t respond to one drug, the chances of them responding to another drug that works through the same mechanism are low,” according to John Wemmie, M.D., Ph.D., associate professor of psychiatry and neurosurgery at the UI Carver College of Medicine and a staff physician and researcher at the Iowa City Veterans Affairs Medical Center. He went on, “We need antidepressants with new mechanisms of action to help those people who don’t respond to what is currently available.” He said that although there was no immediate therapy available based on the new findings, the results suggest a new approach to antidepressant therapy in the treatment of depression.

Mainstream Treatments

Turning away from the news, perhaps 20% of the population of developed countries is affected by major depressive disorder at some stage of their lives and thus likely to undergo mainstream treatments. Patients are usually treated as outpatients. Commonly the treatment of depression is by means of psychotherapy, medication, and electroconvulsive therapy (ECT). In young patients psychotherapy is preferred, with medication secondary and in parallel.

Treatment may be by many means. The list of possible treatments is long and perhaps, therefore, indicative that the search for, and the research into, effective treatment continues. We have mentioned psychotherapy, medication, and ECT. The most used form of psychotherapy is cognitive behavioral therapy (CBT), which teaches cognitive and behavioral skills. Research indicates that it can be as effective as antidepressants as a treatment of depression in moderate to severe instances.

We note that one antidepressant may be prescibed and augmented by another, or with a drug of a different type, such as Lithium, in cases of treatment resistance in a process known as augmentation. It is interesting to note that opiates were used as a treatment of depression into the 1950s. The well-known side efects were a disincentive to their continued use but some research has continued. Other drugs used include Gamma-Hydroxybutyric acid (GHB) which is now restricted to the treatment of narcolepsy rather than as a generally-applicable treatment of depression. Patients who do not respond well to the usual antidepressants, or their side effects, may do well with moderate use of marijuana.

Other Treatments

St. John’s Wort (hypericum perforatum) is prescribed widely in Europe in the treatment of depression. It is sold as a herbal supplement over-the-counter in the US.

S-Adenosyl methionine (SAM-e) is on prescription in Europe and over-the-counter in the US.

Repetitive transcranial magnetic stimulation (rTMS) is not approved in the US but may be as effective as ECT.

Vagus nerve stimulation (VNS) sends electrical impulses to the vagus nerve in the brain via an electrode implant.

Bright light therapy is used particularly in Seasonal Affective Disorder treatment.

Exercise and Acupuncture are used in the treatment of depression.

A low fructose diet and the ingestion of Omega-3 fatty acids have been shown to be beneficial.

Saffron, Ginseng and Kanna have their advocates. Don’t forget Meditation. What about Music Therapy? or Sleep Therapy? Vitamins and mineral supplements? Tai Chi and Cold Showers? Clearly, there is much searching and researching taking place trying to find the magic bullet to use in the treatment of depression.

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