Depression treatment
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Beyond Prozac:
New Treatments, New Hope
Welcome to the 21st-century lab, where hormones, brain pacemakers
and magnetic coils can be a depression treatment
We've come a long way. Some psychiatrists used to think you
could cure depression by removing a patient's colon or teeth.
In the late 1800s, there was a doctor who observed his anxious
patient become calm on a bumpy train; thereafter treatment
consisted of shaking the poor man for greater and greater
lengths of time.
In an attempt to cure the ancient malady of melancholia,
we have resorted to scads of strategies, some of them plainly
stupid or cruel, others, like Prozac, that work. But an estimated
30 percent of depressed patients are what's called treatment
resistant; they don't respond to pills or talkor even shock.
The good news is that there are new treatments making their
way into the 21st-century world—treatments that offer
hope for the newly diagnosed or for someone who has been suffering
without, so far, a cure in sight.
Miracle Meds – depression treatment
It used to be that psychiatrists would try a patient on
one antidepressant medication, wait eight weeks and, if it
didn't work, switch to another one. While this is still a
viable (if frustratingly slow) tactic, psychiatrists are relying
more and more on secondary, and even tertiary, drugs to boost
the primary player. One of those booster drugs is Cytomel,
a thyroid stimulator. Even women with normal thyroid levels
can, under a psychiatrist's supervision, take Cytomel in addition
to an antidepressant. About 50 percent of the time, it helps
the primary drug work more effectively. Other popular booster
medications are lithium and Ritalin.
Hormone Therapy – depression treatment
Scientists have spent years and years investigating chemicals
like serotonin and their effects on mood, while neglecting
to study brain chemicals still more common, and abundant,
like estrogen and progesterone. Andrew Herzog, M.D., a neuroendocrinologist
at the Beth Israel Deaconess Medical Center in Boston, treats
many women who don't respond to Prozac and its chemical cousins
with sex steroids. "The future of psychiatry lies largely
in the realm of using hormones to regulate brain states,"
Herzog says.
He believes many women become depressed either because they
have a measurable imbalance of estrogen and progesterone or
because their brains are too sensitively tuned to normal fluctuations.
"Hormones are psychoactive," Herzog says, "and
there's no doubt that they can have huge effects on our feelings."
Progesterone, claims Herzog, is seven times stronger than
your average barbiturate, and it exerts a strong calming,
even sleepy, effect. Estrogen, the opposite, provides pep
just as well, if not better, than that Prozac pill you're
taking. For women with agitated depressions that make them
nervous and jumpy, Herzog might prescribe progesterone to
calm with a bit of estrogen to brighten, in the form of a
cream the woman rubs into her skin. For lethargic depressions,
Herzog emphasizes the estrogen instead, and he's had remarkable
success treating women who were deemed "untreatable."
"These hormones gave me my life back," says one
of his patients, who became depressed in her 40s and was incapacitated
by her 50s.
Hormone treatment for depression requires that you see a knowledgeable
neuroendocrinologist and that you undergo a hormone profile,
having your levels of progesterone and estrogen measured at
the beginning and end of the month. The procedure is new but
so far highly promising.
"Get Happy" Pacemakers- depression treatment
The vagal nerve connects your brain stem with your upper
body, specifically your lungs, heart and stomach. The nerve
is a critical conduit for relaying information to and from
your central nervous system, carrying electrochemical signals
up its tubing and depositing them directly into your cortex.
Some years ago researchers began implanting a small pacemaker
into the vagal nerves of epileptics to see if tiny pulses
might help stop the seizures. The pacemakers did indeed reduce
or eliminate seizures in some epileptics, but they did something
else, as well, something surprising and critical. Epileptics
with vagal-nerve pacemakers got happy. Their moods improved.
That's when researchers decided to try using them in people
with treatment-resistant depression.
No one quite knows how or why they work. Some doctors hypothesize
that vagal-nerve stimulation (VNS) instigates changes in norepinephrine
and serotonin, two neurotransmitters closely associated with
mood. John Rush, M.D., at the University of Texas Southwestern
Medical Center at Dallas, and colleagues did a study of 30
people with treatment-resistant depression. They implanted
the pacemakers into those people and, over a two-week period,
gradually increased the amount of stimulation current to levels
the patients could tolerate comfortably.
Forty percent of these patients showed a substantial decrease
in depression as measured by a verbal test asking them about
their thoughts and feelings; 17 percent had a complete remission.
After one year of VNS, more than 90 percent of the patients
who benefited from the initial treatment continued to show
a decrease in depression.
Magnetic Healing
Transcranial magnetic stimulation (TMS) may someday replace
electroconvulsive therapy (ECT) altogether. In TMS, an electrical
current passes through a handheld wire coil that a doctor
then moves over your scalp. The electrical current makes a
powerful magnetic pulse, which passes straight through your
scalp and stimulates nerve cells in the brain.
TMS is in part remarkable because of its specificity. Researchers
now believe they can target brain structures that they know
are involved in the creation and maintenance of depression
and anxiety.
Many studies indicate that magnetic brain stimulation once
daily for two or more weeks may relieve depression (a typical
patient's symptoms are reduced by almost 30 percent). Although
TMS is still considered an experimental form of treatment,
various hospitals and clinics offer it. Within five to ten
years, TMS may become a common form of treatment for people
with depression.
And this is just the beginning. Twenty years ago we had
only the crudest psychiatric drugs; in the space of two short
decades, we've developed an arsenal, and more important than
that, we've shown we're capable of ever more complex and innovative
treatment strategies. The next few decades will bring as-yet-unheard-of
kinds of cures, for us, for our children and so on down the
line.
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