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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


The Future Of Depression Treatment


September 08, 2011

Depression
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The Future Of Depression Treatment
The Future Of Depression Treatment
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Depression is a very common problem. There is plenty of reason to hope that the coming years will bring new and exciting treatments.
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InteliHealth
2011-09-08
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InteliHealth/Harvard Medical Content
2014-09-08

Reviewed by the Faculty of Harvard Medical School

The Future Of Depression Treatment
Depression is a very common problem, so it is the subject of intense research. There is plenty of reason to hope that the coming years will bring improvements in treatment.

 

New Drugs
 
One problem in developing new drugs to treat depression is that we're only beginning to understand depression's biological causes.
 
Most antidepressants aim to enhance the functioning of nerve pathways involving two of the brain's chemical messengers, serotonin and norepinephrine. As good as this treatment can sometimes be, these two chemical messengers are only a small part of the story. There are other chemical messengers that probably influence mood. One of them, dopamine, has a role in the brain's reward system, contributing to pleasure and motivation. Drugs such as amphetamines and cocaine stimulate the dopamine system, which is one of the reasons these drugs are so addictive.
 
The chemical messengers glutamate and gamma-amino butyric acid (GABA) may also play a role in the ups and downs of mood, making them potential targets for future drug therapy.
 
The stress-response system is also under study. When you are stressed physically or emotionally, your body responds by changing the concentration of stress hormones circulating in your blood. People with depression tend to have an overactive stress response. Researchers are searching for a way to retune this system.
 
The future of depression treatment may come from a better understanding of the chemical reactions inside cells (as opposed to the chemical communication between them). We also are likely to learn more about how the genes govern the cascade of chemical reactions that ultimately lead to a change in mood.
 
A great hope is that new discoveries about what genes do will help scientists to clarify the biological causes of depression. With any luck, this will lead us to more selective and effective treatment.

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Alternatives To Electroconvulsive Therapy
 
Repetitive transcranial magnetic stimulation. In recent years, health-care providers have been using strong magnets to treat depression. Repetitive transcranial magnetic stimulation involves passing a magnet over the scalp, directing a magnetic field to a small part of the brain. There is no need for anesthesia, as there is no pain or discomfort. Repetitive transcranial magnetic stimulation takes less than an hour. It is done daily for about 10 days. Although there have been some promising results, the treatment is still being standardized, and it does not appear to be as effective as electroconvulsive therapy. But the treatment has not yet been standardized. It is not clear how many treatments are required or what part of the brain is best treated with the magnet.
 
Vagus-nerve stimulation. The vagus nerve is a very long nerve that starts in the brain and travels through the chest to the diaphragm, the muscle at the base of your chest that controls the expanding and contracting of your lungs during breathing. The vagus nerve is connected to parts of the brain that control mood and anxiety. In 1997, a process to treat seizures was approved that uses a small pacemaker-like device to stimulate the vargas nerve. Researchers noticed that this stimulation also improved mood in some people. A few studies have shown vagus nerve stimulation to be effective in treating depression. Unfortunately, the results are not from the kind of randomized, controlled studies that give us the best information about a treatment’s helpfulness. Another major downside to vagus nerve stimulation is that it requires surgery to install the device. Some specialists now recommend the procedure and device for a small number of people who have treatment-resistant depression. It is still rarely use because it is a relatively untried procedure.
 
Deep brain stimulation. In this technique, ultra-thin electrodes are implanted deep in the brain in order to stimulate a specific region. The technique has been used to treat neurological illnesses such as Parkinson’s disease, tremor and seizures. In recent years, researchers have offered it to a small number of severely depressed people who have not found relief with any other treatment. Some have improved, but research is still in its earliest stages, so it is difficult to say how helpful this treatment might be. As with vagus nerve stimulation, surgery is required with deep brain stimulation.

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Complementary And Alternative Medicine
 
There has been enormous interest in the herbal remedy St. John's wort. Although this herb may be somewhat helpful in people who have mild depression, it is probably not as effective as standard treatments for severe depression.
 
Fish have also caught researchers’ attention. Omega-3 fatty acids, which are found in tuna, salmon and other fish, are an essential part of the diet because the body cannot produce them. Because these fatty acids are a component of nerve-cell membranes, some scientists believe that absorbing more of them may help support nerve function. Can eating more fish help people with mood problems? There is no clear evidence yet that it is a good treatment for depression, although omega-3s are probably good for general brain health.

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