New depression treatments move beyond just drugs

New findings in the physiological causes of depression are leading to treatments other than widely used antidepressants, such as Prozac and Zoloft, according to a report in the journal Current Psychiatry.

Depression is a problem facing many seniors. New treatments include new medications, electrical and magnetic stimulation of the brain, and long-term cognitive behavioral therapy for stress management.

Authors of the new study are Murali Rao, MD, and Julie M. Alderson, DO. Rao is professor and chair of the Department of Psychiatry and Behavioral Neurosciences at Loyola University Chicago Stritch School of Medicine. Alderson is a resident at East Liverpool City Hospital in East Liverpool, Ohio.

For half a century, depression has been considered a deficiency of chemical messengers, called neurotransmitters, that carried signals between brain cells. Commonly used antidepressants are intended either to increase the release or block the degradation of the following three neurotransmitters: dopamine, norepinephrine and serotonin.

But drugs that target neurotransmitters, such as Prozac, Zoloft and Paxil, succeed in reducing depression in fewer than half of patients. This has driven researchers “to look beyond neurotransmitters to understand” what could effectively deal with depressive disorders, Rao and Alderson write.

New theories about depression are aimed at differences in neuron density in regions of the brain; on how stress effects the birth and death of brain cells; on the alteration of pathways in the brain and on the role of inflammation brought on by the response of stress.

The article about the research said that chronic stress is thought to be the leading cause of depression. The authors of the study write that long-term stress harms cells in the brain and body. Stressful experiences are thought to be closely associated with the development of psychological changes and, therefore, neuropsychiatric disorders. Where there is chronic stress in a person, nerve cells in the hippocampus begin to atrophy. (The hippocampus is that part of the brain involved with emotions, learning and memory.)

The new depression theories “should not be viewed as separate entities, because they are highly interconnected,” Rao and Alderson write. “Integrating them provides for a more expansive understanding of the pathophysiology of depression and biomarkers that are involved.”

Such biomarkers are molecules in the body that can be indicators of depression. The authors identify more than a dozen potential complex biomarkers of depression, including monoamine regulators; proinflammatory cytokines and other inflammatory mediators; mediators of glutaminergic activity and GABAergic activity; and regulators of neurogenesis.

You probably have to be a medical scientist to appreciate this technical talk.

Depression treatments currently used or on the horizon include corticotropin-releasing hormone antagonists; dexamethasone; partial adrenalectomy; long-term cognitive behavioral therapy; ketamine and other NMDA antagonists; benzodiazepines; anesthetics; deep brain stimulation; transcranial magnetic stimulation; exogenous brain-derived neurotrophic factor; selective serotonin reuptake inhibitors; tricyclic antidepressants; atypical antidepressants; reduction in inflammation; and anti-inflammatory drugs.

Seniors, you’ll have to get your doctor to explain what may lie ahead in treatments as suggested above. At least it is reassuring to know scientists are following new leads.

It can take months to recover from depression. Rao and Alderson write that current depression treatment programs that average six weeks “are not long enough for adequate recovery.” New treatments maybe, but no immediate cure.

Loyola University Health System provided the information for this article.

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