CINCINNATI—In the United States, over 15 percent of the population will suffer from depression at some point in their lives. In addition to the dark moods that give the psychiatric disorder its name, individuals with depression often lose all ability to find joy in their lives; experience changes in energy, sleep and appetite; and find themselves so unable to concentrate that they may be mislabeled as suffering from dementia.
Fortunately, the past few years have seen an unprecedented expansion in treatment options for depression. New medication classes have become available, and innovative psychotherapeutic approaches are being brought to bear on the illness. Nonetheless, many patients have been failed by even these new treatments; depression remains a major source of disability, and suicide is the 10th-leading cause of death in the United States.
Unfortunately, notes Cal Adler, MD, a professor in the University of Cincinnati (UC) Department of Psychiatry and Behavioral Neuroscience and co-director of the Mood Disorders Center at the UC Neuroscience Institute, "The common approach in these cases, rotating or combining different medications to target separate chemicals in the brain, does not always give adequate treatment response. The debilitating symptoms of some patients are not adequately treated by any combination of medications. These patients may be experiencing what is often termed treatment-resistant depression.
"One challenge for researchers and clinicians at the Mood Disorders Center has been to identify and apply additional clinical interventions to treat patients with treatment-resistant depression.”
In response to that challenge, the Mood Disorders Center has recently started offering innovative approaches to helping patients diagnosed with treatment-resistant depression:
• Repetitive transcranial magnetic stimulation (rTMS) employs a powerful electromagnet to stimulate a very specific portion of the brain, using indirect electromagnetic induction. Based on research showing that an area termed the prefrontal cortex is involved in regulating mood, rTMS treats symptoms of depression by increasing neural activity in this region. It is usually well tolerated, and has been approved by the U.S. Food and Drug Administration (FDA) for treating treatment-resistant depression. The Mood Disorders Center has the newest rTMS machine available, one of only two in the region.
• Electroconvulsive therapy (ECT) is both one of the oldest treatments for depression and one of the most effective. "The natural discomfort many people have with the idea of using electric current to treat depression has limited its use, but this visceral response reflects just how poorly understood ECT remains,” Adler says. "Despite rather frightening portrayals in popular media, ECT can be an extremely effective and well-tolerated treatment for treatment-resistant depression. Many patients who elect treatment with ECT regret not having started sooner.” ECT can have potentially serious side effects, but using the advanced ECT apparatus and techniques available through the Mood Disorders Institute can minimize side effects while maximizing treatment response.
• Ketamine is an anesthetic medication recently found to have strong and rapid antidepressant effects for many patients, at substantially lower doses than those used during surgery. The Mood Disorders Center is starting a program to make ketamine available to patients with otherwise non-responsive symptoms of depression. "Ketamine should not be used as an initial treatment for depression, but is an option for patients who have not responded well to more conventional interventions,” Adler says.
"Depression is all too often dismissed as somehow less real or debilitating than other serious medical illnesses,” Adler says. "Although the continued stigma often faced by patients with depression and other psychiatric illnesses can also stand in the way of their getting the most effective treatments, individuals facing the pain and disability of depression deserve the most rigorous and evidence-based treatments available.
"Most patients will respond to some combination of medications and psychotherapy. However, for those individuals whose symptoms persist the Mood Disorders Center at the UC Neuroscience Institute can now offer potential new approaches that patients can discuss with their mental health professional. There is less reason than ever for anyone to have to endure the pain of severe depression without relief.”