Depression is society’s silent killer; only getting worse as time goes on. Given how the dialogue around mental health has changed — for the better — over the preceding two decades, one would expect matters to be improving.
Depression affects approximately 300–400 million people worldwide; around 3.8% — 5% of the total population, depending on your source. Shockingly, 700,000 of these people will die by suicide every year; the fourth leading cause of death amongst 15–29-year-olds, the World Health Organization reports.
Many leaps and bounds are being made by researchers attempting to understand the effects of depression on a neurological, physical and even spiritual level. But for those who have experienced it — depression is like torture; an arduously slow burn, like a red-hot tattoo needle, infecting its way into every aspect of your life.
Otsuka America Pharmaceutical and Scientific American recently reported that one of the biggest flaws in modern depression treatment is the lack of nuance built into the diagnosis framework. “It’s great that our treatments work as well as they do for these very different kinds of people,” Conor Liston, a psychiatrist and neuroscientist at Weill Cornell Medicine, told SciAm. “But they don’t work for everybody.”
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Researchers say a major issue with the practice guidelines is they “do not distinguish patients other than by severity,” leaving many patients out in the cold — untreated.
Trial-and-error
Recent advances in brain-imaging techniques, like Functional Magnetic Resonance Imaging (fMRI), are enabling clinicians to effectively treat a wider variety of depression symptoms.
A depressed brain has a different flow of neurons to different parts of the brain, compared to people who do not suffer from depression. And the effects of such can be seen on a neurological level via the brain’s circuitry, which is linked by neurons, using fMRI, according to Liston.
Understanding this process can help clinicians identify different “biotypes” of depression, helping to better categorise patients and “identify who will respond best to which treatment mode.” A more nuanced approach to previous methods. Using fMRI scans in conjunction with tailored cognitive behavioural therapy (CBT), medication and in extreme cases, electroconvulsive therapy (ECT), can be an effective means of treating depression.
“These new tools and technologies are transforming how we do science in this area and are allowing us to ask questions that would have seemed like science fiction not that long ago,” Liston told SciAm.
But even the greatest minds in psychology and psychiatry agree that treating depression is still very much a matter of “trial-and-error.” Leaving a risk for many patients wide open to go untreated. So what about alternative treatment options for patients who slip between the cracks?
Alternative depression treatment
It’s an established fact that traditional pharmaceutical treatments for depression and major depressive disorder like anti-depressants (Selective Serotonin Reuptake Inhibitors, or SSRIs), can lead to a diverse range of nasty unwanted side effects.
According to the NHS, anti-depressant side-effects can include but are not limited to: bruising or bleeding easily, including vomiting blood or bleeding from the anus, suicidal thoughts, weight gain, loss of libido, erectile dysfunction, and confusion. The list goes on…
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But ironically, it may be the drugs once demonised by society that hold the greatest potential for the treatment of depression — like psilocybin, ketamine, LSD and cannabis. A field of research only just beginning to heat up.
According to a recent study by scientists at UC San Francisco and Imperial College London, psilocybin was found to foster greater connections between different regions of the brain in depressed people, “freeing them up from long-held patterns of rumination and excessive self-focus.”
“For the first time we find that psilocybin works differently from conventional antidepressants — making the brain more flexible and fluid, and less entrenched in the negative thinking patterns associated with depression,” said David Nutt, head of the Imperial Centre for Psychedelic Research, in response to the findings.
“This supports our initial predictions and confirms psilocybin could be a real alternative approach to depression treatments.”
Ketamine, a dissociative anaesthetic and (occasional) recreational party drug, was recently found to have strong, although temporary, anti-depressant and anti-suicidal effects after a single IV ketamine infusion treatment.
“The paradigm-shifting nature of the antidepressant response associated with IV ketamine and intranasal esketamine, their growing use in the community, and the evidence-based treatment recommendations for their use in mood disorders all underscore the importance of this novel addition to the treatment armamentarium for Treatment-resistant depression (TRD).”
Ketamine IV therapy has been a miracle treatment for PTSD sufferers, also. Particularly in the veteran community. Although more controversial, LSD therapy has also been shown to have promising effects on treatment-resistant depression and PTSD symptoms.
