Depression

New Inventions for Treating Depression

From transcranial brain stimulation to esketamine nasal spray.

Posted Mar 08, 2019

Shutterstock, by permission
Source: Shutterstock, by permission

Could technology augment or even replace drug therapies for depression?  Major depression affects about 15 million adults in the U.S., and even more suffer other forms of mood disorder, with symptoms such as loss of interest, feeling helpless or worthless, sleep disturbance, weight gain/loss, and low energy.

“Transcranial Magnetic Stimulation” (TMS), and “Transcranial Direct Current Stimulation” (TDCS) , are new technologies that may provide relief for depression.

Magnetic or electrical stimulation of the brain has been used for a wide range of mental disorders, including depression. TMS or TDCS typically has a patient wear a headset to provide repeated magnetic or electrical stimulation to the forehead and temples. Depressed patients are known to show differences in brain activity in the frontal area, compared with non-depressed subjects.  Certain frontal lobe areas of the brain are associated with mood and emotional regulation. On this basis, electrical pulses have been applied to depressed patient’s frontal lobes in an attempt to re-balance neural activity in these brain areas to relieve depression. Preliminary results from clinical studies look promising [see references, below].

TMS and TDCS are relatively safe, low-cost, and simple to use interventions. Plus, brain stimulation is more targeted than a drug.  The lack of drug side effects is important for those who experience depression during pregnancy, or others who don’t tolerate drug therapies.  The brave new world of transcranial brain stimulation may offer a new strategy to augment psychotherapy and pharmacological therapies.

However, since this is a new treatment modality, caution should be exercised. Some patients experienced headaches from the treatment, and obviously, patients at risk for seizures or with metal implants must be careful before sending even small electromagnetic currents into your head!  Additional studies will continue to test the safety and efficacy of this new psychology through technology, meanwhile, the preliminary results look promising. Several studies have shown that this type of treatment, alone or in conjunction with other therapies, did help to reduce depressive symptoms (see references).  We can look forward to transcranial brain stimulation becoming a useful new treatment option for depression and other mood disorders.

We can also look to the future for new pharmacological interventions for depression. For example, the FDA recently approved Esketamine (a derivative of Ketamine) in the form of a nasal spray for treating severe depression. Ketamine was first used as an anesthetic to reduce pain and enhance the effect of sedatives. But Ketamine, derived from PCP, also developed a bad reputation when it was used as a club drug (“Special K, Kit-Kat, Vitamin K” etc.), and even as a date-rape drug. Users have overdosed and died from Ketamine. Yet, despite a bad rap from misuse in the broader culture, within medical settings, Ketamine is an effective and widely used drug. Esketamine nasal spray may prove to be an effective new treatment for severe depression.  

An unusual aspect of using Ketamine to treat depression, is this drug’s ability to counteract symptoms very rapidly.  Most antidepressants often take weeks to produce effects on mood, yet Ketamine can work within hours. This faster-acting drug could be a critically important intervention for severely depressed and suicidal patients. We must wait for clinical researchers to evaluate use of this powerful medication, but early research suggests that Esketamine will soon become another tool in the arsenal for treating depression.

From brain stimulation to a new, intranasal anti-depressant—that’s some amazing psychology through technology! Stay tuned as we journey to the center of the mind-technology interface.

References

Palm, U.; Hasan, A.; Strube, W.; Padberg, F. (2016) TDCS for the treatment of depression: A comprehensive review. Eur. Arch. Psychiatry Clin. Neurosci., 266, 681–694.

Bennabi, D.; Haffen, E. (2018) Transcranial Direct Current Stimulation: A Promising Treatment for Major Depressive Disorder Brain Sci. , 8, 81.

Bikson, M.; Grossman, P.; Thomas, C.; Zannou, A.L.; Jiang, J.; Adnan, T.; et al. (2016). Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 9, 641–661.

Brunoni, A.R.; Amadera, J.; Berbel, B.; Volz, M.S.; Rizzerio, B.G.; Fregni, F. (2011). A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int. J. Neuropsychopharmacol. 14, 1133–1145.

Lam, RW; Chan, P; Wilkins-Ho, M; Yatham, LN (2008). Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-analysis. Can J Psychiatry;53(9):621–631