Recently, a number of studies have suggested the benefits of Botox, ketamine, and certain sometimes-unexpected means of treating depression.
“I’m excited in general, and I’m curious,” says Peter D. Kramer, MD, author of Listening to Prozac and Against Depression.
Each year, around 16 million U.S. adults battle major depression. Many of them benefit from antidepressants.
But as many as a third get depressive symptoms despite medication. And
side effects, which can include weight gain, nausea, and insomnia, are
troublesome for some patients. That leaves many people with depression
searching for alternatives.
But if Kramer is hopeful about the newer, novel
ways to treat the condition, he’s also cautious. The studies backing
those treatments aren't conclusive, and none of the approaches have been
approved by the FDA to treat depression (though some, such as ketamine,
have been approved for other uses).
“Things are merely hopeful until they are
demonstrated [safe and effective],” Kramer says. “It’s always hard to
tell what’s going on, but it’s a very interesting time, and I think some
of them will come through.”
Here’s a closer look at what might be used to help treat depression in years to come.
Ketamine. Already in use in certain clinics and in some
emergency departments around the country, ketamine is an anesthetic most
often used during surgery. It's given through an IV, and it quickly
eases symptoms of depression, often in a matter of hours. The benefit is temporary, though.
One recent study found it to be very good at helping curb suicidal
thoughts in severely depressed people. But it's expensive, still
experimental as a depression treatment, and can cause hallucinations and
other side effects.
“Some people are very uncomfortable with the side
effects,” says Alan Manevitz, MD, a psychiatrist who specializes in
treatment-resistant depression at Lenox Hill Hospital in New York City.
Nitrous oxide, or laughing gas. This is an anesthetic
commonly used by dentists. A small study published last December reports
that nitrous oxide improved depression symptoms within less than 2.5
hours.
Unlike ketamine, though, nitrous oxide had few side
effects. The benefits lasted from 24 hours to a full week in some of the
10 people in the study. Much more research needs to be done on the
safety and effectiveness of nitrous oxide, but Manevitz says it’s
promising.
“For
people who are in suicidal despair or crisis, it may, like ketamine,
temporarily relieve that person and act as a bridge until other
treatments start working,” he says.
Botox. Best known for temporarily erasing frown lines and
crow's feet, onabotulinumtoxinA (Botox) has recently attracted interest
as a novel means of lifting major depression. The theory is simple: If
you can’t frown, you won’t be sad. And some research has borne this out.
A single Botox injection into the facial "frown
muscles" provided lasting relief from depression symptoms, according to a
study published last spring in the Journal of Psychiatric Research.
Another study found similar effects following Botox injections into
frown lines around the eyebrows. Many questions remain, though.
“The Botox is very interesting, and the best
evidence [it helps] is as an add-on to antidepressants, but what’s going
on?” asks Kramer. “Is it really feedback to the brain, that if you
can’t frown, do you feel more resilient? Or is it that people respond to
you differently?”
Anti-inflammatory medications. Inflammation has been linked to depression for several years now, says Brown. A recent review of studies, published in JAMA Psychiatry, further backs up the connection. The researchers found that painkillers such as celecoxib, ibuprofen, and naproxen reduced depression symptoms. Another class of anti-inflammatory drugs, called cytokine inhibitors, also showed some benefit.
The authors of the review call their findings
"proof of concept," meaning that their results are strong enough to
encourage further research. Another recent study reports that omega-3
fatty acids, which have anti-inflammatory properties, helped treat
depression linked to chronic hepatitis C.
“If you could actually treat depression symptoms
along these lines, that would be interesting,” Kramer says. “Some of the
antidepressants are also anti-inflammatories, and some people have
thought that maybe it’s just coincidence that they work on [the brain
chemicals] serotonin and norepinephrine, and that the real effect is
anti-inflammatory.”
Uncertain Future
The treatments listed above aren't the only ones being tested.
Nasal
sprays that have protein peptides or small molecules have shown some
promise, Kramer and Manevitz say. A method called transcranial direct
current stimulation, which uses electricity to change brain activity, is
also being tested.
Mindfulness meditation is another promising addition to depression treatment, and exercise is known to help relieve symptoms, too.
If some of the newer treatments seem far-fetched,
Manevitz points out that the same was said just a few years ago about
transcranial magnetic stimulation (TMS), a non-invasive therapy that
uses magnets to affect parts of the brain linked to mood.
“People looked at me cross-eyed and thought it
sounded wacky,” he says. “Now, it’s an FDA-approved treatment for
depression, and it’s used around the world.”
Which, if any, of these treatments prove effective
is anybody’s guess at this point. Researchers have a lot of work ahead
of them before any make it to patients in the clinic.
“So many medicines get lost in the pipeline,”
Kramer says. “Either it’s hard to engineer them in ways that are not
going to harm the kidneys or the liver, or the actual principle under
which they are working turns out not to be right. It’s hard to give your
heart to any one of them because they tend to disappoint.”
Source: http://www.webmd.com/depression/news/20150225/depression-treat-without-antidepressions
