Major Depression Disorder Treatments: Analytical Essay

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Abstract

With the rising number of clinically diagnosed teens and adults, there is also a need for different treatments due to the different lifestyles of individuals. Newer advances such as a new use for ketamine, acupuncture therapy, and even a mild form of therapeutic shock therapy have all shown to improve one’s condition by either working side by side the antidepressant medication, or completely replacing it altogether. All three methods have shown to improve one’s rating on the depression scale by lowering their score dramatically.

New Research is Finding More Ways to Cope with Major Depressive Disorder

Major depressive disorder is one of the most prevalent mental illnesses within the population. According to the National Institute of Mental Health, a reported 6.7% of the adult population being clinically diagnosed with the illness, meaning that approximately 14.8 million Americans are diagnosed. In adults, this disorder leads to a lower quality of life and makes it harder to accomplish everyday tasks as well as maintain healthy social interactions. Symptoms of this disease include diminished levels of self-esteem, and lack of energy or daily motivation. Episodes of this disorder can linger from days to weeks if not being constantly treated

Treatments.

Treatments for this illness are necessary for individuals proceed in living productive, normal lives. Luckily there is a long list of proven treatments to help people find the best fit for themselves. From medication to acupuncture therapy, to even sometimes shock therapy

Acupuncture Therapy.

Acupuncture is mostly known to the public as a seemingly painless way to help release negative energy that is stored deep inside our bodies. Recently, researchers have been testing the effectiveness of this procedure on those diagnosed with major depressive disorder or MDD. Multiple studies were conducted by RAND Corporation, trying to determine the effects of acupuncture on participants diagnosed with major depressive disorder. The participants were adults between the ages of 30 and 49. Of the three studies, the researchers were trying to determine the best way to incorporate acupuncture into one’s treatment of MDD. Participants were tested with and without their usual antidepressant medication to possibly try to replace that medication in some participants. At the end of the study, most participants receiving conventional acupuncture reported that the acupuncture on its own did not show much improvement in their depression scores. On the other hand, participants taking antidepressants while also receiving conventional acupuncture scored much lower on a depression scale.

Repetitive Transcranial Magnetic Stimulation (rTMS).

Repetitive transcranial magnetic stimulation (rTMS) has become a more widely accepted form of major depressive disorder treatment over recent years. In 2008, the treatment was approved for treatment of individuals who were or became resistant to normal anti-depressants. Although clinical guidelines limited the testing of subjects because of the increased risk of lowering a subject’s seizure threshold. With the addition of medications such as antiepileptics, benzodiazepines, or other medications with anticonvulsant properties, researchers were able to continue their study alongside adding the subject’s original anti-depressant medication in order to conclude whether or not repetitive transcranial magnetic stimulation would increase the drugs ability to function as it normally should within the patient. The testing took place at UCLA, within their own research facility and research program. All 227 patients were tested from 2009-2017. Of that, 181 participants continued use of at least one psychotropic medication (92%) or antidepressant (72%). Treatment took place using the NeuroStar TMS System (Neuronetics, Inc, Malvern, PA 30 separate times, scheduled over six weeks. The start of treatment starts slow, beginning by using parameters of 3,000 pulses per session at 10 Hz administered to the left dorsolateral prefrontal cortex with a 40‐pulse train and intertrain interval of 26 seconds, for a total duration 37.5 min. Intensity was amplified to 120% of the resting motor threshold as the subject tolerated. After the first two weeks, minor adjustments were made to treatment. Treatment adjustments were guided by changes in symptom severity, and physician clinical judgment, within established treatment guidelines. After the trial was concluded, Subjects showed an average improvement of wellbeing on the depression score scale (7.9 ± 9.8 points on the IDS‐SR after 2 weeks of treatment). Change in symptom severity at week 2 was not associated with gender, although the older the subject, the greater showed improvement. After 6 weeks of treatment, subjects improved even more (13.8 ± 12.1 points). During week 6, not only was the patient’s depression score improving, but also their anxiety subscale (r = −0.16, p = 0.05). This study concluded by stating that the use of benzodiazepine was less helpful to the subjects, whereas psychostimulant use much more rewarding over the time studied. Over recent years, the correlation between medication use and more invasive clinical trials were beginning to become more widely accepted in the medical and psychological fields. Given that psychostimulant effects were observed at week 2 and across six weeks of treatment, this medication category may be more likely to be associated with rTMS outcome for depression regardless of treatment duration, or the site/frequency of stimulation.

Ketamine.

Ketamine originally started out in the United States as an anesthetic in the 1970s and was soon replaced with a newer more advanced drug. Once ketamine lost its medical use, it was beginning to be used for non-medical purposes and was becoming more of a party drug used for recreation. Only recently have psychologists started to weigh the odds and look at some of its adverse effects on the human brain. New research has proven that the glutaminergic pathway is an alternative target mechanism in the treatment of major depressive disorders. The glutaminergic houses more receptive and powerful neurons. In fact, ketamine targets this portion of the brain, making it very effective. Within the Cochrane systemic review, participants showed significant results in 3 randomized controlled trials with 56 adult participants. This showcased that the response rate of ketamine compared with placebo was excelling at 24 and 72 hours. The odds ratio at 24 hours was 10.77 (95% confident interval [CI] = 2.00–58.00); and at 72 hours was 12.59 (95% CI = 2.38–66.73). Meanwhile, data from 4 randomized controlled trials with 131 participants revealed an odds ratio of 2.58 (95% CI = 1.08–6.16) at a 1-week interval. Interestingly, at a 2-week interval, only 1 study reported no difference in response rate between ketamine treated group and placebo. Repeated dosing of IV ketamine at 0.5 mg/kg given 3 times per week for a total of 6 doses over a 12-day period resulted in a significant reduction of depression symptoms as measured by the Depression Rating Scale. This therapeutic effect was observed beginning at 2 hours after the first dose of ketamine infusion and persisted throughout the treatment duration. Unfortunately, relapses were noticed among the responders on an average of 18 days after the last dose of ketamine. This suggests that ketamine has a rapid onset with limited duration effect on depression.

References

Sorbero, M., Reynolds, K., Colaiaco, B., Lovejoy, S., Farris, C., Vaughan, C., . . . Herman, P. (2015). Discussion. In Acupuncture for Major Depressive Disorder: A Systematic Review (pp. 33-48). RAND Corporation. Retrieved from www.jstor.org/stable/10.7249/j.ctt19rmd2p.13
Depression. (n.d.). Retrieved from
https://www.nimh.nih.gov/health/topics/depression/index.shtml.
Hunter, A. M., Minzenberg, M. J., Cook, I. A., Krantz, D. E., Levitt, J. G., Rotstein, N. M., …
Leuchter, A. F. (2019). Concomitant medication use and clinical outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder. Brain and Behavior, (5). https://doi-org.zeus.tarleton.edu/10.1002/brb3.1275
Luu, B., Rice, E., & Goldin, P. (2019). Ketamine in the Treatment of Major Depressive Disorder. The Journal for Nurse Practitioners.
https://doi-org.zeus.tarleton.edu/10.1016/j.nurpra.2019.07.016

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