Past & Future Treatments of Depression

Copyright 2002 Time Inc.

 We've come a long way from Freud's couch. The big breakthrough
arrived in the late 1980s with the advent of safer and more widely
effective drugs, like Prozac. According to Dr. Bruce Cohen of Harvard's
McLean Hospital, we're on the cusp of a new era in treatment as the
search for a single magic pill for depression gives way to a broad
spectrum of therapies.

DRUGS

TODAY'S TREATMENTS

* Most antidepressants work by tweaking levels of various
neurotransmitters, the chemicals that carry signals from one neuron to
another. Prozac, Paxil, Zoloft and the other SSRIs slow the absorption
of serotonin. Effective antidepressants that act on both serotonin and
norepinephrine include Effexor and Remeron. Drugs like Wellbutrin work
in a similar way but probably on the neurotransmitters norepinephrine
and dopamine. The tricyclic antidepressants (such as Elavil and
Tofranil) also blocked the absorption of neurotransmitters, especially
norepinephrine, but the drugs had significant side effects. Another
class of first-- generation drugs, the monoamine oxidase inhibitors
(MAOIs) such as Nardil and Marplan, can be effective but can also
produce dangerous side effects. A transdermal patch just approved by
the Food and Drug Administration will give new life to MAOIs by
reducing the side effects they sometimes caused when taken orally.

ON THE HORIZON

* Researchers are exploring two related molecules, gaba and
glutamate, that are responsible for 90% of chemical signaling in the
brain. Because they control so much of the brain's activity the trick
is to fine-- tune their levels in ways that relieve depression but
don't affect other brain functions. Other targets of drug development
the sex hormone testosterone (a transdermal patch proved effective in a
recent clinical trial for men); the stress hormone cortisol, which
researchers are trying to regulate with the abortion drug RU 486 and
compounds called CRF antagonists; the dynorphins (the evil twins of
feel-good endorphins); and a chemical called substance P, involved in
pain pathways closely related to depression.

ELECTRICAL AND MAGNETIC

TODAY'S TREATMENTS

* Electroshock therapy, despite its unsavory reputation, is
actually quite effective, especially for patients who don't respond to
drugs and seniors for whom drug interactions pose problems. The
treatment today uses a small current to trio mild seizure-a rhythmic
firing of neurons-that can push a depressed brain out of its rut.

ON THE HORIZON

* Researchers are exploring a similar technique that sends an
electrical current through the vagus nerve major conduit wiring the
heart and intestines--which then delivers it to the brain. Another
approach, called regional transcranial magnetic stimulation, uses an
electric coil shaped like a figure eight to create a magnetic field
inside the pre-frontal cortex, which plays a key role in mood
regulation.

TALKING CURES

TODAY'S TREATMENTS

* Most research today is focused on the physiology of
depression, yet clinicians find that approaches combining medical and
psychological treatments are still the most effective. Freud's
techniques have been adapted and streamlined, but analysts still try to
get patients to probe the unconscious roots of their problems.

* Newer techniques like cognitive therapy, by contrast, teach
patients to recognize destructive patterns in their lives and develop
practical steps for changing bad mental habits.

ON THE HORIZON

* Meditation, mindfulness training and biofeedback have long
been championed as proven stress relievers. Now proponents believe
these techniques may also provide relief to people with depression by
lowering levels of cortisol.

ALTERNATIVE THERAPIES

TODAY'S TREATMENTS

* More patients today help themselves to over-thecounter aids,
from St.-- John's-wort to ginkgo biloba and soybean extracts. But
herbs, like prescription drugs, can have side effects, and researchers
are investigating their efficacy. The popular supplement DHEA, for
example, has been linked to an increased risk of cancer.

ON THE HORIZON

* Omega-3 fatty acids (in fish oils) are good for the heart and
also may be good for the brain by promoting the health of nerve-cell
membranes. Studies are under way.





 

This Article has been submitted by the Jeremy's Prophecy Dot Com team for informational and educational purposes. Jeremy's Prophecy Dot Com is a website dedicated to telling the story of Jeremy Jacobs, a character in the novel, Jeremy's Prophecy Dot Com.