Zeenath Ghouskhan, Sherin Shaji, Ansa Kuriakose
ABSTRACT
Depression is the common cold of mental disorders and is a complex phenomenon that has influenced the lives of common men to kings. The cause of depression can be traced back to several factors as complex as the disorder itself. It is a major cause of morbidity worldwide affecting more than 15 million American adults or approximately 6.7% of the US population. According to statistics, prevalence of depression is more in eastern European countries including Georgia than the western European countries. dysregulations (5 HT) and Nor-epinephrine (NE) in the brain are strongly associated with depression. There are many classical treatments for depression that are low in efficacy and often takes longer time for see their outcome. However, recent breakthroughs in research and treatment around this mental disorder has brought out promising results in the form of Repetitive Transcranial Magnetic Stimulation or rTMS therapy. This revolutionary treatment involves a device that incorporates an electromagnet charged with electricity that is applied to specific points on patient’s head. The powerful magnetic field produced by this device has the potential to affect the brain cells of the person suffering from depression resulting in a positive change. Another treatment KETAMINE, have also found to have a rapid positive impact for many depressed patients. Probiotics in yogurt can reverse the symptoms of depression to some extend. Depression in adolescents is associated with reduced social , occupational,and interpersonal functioning.”Evidence Mapping ” methodology used for the prevention and treatment of depression in young people.Alternative that involves training the mind to fend off negative feelings through meditations, positive affirmations and neurolinguistic programming are also gaining popularity and a synergy between medicine and mind power may hold the key to unlocking patients from the shackles of depression.
INTRODUCTION
Depression is one of the most common types of mental disorders than spans across individuals of all ages, races, gender and socioeconomic status. If we take a look at the history of mankind, we can see traces of depression in the lives from kings to the common man. Famous historical figures who battled with depression included Abraham Lincoln, Sigmund Freud, Siddhartha Gautama who later became Buddha, Wolfgang Amadeus Mozart, Charles Dickens and Isaac Newton to name a few (“Famous People Who Battled Depression,” 2017) (Levine, 2015). According to the American Psychiatric Association, depression is defined as a common but serious medical illness that negatively affects how an individual feel, think and act (Paraekh, 2017). In other words, it is also a state of low mood and aversion to activities that can affect a person’s thoughts, behaviors, feelings and sense of well-being.
We get the following patterns while looking at relevant statistics associated with depression. Depression is the leading cause of disability in developed countries like the United States among individuals between the age group 15-44 and when compared for its effects among males and females, women are nearly twice as likely to suffer from a major depressive disorder than men. It has also been found out that with age, the symptoms of depression become even more severe and about 30% of people with depressive illnesses attempt for suicide in their life-time.We get the following patterns while looking at relevant statistics associated with depression. The current treatment of depression major drawbacks includes it takes a long time especially four to six weeks, improvements after taking medication are not maintained after the medication stopped and its side effects forced patients to stop medications. This nonadherence to the treatment regimen and lead to serious complications. Researches are trying to solve this problem by discovering new strategies for the treatment and prevention
PATHOPHYSIOLOGY
The pathophysiology of depression is still being studied by the medical community but based on studies and research about the human brain, there is a general consensus among leading experts in the field that depletion of one or all of these neurotransmitters in brain namely Nor epinephrine, Dopamine and Serotonin is a causal factor for depression (Jaliiman, 2016). If we look at the pathophysiology of depression from a neurotrophic point of view, the chain reaction that leads to depression is triggered by stress which leads to increased glucocorticoids that causes inhibition of BDNF. The resulting condition leads to atrophy of hippocampus and prevents the release of CRF that in turn leads to release of more glucocorticoids. This goes in a cyclic pattern resulting in a depressive state of mind.
NEW MODALITIES FOR THE TREATMENT :
The increase in the number of depression patients has necessitated urgent action and the saying “necessity is the mother of invention”, the medical community has come up with new, innovative and revolutionary methods to prevent and treat depression, some of which are the following:
rTMS THERAPY is a non-surgical and non-pharmacological intervention that involves the use of transcranial magnetic stimulation where magnetic fields are used to induce electric currents in the cerebral cortex thereby depolarizing the neurons. This magnetic field is created by passing quick current pulses through an electromagnetic coil placed against the forehead. The key advantage of this intervention model is that the magnetic fields can safely penetrate the skull without the sensation of pain. One contraindication for this treatment are patients with any type of non-removable metal in their head. Compared with ECT, rTMS also does not involve direct contact with electricity as well as less stigma (“Brain Stimulation Therapies – rTMS,” 2016).
KETAMINE is another pharmacological agent that has been found to be of optimum use in the treatment of depression. It acts as a “rapidly acting antidepressant” and at low doses increases glutamate neurotransmission by increased glutamate release and increased AMPA receptor expression and insertion in to the synaptic plate. This causes secondary increased BDNF release and activation of ERK signaling which then stimulate mTOR leading to increased structural connectivity between neurons particularly in the pre-frontal cortex (“Ketamine: Facts,” 2017).
LACTOBACILLUS, a probiotic bacteria found in live-culture yogurt is another element in the fight against depression based on new findings that it can reverse symptoms of depression in mice. In a recognized preclinical model of depression, investigators examined the gut microbiome of mice before and after they were exposed to chronic stress. The major change they found was a loss of Lactobacillus and an increase in circulating levels of kynurenine metabolites, which are known to drive depression. With the loss of Lactobacillus came the onset of depressive symptoms (Melville, 2017, para. 1,2).
Other alternative treatments that aids addressing depression involves the help of the mind and involves a wide array of approaches and techniques that includes but not limited to psychotherapy, cognitive behavioral therapy (CBT), nuero-linguistic programming (NLP) and counseling (Goldberg, 2017). Proponents of such therapies argue that the mind must also be involved in any treatment that it is a target of and a cooperation between mind and medicine is necessary for positive prognosis in a mental disorder like depression.
CONCLUSION :
With new and emergent modalities in the prevention and treatment of depression, the medical community in general and the researchers who are after the trail of causal factors for depression in particular, are getting one step closer towards unraveling the mystery of what is causing depression and most importantly, how it can be prevented or addressed once it is evident in a patient.
BIBLIOGRAPHY :
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Famous People Who Battled Depression. (2017). Retrieved from http://www.thefamouspeople.com/depression.php
Goldberg, J. (2017). Cognitive Behavioral Therapy for Depression. Retrieved from http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression
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Levine, B. (2015). 7 historical figures who wrestled with depression. Retrieved from http://www.salon.com/2015/01/21/7_historical_figures_who_wrestled_with_depression_and_how_they_eased_their_suffering_partner/
Melville, N. (2017). Probiotic in Yogurt May Improve Depressive Symptoms. Retrieved from http://www.medscape.com/viewarticle/877238
Parekh, R. (2017). What Is Depression? Retrieved from http://www.psychiatry.org/patients-families/depression/what-is-depression