Neuroimaging and the news it brings for the treatment of depression

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There are many different ways to treat depression including talk therapy and antidepressant drugs.

Depression, especially what is called clinical depression is one of the most difficult illnesses to have. Many people who are clinically depressed find that their support system gets very tired of dealing with their illness. Even professionals sometimes  tire of listening to stories about how difficult it is to be depressed. Part of the reason for this is that there is nothing to see. If you were injured and had your leg in a cast or your head in a bandage, people are sympathetic and sensitive to your problem. When you are depressed there is not usually any visual imagery that indicates you are struggling with a problem. You look the way you typically do.

Through the years many of my patients (Brett) who have been suffering from depression have shared with me that their friends and families have said things to them such as: “you need to get over yourself” and “you need to suck it up” and “ I am tired of this” as if the person were being depressed on purpose or were depressed as a way to create a problem for the friend or family. This is a shame and it is a horrible thing to endure when you are clinically ill.

There are many different ways to try to treat depression, including talk therapy and antidepressant drugs. Historically even shock therapy was used for severe depression.

One of the concerns that those dealing with treating depression have is the question of suicide or suicidal ideation. Depressed individuals often contemplate suicide and some attempt it and some are successful. We have developed rubrics such as scales of lethality to help us determine the actuality and the degree of risk of suicide, but they are not perfect measures. There are different types of anti depressant medicines such as MAOI inhibitors, and SSRIS ( Selective Seritonin Reuptake Inhibitors) and Uni Lateral shock treatment, along with counseling interventions. The major problem with treating depression with medicines is that we do not know which one to use for which type of depression.  Doctors will give you an antidepressant that they have had success with or that has been recommended to them by sales reps or other doctors, and then you have to wait a couple of weeks to see if this works for you. If it does not seem to work and we want to try another one, then you have to wait a couple of weeks to “come off “ the med and are given a new one to try. As you can see this may take months and all the while you are still hampered by the debilitating impact of depression.

In today’s Healthcast we are discussing some new information which comes to us from the research of Dr. Connor Liston, MD, PhD neuroscientist and psychiatrist at the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York.  Dr. Liston has developed ways to do Functional MRI’s that can show the activity of the brain in various regions of the brain as they are in the moment of activity. He can identify and locate those areas of the brain that are active (or inactive) during a depressive episode. The importance of this research is that we think it will allow us in the near future to determine the areas of the brain that are impacted by the various antidepressant medicines so that we can know better which ones to prescribe for specific types of depression. We can watch as they work to see if they are targeting the correct area of the brain that is the focus of the type of depression you suffer from.  This is exciting news. It is still not ready for broad public use as it is in the testing stages, but it is very exciting to hear that it may become possible to target specific types of depression with specific medicines and have a better expectation of success!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.  

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