Taking Charge of Your Health

[ ♪ INTRO ] As many as one-fifth of people experience
depression at some point in their lives. Thankfully, for most, antidepressants and
psychotherapy can reduce symptoms dramatically. But they don’t work for everyone. So doctors and scientists have been looking
for ways to help people with treatment-resistant depression. And they seem to have found some really good
alternatives. The weird thing is: they don’t know why
these alternatives work — which underscores just how little we know about our brains. For example, a randomized controlled trial
in 2013 found that ketamine significantly improved symptoms in people with treatment-resistant
depression. Ketamine is perhaps best known as a party
drug since taking it can induce euphoria, a sense of peace and serenity, and an altered
perception of reality. Doctors are excited, though, because even
when doses are similar to recreational ones, its anti-depressive effects can last 1 to
2 weeks. That’s long after the drug itself is gone
from the person’s body. And in addition to being long-lasting, it
also starts working fast. You usually have to take traditional antidepressants
for weeks before their effects kick in. Ketamine can improve symptoms in as little
as 4 hours. Why ketamine works so well is a mystery, though. Medically, it’s used to sedate patients
before procedures — an effect which stems from blocking specific receptors in neurons
involved in consciousness. But that doesn’t explain how the drug continues
to alleviate depression for weeks after it’s gone. That’s partly why scientists now think that
ketamine triggers a chain of reactions that ultimately results in synaptogenesis — the
process by which brain cells make more connections with one another. People with fewer of these connections tend
to be more depressed, so it could be that building new ones can relieve depression symptoms. But even though ketamine seems promising,
you can’t get a prescription for it just yet. We don’t know if it’s safe or effective
if used repeatedly. And doctors are concerned about the dissociative
side effects — that detached from reality feeling that makes it such an appealing recreational
drug. Several clinical trials are being conducted,
though, so we’ll know more soon. Another weird thing that mysteriously helps
relieve depression is sleep deprivation. In a large meta-analysis, about 60% of people
with depression had their symptoms at least somewhat alleviated by being kept awake overnight. Like ketamine, the anti-depressive effects
of sleep deprivation were felt within hours. But… most of the people returned to feeling crummy
after they started sleeping again, so it’s not really a long term solution. Still, doctors are intrigued. If they can figure out how it works, they
might be able to design a drug to mimic its effects without having to keep people up. The trouble is, sleep deprivation affects
a lot in your brain, so it’s hard to pinpoint what is making you feel better. It could have something to do with the neurotransmitter
adenosine, as staying awake all night increases the levels of it in the brain. Although the specifics aren’t fleshed out,
neuroscientists know that adenosine is important for regulating mood. But there are also studies which suggest sleep
deprivation increases brain-derived neurotrophic factor — a protein that helps neurons survive
and form new connections. And in rats, it’s even been shown to stimulate
neurogenesis — the growth of new neurons — in the hippocampus, a region of the brain
which is important for cognition and emotion. So that could be how it works. Or… it could be something else. With all this uncertainty, it’ll probably
be awhile before any real treatments come out of this research. And while you could theoretically stay up
a night or two to feel better, chronic sleep deprivation usually makes depression worse. Another experimental treatment that’s a
bit more sustainable, is vagus nerve stimulation or VNS. The vagus nerve transmits information between
the brainstem and organs like the lungs, heart ,stomach, and liver. And it’s possible to get implanted with
a device that electrically stimulates this nerve — kind of like a pacemaker. That’s because in the 1980s, doctors demonstrated
that stimulating this nerve can help with epilepsy. But during trials, they noticed that using
the device often improved patients moods, too even when it didn’t stop their seizures. This led to larger clinical trials in people
with treatment-resistant depression. And a 5 year study of nearly 800 patients
found that about 68% of the ones that received VNS had their depression symptoms decrease
by 50% or more. That’s particularly impressive given that
these patients had failed to respond to at least 4 other treatments for depression prior
to the study. No one is quite sure why it works, though. It may be that stimulating the vagus nerve
activates areas of the brain like the prefrontal cortex and limbic system, which are important
for regulating thoughts and emotions. Studies have also found that, like sleep deprivation,
it can affect the levels of neurotransmitters often implicated in mood disorders. Or, it may be all about those connections
again — VNS therapy can also increase neuronal growth. But even though VNS stimulation seems to be
effective for treatment-resistant depression, it’s not easy to get an implant. While the nerve stimulation part is fairly
safe, the initial surgery to put the device in is pretty invasive. And if things don’t go well, you could lose
the ability to speak. So these implants are generally considered
a last resort. And hopefully, less dangerous ways of stimulating
the vagus nerve are on the horizon. Doctors are currently investigating devices
that work from outside the body, and in Europe, they can be prescribed alongside another approved
treatment for depression. But for now, in the United States, they’re
only approved for treating migraines. And even if they’re deemed safe and effective
worldwide, neuroscientists won’t consider their work done. They won’t stop studying them until they
understand why they help. Like with sleep deprivation and ketamine,
knowing how VNS works could lead to safer, more effective treatments. But in a more general sense, it can help scientists
better understand the underlying causes of depression. We don’t know how these treatments work
because there’s just still so much we don’t know about our brains and why we experience
depression. And research into things like ketamine and
sleep deprivation, as weird as they might seem, can help us fill in those gaps. Thanks for watching this episode of SciShow
Psych! And thanks especially to our patrons on Patreon,
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more about joining our community of patrons. [ ♪OUTRO ]

4 thoughts on “3 Baffling Depression Treatments and Why They Might Work

  1. Electroshock or ECT has no FDA testing for safety or even effectiveness. Devices have never had pre-market approval before the FDA. Based on electrical mechanism of trauma CA. courts have proved brain injuries at minimum. Electrical trauma can evolve years out to include CTE and ALS. National product liability suit taking place and medical malpractice firms interviewing for suit. Two suits also filed against the FDA. We have also approached for discrimination and fraud/false claims suits. ECT no longer just used for depression nor as a last resort. It is battery of patients. This is a women's rights issue as well. Women mostly impacted and secondary to TBI one becomes less effective in life. Inform yourselves. See ectjustice now owned by firms participating in national suit. Consent is fallible. Actual structural brain changes result from this and that is certainly missing from consent but not from their research. We need many more firms to hear from patients. You have a known mechanism and you have a known and anticipated outcomes in ALL populations. This is what all trauma is based on and this is purely trauma. 

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