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New treatment for resistant depression offers hope Scott Smith

Capital - 8/26/2020

Depression affects millions of people worldwide and the COVID-19 situation we are in serves as the perfect incubator for the illness. Many people today are feeling isolated, fearful, and facing financial problems due to the loss of their job and societal restrictions. Unfortunately, not everyone receives effective treatment for depression which leads to needless suffering, disability and even death from suicide.

Severe depression with suicidal thought and feeling has long been one of the most difficult forms of illness to treat. In 2019, the FDA approved a new medication for patients with major depressive disorder who haven't responded to other treatments. Now, the agency is also approving its use for patients who are having suicidal thoughts or have recently attempted to harm themselves or tried to take their own lives.

The drug is a nasal spray with the brand name "Spravato" and it contains esketamine, a chemical cousin of ketamine. Spravato is the first approved antidepressant medication that's been able to demonstrate a reduction in symptoms of major depressive disorder within 24 hours after the first dose, making it a potential breakthrough medicine for treating depression.

This quick action is important for suicidal patients because most traditional antidepressant medication may take weeks or even longer to obtain noticeable clinical changes. One dose of esketamine along with psychotherapy could help to get a person out of a terrible and even life-threatening situation. It is a great improvement for treating people who are having intense suicidal feelings and can't wait weeks for improvement. The medicine is also useful in situations where patients have not responded to two or more conventional antidepressants. The new medicine can be added on to an existing conventional antidepressant to increase its effectiveness.

It is believed that depression is a result of disruption of "circuits" comprised of several neuronal pathways in the brain including Serotonin. Esketamine works as an antagonist, or blocker, at NMDA receptors. Serotonin is found in one node of this circuit while NMDA is found in another location in the same circuit. It is theorized that esketamine can affect the same circuit that is disrupted in depression by affecting a different neurotransmitter in a different location in the circuit. At this time, not many providers are trained or experienced in administering Spravato. It needs to be administered as a nasal spray in the physician's office and requires monitoring for adverse effects in the doctor's office for two hours after it is administered. Local psychiatrist, Dr. Robert Herman is one of the only psychiatrists in the area who is experienced in using Spravato. According to Dr. Herman, "We have been using Spravato in our office, and are having excellent results in many cases. Patients who have suffered from debilitating depression for many years that did not respond to multiple conventional antidepressants have been responding well, often very quickly."

Dr. Herman, whose father was also a psychiatrist, says he has been reading the American Journal of Psychiatry since he was twelve. He majored in chemistry in college and then went to medical school at the University of Buffalo. During his residency at Bellevue Hospital in New York, Dr. Herman had more therapy and medication patients than anyone in his class. "I thought that was the best way to learn and since then, I have kept up that pace!" As a dedicated professional, he is often looking for new treatments to help as many people as possible, recover as quickly as possible, and Spravato supports that objective.

Dr. Herman reports that one Spravato patient described their experience this way, "Once I started taking Spravato the positive effects immediately set in. It was amazing, a cloud was lifted from my eyes, the weight on my shoulders disappeared and I felt happy again- I was smiling again. Spravato is truly a life-saving drug. I never thought I would feel this way again and here I am. I feel like a phoenix rising from the ashes."

Antidepressant medications were first developed in the 1950's and there are now approximately 30 different antidepressant medications in use. If one medication does not work, many times people are helped by trying another. In some cases, two different antidepressant medications that have different actions can be used in combination. No medication is without its risks or side effects and a thorough consultation with an experienced provider is highly recommended to discuss these options. Outcome studies also show that medication works best when combined with therapy or counseling.

Whether depression is caused by the times in which we live or something else, it is important to know that help is available. If you or someone you know is suffering, please contact a licensed mental health provider to discuss your treatment options.

Scott E. Smith, Ph.D. is a licensed psychologist with Spectrum Behavioral Health in Arnold, Crofton, and Annapolis MD. To contact Dr. Smith, please call 410-757-2077 or write to 1511 Suite 202, Ritchie Hwy., Arnold, MD. 21012