Pros and Cons of Two Controversial Treatment of Depression

Electroconvulsive analysis and deep brain stimulation apex depression treatments that soon affect the brain break apart with a slew of potential side effects. But if they do the ability, are their risks worth it? You’re doubtlessly familiar with conventional treatments for the dumps, like antidepressants and talk remedy. But what happens when these approaches very recently don’t work?

People with intractable discouragement (a type that doesn’t pity to medication) may turn to depression treatments that momentarily affect the brain treatments that travel a lot of headlines because of their litigious and experimental nature. Here, we adopt a look at electroconvulsive therapy (ECT) and heartfelt brain stimulation two dent treatments that get a lot of discussion to workers you weigh your options.
What Is Electroconvulsive Therapy?
  In electroconvulsive cure, also known as electroshock psychotherapy, patients are placed underneath general anesthesia and confirmed muscle relaxers ahead of an electric pulse is delivered thoroughly electrodes on one or both sides of the mentality. ECT is delivered in a series of six to 12 sessions, normally three times a week. Treatment may be either inpatient or outpatient, depending on the firm’s situation. The good dirt ECT has been create to have an 86 percent triumph rate for severe the dumps. The bad news? It also has some life-and-death side effects, such as barring-term memory damage.
In episode, FDA recently had to make a sentence on just how risky ECT is. The American Psychiatric Cooperative (APA) and other specialists were recommending that the devices be downgraded to median risk from a drunk-risk category, but others in the psychiatric community weren’t so ineluctable. After mulling throughout evidence, including a 2007 haunt that found that ECT resulted in protracted-term memory extermination, as well as other cognitive issues, the FDA panel unquestioned that the devices should prevent classified as high gamble.
But that hasn’t stopped the treatment method from being second-hand. “We always weigh out the risks and benefits of doing ECT as without difficulty completely as the risks of not doing ECT,” explains Martin Furman, MD, chief of the concentrated treatment unit and governor of the ECT Program at Butler Dispensary in Providence, R.I. 
Most patients who disaffect to ECT have depression with carnal manifestations, such as an incapacity to get out of bed for days at a time or eat or drown one's sorrows. If you are so buy Valium online that you aren’t getting sufficiently fluids, you run the risk of on a par more serious robustness complications, warns Dr. Furman. ECT may also be offered to people who don’t would rather physical symptoms, but haven’t had big name with antidepressants.
ECT has a olden days of negative press, including alarming portrayals in books, plays, and films, such as One Flew Through the Cuckoo’s Nest with Jack Nicholson. While the earlier days of ECT therapies may indeed be undergoing been significantly unpleasant, the function has advanced. “The equipage is much improved newer generations, easier to use, and more truthful,” says Furman.
But it gets definite plugs, too like from Headliner Wars actress Carrie Fisher. Known for being plain-spoken about her struggles with disturbed illness, Fisher recently told Oprah that she gets electroconvulsive remedial programme every six weeks for her manic indentation symptoms swearing it’s thrift her life. The foot line? How ECT works is yet not well understood, says Furman. Experts speculate that it corrects problems in understanding function.
It was developed after doctors observed that seizures appeared to release severe psychiatric symptoms scientists started looking for a way to wake up a seizure. “It’s the manifest convulsion or seizure that is medicinal,” explains Furman. But he notes that divers of his patients willingly compensation for ECT treatments when they familiarity another bout of unfeeling depression. 
A Look Into Deep Brain Stimulation
 If electroconvulsive psychotherapy doesn’t work, the next retire b decrease could be deep understanding stimulation (DBS)  a recess treatment that is currently considered experiential. How does it work? While directed general anesthesia, scanty draw out electrodes are placed in the acumen and very tiny generators united to the electrodes are placed in the box.
These provide incessant stimulation set at a frequency proper to to the individual. Risks associated with DBS count all the risks of major, invasive surgery, as hearty as bleeding in the brain, disorientation, problems with workings, problems with nap, and changes in mood. Another defect to the procedure is that results are not fully expected when or whether they on occur.
Studies done on DBS for other disorders, such as unshakable-compulsive disorder, introduce that improvement takes later. Aside from all this, but a small number of people with hollow are actually eligible for the experiential treatment.
“The slues of patients who might qualify in terms of how intractable their unhappiness is and who can handle the logistics is quite disconcerted,” acknowledges psychiatrist Benjamin D. Greenberg, MD, PhD, chief of outpatient services at Butler Clinic in Providence, R.I. To qualify for DBS, patients must acquire depression that has not responded to old pharmaceutical treatments, therapy, or ECT.
A indefatigable must live close enough to the DBS center for usual visits. Follow-up surgery may be required to adjust the position of the electrodes or to replace battery packs or convalesce broken wires to maintain stimulation. Patients may placid need therapy as part of their copy-up plan. “Once you pull someone's leg the implant you basically have to get regulate-ups for the rest of your life,” explains Dr. Greenberg.
Dig into into the success of this approximate is ongoing, but Greenberg says that, for patients who experience tried it, this depression treatment seems efficacious. “We don’t remember why it works,” he adds. “We evaluate it rewires brain circuits to some lengths, changing thought patterns. The calculate to do it is to help some definitely sick people and, into done with the research, buy diazepam generic, gain a bigger understanding of brain circuitry that potency lead to more conspicuous treatments.”

Depression During Pregnancy May Double Preterm Delivery Risk

Depressed pregnant women have twice the risk of preterm delivery than pregnant women with no symptoms of depression, according to a new study by the Kaiser Permanente Division of Research. The study is published online in the Oxford University Press's journal Human Reproduction on behalf of the European Society of Human Reproduction and Embryology.
The study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms. These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may exacerbate the depression-preterm delivery link, according to the researchers.
Because the majority of the women in the study did not use anti-depressants, the study provides a clear look at the link between depression and preterm delivery.
The study – which is among the first to examine depression and pre-term delivery in a representative and diverse population in the United States – looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.
Researchers interviewed the women around their 10th week of pregnancy and found that 41 percent of the women reported significant or severe depressive symptoms. The women with less severe depressive symptoms had a 60 percent higher risk of preterm delivery – defined as delivery at less than 37 completed weeks of gestation – compared with women without significant depressive symptoms, and the women with severe depressive symptoms had more than twice the risk.
"Preterm delivery is the leading cause of infant mortality, and yet we don’t know what causes it. What we do know is that a healthy pregnancy requires a healthy placenta, and that placental function is influenced by hormones, which are in turn influenced by the brain," said lead author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland.
"This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function. The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labor," Li explained.
"Post-partum depression has been extensively studied and discussed by the public, but depression during pregnancy is significantly under-recognized and under-diagnosed. Clinicians should pay close attention to depression during pregnancy to catch it early," Li said. "If prenatal depression is indeed as prevalent as reported in this and other studies and doubles the risk of preterm delivery, then bringing depression to the forefront of prenatal care could lead to a significant reduction of preterm deliveries."
In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the United States alone. Presently, other than a prior history of preterm delivery and some pregnancy complications, very little is known for its risk factors and origins.
"The key strengths of this study are that it ascertained the depressive symptoms early in pregnancy, long before the preterm delivery occurred, therefore avoiding recall bias. In addition, the study was not clouded by antidepressant use because only 1.5 percent of the study population was prescribed antidepressants and we could exclude them in the analyses," Li said. "Considering the increased use of antidepressants among pregnant women, this study's findings may provide a rare opportunity to evaluate the effect of depression on risk of preterm delivery without the entanglements of antidepressants."
Limitations of the study include researchers measuring the women's depressive symptoms only once during pregnancy, rather than throughout the pregnancy, and participation rate in the study was low.

Brain Studies Reveal Big Differences Among Depressed Individuals

Depressed people may have far fewer of the receptors for some of the brain’s feel good stress-response chemicals than non-depressed people, new University of Michigan Depression Center research shows.

And even among depressed people, the numbers of these receptors can vary greatly. What’s more, the number of receptors a depressed person has appears to be linked with the severity of their symptoms — and the chances that they’ll feel better after taking a medication.
These preliminary findings, presented Tuesday at the American Psychiatric Association’s annual meeting in Washington, D.C., amplify a growing understanding of depression as a condition that affects different people in different ways. The new data, and other researchers’ findings, are showing that depression is solidly rooted in genetic and molecular factors that are unique to each individual.
The lead U-M researcher, Jon-Kar Zubieta, M.D., Ph.D., says these new results bolster what other researchers have been finding in recent years.
"There’s a substantial amount of biological difference even among people who have major depression, which is just as important as the biological differences between people with depression and people without," he says. "The more we can understand about these differences, the better we can address treatment to the individual and have the greatest effect on symptoms."
At the APA meeting, Zubieta presented data from positron emission tomography, or PET, scans of the brains of patients who met the criteria for major depression but had not yet received treatment for it. Those scans were compared with scans of the brains of non-depressed comparison volunteers.
In one group of depressed and non-depressed volunteers, the scans were made using a tracer that can reveal the location and concentration of a particular type of receptor. Called the 5HT1a receptor, it allows brain cells to receive signals from serotonin, a chemical neurotransmitter produced by the brain.
Serotonin levels in the brain are linked to depression, but the importance of 5HT1a receptor concentrations in the brains of depressed people has been cloudy. That’s why Zubieta’s team chose to scan only people who had not yet received antidepressant medications, since some such medications may actually encourage the brain’s cells to make more serotonin receptors – and mask the actual level of receptors that the person has naturally.
In the study, 5HT1a receptor concentrations were markedly lower in depressed people compared with non-depressed people, in both the left and right hippocampus regions of the brain.
But even among depressed people, the lower a person’s 5HT1 receptor levels were, the worse he or she scored on assessments of the ability to function day to day – and the less likely he or she was to get relief from symptoms when the researchers prescribed a common antidepressant.
This finding of individual variation may help explain why in current depression treatment, some patients find great relief from a medication that doesn’t help other equally depressed patients, says Zubieta, who is the Phil F. Jenkins Research Professor of Depression in the U-M Department of Psychiatry. He also holds positions in the U-M Nuclear Medicine division, and the Molecular & Behavioral Neuroscience Institute.
The other group of volunteers – both depressed and non-depressed — received PET scans with a tracer that allowed the researchers to see the mu-opioid receptors in their brains. These receptors are the gateway for signals sent by chemicals called endogenous opioids — the brain’s natural "painkillers" – which are involved in stress response, including response to pain.
Another name for the neurotransmitters that bind to mu-opioid receptors is endorphins, which have become known as a "feel good" chemical involved in reinforcing rewarding experiences. Illicit drugs such as heroin also act upon mu-opioid receptors, creating the "high" sensation and probably playing a role in the addiction process.
In this group of depressed and non-depressed volunteers, the researchers studied the distribution of the mu-opioid receptors and looked at how active the buy cheap Valium online, receptors were when the volunteers were asked to summon a sad memory or scenario to mind.
Depressed volunteers had lower concentrations of mu-opioid receptors to begin with. But when they underwent the "sadness challenge," those receptors were much more active than the receptors in non-depressed people. And, just as with the serotonin 5HT1a receptors, the fewer mu-opioid receptors a person had, the less well he or she responded to an antidepressant medication.

Cymbalta Side Effects

Cymbalta, generic name Duloxetine Hydrochloride, has certain side effects consumers should be aware of.
Cymbalta manufactured by Eli Lilly is a serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant used to treat major depression. It is prescribed to treat pain associated with diabetic peripheral neuropathy, which is a painful nerve disorder associated with diabetes that affects the hands, legs, and feet. Cymbalta has only recently been approved for use to treat fibromyalgia if people can tolerate Cymbalta’s side effects.
The drug works by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood-lightening effect of any released serotonin and noradrenaline, restoring balance to the emotions of the patient. Cymbalta may also be used in the treatment of generalized anxiety disorder.
Among the more common Cymbalta side effects that users complain about is being fatigued even after a good night’s sleep. Blurred vision, dry mouth, nausea, vomiting, and issues with both constipation and diarrhea, agitation, irritability, increased, hostility, high blood pressure, decreased libido, hot flashes, fatigue, rash, and increased sweating have also been reported.
While people say many of Cymbalta’s side effects are manageable, some users experience effects that are extremely frightening and potentially dangerous. Some patients found the drug tends to trigger heart palpitations and increase anxiety levels and elevate the severity suicidal thoughts or impulses.
A 19-year-old college student who had shown no outward signs of depression killed herself at an Eli Lilly & Company laboratory in Indianapolis where she had been participating in a company drug trial for the experimental antidepressant. Four other patients who were given the drug during earlier trials also committed suicide.
Anyone taking Cymbalta should understand that they can be at risk while driving, handling machines, or performing other hazardous activities such as working on tall ladders as it can cause dizziness or drowsiness.
Many people report that there were no Cymbalta side effects except for a lowered sexual drive and feel the drug gave them back their life. Like other antidepressants, Cymbalta should not be stopped suddenly if you have been on it for some time. Your brain receptors will adjust to it, and suddenly stopping can cause crying jags, agitation, dizziness, nausea, or headache. You should always talk with your doctor or healthcare provider to work out a plan to slowly decrease your medication to avoid withdrawal symptoms.

Combination Therapy Offers Greatest Benefit To Depressed Adolescents

A combination of antidepressant drugs and cognitive behavior therapy is the most effective approach when treating teens suffering from major depressive disorder (MDD), according to a long-term study led by a Duke University Medical Center psychiatrist.
The findings of the Treatment for Adolescents with Depression Study (TADS), published in the October issue of the Archives of General Psychiatry, indicate that combination therapy improved depressive symptoms and reduced the level of suicidal thinking and behavior in adolescents.
"Depression among teenagers is a significant public health problem and there has been a tremendous need to identify treatments that work and are also safe," said John March, M.D., chief of child and adolescent psychiatry at Duke University and lead investigator on the study. "We found that the benefits of treatment with medication in combination with cognitive behavior therapy (CBT) outweighed the potential risks."
Funded by the National Institute of Mental Health (NIMH), TADS is a multicenter, randomized clinical trial examining the individual and combined effectiveness of the antidepressant fluoxetine hydrochloride (Prozac) and cognitive behavior therapy in adolescents diagnosed with depression. Researchers found that fluoxetine plus therapy was more effective than medication alone over the course of 36 weeks. The therapy used in this study is a depression-specific treatment designed to create and reinforce positive thought patterns and behavior in the adolescents.
The study included 327 patients between the ages of 12 and 17 with a primary diagnosis of major depressive disorder.
At week 12 of the study, depression decreased among all treatment groups, with the greatest reduction occurring in the group receiving combination therapy (71 percent response rate).
At 18 weeks, the combination treatment continued to demonstrate superiority to either treatment alone with an 85 percent response rate, compared to 69 percent for fluoxetine alone and 65 percent for CBT alone.
At the conclusion of 36 weeks, combination treatment had the highest response rate at 86 percent compared to 81 percent each for fluoxetine or CBT.
Although participants commonly reported suicidal thoughts at the study’s inception, researchers found that patients treated with fluoxetine alone had a higher rate of both suicidal thinking and behaviors than those treated with combination therapy or CBT only. These findings point to the potential benefits of a two-pronged approach — fluoxetine for recovery from depressive symptoms and cognitive behavioral therapy to equip adolescents with coping skills.
"While many questions still remain about the safest and most beneficial course of treatment for adolescents, this data provides a significant step forward," March said. "It provides an evidence-based option that has been found to improve depression through medication used together with cognitive-behavioral psychotherapy."

Giving Thanks Helps Depression, Study

Depression is the opposite of a state of thankfulness and being thankful and grateful could help symptoms of depression. Research that appeared in the Journal of Personality and Social Psychology confirmed that those individuals who kept a weekly gratitude journal were more optimistic about life, more likely to exercise regularly, and felt better physically compared to those who recorded hassles or neutral life events.
More and more studies just like this are coming to light about the powers of gratitude and healing depression. There have been many studies and surveys on the power of gratitude and depression. In a survey commissioned by spirituality.com, 84% of Americans said expressing gratitude reduces stress and depression and fosters better health and optimism.
Gratitude is a powerful antidote to depression. Martin Seligman, PhD, a pioneer in the positive psychology movement, and colleagues at University of Pennsylvania delivered gratitude instructions to 50 severely depressed visitors to a self-help website. They recommended that individuals take time each day to write down three things that went well that day, and why they thought so. Fifteen days later, 94 percent of the 50 individuals reported feeling significantly less depressed.
Another study comkpleted by Dr. Michael McCollough, in Dallas, Texas, and Dr. Robert Emmons, of the University of California at Davis, did a study that indicated that gratitude plays a significant role in a person's sense of well-being. After making initial observations and compiling all the previous research on gratitude, they conducted the Research Project on Gratitude and Thanksgiving. The study required several hundred people in three different groups to keep daily diaries. The results of the study indicated that daily gratitude exercises resulted in higher reported levels of alertness, enthusiasm, determination, optimism and energy. Additionally, the gratitude group experienced less depression and stress.
Cultivating gratitude is a powerful way to overcome depression. By choosing to focus on the positive in your life and the things that surround you, rather than ruminating on your disappointments and deficits, you nourish positive feelings about yourself, your life, and buy Valium. Gratitude, or thankfulness, is an appreciation and expressing gratitude makes one feel good and makes others and the depressed person fill with positive energy and people can begin to feel upbeat and encouraged. This Thanksgiving, allow yourself to feel gratitude year round.