Statis­tics make for sorry read­ing, but are ways of ad­dress­ing this con­di­tion with­out med­i­ca­tion, writes

The Star Early Edition - - LIFESTYLE -

IT IS NOWthought that one in five of us will suc­cumb to this most common men­tal health prob­lem. Yet it is be­com­ing clear that the most popular pre­scribed drugs sim­ply aren’t up to the job for the majority of suf­fer­ers.

Most will be of­fered anti-de­pres­sants, gen­er­ally in the form of se­lec­tive sero­tonin re-up­take in­hibitor (SSRI) drugs, such as Prozac, Cipramil and Seroxat.

It was thought that a de­fi­ciency of the neu­ro­trans­mit­ter sero­tonin was a key cause – and SSRIs in­crease sero­tonin lev­els. So far, so sim­ple.

How­ever, although pre­scrip­tion rates are soar­ing – from 15 mil­lion in 1998 to 40 mil­lion in 2012 – for some 62 per­cent of de­pres­sion suf­fer­ers, they have lit­tle to no ef­fect.

So how do we com­bat de­pres­sion in fu­ture? We looked at the new so­lu­tions that of­fer hope to mil­lions… Se­vere long-term de­pres­sion

One of the lat­est treat­ments is rTMS.

This uses mag­netic pulses, sim­i­lar to those used in MRI scans, to stim­u­late the left pre-frontal cor­tex area of the brain, the area in­volved in mood reg­u­la­tion, emo­tion, mem­ory and mo­ti­va­tion. It tends to be less ac­tive in peo­ple with de­pres­sion.

This newly li­censed Food and Drug Ad­min­is­tra­tion (FDA)-ap­proved treat­ment is for pa­tients with se­vere, chronic de­pres­sion, for whom mul­ti­ple treat­ments with anti-de­pres­sants have failed.

It is avail­able at The London Psy­chi­a­try Cen­tre and the pri­vate Nightin­gale Hos­pi­tal, also in London.

Pulses are de­liv­ered via a metal coil in a hel­met that pa­tients wear dur­ing five 25minute ses­sions a week over two to six weeks, with stud­ies show­ing most peo­ple need 12 to 20 treat­ments.

The stud­ies in­di­cate that more than 30 per­cent of peo­ple who don’t re­spond to any other treat­ment re­cover us­ing rTMS.

Psy­chi­a­trist Dr Michael Craig, se­nior lec­turer in re­pro­duc­tive and de­vel­op­men­tal psy­chi­a­try at King’s Col­lege, London, who of­fers treat­ment at the Nightin­gale, says: “Suc­cess rates will dou­ble if used as a first­line treat­ment.”

It is avail­able only pri­vately (not through in­surance) and treat­ment costs from £1 000 (R17 258) a week. De­pres­sion caused by hor­mones

Ac­cord­ing to new ev­i­dence, women who suf­fer de­pres­sion at cer­tain times of the month may have re­pro­duc­tive re­pres­sion, or pre­men­strual dys­pho­ric disorder (PMDD). They could be sen­si­tive to the surge in pro­ges­terone that fol­lows ovu­la­tion and pre­cedes men­stru­a­tion. PMDD can cause rage, sui­ci­dal feel­ings and ex­treme tear­ful­ness.

Dr Michael Craig, a gy­nae­col­o­gist and psy­chi­a­trist, has opened the first fe­male hor­mone clinic at London’s Maud­s­ley Na­tional Health Sys­tem psy­chi­atric hos­pi­tal with Dr Mike Marsh, a gy­nae­col­o­gist based at King’s Col­lege Hos­pi­tal. Dr Craig has pub­lished re­search say­ing PMDD re­sponds pos­i­tively to the pre­scrip­tion of cer­tain agents that sup­press ovu­la­tion, such as oe­stro­gen gel, patches and pills.

John Studd, a for­mer pro­fes­sor of gy­nae­col­ogy at Im­pe­rial Col­lege, runs the pri­vate London PMS & Menopause Clinic. He treats women with PMDD us­ing oe­stro­gen gel, which pa­tients are told to rub on to an arm or leg ev­ery day.

De­pres­sion caused by in­flam­ma­tion

There is grow­ing ev­i­dence that de­pres­sion is linked to chronic, low-grade in­flam­ma­tion in the body, which may be caused by ill­ness, in­fec­tion or an over­ac­tive im­mune sys­tem.

Pro­fes­sor Gra­ham Rook, Emer­i­tus Pro­fes­sor of Med­i­cal Mi­cro­bi­ol­ogy at Univer­sity Col­lege London, says: “Mil­lions of peo­ple have raised lev­els of in­flam­ma­tory chem­i­cals such as C Re­ac­tive Pro­tein (CRP) and we know they are at in­creased risk of de­pres­sion later in life.”

In­flam­ma­tion-linked de­pres­sion may be con­nected with al­ter­ations in the gut “mi­cro­biome”, the com­po­si­tion of the mil­lions of mi­crobes in the gut that com­mu­ni­cate with the brain. We can un­bal­ance our mi­cro­biome and cause in­flam­ma­tion by eat­ing pro­cessed food or be­ing too clean, too stressed, too seden­tary or too fat. Stud­ies have shown that you can cut in­flam­ma­tion by spend­ing time in green spa­ces, eat­ing a diet low in sugar and pro­cessed car­bo­hy­drates and high in vegetables, fruit, lean pro­tein (par­tic­u­larly oily fish) and olive oil. Ex­er­cise mod­er­ately, sleep more and try to con­trol stress. De­pres­sion caused by in­som­nia

Many suf­fer­ers from de­pres­sion com­plain of in­som­nia, but there is now ev­i­dence that lack of sleep pre­cedes and even causes de­pres­sion.

Last year, re­searchers at Ry­er­son Univer­sity, Toronto, found de­pres­sion lifted sig­nif­i­cantly among pa­tients whose in­som­nia was cured.

Treat­ment con­sisted of four talk­ther­apy ses­sions over eight weeks, and was twice as ef­fec­tive as tak­ing med­i­ca­tion or a placebo. This has been de­scribed as “the big­gest ad­vance in de­pres­sion treat­ment since Prozac”.

Pa­tient ad­vice in­cluded: stick to a spe­cific wake-up time; get out of bed when awake but don’t eat, read or watch TV; and avoid tak­ing day­time naps.

Ja­son El­lis, a pro­fes­sor in psy­chol­ogy at Northum­bria Univer­sity and di­rec­tor of the Northum­bria Cen­tre for Sleep Re­search, says: “We aren’t en­tirely sure why in­som­nia makes us more vul­ner­a­ble to de­pres­sion, but there is some ev­i­dence that the changes that oc­cur in our sleep, and par­tic­u­larly to our rapid eye-move­ment (REM) sleep when we first get in­som­nia, may im­pact on our mood.

“REM – or dream – sleep is vi­tal for re­gen­er­at­ing con­nec­tions in the brain. Older peo­ple, who are far more prone to de­pres­sion, have less REM sleep, as do peo­ple with de­pres­sion.”

He is study­ing if treat­ment at the first signs of in­som­nia can pre­vent de­pres­sion. – Mail On Sun­day


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