What can be done for depression?

Q:

My son, 42, has had major depression on and off for 20 years. He has tried many things. Are there new treatments that could help? What about deep-brain stimulation?

A: Treatment for depression typically involves a combination of psychotherapy and medications. All current antidepressants act on monoamine neurotransmitters like serotonin, norepinephrine, and dopamine. Efforts to develop new treatments are focused on other targets: non-monoamine neurotransmitters, hormone receptors, and molecules involved in inflammation, immune responses, and glucose metabolism.

For example, there have been recent reports of antidepressant effects from ketamine, but it's also a drug of abuse, especially on the club scene, where it's called "Special K." Drugs that work like ketamine by targeting the glutamate without causing the same side effects are being studied.

Electroconvulsive therapy remains the most effective antidepressant. It is used when medications are ineffective. Not all patients respond well, and significant side effects are common. Advances now provide a more tolerable alternative called ultra-brief electroconvulsive therapy.

New brain-stimulation treatments include transcranial magnetic stimulation and vagal nerve stimulation. Both are FDA-approved for treatment-resistant depression. Magnetic-seizure therapy and deep-brain stimulation are still being researched.

The cure to depression may not necessarily be in a pill. We live in a culture where we want prescriptions, but sometimes we need to resort to lifestyle changes like reducing stress, exercising more, and eating a better diet.