Not just antidepressants – what therapies help with depression

The signs of depression are not always clear, because the symptoms are varied. Loss of joy, no interest in life or activities are just a few symptoms that can indicate depression.

In addition, depression and melancholy are signs of the disease, but also problems falling asleep or staying asleep. Tiredness and many other symptoms are added, all of which are very individual in their type and characteristics, such as complete disinterest in life and listlessness.

Those affected often suffer from suicidal thoughts and impulses, which is why it is a dangerous disease that can be treated well and has a good prognosis. Antidepressants are the most common drug of choice, but there are many other treatment options.

Ketamine is both a medicine and a drug

Therapy with ketamine is relatively new. Originally it is an anesthetic that was mainly used in veterinary medicine. In human medicine, it is given in combination with antidepressants to patients who suffer from a severe form of depression and who react little or not at all to antidepressants or psychotherapy.

When treated with ketamine, a certain type of neuron in the hippocampus changes. This part of our brain is the working memory and the interface between short- and long-term memory. New nerve cells can be formed in this area throughout life, and antidepressant reactions are controlled in this region. A single dose of ketamine can show a positive effect within a few hours. However, this decreases again relatively quickly.

“A nasal spray containing ketamine has now been approved in the USA and Europe. It is intended to help patients with therapy-resistant depression,” explains Andreas Wahl-Kordon. He is a specialist in psychiatry and psychotherapy and medical director of the Oberberg specialist clinic in the Black Forest.

In Europe and Germany, however, ketamine has now also become a popular party drug, the consumption of which can have serious consequences. The substance can not only make psychologically dependent. Long-term use of ketamine can damage short-term memory and the central nervous system.

Other substances such as LSD, MDMA or psilocybin, which are known for their hallucinogenic effects, have already been approved or are being tested as a remedy for severe depression.

Stimulation methods have proven themselves

In the case of severe depression, the therapy often consists of so-called stimulation methods. This includes electroconvulsive therapy (ECT), also known as electroconvulsive therapy. It is intended for people who have already gone through a number of other therapies but whose condition has not improved.

“As a rule, electroconvulsive therapy is carried out under short-term anesthesia in the hospital. Many may have images from the film “One Flew Over the Cuckoo’s Nest” in mind. The main character was given electric shocks to his brain while he was fully conscious, causing terrible convulsions. But that’s not how ECT works in reality,” explains Wahl-Kordon.

“There is an anesthesiologist present who oversees the treatment. In principle, this artificially triggers an epileptic seizure in the brain. It was found that in people suffering from epilepsy and depression, the depression got better after a seizure.” Medicine mimics this with electroconvulsive therapy. It stimulates the nerve cells and also the network of nerves in the hippocampus.

Transcranial magnetic stimulation (TMS)

“With transcranial magnetic stimulation (TMS), certain areas in the brain are stimulated with the help of magnetic waves and neurons are activated,” explains Wahl-Kordon. Magnetic impulses gently influence the excitability of nerve cells in the cerebral cortex. In people with depression, the activity in the areas of the brain that are responsible for things like our thoughts and our feelings is altered. Perception and memory are distorted in depression. This also applies to attention. With TMS, magnetic pulses are delivered from a coil across the skull. This is to restore the balance.

In this therapy, those affected are conscious. The treatment does not cause pain. The patient may notice the stimulation in a weak form on the skin surface. However, an epileptic seizure does not occur. This procedure is not quite as effective as electroconvulsive therapy and is used, for example, in people who do not want or cannot tolerate drug treatment.

Worth a try: brain pacemaker

If all common therapies fail, often only an invasive treatment is possible, the so-called deep brain stimulation (DBS), a type of brain pacemaker. However, this type of therapy is used only rarely and in exceptional cases, because it involves direct intervention in the brain. “Very thin electrodes are implanted in certain areas of the brain. Then you start with an electrical stimulation similar to a cardiac pacemaker. This brain pacemaker corrects and modulates the neuronal network,” says Wahl-Kordon.

The therapy works very well and is used for Parkinson’s and mental disorders such as obsessive-compulsive disorders. This method is also used to try to bring the brain back into balance, but it is an invasive procedure and is only used when other therapies show no prospect of success.

Therapeutic sleep deprivation

Many people struggling with depression cannot fall asleep or stay asleep. While they have pronounced mood swings during the day, they often feel better in the early morning and evening. In therapeutic sleep deprivation, patients are kept awake for a whole night.

“You’re not even allowed to doze off for a moment during this time. That would affect the effect. If the sleep deprivation is adhered to, the mood will improve the following day, which is a very positive experience for most people,” says Wahl-Kordon. “You remember what it’s like to be without depression, even if the effects don’t last long.” With this form of therapy, those affected suddenly see light at the end of the tunnel. That gives them hope.

Cognitive-behavioural therapy is well-established

Any type of psycho-therapeutic treatment requires a willingness to get involved and a high degree of patience, because the therapy is often lengthy. “Cognitive-behavioural therapy (CBT) ranks first among psychotherapies because it is the best studied. A central point is to structure the days and plan pleasant activities for those affected,” advises Wahl-Kordon.

Thoughts and feelings are discussed with the therapist and behaviors are reflected in order to find alternatives that counteract depressive feelings and behavior. Especially in the case of severe depression, it is important to combine psychotherapy with drug therapy,” Wahl-Kordon continued.

Psychotherapy plus antidepressants

These include, for example, so-called serotonin reuptake inhibitors (SSRI). They block the removal of serotonin, which, among other things, regulates our mood and sleep as well as our appetite. The blockade increases the concentration of serotonin in the tissue fluid of the brain and can thus brighten the mood.

About a third of all people with depression respond to this. Another third at least experience relief of symptoms, but the last third cannot be helped by this treatment.

The overarching goal of this therapy is to filter out negative thought patterns and corresponding behaviors and then to change them accordingly.

Sport is supportive

It is well known that exercise can help with many physical illnesses. But sport and exercise are also important factors in mental illnesses. “We know that exercise has been shown to have an antidepressant effect. It’s important to encourage people with depression to exercise,” says Wahl-Kordon.

“It can be a bit difficult with outpatient therapy, but it is easier in a clinic. There, for example, the obligation to actively participate is much higher there.” It is also good if these activities take place in a group, because that motivates most people.

But it often takes a lot of effort to admit the illness at all, to accept it as such, to talk about it and to have depression treated, because depression is still taken lightly by many and not seen as a serious illness that can be treated can be.

More information and help is available here:

• German Depression Aid
• Info-Telephone “Depression” of the German Depression Aid for those affected and their relatives: (0800) 33 44 533
• German Depression League
• International: CheckPoint

Author: Gudrun Heise