DEPRESSION DISCOVERY

With mental health on the forefront of every news cycle, there’s a lot to keep up with. While it can seem daunting at times, if the impact of depression is at the center of your world, there’s hope at last. Mobile’s Dr. Brad Sadler of Southern Psychiatry Associates is beyond elated with the latest treatment options for those searching for a true solution. A local authority on all thing’s psychiatry, he prides himself on bringing the best care options to the Bay area and he’s excited about this one. 

By Hayley Hill

There’s good news for people with severe Treatment-Resistant Depression (TRD). And relief from the debilitating symptoms could be only hours away. Clarifying, TRD occurs when a person has been treated for depression, but their symptoms don’t improve after trying two antidepressants. While taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people, standard treatments aren't enough for those suffering from TRD. 

Esketamine, also called Spravato, is a groundbreaking drug therapy that can quickly provide relief from major depression and is even considered revolutionary by some. Dr. Sadler shares, “Spravato has been game changing for a large segment of my patients that have not responded to typical antidepressant therapy.  I’ve been offering this in-office treatment for the past 4 years and have had wonderful success.” Spravato, a mirror image of the anesthetic drug Ketamine, is given in-office where patients are monitored by Dr. Sadler and his capable staff. They monitor blood pressure and other side effects and ensure patients have a ride to and from their office before they can start. While it’s true some people abuse ketamine for illicit use, when it’s used in a REMS certified treatment setting with medical monitoring, it’s very different. And the patients never have access to the drug as it’s only administered in compliance in a therapeutic setting.

Interestingly, research suggests that untreated depression may be associated with long-term damage to certain areas of the brain and is associated with an increased risk of dementia. Studies show that people with depression could have up to 20% shrinkage of the hippocampus, a region of the brain critical for memory and learning. Esketamine likely works by encouraging neurons to grow and proliferate in conjunction with an antidepressant.

This is good news considering that an estimated 30.9% out of the 8.9 million adults taking depression medications have TRD — that’s a staggering 2.8 million people. Esketamine, and its related drug ketamine, are highly effective depression treatments for several reasons. “There are very few treatments available that have shown efficacy in people with Treatment-Resistant Depression. I’m very happy to notate that I’ve had immense success with this population and the use of esketamine has been truly incredible. Most of my patients that have started esketamine treatment have responded, and some have even gone into remission from depression — this is truly amazing,” Dr. Sadler shares.

Major Depressive Disorder (MMD), or clinical depression, affects how a person feels, thinks, and behaves and can lead to a variety of emotional and physical problems. For example, those suffering MMD may have trouble doing normal day-to-day activities, and sometimes feel as if life isn't worth living. A recent U.S. study estimated the total annual burden of medication treated MDD among the US population was $92.7 billion, with $43.8 billion attributable to TRD. Concluding that TRD is associated with disproportionate health care costs and unemployment, the study clearly suggests there can be large economic and societal gains with effective management.

Esketamine’s antidepressant function works through a different mechanism than other drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine, and dopamine. These chemicals are messengers that relay communication between brain cells. The theory is that having greater quantities of these neurotransmitters allows for better communication between brain cells and positively affects mood.

Esketamine works in a similar fashion, but unlike other antidepressants it increases levels of glutamate, the most abundant chemical messenger in the brain. The result? Glutamate likely increases the brain-derived neurotrophic factor which is key in helping neurons grow and recover from depression. “This is the very first treatment approved for depression that has worked in this manner. I believe it’s the new paradigm by which we will begin to treat depression and there are more exciting drugs like this coming down the pipeline,” Dr. Sadler adds.

The only other approved drug therapy for Treatment-Resistant Depression is a combination of olanzapine (an antipsychotic drug) and fluoxetine (a conventional antidepressant). However, this treatment has significant long-term effects that include substantial weight gain, metabolic changes, diabetes, and high blood pressure. “Esketamine has no effect on weight and has no sexual side effects. Most of the side effects of esketamine resolve by the time the patient leaves the office after treatment. It can even be used for patients who are dealing with acute suicidal thoughts,” Dr. Sadler says.

When compared to common antidepressants, esketamine can immediately impact brain cells, offering relief from depressive symptoms within hours, where traditional antidepressants often take several weeks to make a noticeable difference, if any. Up to 33% of people with depression don’t respond to multiple kinds of conventional antidepressants. Esketamine reduces depression symptoms in most of these people in clinical trials. “My patients have been so thankful to receive this treatment. It’s amazing to hear the positive stories from the patients and their families in relation to the experience and improvement after starting Spravato therapy,” Dr. Sadler happily concludes.

Southern Psychiatry Associates

3737 Government Blvd., Suite 203

Mobile, AL 36693

&

3501 Gulf Shores Parkway 

Gulf Shores, AL 36542

251.300.7134

SouthernPsychiatry.net