In my clinical work, one of the most challenging aspects is managing patients with ‘treatment-resistant depression’. Unfortunately, up to 30% of individuals diagnosed with major depressive disorder (MDD) do not respond well to traditional drug therapies (Jaffe et al 2019).
In December 2323, Amelia Talbot shared her experience with treatment-resistant depression on her blog, highlighting the need for innovative treatment approaches. It was encouraging to come across Njenga et al’s state-of-the-art review published in BMJ in July of this year (Njenga et al, 2024). The review aimed to provide a comprehensive overview of novel and emerging treatments for MDD, focusing on their effectiveness, safety, and applicability in real-world settings.
The researchers conducted a thorough search of PsycINFO, Medline, EMBASE, and Web of Science using specific search terms related to depression and novel treatments. They included 42 relevant articles in their study, categorizing them into pharmacotherapy, neuromodulation, and psychological interventions.
The review highlighted various emerging treatments for MDD, including pharmacological options such as psychedelics like esketamine, ketamine, psilocybin, and ayahuasca. The researchers also discussed the potential benefits of neuropeptide Y, minocycline, anti-inflammatory drugs, statins, omega-3 fatty acids, buprenorphine-samidorphan, and Onabotulinumtoxin A as adjunct treatments for depression.
In terms of neuromodulation, the review detailed different forms of transcranial magnetic stimulation (TMS) and their effectiveness, including accelerated TMS, theta burst stimulation, Stanford neuromodulation therapy, low field magnetic stimulation, and bilateral TBS.
The review concluded that psychedelics and newer forms of TMS show promise as novel treatments for MDD, with minocycline standing out among pharmacological agents. The integration of psychological and social aspects alongside neurobiological treatments was also emphasized as crucial for effective management of MDD.
While the review provides a comprehensive overview of psychedelic and neuromodulation treatments for depression, it may not capture all new and emerging treatment options for MDD. Future research should focus on comparing the effectiveness of these novel treatments with established therapies and identifying specific patient subpopulations that may benefit the most.
Overall, this state-of-the-art review serves as a valuable resource for clinicians seeking alternative approaches to managing treatment-resistant depression and highlights the need for further research in this evolving field.
