In the world of clinical psychology, one of the greatest challenges is dealing with patients suffering from ‘treatment resistant depression’. Shockingly, up to 30% of individuals diagnosed with major depressive disorder (MDD) show resistance to conventional drug therapies (Jaffe et al, 2019).
Reflecting on the struggles faced by individuals with treatment resistant depression, Amelia Talbot shared her experiences in a blog post back in December 2323. It was refreshing to come across Njenga et al’s recent state-of-the-art review, published in the prestigious BMJ in July (, which delved into novel and emerging treatments for MDD across different stages of the treatment cycle.
Their comprehensive review aimed to shed light on innovative approaches and their effectiveness, safety, and real-world applicability. Today, we will walk through a summary of their findings.
Sprouts of hope for treatment resistant depression?
Methods
The team meticulously searched PsycINFO, Medline, EMBASE, and Web of Science using specific search terms to identify studies on novel and emerging treatments for depression. They focused on interventional data from January 2017 to June 2023, resulting in the inclusion of 42 relevant articles.
Results
The selected articles were clustered into two main categories: pharmacotherapy and neuromodulation, with additional focus on psychological interventions alongside novel treatments.
1. Pharmacological Treatments
Psychedelics
- Esketamine and ketamine
- Rapid alleviation of suicidal thoughts and mood symptoms.
- Limited evidence of sustained improvement.
- Ketamine deemed more effective than placebo in a Cochrane review.
- ECT may offer superior benefits.
- Clinical application involves weekly infusions for several weeks, serving as an off-label alternative to ECT.
- Psilocybin
- Effective with drug-facilitated psychotherapy, showing rapid mood enhancement.
- Some sustained benefits observed up to 28 days.
- Comparable to escitalopram at 6 weeks.
- Possible increase in suicidality reported.
- Scalability challenges due to prolonged treatment duration with dual therapist support.
- Ayahuasca and dimethyltryptamine
- Preliminary studies exhibit short-term improvements in MDD.
- Potential gastrointestinal side effects limit broad implementation.
- Single dosage administration with support available if necessary.
- Current data does not warrant widespread use.
