- What exactly is drug-resistant depression?
- What is this "normal" depression then?
- Hope for patients with drug-resistant depression.It is about esketamine.
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Drug-resistant depression affects about ⅓ of people diagnosed with depressive disorders. Worldwide, millions of people suffer from this type of depression. Their loved ones suffer with them. But now hope has come.
Esketamine, which so far has only been used in anesthesiology, is the last resort for people who think that nothing will help. Dr. Sławomir Murawiec answers questions about drug-resistant depression and esketamine.
What exactly is drug-resistant depression?
- We are talking about those situations where depression does not respond to usual standard treatment. More precisely, because this drug-resistant depression has its definition, it is about situations in which a person suffering from depression does not get better after two correct treatments for this depression. The point is that these therapies must be properly selected with milk, they must be long enough, this drug is to be in the dose that should turn out to be effective. If two treatments of this type - properly performed - do not improve the mental state, i.e. the depression continues, then according to the medical definition we refer to the drug-resistant depression.
What is this "normal" depression then?
- Depressive symptoms include a certain depressive mood. It is worth noting that a depressive mood is, for example, sadness, depression and all that is hidden under the words "mental pit". Also a mood related to irritability, easy nervousness, anger, or a feeling of emptiness. It is a loss of feeling pleasure, satisfaction - nothing is pleasing, nothing is of interest.
- These are the symptoms of the propulsion, such a motor to operate. It is difficult to go somewhere, it is difficult to do something, it is difficult to find the strength to do something. This can also be called fatigued, meaning "I'm so tired that I can't." It is also disturbance of circadian rhythms, deterioration of well-being in the morning hours, slightly better mood in the evening hours, irritability and anger. In addition, there is a disturbance of cognitive functions (memory, concentration, attention, inability to focus and learn, mental work). This set of symptoms, if someone has it, is called classic depression.
Hope for patients with drug-resistant depression.It is about esketamine.
In the article "Drug-resistant depression - new possibilities for help" you can read that esketamine works very quickly - even after 24 hours. How is it that a substance can help so quickly? What areas of the brain does it affect?
- I'll start from the beginning. We have a certain pool of drugs that have been present on the market for years. These drugs are of course effective and we can help many, often most, patients. As I said, not everyone, because about of people are still beyond the scope of help. Therefore, an intensive search for substances that could help this special group of patients has been carried out for years. One such substance is esketamine, originally used in anesthesiology. As part of the search for opportunities to help people with drug-resistant depression, it was discovered that it is a substance that can help them quickly and decisively.
The mechanism of this action is different. There is an effect not on the neurotransmitters that we traditionally associate with depression, i.e. serotonin, noradrenaline but on other transmission - glutamine. There is another unique mechanism of action. This other unique mechanism of action translates into improvement that occurs quickly. In the case of traditional drugs, as it is included in the leaflets, we have to wait about 2 weeks for improvement. Here the improvement occurs within 24 to 48 hours. Mood improves quickly, which is even more important and spectacular in the case of patients who suffer from drug-resistant depression, i.e. suffer deeply. The treatment trials so far do not help and suddenly this improvement may occur within a relatively short period of time.
In an interview for the medical magazine Via Medica "Hear from the patient: You gave me another life", Dr. Murawiec talked about esketamine with Dr. Jolanta Klemens. Regarding this substance, she said “[…] The next very important stage is regaining the lost family, social and professional position. This is where esketamine came to the rescue. Amazing molecule! Apart from the fact that it works “almost immediately”, the most important from my point of view is what happens a bit later. […] ”. Esketamine is a great opportunity for patients who have started to lose hope. Thanks to the quick action, many of them will not only feel better physically. Patients who have thought about psychotherapy will find it easier to make an attempt, and this is the first step to improving the quality of life.
About the author
Dominika StanisławskaShe graduated from Polish Studies and Philosophy at the University of Warsaw. She worked on film sets as a script and assistant director. Her intereststhey mainly focus on new technologies used in medicine, which may revolutionize the treatment of many diseases. He is interested in film and learning foreign languages. He spends his free time by the water.
Sławomir Murawiec, MD, PhD Sławomir Murawiec, MD, PhD, psychiatrist, psychotherapist, Medical Director for Outpatient Care Allenort, specialist with over 20 years of experience in various areas of psychiatry. He deals with, among others an accurate selection of drugs in the treatment of depression, anxiety and sleep disorders. Co-author of the book "Therapeutic Ornithology. Birds - he alth - psyche ”.