Question: My wife has suffered from depression for years. Several psychiatrists treated her, but they changed her medications for depression and sent her to a psychologist. With so many advances in Medicine, is there nothing new in Psychiatry? (Romualdo Cáceres, from Mendoza)
In the last 5 years, Psychiatric treatments experienced advances that open alternatives to faster, more personalized therapies with fewer side effects.
Here, 7 of the most significant:
1) Fast-acting antidepressants. Esketamine was approved by the FDA in the US in 2019 for the treatment of resistant depression, with rapid action to reduce symptoms within hours or days, unlike traditional antidepressants. It is applied as a nasal spray – generally in a weekly dose – and can only be performed in an institutional setting.
2) Psychedelics as therapeutic tools. Psychedelics (used as recreational drugs or in religious rituals) are beginning to emerge as promising treatments. Among them, psilocybin, present in certain mushrooms, shows effectiveness in treating severe depression, anxiety in terminally ill patients, and obsessive-compulsive disorder.
Clinical trials have shown that one or two controlled sessions with psilocybin, combined with psychological therapy, can produce lasting improvements.
Ecstasy (or MNDA) is also in the final phase of approval for the treatment of post-traumatic stress disorder since it allows severe trauma to be processed by temporarily reducing fear and improving emotional connection during psychotherapy.
3) New approaches in schizophrenia. The treatment of schizophrenia is progressing with recently approved drugs (xanomeline, in 2024) that offer a different action profile and better tolerance compared to traditional antipsychotics.
4) Regulators of the cannabinoid system. This system, which is involved in a wide variety of physiological processes (sleep, pain regulation, cardiovascular and gastrointestinal functions), emerges as a new therapeutic target with drugs that are being investigated to treat disorders such as generalized anxiety, depression and insomnia.
Even in experimental stages, they promise to be effective alternatives with fewer side effects.
5) Personalized treatments. It involves adjusting the treatment according to the needs and genetic and biological characteristics of each patient.
For example, brexanolone was approved in 2019 to treat postpartum depression and is the first specific treatment for a particular psychiatric condition. He would pioneer a new era in which treatments are tailored to a specific disorder a patient suffers from.
Personalized treatments adjust to the needs of each patient. / Shutterstock Photo.6) Anti-inflammatories and mental health. The clear relationship between chronic inflammation and disorders such as resistant depression, schizophrenia or Alzheimer’s has led to the development of anti-inflammatory drugs that act on the immune system.
Still under investigation, one of them are monoclonal antibodies that reduce brain inflammation and show therapeutic benefits in these diseases.
7) Multitasking drug development. They are medications capable of acting simultaneously on multiple brain neurochemical systems. An example is cariprazine which has shown effectiveness for bipolar disorder and schizophrenia.
Thus, the future appears promising with advances in personalized therapies and the integration of multidisciplinary approaches.
