Mood Disorders, such as major depressive disorder and bipolar disorder, represent a group of common and debilitating mental illnesses. While major depressive disorder is the most widespread mood disorder with an approximate lifetime prevalence of 15%, bipolar disorder is a severe form of mood disorder with an estimated prevalence of 2-4%. The World Health Organization has ranked depression and bipolar disorder among the most disabling conditions worldwide.
A group of researchers in the UAB Department of Psychiatry and Behavioral Neurobiology, including Drs. Richard Shelton, Yogesh Dwivedi, Matthew Macaluso, Karen Gamble, Merida Grant, Rachel Fargason, Li Li, and James Cullinan, have developed a wide range of laboratory, clinical, and translational neuroscience projects to investigate the neurobiology and treatment of mood disorders. The objective of this work is to increase our understanding of treatment for these serious conditions leading to improved treatment.
Intranasal Esketamine
Intranasal esketamine is the first and only drug approved for depression that works on the NMDA receptor, which makes it mechanistically different than all drugs approved before it. A component of ketamine, esketamine is now available commercially as an approved drug for individuals who have failed to achieve response with two or more oral antidepressant trials. Our center was involved in the early studies of intranasal esketamine and now offers the drug in clinical practice. Intranasal esketamine has demonstrated efficacy in short and long-term studies of depression and in 2020 was the first drug in history to receive an FDA indication for treating suicidality. An average of 75 esketamine treatments are administered each month at UAB for depression. In collaboration with the Kirklin Clinic of UAB, the UAB Depression & Suicide Center now has a protocol in place to treat patients with intravenous ketamine for depression in clinical practice, which is a service we will begin offering this year. Intravenous ketamine has been studied for treatment resistant depression for over 20 years and much is published about its mechanism of action. In 14 publications, ketamine demonstrated rapid antidepressant effect with maximum efficacy reached 24 hours post-dose and lasting for up to one to two weeks.
Vagus Nerve Stimulation
The Vagus Nerve Stimulation (VNS) deviceconsists of a generator implanted in the chest cavity which feeds electrical impulses to a lead implanted at the vagus nerve. It was approved in 2005 for use in depression but has not been widely used, because 3rd parties don’t cover the device for depression. Studies have shown that patients with the most treatment resistant forms of depression may respond to VNS, including those who have not responded to ECT. UAB is participating in the largest and longest national study of VNS to date, sponsored by the device manufacturer and by Medicare. Eligible participants include Medicare patients who have failed to respond to four antidepressant treatments.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) involves direct electrical stimulation of the brain under general anesthesia with the goal of intentionally triggering a brief seizure. ECT is believed to cause changes in brain chemistry that have been demonstrated to rapidly treat certain mental health conditions including treatment resistant depression, depression during pregnancy, psychotic depression, and severe suicidality. In calendar year 2021, 553 ECT treatments were performed by the UAB Department of Psychiatry and Behavioral Neurobiology. As of August 2022, the department has performed 277 ECT treatments for the year.