The Need for Alternative Treatments for Depression
Treatment through the Neuromuscular Pathway
by Sebastian De Beurs and Eric Finzi, MD, PhD
According to the World Health Organization (WHO), 280 million people suffer from Major Depressive Disorder (MDD).1 MDD is characterized by a persistent feeling of sadness and loss of interest in activities that were previously enjoyed. People with depression may also experience changes in their sleep patterns, changes in appetite, low energy levels, difficulty concentrating, feelings of hopelessness or worthlessness, difficulty making decisions, and thoughts of self-harm.
Current biopharmaceutical treatments for depression primarily focus on two pathways: the monoamine pathway and the glutamatergic pathway. The monoamine pathway involves the neurotransmitters serotonin, norepinephrine, and dopamine. Antidepressant medications that target this pathway, such as selective serotonin reuptake inhibitors (SSRIs) work by increasing the levels of these neurotransmitters in the brain.
The glutamatergic pathway, on the other hand, involves the neurotransmitter glutamate. Antidepressant medications that target this pathway, such as ketamine and other NMDA receptor antagonists, work by inhibiting the action of glutamate in the brain. While these treatments can be effective for some people with depression, they do not work for everyone. In fact, a significant number of people with depression do not respond to these treatments and continue to suffer from the symptoms of their condition.
There has also been renewed interest in using psychedelic pathways to treat mental health disorders.2 Recent studies have explored the potential benefits of compounds such as ketamine, psilocybin, LSD, and MDMA for the treatment of depression. These studies have shown promising initial results, suggesting that psychedelics may be helpful in providing relief from symptoms of depression and other mental health conditions.
While preliminary research has suggested that psychedelics may be effective in the treatment of depression, it is important to note that these compounds can also have negative side effects.3 Common side effects of psychedelics include anxiety, confusion, paranoia, and panic attacks. In some cases, these side effects can be severe and may require medical attention. It is also important to note that psychedelics can cause hallucinations and other changes in perception, which can be disorienting and potentially dangerous for some individuals.
Additionally, the long-term effects of psychedelics on the brain and mental health are not well understood. There is some concern that repeated use of psychedelics may lead to a decrease in brain function or the development of mental health conditions such as psychosis. More research is needed to fully understand the potential risks and benefits of psychedelic treatments for depression.
There is a continued need for more research into alternative pathways to the brain that may be involved in the treatment of depression. One such pathway is the neuromuscular pathway, which has been relatively understudied. The neuromuscular pathway involves the interaction between the nervous system and the muscles. Research has suggested that disruptions in this pathway may play a role in the treatment of depression.
One potential treatment for depression that targets the neuromuscular pathway is botulinum toxin (BoNT). BoNT is a protein that is produced by the bacterium Clostridium botulinum. It works by blocking the release of acetylcholine, a neurotransmitter that is involved in the transmission of nerve impulses from the nervous system to the muscles, allowing for the contraction of muscles. By blocking the action of acetylcholine, BoNT can prevent the contraction of muscles, leading to a temporary paralysis of the muscles.
A body of research has suggested that BoNT may be an effective treatment for depression. Multiple randomized controlled trials have shown that people with depression who received injections of BoNT showed significant improvements in their symptoms compared to those who received a placebo.4 Researchers suggested that the paralysis of the facial muscles expressing negative emotions may have a beneficial effect on the brain, leading to an improvement in mood. While these results are promising, more research is needed to fully understand the potential of BoNT as a treatment for depression.
One of the key advantages of BoNT as a treatment for depression is its improved side effect profile compared to alternative treatments. In a study published in JAAD of 1678 subjects who received BoNT, only 24% of patients who received injections of BoNT reported temporary side effects such as injection site pain.5 In contrast, up to 86% of patients who take selective serotonin reuptake inhibitors (SSRIs) report persistent side effects, and 55% report bothersome side effects such as sexual dysfunction, nausea, insomnia, drowsiness, and weight gain, among other serious side effects.
Another advantage of BoNT as a treatment for depression is its ease of delivery. Clinical trials suggest that a single injection of BoNT may provide relief from the symptoms of depression for three to four months. This is a significant advantage over other treatments for depression, such as SSRIs, which require daily pill regimens, and psychotherapy, which can require significant time and supervision.
In addition, BoNT is already FDA approved for multiple therapeutic indications and has decades of use, providing a strong safety profile and a track record of effectiveness. Overall, BoNT has the potential to be a highly effective and convenient treatment for depression, with significantly lower side effects than other available options.
Research into new treatments for depression is critical, especially those that target understudied pathways such as the neuromuscular pathway. The existing treatments for depression are not effective for everyone, and there is a need for more options that can help people who do not respond to these treatments. BoNT is a potential treatment that has shown significant promise in clinical trials to date, but more research is needed to fully understand its potential. Investing in research into new treatments for depression can help improve the lives of the millions of people who suffer from this condition.
References:
1. https://www.who.int/news-room/fact-sheets/detail/depression
2. https://pubmed.ncbi.nlm.nih.gov/33888297/
3. https://www.sciencedirect.com/science/article/abs/pii/S0165032719319834?via%3Dihub
5. https://pubmed.ncbi.nlm.nih.gov/19744746/
Disclaimer:
BoNT is not currently an FDA-approved drug for the treatment of depression. The information provided in this article is for educational purposes only and is not intended to replace the advice of a healthcare provider. The use of BoNT for the treatment of depression should only be considered under the guidance of a qualified healthcare provider. The information provided in this article is not intended to diagnose, treat, or cure any medical condition. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking treatment because of something you have read in this article.