Treating Depression at Yale

Transcript

• 00:05So we've struggled with the
• 00:07understanding of what is what
• 00:09we would call the pathophysiology
• 00:11of depression or other psychiatric
• 00:13disorders.
• 00:14What actually is malfunctioning in
• 00:16the brain that's leading to
• 00:18these disorders?
• 00:19The Nobel Prize was awarded
• 00:21about a hundred and twenty
• 00:22years ago for really
• 00:24the basic understanding of how
• 00:26individual cells, the neurons in
• 00:28the brain, actually communicate
• 00:30with each other through chemical
• 00:32impulses that are then translated
• 00:34to electrical stimuli.
• 00:36Since then, our understanding has
• 00:38evolved. We started to realize
• 00:40that these neurons are
• 00:42localized into nuclei, and then
• 00:44those nuclei form circuits the
• 00:45way they communicate with each
• 00:47other. And then those circuits
• 00:48actually form networks.
• 00:50So we're really starting to
• 00:51understand how the brain works
• 00:53as a
• 00:54very
• 00:55complex unit
• 00:57to regulate our emotions, our
• 00:59perceptions,
• 01:00our thoughts. We use the
• 01:01term neuroplasticity,
• 01:02which has become a big
• 01:04buzzword in the field.
• 01:06The ability for the cells
• 01:08in the brain to form
• 01:09new connections,
• 01:10to strengthen or weaken those
• 01:11connections.
• 01:13And we think there's some
• 01:14combination of those events
• 01:16that's leading to many of
• 01:17our psychiatric illnesses.
• 01:19The most common medications aren't
• 01:21always effective for depression
• 01:23even in combination with effective
• 01:25psychotherapy like cognitive behavioral therapy.
• 01:28And the greater number of
• 01:30medications
• 01:31that people try
• 01:33unfortunately
• 01:34the lower the likelihood that
• 01:35they'll have success.
• 01:37This has been
• 01:38a call for our field
• 01:40to figure out alternative ways
• 01:42to treat depression.
• 01:44To think outside the box
• 01:45to other neurotransmitters
• 01:47and other networks within the
• 01:49brain that may be involved
• 01:51in the pathophysiology
• 01:52of depression.
• 01:58Interventional psychiatry
• 02:00here at Yale includes
• 02:02treatment modalities
• 02:03such as rapid acting antidepressants
• 02:06such as ketamine or s
• 02:07ketamine,
• 02:08which we think
• 02:09works more in regards to
• 02:11the glutamate system and
• 02:14causes
• 02:16a myriad of downstream effects
• 02:19in terms
• 02:20of synaptic plasticity.
• 02:22This phenomenon
• 02:23where things that fire together
• 02:26wire together in the brain.
• 02:28It's really the idea
• 02:30that you're able to use
• 02:32both the neurochemistry
• 02:33and drugs such as ketamine
• 02:35that can do that, but
• 02:36also using
• 02:37treatments like electroconvulsive therapy or
• 02:40transcranial magnetic stimulation
• 02:42that have more of a
• 02:43direct effect on the electrical
• 02:45system in the brain.
• 02:47TMS is
• 02:48a non invasive form of
• 02:50neuromodulation.
• 02:52We're able to painlessly
• 02:54and
• 02:55safely
• 02:56target certain areas of the
• 02:58brain
• 02:59and induce what we call
• 03:00eddy currents,
• 03:01which are these small electrical
• 03:03currents that influence the activity
• 03:05of individual neurons.
• 03:07And when there are enough
• 03:08neurons
• 03:10collectively
• 03:10acting,
• 03:11it can cause downstream effects
• 03:14in terms of chemical release.
• 03:17So even though we're using
• 03:18the electrical
• 03:20manipulation,
• 03:21it's causing
• 03:23downstream
• 03:24chemical changes as well. So
• 03:25it's this idea of
• 03:27inducing some level of plasticity
• 03:29and then really trying to
• 03:32work through therapeutic techniques, through
• 03:35behavioral activation.
• 03:37We're trying to figure out
• 03:38the different mechanisms by which
• 03:39these illnesses occur
• 03:41and how we can individualize
• 03:43treatment on a clinical level
• 03:44for each individual patient.
• 03:46And that's where the basic
• 03:47neuroscience
• 03:48really
• 03:49allows us
• 03:50to grow and target treatments
• 03:52to be much more effective
• 03:53and and in this case,
• 03:55hopefully, much safer.
• 04:00The nice thing at the
• 04:01Yale Depression Research Program is
• 04:03it's a pretty broad range.
• 04:04We really try to do
• 04:06translational
• 04:08neuroscience
• 04:09work.
• 04:10We work very closely with
• 04:11colleagues in some of our
• 04:12own studies trying to
• 04:14what is
• 04:15underlying the pathophysiology
• 04:17of depression.
• 04:19But moving up, we also
• 04:20have real interest in studying
• 04:24the the actual clinical utility
• 04:26if we truly wanna optimize
• 04:28our treatments,
• 04:30it's not simply
• 04:32targeting a receptor or even
• 04:34targeting a circuit or a
• 04:36network.
• 04:37You really have to understand
• 04:38how
• 04:39that is interacting with what
• 04:41we call these contextual factors,
• 04:43all the other events that's
• 04:45going on in the environment
• 04:47in our lives.