Role of Hyperbaric Oxygen Therapy in Depression
What is Depression?
Major depressive disorder, known as depression is count as a serious medical condition that frequently affects people’s feelings, thoughts, and behaviors. Thankfully, it is also curable. Sadness and a loss of interest in previous hobbies are symptoms of depression. Depression disorder is more common in women than in males. According to some research, one-third of women will go through a significant depressive episode at some point in their lives. When first-degree relatives (parents, children, or siblings) also have depression, there is a significant degree of heritability (about 40%).
Symptoms
From moderate to severe, depression symptoms might include:
- experiencing sadness or depression
- loss of enjoyment or interest in once-enjoyed activities
- Appetite changes, weight loss or increase unrelated to diets
- Inability to sleep or excessive sleeping
- Energy loss or increased fatigue
- An increase in pointless movement
- A sense of worthlessness or guilt
- A feelings of unease, anxiety, or worries
- Sluggish speech, posture, or other body movements
- A feelings of guilt or worthlessness, a fixation on mistakes made in the past, or self-blame
- A problems with memory, concentration, decision-making, & thought
- A thoughts of suicide, death, or other suicidal behavior regularly or repeatedly
- Undiagnosed physical issues such as headaches or back pain
- Having trouble focusing, thinking, or making decisions
- Suicidal or death-related ideas [1]
Pathophysiology
It is unclear what the pathophysiology of major depressive illness is at its core. The emotional symptoms are thought to be caused by a complicated relationship between neurotransmitter availability, receptor modulation, and sensitivity, according to current research.
Clinical and preclinical studies point to a disruption in serotonin (5-HT) function in the central nervous system as a significant contributing factor. Norepinephrine (NE), dopamine (DA), glutamate, and brain-derived neurotrophic factor are among more neurotransmitters that have been linked (BDNF).
The effectiveness of selective serotonin reuptake inhibitors as a treatment for major depressive disorder raises the possibility that CNS 5-HT activity plays a role in the pathophysiology of the condition (SSRIs). In addition to increased neurotransmitter availability, research results suggest a function for neural receptor modulation, intracellular signalling, and gene expression throughout time. A type of serious depressive disease called seasonal affective disorder often develops in the fall and winter and goes away in the spring and summer. According to studies, seasonal affective disorder is likewise mediated by changes in 5-HT levels in the CNS and is thought to be brought on by changes in circadian rhythm and sunshine exposure [2].
Types of Depression
1. Bipolar Disorder
Bipolar disorder is characterized by alternating episodes of depression and mania (an abnormal elevation of mood) or hypomania (a distinct elevation of mood that is not necessarily abnormal).
2. Major Depressive Disorder
Major depressive illness is defined by severe symptoms that interfere with a person’s daily activities, frequently affecting the person’s ability to enjoy life, sleep, eat, or work. Major depressive episodes can strike anyone at any age, and they might happen only once or repeatedly throughout a person’s life.
3. Persistent Depressive Disorder
A major depressive episode may occasionally accompany the symptoms of persistent depressive illness, which remain for two years or longer.
Other Types
Other forms of depression include psychotic depression, seasonal affective disorder, and postpartum depression, each of which appears under conditions. Women experience postpartum depression in the time after giving birth. Anxiety, a lack of interest in raising the child, and emotions of despair, helplessness, or inadequacy are other symptoms [3].
Treatment
ü Selective Serotonin reuptake inhibitors
ü Anti-depressants
ü Serotonin-Dopamine Activity Modulators
ü Tricyclic antidepressants
ü Monoamine oxidase inhibitors [4].
Hyperbaric Oxygen as Effective Medicine for Depression
What is HBOT?
Hyperbaric oxygen therapy (HBOT) improve the amount of oxygen in the blood and tissues (hyperoxia) by delivering pure oxygen at high pressure (about 2-3 atmospheres). Being exposed to pure oxygen (O2) concentrations at high atmospheric pressures, sometimes known as hyperbaric oxygen therapy, is one form of treatment (HBOT). This pressure may be greater than or equivalent to 1.4 atmospheres (atm), as per Undersea and Hyperbaric Medical Society (UHMS). Patients may only breathe in oxygen while constrained in an area with a minimum air pressure of 2 ATA for all current UHMS-approved usage. A pressure environment that is higher than the air pressures at the sea level is necessary for hyperbaric medicine to function. For hyperbaric oxygen therapy, a 100% oxygen delivery system and pressure chamber—which might be flexible or rigid—are necessary. A predetermined plan is followed by trained specialists who monitor the patient and adjust as necessary [5].
Nervous System Benefits of HBOT
Numerous health advantages of HBOT include improved mental clarity, less swelling or inflammation, athletic therapies, anti-ageing, and more. After HBOT, some people claim to feel focused and sharper mentally. Because elevated oxygen levels boost brain activity, which influences stem cells and neurotransmitters, hyperbaric oxygen therapy is regarded to be a successful method of treating depression. In the end, this assists in balancing brainwave activity, which balances the chemicals made in the brain [6].
In a recent study, the effectiveness of treating depressed individuals with HBOT plus escitalopram, a selective serotonin reuptake inhibitor (SSRI) drug frequently prescribed to treat depression and generalized anxiety disorder, was examined. According to the study, patients’ cognitive function improved after four to six weeks of treatment [7].
Another study examined the impact of hyperbaric oxygen therapy on nerve function following incomplete spinal cord injury and psychological problems including depression and anxiety (ISCI). After eight weeks of therapy, the results demonstrated that HBOT dramatically improved nerve function and daily activity capacity while treating patients’ depression and anxiety at a level comparable to psychotherapy [8].
Gut microbiota targeted by HBOT to Treat Depression
Researchers discovered a substantial association between 18 metabolites and campylobacteria. Significantly more concentrated in the metabolism of d-glutamate and d-glutamine were the metabolites linked to campylobacteria. HBO group and the combined group used hyperbaric oxygen. In the small animal HBO chamber, sodium lime was placed at the bottom to absorb CO2, pure oxygen was used to clean the chamber and then to raise the interior pressure to 0.2 MPa for 60 minutes (pure oxygen was also used to ventilate the chamber for 10 minutes during this time), and 5 minutes were needed to return the pressure to normal. 22, 30 21 days were spent receiving treatment. 31 The model group was placed into a box that was another chamber while the mice were given HBO treatment, but the chamber gate was left open, and no pure oxygen was provided. By modifying Campylobacteria-associated metabolites, hyperbaric oxygen reduces depressive-like behaviors in chronic stress model mice [9].
HBOT was also used to assess a case study of 39 US patients who had minor traumatic brain injuries. A complete course of HBOT treatment required 40 sessions. Only on Mondays through Fridays for a total of 20 days, each session involved the delivery of 100% oxygen at 1.5 atmospheres for 90 minutes, twice daily. When HBOT was administered to patients, their traumatic brain injury symptoms improved [10].
Parkinson’s disease adjunctive therapy using HBOT has been proposed (PD). A hallmark of Parkinson’s disease (PD), a neurodegenerative condition, is the progressive loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). Three groups of male C57BL/6 mice were created at random: control, MPTP group, and MPTP+HBOT group. Four times a day, MPTP (20 mg/kg) was intraperitoneally administered to the mice that had been treated with it. After receiving MPTP treatment, mice with the HBOT mutation were given 7 days of daily exposure to 100% oxygen in hyperbaric oxygen at 2.5 atmospheres absolute (ATA) starting the day after MPTP treatment. By enhancing mitochondrial biogenesis, lowering apoptotic signalling, and attenuating inflammatory mediators in the midbrain, HBOT may have beneficial effects in the treatment of Parkinson’s disease [11].
References
1. Kessler, Ronald C., and Evelyn J. Bromet. “The epidemiology of depression across cultures.” Annual review of public health 34 (2013): 119.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100461/
2. Heim, Christine, and Elisabeth B. Binder. “Current research trends in early life stress and depression: Review of human studies on sensitive periods, gene–environment interactions, and epigenetics.” Experimental neurology 233.1 (2012): 102-111.
Link: https://www.sciencedirect.com/science/article/pii/S0014488611004043
3. Nihalani, Nikhil, Mihai Simionescu, and Boadie W. Dunlop. “Depression: phenomenology, epidemiology, and pathophysiology.” Depression. CRC Press, 2009. 13-33.
4. Namkung H, Lee BJ, Sawa A. Causal Inference on Pathophysiological Mediators in Psychiatry. Cold Spring Harb Symp Quant Biol. 2018; 83:17-23.
Link: https://www.ncbi.nlm.nih.gov/books/NBK430847/
5. Knappe S, Einsle F, Rummel-Kluge C, Heinz I, Wieder G, Venz J, Schouler-Ocak M, Wittchen HU, Lieb R, Hoye J, Schmitt J, Bergmann A, Beesdo-Baum K. [Simple guideline-oriented supportive tools in primary care: Effects on adherence to the S3/NV guideline unipolar depression]. Z Psychosom Med Psychother. 2018 Sep;64(3):298-311.
Link: https://pubmed.ncbi.nlm.nih.gov/30850434/
6. Mi K, Guo Q, Xu BY, Wang M, Bi H. Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function. Pak J Med Sci. 2021 Jul-Aug;37(4):1054-1057. doi: 10.12669/pjms.37.4.3993. PMID: 34290782; PMCID: PMC8281171.
https://doi.org/10.12669%2Fpjms.37.4.3993
7. Feng JJ, Li YH. Effects of hyperbaric oxygen therapy on depression and anxiety in the patients with incomplete spinal cord injury (a STROBE-compliant article). Medicine (Baltimore). 2017 Jul;96(29): e7334. doi: 10.1097/MD.0000000000007334. PMID: 28723746; PMCID: PMC5521886.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521886/
8. Hyperbaric oxygen improves depression-like behaviors in chronic stress model mice by remodeling gut microbiota and regulating host metabolism. Doi: doi.org/10.1111/cns.13999
Link: https://onlinelibrary.wiley.com/doi/full/10.1111/cns.13999
9. Bested, Alison C., et al. “A Case Series of 39 United States Veterans with Mild Traumatic Brain Injury Treated with Hyperbaric Oxygen Therapy.” Clinical and Translational Neuroscience 6.3 (2022): 21.
Link: https://www.mdpi.com/2514-183X/6/3/21
11. Hsu, Hung-Te, et al. “Hyperbaric Oxygen Therapy Improves Parkinson’s Disease by Promoting Mitochondrial Biogenesis via the SIRT-1/PGC-1α Pathway.” Biomolecules 12.5 (2022): 661.
Link: https://www.mdpi.com/2218-273X/12/5/661
