Advanced Depression Treatment
If you don't see any improvement from a first-line antidepressant your doctor may increase the dosage or prescribe another type of medication. They may also recommend psychotherapy.
The newer psychotherapy techniques like augmented depression treatment offer empirical support and can help reduce depression symptoms. These treatments aim at finding and resolving specific ways in which depression affects your daily life.
Transcranial Magnetic Stimulation (TMS)
TMS is a noninvasive brain stimulation technique that utilizes magnetic pulses to stimulate neurons that are responsible for mood. It is usually used to treat depression when medication fails or isn't suitable for the individual. It is used to treat PTSD and can be combined psychotherapy. TMS is an effective and safe treatment that doesn't trigger serious side effects.
During the session, a healthcare professional will place an electromagnetic coil on your scalp to the brain region that controls your mood. In advanced depression treatment is the dorsolateral frontal cortex (dLPFC). This is a small area situated in front of your brain. The device will send electrical impulses to your brain. You will hear clicking sounds and feel a tingling sensation. The healthcare professional will adjust settings to stimulate the desired areas of the brain.
The healthcare professional will assess the intensity of the pulses using how much energy is required to elicit an itch in the thumb. This is crucial, since it lets them know the power they're using to ensure patient safety. In the past, the pulses were delivered at 120% of the threshold of motor. However, current research is focused on accelerating TMS therapy to reduce time required to treat and improve response rates.
In a randomized control trial, researchers have shown that TMS can help people with major depressive disorder (MDD) who don't respond to antidepressants. The study revealed that those who were treated with rTMS saw significant improvement in symptoms, such as low mood and sadness as well as changes in appetite, decreased interest or enjoyment of activities. The study also revealed improvements that lasted a long time.
TMS is not like other types of brain stimulation, such as electroconvulsive treatment and vagus nerve stimulator. It is not a factor with psychotherapy. It is safe for women who are pregnant and has a low risk of seizures. However, some people can feel pain or discomfort on the scalp beneath the magnet while they are receiving treatment.
TMS treatments usually last around 30 minutes. The doctor will inform you of the duration of the treatment and may pause pulses to allow the magnet to cool down.
Vagus nerve stimulation (VNS)
VNS (also known as Vagus Nerve Stimulation Therapy) is a treatment option that transmits timed electrical signals to change brain wave patterns and reduce depression symptoms. This is an implanted surgical device that employs a tiny pulse generator that is connected to a wire which is placed beneath the skin and wound around the left vagus nerve inside the neck. FDA approved the procedure for those suffering from treatment-resistant depression who haven't had relief from other treatments such as psychotherapy and medication. It's also approved for seizure control in certain epileptic patients.
In the largest study of VNS researchers compared the effectiveness against a sham device in people who suffered from treatment-resistant unipolar or depressed-phase bipolar disorder. The VNS group received moderate, low, dose or high dosage of electrical stimulation over a period of 22 weeks. The primary goal was changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group improved significantly more than those in the sham group. At a 12-month follow-up patients in the VNS group had a mean IDS-SR30 score of 9.3 points, whereas those in the group of sham scored 4.2 points.
The VNS treatment was well tolerated. The most frequently reported side effects were voice distortion, hoarseness, and a sensation on the chest. Other reported side effects were tingling, headache, fatigue, and changes in swallowing or speech. Some of these adverse effects occurred more frequently in higher dose groups while others were seen at all doses. The rate of AEs was similar to those seen in other studies, and they were typically cleared by the end the acute study period.
The psychiatrists at Ohio State Wexner Medical Center regularly participate in national conversations about the best methods to treat depression and other mood disorders. Our experts help shape national standards of care and are currently a site for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial to further investigate VNS as a treatment for treatment-resistant depression. This is a crucial research project, as the available evidence suggests that VNS could be a more effective treatment for patients suffering from chronic illness.
Electroconvulsive Therapy (ECT)
ECT is a potent treatment for depression that doesn't improve through medication. It is particularly helpful for those who are suicidal, or who are unable to wait for their medication to start working.
During ECT doctors transmit small electrical impulses through the head to intentionally trigger a short seizure. This is believed to alter brain chemical structure and improve symptoms of certain mental health problems. ECT has been in use since the 1930s. Despite the stigma attached to the treatment it has helped a lot of people.
Your psychiatrist will first need to conduct a thorough psychiatric examination before making a recommendation for ECT. They will then go through your medical records and perform a series tests, including an electrocardiogram, blood tests and perhaps a chest X ray. They will ask you how you think about ECT and consider any opinions from family members, friends, or advocates who are speaking on your behalf.
The ECT procedure is done under general anesthesia so you will not feel anything. A mouth guard is placed to protect your teeth and an air mask is placed over your face for oxygen. An anesthesiologist injects a local anesthetic into your vein with needle. After you are asleep, electrodes are positioned on both sides of your head (depending on whether you have bilateral or unilateral ECT). These electrical pulses send small impulses to the brain, which triggers brief seizures. It lasts for 20 to 60 second and you will wake up soon after.
You can revoke your consent to ECT at any time prior to the first treatment. This is your right under the Care Quality Commission (CQC) regulations and your doctor must always take into account your wishes when considering ECT for you.
Certain people find ECT is a good option after having tried other treatments but haven't seen any improvement, but it is also a viable option to treat mild depression or severe psychosis or if you're at risk to others or yourself and can't wait for medication to take effect. The majority of patients will need to attend several ECT sessions over a period of three to six weeks.
Light therapy
Light therapy helps to compensate for the absence of sunlight, a factor that may contribute to major depressive disorder that has seasonal patterns (formerly known as seasonal affective disorder). It can be used as a stand-alone treatment or as an add-on to other treatments like psychotherapy or medication. During the treatment, you sit in front of a light box or lamp that emits bright light usually in the range of 2,500-10,000 lux. During each session, you'll be sitting for 30 minutes near the lamp. The light can boost your mood and alleviate symptoms of SAD like feeling constantly tired and sleeping excessively.
Researchers aren't sure what the effects of light therapy on SAD. However, they are aware that it can have an impact on the circadian rhythms. Circadian rhythms are biological cycles that impact the patterns of sleep, hormone levels, and other vital functions. Light therapy can reset your internal clock by influencing the release of melatonin, which is a chemical that regulates your sleep-wake cycle. It also impacts neurotransmitter function through affecting the production of serotonin an ingredient that boosts your mood.
Numerous studies have demonstrated that light therapy improves depression symptoms and enhances the effectiveness of antidepressant drugs. Several studies have also shown that light therapy can be used to treat bipolar disorder. These results are encouraging, and suggest that light therapy could be an option for those with depression and bipolar disorder.
Before you begin using light therapy, speak to your doctor or mental health professional about it. They can help you find the right device for your needs and provide guidelines on how to utilize it. They can also tell if it interferes with other medications you take.
Light therapy is a safe treatment that has no adverse side effects. You should only use it if your doctor prescribes. It is crucial to seek treatment as soon as you can if suffering from depression that is severe. Depression is a serious disease and can have grave consequences for your emotional and physical well-being. In severe cases, it can even cause thoughts of suicide. If you are experiencing suicidal thoughts, seek help immediately from an expert in mental health.