Advanced Depression Treatment
If your depression isn't responding to a first-line antidepressant, your doctor might suggest increasing the dosage or adding a different medication. They might also suggest psychotherapy.
The newest psychotherapy methods like augmented depression treatment have empirical evidence-based support and could help alleviate depression symptoms. These therapies are focused on identifying and resolving the specific ways that depression affects your daily activities.
Transcranial magnetic stimulation (TMS)
A form of non-invasive brain stimulation, TMS uses magnetic impulses to affect the brain's neurons that are responsible for mood. It is typically prescribed to treat depression if medication fails or is not suitable for the individual. It can also be used to treat PTSD and is often combined with psychotherapy. TMS is an effective and safe treatment that does not cause serious side effects.
During the session, a medical professional will install an electromagnetic coil on the region of your brain which controls mood. In the case of rTMS this is the dorsolateral frontal cortex (dLPFC). It is a tiny region that is located in front of your brain. You will hear a clicking sound and feel a tapping sensation as the device delivers signals to your brain. The healthcare expert will adjust the settings to stimulate the areas you want of your brain.
The healthcare professional will determine the strength of the pulses by determining the amount of energy needed to trigger the thumb to twitch. This is important, as it allows them to determine the power they're employing to ensure the safety of patients. In the past, pulses were delivered 120% of the motor threshold. But, current research is focused on accelerating TMS therapy to reduce duration of treatment and increase response rates.
In a randomized control trial, researchers have shown that TMS can benefit people suffering from major depressive disorder (MDD) who do not respond to antidepressants. The study showed that those treated with rTMS showed significant improvements in symptoms like depression sadness, depression, changes in appetite, and decreased enjoyment or interest in activities. The study also showed improvements that lasted a long time.
In contrast to other forms of brain stimulation, like vagus nerve stimulation or electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for women who are pregnant and has a low chance of seizure. Some people might experience pain or discomfort on their scalp beneath the magnet while they are receiving treatment.
TMS treatments usually last around 30 minutes. Your doctor will let you know the duration of the treatment and may also pause the pulses to allow the magnet to cool.
Vagus nerve stimulation (VNS)
VNS (also called Vagus Neuro Stimulation) is an approach that utilizes timing of electrical signals to alter brainwave patterns and decrease depression symptoms. This is a surgically implanted device that utilizes a small pulse generator that is connected to a wire that is wrapped under the skin and wound around the left vagus nerve of the neck. The procedure is FDA-approved for treating depression that is resistant to treatment in patients who have not received relief from other treatments, like psychotherapy or medications. It is also approved as a seizure treatment option for certain individuals with epilepsy.
Researchers evaluated the effectiveness of VNS with a sham-device for patients with bipolar disorder that is resistant to treatment or depression. Patients in the VNS group received a moderate, low or high dose of electrical stimulation throughout an 22-week "acute phase." The primary endpoint was the improvement in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group showed improvement significantly more than those in the group with a sham. At the end of a 12-month period participants in the VNS group had an average IDS-SR30 score of 9.3 points, while those in the sham group scored 4.2 points.
The VNS treatment was well-tolerated. The most common adverse effects were voice changes, hoarseness, and a sensation in the chest. Other reported side effects included tingling, headache fatigue, fatigue and changes in speech or swallowing. Some of these side effects occurred more frequently in the higher dose groups while others were seen at all doses. The frequency of AEs in this study was comparable to previous studies and generally cleared by the end the acute study time.
The psychiatrists at Ohio State Wexner Medical Center regularly take part in national discussions on the best ways to treat depression and other mood disorders. Our experts help shape national standards of care and are currently a participant for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial that will further study VNS as a treatment option for treatment-resistant depression. This is a significant research project, as the evidence available now suggests that VNS could provide better benefits and hope to this difficult-to-treat chronic patient.
Electroconvulsive Therapy (ECT)
ECT is a potent treatment for depression that isn't improving through medication. It is particularly beneficial for people who are suicidal or can't wait for their medication take effect.
During ECT doctors transmit small electrical currents to the head to intentionally cause a brief seizure. This is believed to alter brain chemical structure and improve the symptoms of certain mental health disorders. ECT has been used since the 1930s, and despite the stigma that is associated with the treatment, a lot of people have seen positive results from it.
In order to be prescribed ECT your doctor will need to do an exhaustive psychiatric assessment. They will review your medical records and conduct a series tests, such as an electrocardiogram, blood tests, and maybe the chest X-ray. They will ask you about how you are feeling about ECT and consider any opinions from family members or friends speaking on your behalf.
The ECT treatment is given when you're asleep under general anesthesia, so you won't feel anything during the procedure. A mouth guard is put on to protect your teeth. an air mask is placed over your face to allow oxygen. The anesthesiologist will inject an the anesthetic via a needle into your vein. After online therapy for depression are asleep, electrodes are placed on both sides of your head (depending on whether you have bilateral or unilateral ECT). These pulses deliver small electrical impulses to the brain, which triggers a short seizure. It lasts for 20 to 60 seconds and you wake up shortly after it's over.
You can withdraw your consent to ECT at any point before the initial treatment. You have a right to withdraw your consent in accordance with the Care Quality Commission (CQC) and your doctor should always consider your wishes when deciding whether or not to utilize ECT.
Some people find that ECT is a great option after having tried other therapies but haven't seen any improvement, but it can also be used to treat mild depression or severe psychosis, or if you're a danger to others or yourself and you are unable to wait for medication to begin working. In most instances, you'll have to take several ECT sessions over the course of three to six weeks.
Light therapy
Light therapy compensates for lack of sunlight, a factor that could contribute to major depressive disorder that has seasonal patterns (formerly called seasonal affective disorder). It can be used as a stand-alone treatment or to complement other treatments, such as psychotherapy and medications. When you undergo light therapy, you sit next to a light box that emits bright, white light. The light is usually between 10,000 and 2,500 in lux. Each session, you'll sit for 30 minutes near the lamp. The light could aid in improving your mood and alleviate other symptoms of SAD, such as feeling tired all the time and having trouble sleeping.
Researchers aren't aware of how light therapy can treat SAD. However, they know that it can have an impact on the circadian rhythms. Circadian rhythms are biological cycles that affect sleep patterns, hormone levels, and other vital functions. Light therapy can alter your internal clock by altering the release of melatonin an ingredient that regulates the sleep-wake cycle. It also affects neurotransmitter functions through the alteration of serotonin production.
Several studies have shown how light therapy can improve depression symptoms and increase the effectiveness of antidepressant medication. Numerous studies have also demonstrated that light therapy can be used to treat bipolar disorder. These results are encouraging and suggest light therapy could be a possibility for people with both depression and bipolar disorder.
Talk to your physician or a mental health professional before you begin using light therapy. They can help you choose the right device for your needs and offer guidance on how to make use of it. They can also tell if it interferes with other medications you are taking.
Light therapy is a safe treatment that doesn't cause any serious side effects. It is recommended to only take it if your doctor prescribes. It is important to seek treatment as soon as possible if you are suffering from depression that is severe. Depression is a serious disease that can have a significant impact on your mental and physical well-being. In extreme instances, it may result in thoughts of suicide. Get immediate help from a mental healthcare professional if you have suicidal feelings.