Advanced Depression Treatment If your depression doesn't respond to a first-line antidepressant, your doctor may try increasing the dosage or adding another type of medication. They may also recommend psychotherapy. Newer psychotherapy methods like augmented depression therapy have empirical evidence-based support and can help reduce depression symptoms. These treatments aim at identifying and resolving specific ways depression interferes with daily life. Transcranial magnetic stimulation (TMS) A type of noninvasive brain stimulation, TMS utilizes magnetic impulses to affect the brain cells responsible for mood. It is often recommended to treat depression when medication has failed or is not suitable for the individual. It can also be used to treat PTSD and is often combined with psychotherapy. TMS is a safe and safe treatment with no adverse negative side adverse effects. During the session, a healthcare professional will position an electromagnetic coil on your scalp to the brain region that regulates mood. In the case of rTMS, it is known as the dorsolateral forefrontal cortex (dLPFC). This is a small area situated on the front of your head. The device will send signals to the brain. You will hear sounds of clicking and feel tapping sensations. The healthcare expert will alter the settings to stimulate the specific areas of your brain. The healthcare professional will determine the intensity of the pulses by determining how much energy is required to trigger a thumb twitch. This is important, as it lets them know the amount of power they are using to ensure patient safety. In the past, pulses were given at 120 percent of the threshold for motor. Current research focuses on accelerating TMS treatment to decrease the duration of treatment and increase the rate of response. Researchers have demonstrated in a controlled, randomized study that TMS can assist people suffering from MDD who do not respond well to antidepressants. The study revealed that those who were treated with rTMS saw significant improvement in symptoms, such as sadness and low mood as well as changes in appetite, decreased enthusiasm or enjoyment for activities. The study also revealed improvements that lasted for a long period of. Unlike other forms of brain stimulation, such as vagus nerve stimulation or electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for pregnant women and has a low risk of seizure. Some patients may experience discomfort or pain on their scalps under the magnet while they are receiving treatment. TMS treatments typically last about 30 minutes. Your provider will tell the duration of the treatment and may also pause the pulses to allow the magnet to cool down. Vagus Nerve Stimulation (VNS) VNS (also known as Vagus Neuro Stimulation Therapy) is an option for treatment that sends periodic electrical signals to alter brain wave 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 threaded beneath the skin and wound around the left vagus nerve of the neck. The procedure has been approved by the FDA for treatment-resistant depression in people who have not received relief from other treatments, like psychotherapy or medications. It is also approved to control seizures in certain epileptic patients. Researchers evaluated the effectiveness of VNS with a sham-device for people with treatment-resistant unipolar disorder or bipolar depression. Patients in the VNS group received a low, medium or high dose of electrical stimulation throughout a 22-week "acute phase." The primary goal was changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS groups improved significantly more than patients in the sham group. At the end of a 12-month period participants in the VNS group had a mean IDS-SR30 score of 9.3 points, while those in the group with a sham score scored 4.2 points. The VNS treatment was well-tolerated and the most frequent side effects being voice alteration or hoarseness, as well as a feeling of weight on the chest. Other reported side effects included tingling, headache fatigue, fatigue and changes in swallowing or speech. Certain of these were more often in the higher dose groups, and others happened at all doses. The rate of AEs in this study was similar to previous studies and generally resolved by the end of the acute study period. Psychiatrists from Ohio State Wexner Medical Center regularly participate in national conversations about the best ways to treat depression and other mood disorders. Our experts help define national standards for health care. We are also a part of a multicenter clinical trial called RECOVER which is being conducted by the Centers for Medicare & Medicaid Services. The aim of this study is to evaluate VNS for treating resistant depression. This is an important research project, as the evidence available today suggests that VNS could provide better benefits and hope to this difficult-to-treat chronic population. https://www.iampsychiatry.com/depression-treatment (ECT) ECT is a potent treatment for depression that doesn't improve by taking medication. It's especially useful for those who are suicidal or cannot wait for their medication to start working. During ECT doctors transmit small electrical currents to the head to cause a brief seizure. This is believed to alter brain chemical structure and speedily improve symptoms of certain mental health disorders. ECT has been in use since the 1930s, and despite the stigma that is associated with the treatment, numerous people have seen positive results from it. To be given ECT your doctor will need to do a thorough psychiatric assessment. They will then review your medical history and perform a series of tests that include an electrocardiogram (EKG) and blood tests, and perhaps a chest X-ray. They will also ask you what you think about the possibility of having ECT and will consider any opinions from family members, friends or advocates who are supporting or speaking on your behalf. The ECT treatment is given when you're asleep under general anesthesia. This means that you won't feel anything during the procedure. A mouth guard protects your teeth, and a mask covers your face to provide oxygen. An anesthesiologist injects an the anesthetic via a needle into your vein. Once you've fallen asleep, electrodes will be placed on either or both sides of your head (depending on whether you have unilateral or bilateral ECT). These electrical pulses send tiny impulses to the brain, causing brief seizures. It lasts for 20 to 60 seconds, and you are awake soon after it's over. It's important to remember that you can withdraw your consent for ECT at anytime, even prior to the first treatment. You have a right to withdraw your consent in accordance with the Care Quality Commission (CQC), and your doctor must always take your wishes into consideration when deciding whether or not to use ECT. Some people find that ECT is a great option for them after they've tried other therapies but did not see any improvement, but it is also a viable option for mild depression or severe psychosis or if you're risky to yourself or others and you are unable to wait for medication to take effect. In the majority of instances, you'll need undergo several ECT sessions over the course of three to six weeks. Light therapy Light therapy compensates for lack of sunlight, which could contribute to major depressive disorder that has seasonal patterns (formerly known as seasonal affective disorder). It can be used as a separate treatment or in conjunction with other treatments like psychotherapy and medication. When you undergo light therapy, you sit next to the light box, which emits white light with bright colors. The light usually has between 2,500 and 10,000 in lux. Each time you undergo a treatment you are seated for approximately 30 minutes at the light source. The light can improve your mood and ease symptoms of SAD like feeling tired all the time and a sleepy night. Researchers aren't aware of what the effects of light therapy on SAD. However they do know that it has an effect on the circadian rhythms. Circadian rhythms are biological cycles that affect the pattern 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 can also affect neurotransmitter functions by affecting serotonin production. Several studies have shown how light therapy can improve depression symptoms and increase the effectiveness of antidepressant medications. Numerous studies have also demonstrated that light therapy can be used to treat bipolar disorder. These findings are encouraging and suggest light therapy may be a viable option for those with bipolar and depression disorder. Before you start using light therapy, speak to your physician or mental health professional about it. They can assist you in selecting the appropriate device and give you instructions on how to use it. They can also tell whether it interacts with other medications you're taking. Light therapy is a safe treatment that does not cause serious adverse side effects. It is best to only use it if your doctor prescribes. If you are experiencing severe depression, it's crucial to seek treatment as soon as you notice it. Depression is a serious disease that can have serious effects on your mental and physical well-being. In severe instances, it may cause thoughts of suicide. Seek immediate assistance from a mental health professional in the event that you feel suicidal.