Advanced Depression Treatment If you don't see any improvement from a first-line antidepressant your doctor might increase the dose or add another kind of medication. They may also recommend psychotherapy. The newer psychotherapy techniques like enhanced depression treatment have scientific support and may help improve depression symptoms. These therapies are focused on identifying and resolving the specific ways that depression interferes with your daily activities. Transcranial magnetic stimulation (TMS) A type of noninvasive brain stimulation, TMS employs magnetic impulses to affect the neurons responsible for mood. It is usually recommended to treat depression when medications have failed or are not suitable for the individual. It is also used to treat PTSD and is often combined with psychotherapy. TMS is a reliable and safe treatment that has no serious side effects. During the session, a healthcare professional will place an electromagnetic coil on your scalp that is over the brain region that regulates mood. In the case of rTMS, it is the dorsolateral prefrontal cortex (dLPFC). It is a tiny area situated on the front of your head. The device sends electrical impulses to your brain. You will hear sounds of clicking and feel tapping sensations. The healthcare professional will adjust settings to stimulate the desired areas of the brain. The healthcare professional will assess the amount of energy needed to trigger a thumb twitch. This is important because it allows them to determine how much power they're using and ensures the security of the patient. In the past, the pulses were given at 120% of the threshold for motor. However, the current research is focused on accelerating TMS treatment to decrease the time required to treat and improve the rate of response. Researchers have demonstrated in a controlled, randomized study that TMS can help people with MDD who do not respond well to antidepressants. The study showed that patients treated with rTMS experienced significant improvements in symptoms such as depression and sadness, changes in appetite and decreased interest or enjoyment of activities. The study also found that the effects lasted for a long time. TMS is different from other forms of brain stimulation, such as vagus nerve stimulator. It is not a factor with psychotherapy. It is also safe for women who are pregnant, and it has a very low risk of seizures. However, some people can suffer from discomfort or pain on the scalp underneath the magnet during treatment. TMS treatments usually last around 30 minutes. Your doctor will let you know the length of the treatment and may pause pulses to allow the magnet to cool. Vagus Nerve Stimulation (VNS) VNS (also known as Vagus Nerve Stimulation Therapy) is an option for treatment that sends precise electrical signals to alter brain wave patterns and decrease depression symptoms. It's a surgically implanted device that utilizes a small pulse generator that is connected to a wire that's placed beneath the skin and wrapped 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 found relief from other treatments like psychotherapy or medications. It's also approved as a seizure treatment option for epilepsy sufferers. Researchers evaluated the effectiveness of VNS with a sham-device in people with treatment-resistant unipolar disorder or bipolar depression. Patients in the VNS group received a moderate, low or high dose of electrical stimulation over an 22-week "acute phase." The primary goal was improvement in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group had significantly better results than those in the group with a sham. At a 12-month check-up the VNS group scored an average IDSSR30 of 9.3 while the group of sham scored 4.2. The VNS treatment was well tolerated. The most common adverse effects were voice changes hoarseness, a feeling of numbness, and a feeling on the chest. Other reported side effects included headache, tingling, fatigue and changes in speech or swallowing. Some of these side 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 generally resolved by the end of the acute study period. Psychiatrists from Ohio State Wexner Medical Center are regularly invited to take part in national discussions on the best method to treat depression and other mood disorders. Our experts are involved in shaping national standards of care and are currently a participant for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial that will further investigate VNS as a treatment for treatment-resistant depression. This is a very important research study, as the evidence available suggests that VNS could be a more effective treatment for patients suffering from chronic illness. Electroconvulsive therapy (ECT) ECT is a powerful treatment for depression that doesn't improve through medication. It's particularly helpful for those who are depressed or can't wait for their medication to take effect. During ECT, doctors send small electrical currents through the head to intentionally cause a brief seizure. This is believed to alter brain chemical structure and improve symptoms of a variety of mental health conditions. ECT has been around since the 1930s. Despite the stigma associated with the treatment it has helped many people. Your psychiatrist will need to perform a thorough psychiatric assessment before making a recommendation for ECT. They will then go through your medical records and conduct several tests, including an electrocardiogram, blood tests, and possibly a chest X ray. They will ask you to describe how you feel about ECT, and consider any opinions from family members or friends representing you. The ECT procedure is carried out while you are asleep under general anesthesia. This means that you won't feel anything during the procedure. A mouth guard is put on to protect your teeth and an air mask is placed over your face for oxygen. The anesthesiologist injects the anesthetic via a needle into your vein. When you are asleep, electrodes are placed on either one or both of your heads depending on whether you're receiving unilateral or bilateral ECT. These electrical pulses send tiny impulses to the brain, causing an instant seizure. It lasts for 20 to 60 seconds, and you'll be awake within a few minutes after. You can revoke your consent to ECT at any time before the initial treatment. You are entitled to withdraw your consent in accordance with the Care Quality Commission (CQC), and your doctor must always take your preferences into consideration when deciding whether or not to make use of ECT. Some people find ECT is a good option after having tried other treatments but failed to see improvement, but it can also be used for mild depression or severe psychosis or when you pose risky to yourself or others and can't wait for medication to start working. In most cases, you'll need to take several ECT sessions over three to six weeks. Light therapy Light therapy compensates the lack of sunlight. This is a reason that can cause seasonal affective disorder (formerly known as major depressive disorder). It can be used as a stand-alone treatment or to complement other treatments such as psychotherapy and medications. During light therapy, you are seated in front of a light box or lamp that emits bright light, usually in the range of 2,500-10,000 lux. During each treatment session you will sit for around 30 minutes at the light. The light can help improve your mood and alleviate other symptoms of SAD like being tired all the time and sleeping too much. Although scientists don't know for certain how light therapy can help treat SAD but they do know that it has an immediate impact on circadian rhythms. Circadian rhythms affect sleep patterns, hormones, and other functions. Light therapy can alter the internal clock of your body by influencing melatonin release, a chemical which regulates sleep-wake cycles. It can also impact neurotransmitter functions by altering the production of serotonin which is a chemical that improves your mood. Numerous studies have demonstrated that light therapy can improve depression symptoms and boosts the effectiveness of antidepressant drugs. Additionally, some studies have found that light therapy is effective in treating bipolar disorder. These findings are encouraging, and they suggest that light therapy may be a viable option for people with depression and bipolar disorder. Before you begin using light therapy, consult your physician or a mental health professional about it. They can assist you in selecting the best device and provide you with guidelines on how to use it. They can also inform you whether it interacts with any other medications that you are taking. Light therapy is a safe treatment that does not cause serious side effects. However, https://www.iampsychiatry.com/depression-treatment should only use it as prescribed by your doctor. It is crucial to seek treatment as quickly as possible if you are suffering from severe depression. Depression is a serious condition and it can result in serious consequences for your physical and emotional well-being. In severe cases, it could lead to thoughts of suicide. If you're having suicidal thoughts, seek assistance immediately from an expert in mental health.