Advanced Depression Treatment
If you don't experience any improvement with a first-line antidepressant your doctor might increase the dosage or suggest another type of medication. They may also recommend psychotherapy.
Modern psychotherapy techniques like augmented depression therapy have empirical support and can aid in reducing depression symptoms. These therapies concentrate on identifying and solving the specific ways depression can affect your daily routine.
Transcranial magnetic stimulation (TMS)
TMS is a non-invasive brain stimulation that uses magnetic pulses to affect the brain's neurons that control mood. It is often prescribed to treat depression when medication fails or is not suitable for the individual. It is also used to treat PTSD and is sometimes combined with psychotherapy. TMS is a safe and effective treatment that does not cause severe side effects.
During the session, a healthcare professional will place an electromagnetic coil over the part of your brain which controls mood. In the case of rTMS it is the dorsolateral prefrontal cortex (dLPFC). It is a small region located on the front of your head. You will hear a clicking sound and feel a thumping sensation as the device delivers the brain with electrical impulses. The healthcare professional will adjust the settings to stimulate the areas you want of your brain.
The healthcare professional will determine the strength of the pulses using the amount of energy required to trigger an itch in the thumb. This is crucial because it helps them know the amount of power they are using and to ensure the security of the patient. In the past, pulses were given at 120 percent of the motor threshold. The current research focuses on speeding up TMS treatment to decrease time to treatment and increase the rate of response.
In a controlled, randomized study researchers have proven that TMS can aid people suffering from major depressive disorder (MDD) who don't respond to antidepressants. The study revealed that those treated with rTMS experienced significant improvement in symptoms, such as low mood and sadness as well as changes in appetite, loss of enthusiasm or enjoyment for activities. The study also showed improvements that lasted for a long time.
Unlike other forms of brain stimulation such as vagus nerve stimulation and electroconvulsive therapy, TMS does not interfere with psychotherapy. It is also safe for women who are pregnant, and it has a very low risk of seizures. Some patients may experience discomfort or pain on their scalp beneath the magnet while they are receiving treatment.
TMS treatments typically last about 30 minutes. The doctor will inform you of 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 lessen depression symptoms. The device is surgically implanted and uses an insignificant generator that is connected to a wire wrapped around the left Vagus nerve at the neck. FDA approved the procedure for patients suffering from treatment-resistant depression who haven't been able to get relief from other treatments like psychotherapy or medication. It's also approved as a seizure treatment option for those suffering from epilepsy.
Researchers evaluated the effectiveness of VNS with a sham device in patients suffering from treatment-resistant unipolar disorder or bipolar depression. The VNS group received moderate, low, dose or high dose of electrical stimulation for 22 weeks. The primary endpoint was improvement in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group had significantly better results than those in the sham group. After a 12-month follow-up participants in the VNS group had a mean IDS-SR30 score of 9.3 points, whereas those in the sham group scored 4.2 points.
The VNS treatment was well-tolerated, with the most common side effects being voice alteration or hoarseness and a feeling of weight on the chest. Other reported side effects included headache, tingling, fatigue, and changes in swallowing or speech. Certain of these side effects occurred more frequently in higher dose groups, while others were seen at all doses. The frequency of AEs was similar to those seen in other studies, and 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 approach to treat depression and other mood disorders. Our experts contribute to shaping national standards of care and are currently a part of the site for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial that will further investigate VNS as a treatment option for treatment-resistant depression. This is a crucial research effort, 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 highly effective advanced depression treatment for those who aren't getting better with medication. It is particularly beneficial for those who are suicidal or can't wait for their medication take effect.
During the ECT procedure doctors transmit tiny electrical currents through the brain to intentionally cause a brief seizure. This is believed to alter brain chemical structure and improve symptoms of a variety of mental health issues. ECT has been used since the 1930s, and despite the stigma associated with the treatment, many people have successfully benefited from it.
If you are to receive ECT the doctor will require an exhaustive psychiatric assessment. They will review your medical records and conduct various tests, including an electrocardiogram, blood tests, and maybe an X-ray of your chest. They will ask you how you feel about ECT, and take into account any opinions from family members, friends, or advocates who are speaking on your behalf.
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 protects your teeth, and masks cover your face to allow oxygen. The anesthesiologist injects anesthetic through a needle in your vein. When you are asleep, electrodes will be placed on one side or both of your heads depending on whether you are receiving bilateral or unilateral ECT. These electrical pulses send tiny impulses to the brain, which triggers an instant seizure. It lasts only 20 to 60 second and you will be able to get up shortly after.
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 revoke your consent under the Care Quality Commission (CQC) and your doctor must always consider your wishes when deciding whether or not to make use of ECT.
ECT can be a beneficial treatment option for people who have tried other treatments but failed to see any improvement. It can also be helpful those suffering from mild depression, severe psychosis, or when you're a risk to others or yourself and cannot wait for the effects of medication to kick in. In the majority of instances, you'll need have several ECT sessions over 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 called seasonal affective disorder). It can be used as a separate treatment or to complement other treatments like psychotherapy and medication. When you undergo light therapy, you sit in front of a light box or lamp that emits bright light, generally between 2,500 and 10,000 light lux. In each session, you'll be sitting for 30 minutes near the lamp. The light could aid in improving your mood and alleviate other symptoms of SAD, such as being tired all the time and sleeping too much.
Although scientists don't know for certain how light therapy works to treat SAD however, they do know that it has an immediate influence on the circadian rhythms. Circadian rhythms affect sleep patterns, hormones, and other functions. Light therapy can reset your internal clock by influencing the release of melatonin, a chemical that regulates the sleep-wake cycle. It also affects neurotransmitter functions through the alteration of serotonin production.
Numerous studies have demonstrated that light therapy improves depression symptoms and boosts the effectiveness of antidepressant medications. A number of studies have also proven that light therapy can be used to treat bipolar disorder. These results are encouraging and suggest that light therapy could be an option for people who suffer from bipolar and depression disorder.
Talk to your doctor or a mental health professional before you begin using light therapy. They can help you find the right device for your needs, and provide guidance on how to utilize it. They can also inform you whether it interferes with other medications you're taking.
Light therapy is a secure treatment that does not cause any serious side effects. However, you should use it in accordance with the prescriptions of your physician. If you're experiencing severe depression, it is important to get treatment immediately. depression treatment advancements is a serious disease and it can result in grave consequences for your emotional and physical well-being. In severe instances, it may cause thoughts of suicide. If you are experiencing suicidal thoughts, seek assistance immediately from an expert in mental health.