Advanced Depression Treatment
If your depression doesn't respond to a first-line antidepressant, your doctor might suggest increasing the dosage or adding a different medication. They may also recommend psychotherapy.
The latest psychotherapy techniques, such as augmented depression therapy have empirical support and can aid in reducing depression symptoms. These therapies are focused on the identification and resolution of specific ways that depression affects your daily life.
Transcranial magnetic stimulation (TMS)
TMS is a non-invasive brain stimulation that uses magnetic pulses to influence the brain's neurons that control mood. It is usually advised to treat depression if medication has failed or is not suitable for the individual. It is also used to treat PTSD and is sometimes combined with psychotherapy. TMS is a reliable and safe treatment, with no significant side adverse effects.
During the session, a healthcare professional will place an electromagnetic coil over the part of your brain that controls mood. In the case of rTMS it is the dorsolateral prefrontal cortex (dLPFC). It is a tiny area located on the front of your head. The device will deliver pulses to the brain. You will hear clicking sounds and feel tapping sensations. The healthcare expert will adjust the settings to stimulate the desired areas of your brain.
The healthcare professional will measure the amount of energy needed to trigger a thumb flick. This is crucial because it allows them to know the amount of energy they are using to ensure patient safety. In the past, the pulses were given at 120 percent of the threshold of motor. However, current research is focusing on speeding up TMS treatment to decrease the duration of treatment and increase the rate of response.
Researchers have demonstrated in a randomized controlled study that TMS can aid people suffering from MDD who are not responding well to antidepressants. The study showed that patients who were treated with rTMS experienced significant improvements in symptoms like low mood and sadness, as well as changes in appetite, and a loss of enjoyment or enthusiasm for activities. The study also found improvements that lasted a long duration.
In contrast to 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 has a very low risk of seizures. Some patients may feel pain or discomfort on their scalp beneath the magnet while they are receiving treatment.
TMS treatments usually last around 30 minutes. depression therapy Iam Psychiatry will inform you of 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 Nerve Stimulation Therapy) is an option for treatment that sends periodic electrical signals to alter brain wave patterns and lessen depression symptoms. The device is surgically implanted and consists of a small generator that's connected to a wire wrapped around the left Vagus nerve in the neck. The procedure has been approved by the FDA for people suffering from depression that is treatment-resistant who have not found relief from other treatments, such as psychotherapy or medication. It's also approved for seizure control in a few epileptic patients.
Researchers compared the effectiveness of VNS with a sham-device for patients with bipolar disorder that is resistant to treatment or depression. The VNS group received moderate, low, dose or high dosage of electrical stimulation for 22 weeks. The primary goal was a change in Inventory of Depressive Symptomatology Self Report (IDS-SR30) score throughout the study. Patients in the VNS group had significantly better results than those in the sham group. At a 12-month check-up the VNS group had an average IDSSR30 of 9.3 while the group of sham scored 4.2.
The VNS therapy was well tolerated and the most frequent side effects being voice alteration or hoarseness and a feeling of weight on the chest. Other reported side effects included tingling, headache, fatigue, and changes in speech or swallowing. Some of these occurred more frequently in higher dose groups, while others occurred at all doses. The frequency of AEs was comparable to those observed in other studies, and generally eliminated by the end of the acute study period.
Psychiatrists at Ohio State Wexner Medical Center regularly take part in national discussions about the best methods 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 endeavor, since the evidence available suggests that VNS may provide improved benefits and hope for this difficult-to-treat chronic population.
Electroconvulsive Therapy (ECT)
ECT is an effective treatment for advanced depression for those who aren't getting better on their medications. It's especially useful for those who are suicidal or unable to wait for their medication to take effect.
During ECT, doctors send small electrical currents through the head to deliberately cause a brief seizure. The brain is reportedly altered by this chemistry and rapidly improve symptoms of mental health issues. ECT has been used since the 1930s, and despite the stigma that is associated with the treatment, many people have successfully benefited from it.
Your psychiatrist will need to perform a thorough psychiatric evaluation before suggesting ECT. Then they will examine your medical history and do various tests which include an electrocardiogram (EKG) and blood tests, and possibly an X-ray of the chest. They will ask you how you are feeling about ECT, and take into account any opinions from family members, friends, or advocates speaking on your behalf.
The ECT procedure is performed under general anesthesia, so you won't feel anything. A mouthguard protects your teeth, while a mask covers your face to supply oxygen. An anesthesiologist injects an anesthetic into your vein by using needle. After you are asleep, electrodes will be placed on one or both sides of your head (depending on whether you have unilateral or bilateral ECT). They send small electrical impulses to the brain, which trigger an instant seizure. It lasts for 20 to 60 seconds, and you'll be able to get up shortly after.
You are able to 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 should always take into account your wishes when deciding on ECT for you.
Some people find ECT is a viable alternative after having tried other treatments but haven't seen any improvements, but it can also be used for mild depression or severe psychosis, or if you're at risk to others or yourself and you are unable to wait for medication to begin working. The majority of people require several ECT sessions spread out over three to six weeks.
Light therapy
Light therapy compensates for lack of sunlight, which could contribute to major depressive disorder with seasonal patterns (formerly called seasonal affective disorder). It can be used as a standalone treatment or to complement other treatments such as psychotherapy and medications. When you undergo light therapy, you sit next to an illuminated box that emits white light that is bright and bright. The light intensity is typically between 2,500 and 10,000 lux. During each session, you will sit for 30 minutes at the lamp. The light could boost your mood as well as ease other symptoms of SAD like being tired all the time and sleeping too much.
Although researchers aren't sure how light therapy works to treat SAD however, they do know that it has a direct effect on circadian rhythms. Circadian rhythms impact sleep patterns, hormones, and other functions. Light therapy can reset the internal clock of your body through influencing the release of melatonin. It is the chemical that regulates sleep and wake cycles. It can also affect neurotransmitter functions by altering the production of serotonin.
Numerous studies have demonstrated that light therapy improves depression symptoms and increases the effectiveness of antidepressant medication. A number of studies have also proven that light therapy can be used to treat bipolar disorder. These findings are encouraging and suggest light therapy might be a possibility for people with bipolar and depression disorder.
Before you start using light therapy, talk to your doctor or mental health professional about it. They can guide you in choosing the right device and provide you with instructions on how to use. They can also let you know if it interferes with other medications you are taking.
Light therapy is a safe treatment that has no adverse side adverse effects. You should only take it if your doctor prescribes. If you're experiencing severe depression, it is crucial to seek treatment as soon as you notice it. Depression is a serious condition, and it can have serious consequences for your physical and mental well-being. In extreme cases, it could cause thoughts of suicide. Seek immediate assistance from a mental healthcare professional if you have suicidal feelings.