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 might also suggest psychotherapy.
Newer psychotherapy methods like augmented depression therapy offer empirical support and can aid in reducing depression symptoms. These treatments aim at the identification and resolution of specific ways that depression affects your daily life.
Transcranial Magnetic Stimulation (TMS)
A form of non-invasive brain stimulation, TMS utilizes magnetic impulses to influence the brain's neurons that are that are responsible for mood. It is typically prescribed to treat depression if medication fails or is not suitable for the person. It is used to treat PTSD, and is sometimes combined with psychotherapy. TMS is an effective and safe treatment, with no serious side adverse effects.
During the session, the healthcare professional will place an electromagnetic coil on your scalp over the brain region that controls your mood. In the case of rTMS it is the dorsolateral prefrontal cortex (dLPFC). It is a small region situated on the front of your head. The device sends electrical impulses to your brain. You will hear clicking sounds and feel a tingling sensation. The healthcare professional will adjust settings to stimulate the desired areas of the brain.
The healthcare professional will determine the strength of the pulses by determining the amount of energy needed to elicit the thumb to twitch. online therapy for depression is crucial because it allows them to know the power they are employing to ensure the safety of patients. In the past, pulses were given at 120 percent of the threshold for motor. However, the current research is focusing on speeding up TMS therapy to reduce the treatment length and improve response rates.
Researchers have proven in a randomized controlled trial that TMS can be used to aid people suffering from MDD who do not respond well to antidepressants. The study showed that those who were treated with rTMS saw significant improvements in symptoms such as low mood and sadness as well as changes in appetite and the loss of interest or enjoyment of activities. The study also showed improvements that lasted a long time.
TMS is not like other forms of brain stimulation like electroconvulsive treatment and vagus nerve stimulator. It does not interfere with psychotherapy. It is safe for women who are pregnant and has a low risk of seizures. However, some people can feel pain or discomfort on the scalp underneath the magnet during treatment.
Typical TMS treatments last around half an hour. Your doctor will let you know how long the treatment is and may also pause the pulses to allow the magnet to cool.
Vagus nerve stimulation (VNS)
VNS (also called Vagus Nerve Stimulation) is an approach that utilizes controlled electrical signals that are timed to alter brainwave patterns and reduce depression symptoms. The device is surgically implanted, and it uses tiny generators that are connected to a wire that is 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 haven't found relief from other treatments like psychotherapy or medications. It is also approved as a seizure treatment for epilepsy sufferers.
Researchers evaluated the effectiveness of VNS with a sham-device in people with treatment-resistant unipolar disorder or bipolar depression. The VNS group was given moderate, low, dose, or high dose of electrical stimulation for 22 weeks. 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 sham group. At the 12-month check-up, the VNS group had an average IDSSR30 score of 9.3 while the sham group scored 4.2.
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, headaches fatigue, fatigue, and changes in swallowing or speech. Some of these happened more often in the higher dose groups, while others happened at all doses. The frequency of AEs was comparable to those observed in other studies, and they were usually eliminated by the end of the acute study period.
Psychiatrists from Ohio State Wexner Medical Center are frequently invited to participate in national discussions on the best method to treat depression and other mood disorders. Our experts help define national standards for health treatment. We are also a part of a multicenter clinical study called RECOVER which is being conducted by the Centers for Medicare & Medicaid Services. The aim of this study is to examine VNS for treating resistant depression. This is an important research study, as the evidence available suggests that VNS may offer a better treatment for this chronically ill population.
Electroconvulsive Therapy (ECT)
ECT is a highly effective treatment for depression that isn't improving through medication. It is especially helpful for those who are suicidal, or who are unable to wait for their medication to take effect.
During ECT doctors use small electrical currents through the head to deliberately cause a brief seizure. The brain is reportedly altered by this chemical structure and improve the symptoms of certain mental health disorders. ECT has been used since the 1930s. Despite the stigma associated with the treatment it has helped many people.
Your psychiatrist will first need to perform a thorough psychiatric examination before recommending ECT. They will then examine your medical history and perform a series of tests, including an electrocardiogram (EKG) and blood tests, and possibly a chest X-ray. They will also inquire about your feelings about having ECT and will consider any opinions from family members, friends or other advocates who are either supporting or advocating for you.
The ECT procedure is carried out under general anesthesia. This means that you will not feel anything. A mouth guard is put in place to protect your teeth and an air mask is placed over your face to provide oxygen. An anesthesiologist injects a local anesthetic into your vein using needle. Once you've fallen asleep, electrodes are placed on either or both sides of your head (depending on whether you have bilateral or unilateral ECT). These deliver small electrical pulses to the brain which cause 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 point before the initial treatment. You are entitled to withdraw your consent under Care Quality Commission (CQC) and your doctor must always take your preferences into consideration when deciding whether or not to utilize ECT.
Some people find that ECT is a viable option for them after they've tried other treatments and haven't seen any improvement. However, it can also be used to treat mild depression or severe psychosis, or when you pose risky to yourself or others and can't wait for medication to take effect. In the majority of instances, you'll need take several ECT sessions spread over three to six weeks.
Light therapy
Light therapy is a way to compensate for the 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 standalone treatment or in conjunction with other treatments, such as psychotherapy and medication. When you undergo light therapy you are seated next to a light box that emits white light that is bright and bright. The light is usually between 2,500 and 10,000 in lux. Each session, you will sit for 30 minutes near the lamp. The light can boost your mood as well as ease other symptoms of SAD that can be a problem, like being tired all the time and having trouble sleeping.
Although researchers don't know exactly how light therapy works to treat SAD but they do know that it has a direct impact on circadian rhythms. Circadian rhythms are biological cycles that affect the pattern of sleep, hormone levels, and other important functions. Light therapy can reset the internal clock of your body by altering the release of melatonin. It is the chemical that regulates sleep and wake cycles. It also affects neurotransmitter functions through the alteration of serotonin production.
Numerous studies have demonstrated how light therapy can improve depression symptoms and enhance the effectiveness of antidepressant drugs. Additionally, some studies have shown that light therapy is effective in treating bipolar disorder. These results are encouraging, and suggest that light therapy could be a viable option for people who suffer from bipolar disorder and depression.
Before you start using light therapy, consult your physician or a mental health professional about it. They can guide you in selecting the best device and give you instructions on how to use. They can also tell if it interferes with other medications you take.
Light therapy is a safe treatment that has no serious side negative effects. However, you should use it according to the instructions of your doctor. If you are experiencing severe depression, it's crucial to seek treatment as soon as you notice it. Depression is a serious disease and it can result in severe consequences for your physical and mental well-being. In severe cases, it can even cause thoughts of suicide. If you are having suicidal thoughts, seek help immediately from a mental health professional.