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Advanced Depression Treatment If your depression isn't responding to a first-line antidepressant, your doctor might suggest increasing the dosage or adding a different type of medication. They might also suggest psychotherapy. The latest psychotherapy techniques, such as augmented depression therapy have empirical support and can help improve depression symptoms. These therapies focus on identifying and resolving the ways in which depression can affect your daily routine. Transcranial magnetic stimulation (TMS) TMS is a noninvasive brain stimulation technique that utilizes magnetic pulses to affect the brain's neurons that control mood. It is often recommended to treat depression when medications have failed or are not appropriate for a particular person. It is used to treat PTSD and can be combined psychotherapy. TMS is an effective and safe treatment that doesn't cause serious side effects. During the session, a healthcare professional will place an electromagnetic coil on your scalp that is over the region of the brain that controls mood. In the case of rTMS, this is the dorsolateral frontal cortex (dLPFC). This is a small area located on the front of your head. You will hear a click sound and feel a tapping sensation as the device sends pulses to your brain. The healthcare professional will adjust the settings to stimulate desired areas of the brain. The healthcare professional will assess the amount of energy required to cause the thumb to flick. This is important, as it lets them know the amount of energy they are employing to ensure the safety of patients. In the past, the pulses were delivered at 120% 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. In a controlled, randomized study, researchers have shown that TMS can aid people suffering from major depressive disorder (MDD) who are unable to respond to antidepressants. The study revealed that patients who were treated with rTMS showed 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 that the improvements were long-lasting. TMS is not like other types of brain stimulation, such as vagus nerve stimulator. It is not a factor with psychotherapy. It is safe for pregnant women and has a low risk of seizures. Some patients may experience discomfort or pain on their scalps beneath the magnet during treatment. TMS treatments usually last around 30 minutes. Your doctor will inform you what the duration of the treatment will take and may even stop the pulses in this period to let the magnet cool down. Vagus Nerve Stimulation (VNS) VNS (also called Vagus Nerve Stimulation) is a treatment that uses timing of electrical signals to alter brainwave patterns and reduce depression symptoms. The device is surgically implanted and consists of a small generator that's connected to a wire wound around the left Vagus nerve of the neck. FDA approved the procedure for people with treatment-resistant depression who haven't had relief from other treatments like therapy and medications. It's also approved to control seizures in certain epileptic patients. In the largest clinical study of VNS researchers compared its effectiveness against an sham device for patients who had treatment-resistant unipolar or depressed-phase bipolar disorder. The VNS group was given a low dose, medium dose or high dosage of electrical stimulation for 22 weeks. The primary endpoint was the change in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS groups improved significantly more than those in the sham group. After a 12-month follow-up participants in the VNS group had an average IDS-SR30 score of 9.3 points, while those in the sham group had a score of 4.2 points. The VNS treatment was well tolerated. The most frequent side effects were voice alteration hoarseness, a feeling of numbness, and a sensation on the chest. Other reported side effects were the feeling of tingling, headache, fatigue and changes in speech or swallowing. Certain of these were more frequently in higher dose groups, whereas others occurred at all doses. The frequency of AEs was similar to those seen in other studies, and were typically cleared by the end the acute study period. Psychiatrists from Ohio State Wexner Medical Center are regularly invited to participate in national discussions on the best way to treat depression and mood disorders. Our experts help shape national standards of 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 goal of this study is to evaluate VNS for treating resistant depression. This is a very 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 an effective treatment for advanced depression for those who can't get better with medication. It is particularly beneficial for people who are suicidal or can't wait for their medication to start working. During the ECT procedure doctors send tiny electric currents through the brain to intentionally cause an immediate seizure. This is believed to alter brain chemistry, and improve symptoms of certain mental health issues. ECT has been in use since the 1930s and despite the stigma associated with the treatment, a lot of people have seen positive results from it. Your doctor will first have to conduct a thorough mental evaluation before suggesting ECT. Then they will examine your medical history and perform a series of tests, including an electrocardiogram (EKG) and blood tests, and perhaps a chest X-ray. They will also ask you about your thoughts about having ECT and consider any views from family members, friends, or others who are supportive or speaking on your behalf. The ECT treatment is given while you sleep under general anesthesia, which means you will not feel anything during the procedure. A mouth guard is placed to protect your teeth, and a mask is put over your face to provide oxygen. iampsychiatry.com 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). These electrical pulses send small impulses to the brain, causing an instant seizure. It lasts between 20 and 60 second and you will be able to get up shortly after. You can withdraw your consent to ECT at any point, even before the first treatment. This is your right under Care Quality Commission (CQC) regulations and your doctor must always consider your wishes when deciding on ECT for you. Some people find that ECT is a viable option after having tried other treatments but did not see any improvement. However, it can also be used for mild depression or severe psychosis or when you pose a danger to yourself or others and can't wait for medication to take effect. Most people will have to attend multiple ECT sessions spread over a period of three to six weeks. Light therapy Light therapy helps to compensate for the absence of sunlight. This is a factor that could contribute to seasonal affective disorder (formerly known as major depressive disorder). It is utilized as a stand-alone treatment or as an adjunct to other treatments, such as psychotherapy or medication. During light treatment you sit in front of an illuminated box that emits white light with bright colors. The light is usually between 10,000 and 2,500 in lux. Each time you undergo a treatment you will sit for around 30 minutes at the light. The light may aid in improving your mood as well as ease other symptoms of SAD like feeling tired all the time and having trouble sleeping. Although researchers don't know exactly how light therapy can help treat SAD but they do know that it has a direct impact on circadian rhythms. Circadian rhythms are biological cycles that influence sleep patterns, hormone levels, and other important functions. Light therapy can alter your internal clock by altering the release of melatonin, which is a chemical that regulates your sleep-wake cycle. It also impacts neurotransmitter function through affecting the production of serotonin an ingredient that boosts your mood. Numerous studies have demonstrated that light therapy improves depression symptoms and enhances the effectiveness of antidepressant drugs. Additionally, some studies have demonstrated that light therapy is effective in treating bipolar disorder. These findings are encouraging and suggest that light therapy might be an option for people who suffer from bipolar and depression disorder. Before you start using light therapy, speak to your doctor or mental health professional about it. They can guide you in selecting the best device and provide you with guidelines on how to use it. They can also let you know if it is incompatible with other medications that you take. Light therapy is a secure treatment that does not cause any serious side effects. However, you should use it as prescribed by your physician. It is important to seek treatment as quickly as possible if you are suffering from depression that is severe. Depression is a serious disease that can have serious effects on your mental and physical well-being. In severe cases, it can even cause thoughts of suicide. If you are experiencing suicidal thoughts or feelings, seek help immediately from a mental health professional.