Treatments for depression most often include a combination of psychotherapy and antidepressant medications. Medical researchers believe that antidepressant medications work by increasing the levels of neurotransmitters in the brain, which reduce feelings of depression and anxiety. However, major depression is sometimes quite complicated, and is not always effectively treated using antidepressant medications. Additionally, in some patients, antidepressant medications cause unwanted side effects, which may reduce a patient’s desire to take them. Research has shown that antidepressant medications fail to provide adequate benefit for over 4 million patients due to lack of effectiveness or patient intolerance to side effects. 1
The inability to benefit from antidepressant medication is an often-debilitating condition called “treatment-resistant depression.” Patients suffering from “treatment-resistant depression” usually need to explore other depression treatment options with their doctor.
Fortunately, non-medication treatment options for depression are available for patients. These device-based treatments for depression should be discussed with the treating doctor to determine if they are the right patient option. These options include:
- Electroconvulsive therapy (ECT)
- Vagus nerve stimulation (VNS)
- Transcranial magnetic stimulation (TMS)
During electroconvulsive therapy (ECT) the patient’s brain is electrically stimulated to cause an intentional seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.
Patients receiving vagus nerve stimulation (VNS) are required to have a medical device implanted within their chest. Through a wire, this device is attached to the vagus nerve in the neck. Electrical pulses sent from the device travel up the vagus nerve to the brain. Some risks associated with VNS include persistent voice alteration and potential nerve paralysis. Also, since VNS is an implanted device, patients face surgical risks when choosing to undergo treatment.
Transcranial magnetic stimulation (TMS) therapy uses a pulsed magnetic field to non-invasively stimulate the area of the brain thought to control mood. TMS is administered without medication in a physician’s office while the patient remains awake and alert. TMS is delivered in 37 minute treatment sessions given daily over 4 to 6 weeks. TMS is generally well tolerated by patients. The most common side effects associated with treatment are scalp pain or discomfort at the treatment site – generally mild to moderate and occurring less frequently after the first week of treatment. There is a remote risk of seizure under ordinary clinical use, occurring in approximately 0.1% of patients.
