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Advanced Depression Treatment If your depression doesn't respond to a first-line antidepressant, your doctor may try increasing the dose or adding another type of medication. They may also recommend psychotherapy. Modern psychotherapy techniques like augmented depression therapy have scientific support and can help improve depression symptoms. These therapies are focused on identifying and resolving specific ways depression affects your daily life. Transcranial Magnetic Stimulation (TMS) A type of noninvasive brain stimulation, TMS utilizes magnetic impulses to alter the brain cells that are responsible for mood. It is frequently suggested to treat depression when medications have failed or are not suitable for a person. It can also be used to treat PTSD and is sometimes combined with psychotherapy. TMS is a reliable and safe treatment with no adverse side adverse effects. During the session, a medical professional will place an electromagnetic coil on the region of your brain that regulates mood. In the case rTMS this is the dorsolateral frontal cortex (dLPFC). This is a small area located at the front of your brain. The device sends signals to the brain. You will hear sounds of clicking 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 cause the thumb to blink. This is important because it helps them to know how much power they are employing and ensures the security of the patient. In the past, the pulses were given at 120% of the threshold for motor. The current research focuses on speeding up TMS treatment to decrease treatment duration and improve response rates. In a controlled trial that was randomized, researchers have shown that TMS can help people with major depressive disorder (MDD) who don't respond to antidepressants. The study showed that those treated with rTMS showed significant improvement in symptoms like depression and sadness, as well as changes in appetite, and decreased enjoyment or interest in activities. The study also revealed that the effects lasted for a long time. In contrast to other forms of brain stimulation, like vagus nerve stimulation or electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for women who are pregnant and has a low risk of seizure. However, some patients may feel pain or discomfort on their scalp under the magnet during the treatment. Typical TMS treatments last for about half an hour. Your doctor will let you know the duration of the treatment and may stop the treatment to allow the magnet to cool. Vagus Nerve Stimulation (VNS) VNS (also called Vagus Nerve Stimulation) is an approach that utilizes timing of electrical signals to alter brainwave patterns and decrease depression symptoms. The device is surgically implanted and consists of tiny generators that are connected to a wire wound around the left Vagus nerve at the neck. FDA approved the procedure for those suffering from treatment-resistant depression who have not been able to get relief from other treatments, such as psychotherapy or medications. It's also approved for seizure control in certain epileptic patients. In the largest clinical study of VNS, researchers compared its effectiveness against the use of a sham device among patients who suffered from treatment-resistant unipolar or depressed-phase bipolar disorder. Patients in the VNS group received a low, medium or high dose of electrical stimulation over the 22-week “acute phase.” The primary endpoint was the change in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group had significantly better results than those in the group of sham. At a 12-month check-up the VNS group had a mean IDSSR30 of 9.3 while the group of sham scored 4.2. The VNS treatment was well tolerated. The most frequent side effects were voice alteration hoarseness, a feeling of numbness, and a sensation in the chest. Other reported side effects included the feeling of tingling, headache fatigue, fatigue, and changes in swallowing or speech. Some of these happened more often in the higher dose groups, and others occurred at all doses. The frequency of AEs was comparable to those observed in other studies, and they were usually cleared by the end the acute study period. Psychiatrists from Ohio State Wexner Medical Center regularly participate in national discussions about the best methods to treat depression and other mood disorders. Our experts are involved in shaping the national standards of care and are currently a part of the site for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial to further evaluate VNS as a treatment for treatment-resistant depression. This is an important research study, as the available evidence suggests that VNS may offer a better treatment for patients suffering from chronic illness. Electroconvulsive therapy (ECT) ECT is a highly effective treatment for depression that doesn't improve through medication. It is particularly beneficial for those who are suicidal, or who are unable to wait for their medication to take effect. During ECT doctors transmit small electrical currents through the head to deliberately trigger a short seizure. The brain is reportedly altered by this chemical structure and speedily improve symptoms of mental health issues. ECT has been around since the 1930s. Despite the stigma attached to the treatment it has helped a lot of people. If you are to receive ECT the doctor will need to do an extensive psychiatric evaluation. They will review your medical records and perform a series tests, such as an electrocardiogram, blood tests, and perhaps the chest X-ray. They will also ask you what you think about the possibility of having ECT and take into consideration any opinions from friends, family, or advocates who are supporting or speaking for you. The ECT procedure is done under general anesthesia. This means that you will not feel anything. A mouth guard is put on to protect your teeth, and a mask is put over your face to provide oxygen. The anesthesiologist injects the anesthetic via a needle into your vein. When you are asleep, electrodes are placed on either one side or both of your head depending on whether you're receiving bilateral or unilateral ECT. These electrical pulses send tiny impulses to the brain, which triggers a short seizure. It lasts between 20 and 60 seconds and you'll be able to get up shortly after. It's important to remember that you can withdraw your consent to ECT at any time, even just before the first treatment. You are entitled to withdraw your consent in accordance with the Care Quality Commission (CQC) and your doctor should always take your preferences into consideration when deciding whether or not to utilize ECT. Certain people find ECT is a great option after having tried other treatments and did not see any improvement, but it can also be used for mild depression or severe psychosis, or if you're risky to yourself or others and can't wait for medication to begin working. Most people will require several ECT sessions spread over a period of three to six weeks. Light therapy Light therapy helps to compensate for the absence of sunlight, which may contribute to major depressive disorder that has seasonal patterns (formerly called seasonal affective disorder). It can be used as a stand-alone treatment or to complement other treatments like psychotherapy and medications. During light treatment, you sit next to a light box that emits white light with bright colors. The light intensity is typically between 2,500 and 10,000 lux. During each treatment session, you sit for about 30 minutes at the light source. Home Page can improve your mood and ease symptoms of SAD such as being exhausted all the time and sleeping too much. Although researchers don't know exactly how light therapy works to treat SAD, they do know that it has a direct impact on circadian rhythms. Circadian rhythms impact the patterns of sleep, hormones, and other functions. Light therapy can reset the internal clock of your body through influencing the release of melatonin, an ingredient that regulates sleep-wake cycles. It also affects neurotransmitter functions by altering the serotonin production. A number of studies have proven that light therapy can improve depression symptoms and boost the effectiveness of antidepressant medications. Additionally, some studies have demonstrated that light therapy is effective in treating bipolar disorder. These findings are encouraging and suggest light therapy could be a possibility for people with bipolar and depression disorder. Before you start using light therapy, speak to your physician or a mental health professional about it. They can help you choose the appropriate device for your needs and offer guidelines on how to utilize it. They can also inform you whether it is incompatible with other medications that you're taking. Light therapy is a safe treatment that does not cause serious adverse side adverse effects. It is best to only use it if your doctor prescribes. It is important to seek treatment as quickly as you can if you're suffering from depression that is severe. Depression is a serious disease and it can result in severe consequences for your physical and emotional well-being. In extreme instances, depression can result in suicidal ideas. Get immediate help from a mental health professional in the event that you feel suicidal.