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Advanced Depression Treatment If you don't experience any improvement with the first-line antidepressant, your doctor might increase the dosage or prescribe another type of medication. They may also recommend psychotherapy. The newer psychotherapy techniques like augmented depression treatment offer empirical support and may help improve depression symptoms. These therapies are focused on the identification and resolution of specific ways depression can affect your daily routine. Transcranial magnetic stimulation (TMS) TMS is a noninvasive brain stimulation that uses magnetic pulses to affect the brain's neurons that control mood. It is often advised to treat depression if medications fail or are not appropriate for a particular person. It is used to treat PTSD, and is sometimes combined with psychotherapy. TMS is a safe and effective treatment that doesn't trigger serious side effects. During the session, a healthcare professional will position an electromagnetic coil on your scalp to the brain region that regulates mood. In the case of rTMS, this 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 sounds of clicking and feel a tingling sensation. The healthcare expert will adjust the settings to stimulate the specific areas of your brain. The healthcare professional will assess the amount of energy required to trigger a thumb flick. This is crucial because it helps them to know how much power they are employing and ensures the security of the patient. In the past, pulses were delivered 120% of motor threshold. However, current research is focusing on speeding up TMS therapy to reduce the time required to treat and improve response rates. Researchers have demonstrated in a randomized controlled trial that TMS can be used to aid people suffering from MDD who are not responding well to antidepressants. The study found that patients who were treated with rTMS saw significant improvement in symptoms, such as depression and sadness, changes in appetite and loss of enthusiasm or enjoyment for activities. The study also showed improvements that lasted a long period of. Contrary to other types of brain stimulation such as vagus nerve stimulation and electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for women who are pregnant and has a low chance of seizures. Some patients may experience discomfort or pain on their scalp beneath the magnet while they are receiving treatment. The typical TMS treatments last for about half an hour. Your doctor will inform you how long the treatment will last and may pause the pulses during this time to allow the magnet to cool down. Vagus Nerve Stimulation (VNS) VNS (also called Vagus Neuro Stimulation) is an approach that utilizes timing of electrical signals to alter brainwave patterns and decrease depression symptoms. This device is surgically implanted, and it uses tiny generators that are connected to a wire that is wound around the left Vagus nerve in the neck. FDA approved the procedure for those suffering from depression that is resistant to treatment and who haven't had relief from other treatments like therapy and medication. It's also approved for seizure control in certain epileptic patients. In the largest study of VNS researchers compared the effectiveness against an sham device for patients who suffered from treatment-resistant unipolar or depressed-phase bipolar disorder. The VNS group was given moderate, low, dose or high dosage of electrical stimulation over a 22-week period. The primary goal was changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group improved significantly more than those in the group of sham. At the 12-month check-up, the VNS group had an average IDSSR30 score of 9.3 while the group of sham scored 4.2. The VNS therapy was well tolerated, with the most common side effects being voice alteration or hoarseness, as well as a feeling of weight on the chest. Other reported side effects were tingling, headache, fatigue and changes in speech or swallowing. Some of these happened more often in the higher dose groups, and others occurred at all doses. The frequency of AEs in this study was comparable to other studies, and they generally resolved by the end of the acute study period. Psychiatrists from Ohio State Wexner Medical Center regularly participate in national discussions about the best ways to treat depression and other mood disorders. Our experts are helping to shape national standards of health treatment. We are also a site for an international clinical trial, called RECOVER, which is being conducted by the Centers for Medicare & Medicaid Services. The goal of this study is to examine VNS for treating resistant depression. This is an important research project, as the evidence available now suggests that VNS could provide better benefits and hope for this difficult to treat chronic patient. Electroconvulsive therapy (ECT) ECT is a potent treatment for depression that isn't improving by taking medication. It is particularly beneficial for people who are suicidal or are unable to wait until their medication to start working. During ECT doctors use small electrical currents to the head to deliberately cause a brief seizure. The result is that the brain changes chemical processes, and may help alleviate symptoms of some mental health problems. ECT has been around since the 1930s. Despite the stigma attached to the treatment, it has helped many people. Your psychiatrist will first need to conduct a thorough psychiatric evaluation before making a recommendation for ECT. They will then examine your medical history and do a series of tests, including an electrocardiogram (EKG), blood tests, and perhaps a chest X-ray. They will also inquire about your thoughts about having ECT and consider any views from family members, friends or advocates who are supporting or speaking on your behalf. The ECT procedure is done under general anesthesia, so you will not feel any sensation. A mouthguard protects your teeth, while a mask covers your face to provide oxygen. An anesthesiologist injects an anesthetic into your vein using needle. After you fall asleep, electrodes will be placed on either one side or both of your heads based on whether you are receiving unilateral or bilateral ECT. These electrical pulses send tiny impulses to the brain, which triggers brief seizures. It lasts between 20 and 60 seconds and you'll are awake soon after it's over. It is important to keep in mind that you can revoke your consent for ECT at anytime, 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. ECT can be a beneficial treatment option for those who tried other treatments but have failed to notice any improvement. It can also be helpful with mild depression, severe psychosis or when you're a risk to yourself or others and can't wait for medication effects to take effect. In most instances, you'll have to undergo several ECT sessions over the course of three to six weeks. Light therapy Light therapy helps to compensate for the absence of sunlight, which can contribute to major depression disorder with seasonal patterns (formerly known as seasonal affective disorder). It can be used as a separate treatment or in conjunction with other treatments, such as psychotherapy and medication. In light therapy you sit in front of a light box that emits white light with bright colors. The light usually has between 10,000 and 2,500 lux. Each session, you will sit for 30 minutes near the lamp. The light can aid in improving your mood as well as ease other symptoms of SAD like being tired all the time and sleeping too much. Researchers aren't aware of how light therapy treats SAD. However, they know that it can have an impact on the circadian rhythms. Circadian rhythms are biological cycles that impact the pattern of sleep hormone levels, sleep patterns, and other vital functions. Light therapy can alter your internal clock by influencing the release of melatonin an ingredient that regulates the sleep-wake cycle. It also impacts neurotransmitter function through affecting the production of serotonin which is a chemical that improves your mood. Several studies have shown that light therapy can improve depression symptoms and enhances the effectiveness of antidepressant medications. In addition, some studies have demonstrated that light therapy is effective in treating bipolar disorder. These results are encouraging, and suggest that light therapy may be an option for those suffering from bipolar disorder and depression. Speak to your doctor or a mental health professional prior to you start using light therapy. Iam Psychiatry can assist you in selecting the best device and provide instructions on how to use. They can also let you know whether it interacts with other medications you are taking. Light therapy is a safe treatment that does not cause any serious side negative effects. It is best to only use it if your doctor prescribes. It is important to seek treatment as quickly as possible if you are suffering from depression that is severe. Depression is a serious illness, and it can have grave consequences for your physical and emotional well-being. In extreme instances, it may cause thoughts of suicide. Seek immediate help from a mental healthcare professional in the event that you feel suicidal.