If your partner has been taking medication and going to therapy, yet is still struggling with severe depression, there is hope. Sometimes, therapy and medication for depression is not enough. Treatment-resistant depression does not have to be the life sentence it sounds like, however: there are other options that are safe and effective.
Recently, The Dr. Oz Show did an episode on electroconvulsive therapy (ECT) for depression. My department chair at Duke, Dr. Sarah Lisanby, was one of the panel experts. Besides being an expert on ECT, she is also a leading researcher on another alternative treatment for depression, called transcranial magnetic stimulation, or TMS. A third option is vagus nerve stimulator therapy, or VNS. If your partner is not getting relief, one of these three other options might be worth considering.
Electroconvulsive therapy (ECT)
Many of us have visions of One Flew Over the Cuckoo’s Nest or A Beautiful Mind when we think of electroconvulsive therapy treatment. Today’s treatment reality has come a long way from the depictions of those treatments in those movies, though. Someone undergoing ECT usually has six to twelve treatments given three times a week. The patient is given general anesthesia and a muscle relaxant, so they are asleep while the treatment is occurring. The patient’s brain is then stimulated by brief, controlled series of pulses given through electrodes placed at precise locations on their head. The result is that the patient has a seizure, which lasts about a minute, but since the patient is asleep and has been given muscle relaxants, they feel no pain and there is no muscle spasm. The patient wakes up approximately 10 minutes after the procedure is complete.
The pros of this procedure are that, according to the American Psychiatric Association, ECT produces a substantial improvement in at least 80 percent of patients. It also helps patients who suffer with most forms of mania, some forms of schizophrenia, bipolar disorder, Parkinson’s disease and other disorders. The biggest drawback to ECT is memory loss that often accompanies the treatment. For some, the memory loss is short-term; for others, it is long-term and can be permanent.
Transcranial magnetic stimulation (TMS)
TMS is a newer treatment for depression that is non-invasive. Like ECT, it does use electrical pulses to stimulate precise areas of the brain, but these pulses come from a wand that is held over the patient’s head by a technician. The pulses are thought to stimulate neurons that release serotonin, dopamine, and norepinephrine, which are all mood-boosting chemicals. Patients remain awake during the procedure, and do not require any type of anesthesia, as there is no pain. A typical treatment course for TMS is about 30 minutes, five to six times a week, for six to eight weeks.
The pros of TMS are that results generally occur quickly, if a patient is going to respond to treatment. Unlike medication, which may take six to eight weeks to start working, improvement from TMS is usually evident within a few treatments. The cons of TMS are that it can be expensive, and possibly not available nearby, depending on where you live. Also, the time commitment for treatment can be challenging. Side effects including minor face twitching, a headache, or tingling in the scalp, all of which resolve quickly.
Vagus nerve stimulation (VNS)
This treatment came into being after patients with epilepsy who were treated with vagus nerve stimulation reported improvements in mood as well. Subsequent clinical trials proved this to be true. VNS has been controversial as a treatment, however, and is only recommended after four medication and/or ECT trials have failed to relieve the patient’s depression. A pulse generator–similar to a pacemaker–is implanted into the patient’s vagus nerve, where it sends out precisely timed mild electrical pulses to the left vagus nerve, which then go to the brain.
The cons of VNS include that it is not meant to be an exclusive treatment for depression, as it should also be accompanied by medication and possibly ECT treatment. It can also take several months for the patient to notice any mood changes, and some studies have shown its effectiveness to be low. The U.S. FDA reports that patients receiving VNS therapy may experience various side effects including hoarse voice, cough, shortness or breath, difficulty swallowing, and neck pain, some of which may persist as long as the device is active.
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Last reviewed: 17 Feb 2012