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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 another type of medication. They may also recommend psychotherapy.

The latest psychotherapy techniques, such as augmented depression therapy have scientific evidence-based support and can help reduce depression symptoms. These therapies are focused on the identification and resolution of specific ways in which depression interferes with daily life.

Transcranial magnetic stimulation (TMS)

TMS is a non-invasive brain stimulation that uses magnetic pulses to stimulate neurons that are responsible for mood. It is frequently recommended to treat depression when medications have failed or are not suitable for the individual. It is used to treat PTSD and, in some cases, combined with psychotherapy. TMS is an effective and safe treatment, with no significant side negative effects.

During the session, a medical professional will place an electromagnetic coil on your scalp to the region of the brain that controls your mood. In the case of rTMS, this is the dorsolateral frontal cortex (dLPFC). It is a small region that is located in front of your head. You will hear a clicking sound and feel a tapping sensation as the device delivers pulses to your brain. The healthcare expert will adjust the settings to stimulate the specific areas of your brain.

The healthcare professional will assess the intensity of the pulses by measuring the amount of energy needed to trigger the thumb to twitch. This is important, as it allows them to determine the amount of power they're using to ensure patient safety. In the past, pulses were administered at 120% of the motor threshold. Current research is focused on speeding up TMS treatment to reduce the duration of treatment and increase response rates.

Researchers have shown in a controlled, randomized study that TMS can aid people suffering from MDD who do not respond well to antidepressants. The study showed that patients treated with rTMS experienced significant improvements in symptoms such as sadness and low mood as well as changes in appetite, the loss of interest or enjoyment of activities. The study also found improvements that lasted for a long time.

TMS is different from other types of brain stimulation such as vagus nerve stimulator. It does not interfere in psychotherapy. It is also safe for pregnant women and has a low chance of having seizures. Some patients might experience pain or discomfort on their scalps under the magnet during treatment.

TMS treatments usually last around 30 minutes. The provider will inform you the length of time the treatment will last and may even stop the pulses at this point to allow the magnet to cool down.

Vagus nerve stimulation (VNS)

VNS (also known as Vagus Neuro Stimulation Therapy) is a treatment option that transmits precise electrical signals to alter brain wave patterns and reduce depression symptoms. The device is surgically implanted and uses tiny generators that are connected to a wire wound around the left Vagus nerve at the neck. The procedure has been approved by the FDA for treating depression that is resistant to treatment in patients who have not found relief from other new treatments for depression such as psychotherapy or medication. It's also approved as a seizure treatment option for those suffering from epilepsy.

Researchers compared the effectiveness of VNS with a sham device in patients suffering from treatment-resistant unipolar disorder or bipolar depression. The VNS group received a low dose, medium dose, or high dose of electrical stimulation for 22 weeks. The primary endpoint was change in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS groups improved significantly more than those in the sham groups. 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 group of sham had a score of 4.2 points.

The VNS treatment was well tolerated. The most common side effects were voice distortion, hoarseness, and a sensation on the chest. Other reported side effects were tingling, headaches fatigue, fatigue, and changes in swallowing or speech. Some of these occurred more often in the higher dose groups, while others happened at all doses. The rate of AEs in this study was similar to other studies, and they usually resolved by the end the acute study time.

Psychiatrists from Ohio State Wexner Medical Center are regularly invited to participate in national discussions on the best method to treat mood disorders and depression. Our experts contribute to shaping the national standards of care and are currently a participant for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial that will further evaluate VNS as a treatment option for treatment-resistant prenatal depression treatment - Suggested Resource site -. 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 an effective treatment for advanced depression for people who don't get better on their medications. It is especially helpful for those who are suicidal or can't wait for their medication to take effect.

During ECT doctors transmit small electrical currents to the head to deliberately trigger a short seizure. This is believed to alter brain chemical processes, and may help alleviate symptoms of certain mental health issues. ECT has been used since the 1930s, and despite the stigma that is associated with the treatment, a lot of patients have benefited from it.

If you are to receive ECT your doctor will have to conduct an exhaustive psychiatric assessment. They will then examine your medical history and do several tests which include an electrocardiogram (EKG) and blood tests, and perhaps an X-ray of the chest. They will ask you about how you are feeling about ECT and will consider any opinions of family members or friends who are speaking on your behalf.

The ECT procedure is performed under general anesthesia, so you won't feel any sensation. A mouth guard is put on to protect your teeth and the mask is placed over your face to provide oxygen. The anesthesiologist will inject an Anesthetic using a needle in your vein. After you fall asleep, electrodes will be placed on either one or both sides of your head depending on whether you're receiving bilateral or unilateral ECT. They send small electrical impulses to the brain which cause brief seizures. It lasts between 20 and 60 seconds, and you are awake shortly after it's over.

You are able to revoke your consent to ECT at any point, even before the first treatment. This is your right under the Care Quality Commission (CQC) regulations, and your doctor should always consider your wishes when deciding on ECT for you.

ECT is a great treatment option for people who have tried other treatments but failed to see any improvement. It can also assist with mild depression, severe psychosis, or when you're a risk to others or yourself and you are unable to wait for medication effects to take effect. In most instances, you'll have to take several ECT sessions over three to six weeks.

Light therapy

Light therapy compensates the lack of sunlight. This is a factor which may contribute to the development of seasonal affective disorder (formerly known as major inpatient depression treatment centers). It can be used as a stand-alone therapy or as an adjunct to other treatments, such as psychotherapy or medication. In light therapy you are seated next to an illuminated box that emits white light with bright colors. The light intensity is typically between 2,500 and 10,000 lux. During each session, you'll sit for 30 minutes in front of the lamp. The light can boost your mood and ease symptoms of SAD such as being exhausted all the time and sleeping excessively.

Although researchers aren't sure how light therapy can help treat SAD however, they do know that it has a direct influence on the circadian rhythms. Circadian rhythms affect sleep patterns, hormones and other functions. Light therapy can reset your internal clock by altering the release of melatonin which is a chemical that regulates your sleep-wake cycle. It also impacts neurotransmitter functions by altering the production of serotonin, a chemical that lifts your mood.

Numerous studies have demonstrated that light therapy can improve depression symptoms and boosts the effectiveness of antidepressant medications. Additionally, some studies have shown that light therapy is effective in treating depression without antidepressants bipolar disorder. These findings are encouraging, and suggest that light therapy could be a viable option for people with depression and bipolar disorder.

Consult your doctor or mental health professional prior to you begin using light therapy. They can help you choose the right device for your needs, and provide guidelines on how to use it. They can also tell if it is incompatible with other medications that you're taking.

Light therapy is a successful treatment that does not cause any adverse side effects. However, you should only use it as prescribed by your doctor. If you're experiencing severe depression, it's essential to seek treatment right away. Depression is a serious disease that can have a significant impact on your physical and mental well-being. In extreme instances, depression can lead to suicidal thoughts. Seek immediate assistance from a mental healthcare professional in the event that you feel suicidal.