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Advanced Depression Treatment If you don't notice any improvement with the first-line antidepressant, your doctor may increase the dose or add another kind of medication. They might also suggest psychotherapy. The latest psychotherapy techniques, such as augmented depression treatment have empirical support and can help reduce depression symptoms. These treatments concentrate on identifying and solving the specific ways that depression affects your daily life. Transcranial magnetic stimulation (TMS) TMS is a non-invasive brain stimulation technique that utilizes magnetic pulses to affect the brain's neurons that control mood. It is usually used to treat depression when medications fail or are not suitable for the person. It can also be used to treat PTSD and is often combined with psychotherapy. TMS is an effective and safe treatment that doesn't cause severe side effects. During the session, a medical professional will place an electromagnetic coil on the region of your brain that controls mood. In the case of rTMS, this is the dorsolateral frontal cortex (dLPFC). It is a tiny area that is located in front of your head. The device sends electrical impulses to your brain. You will hear sounds of clicking and feel tapping sensations. The healthcare professional will adjust settings to stimulate the desired areas of the brain. The healthcare professional will determine the amount of energy needed to trigger a thumb flick. This is crucial, since it allows them to know the amount of energy they are using to ensure patient safety. In the past, pulses were administered at 120% of motor threshold. But, current research is focusing on speeding up TMS therapy to reduce the duration of treatment and increase response rates. In a randomized control trial, researchers have shown that TMS can benefit people suffering from major depressive disorder (MDD) who don't respond to antidepressants. The study found that patients who were treated with rTMS saw significant improvements in symptoms like depression and sadness as well as changes in appetite, decreased enthusiasm or enjoyment for activities. The study also found that the effects lasted for a long time. TMS is different from other types of brain stimulation like vagus nerve stimulator. It does not interfere in psychotherapy. It is also safe for pregnant women, and it has a low risk of having seizures. However, some people can feel pain or discomfort on their scalp under the magnet while they are receiving treatment. Typical TMS treatments last around half an hour. Your doctor will inform you the length of time the treatment will last and may even stop the pulses in this period 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 timed electrical signals to change brain wave patterns and lessen depression symptoms. It's a surgically implanted device that utilizes a small pulse generator that is connected to a wire that is threaded beneath the skin and wrapped around the left vagus nerve inside the neck. FDA approved the procedure for those suffering from treatment-resistant depression who haven't been able to get relief from other treatments like psychotherapy or medication. It is also approved as a seizure treatment for certain individuals with epilepsy. Researchers compared the effectiveness of VNS with a sham-device in patients with bipolar disorder or unipolar disorder that is resistant treatment. depression. Patients in the VNS group received a low, medium or high dose of electrical stimulation throughout an 22-week “acute phase.” The primary end point was a change in the Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score during the course of the study. Patients in the VNS groups improved significantly more than those in the sham groups. At the 12-month check-up the VNS group scored an average IDSSR30 score of 9.3 while the group of sham scored 4.2. The VNS treatment was well-tolerated. The most frequently reported side effects were voice alteration, hoarseness, and a feeling on the chest. Other reported side effects were tingling, headaches, fatigue, and changes in speech or swallowing. Some of these side effects occurred more frequently in the higher dose groups, while others occurred at all doses. The rate of AEs in this study was comparable to other studies and they generally resolved by the end of 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 depression and mood disorders. Our experts are helping to shape national standards of health care. We are also the 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 evaluate VNS for treating resistant depression. This is a significant research effort, as the evidence available suggests that VNS could provide better benefits and hope for this difficult to treat chronic population. Electroconvulsive therapy (ECT) ECT is a potent treatment for depression that isn't improving by taking medication. It is particularly beneficial for those who are suicidal or are unable to wait until their medication to start working. During the ECT procedure, doctors send small electric currents through the brain to deliberately trigger a brief seizure. The result is that the brain changes chemical structure and improve symptoms of certain mental health issues. ECT has been around since the 1930s. Despite the stigma attached to the treatment it has helped many people. To be given ECT the doctor will have to conduct an extensive psychiatric evaluation. They will review your medical records and perform various tests, including an electrocardiogram, blood tests and maybe the chest X-ray. They will ask you about how you feel about ECT, and consider any opinions from family members or friends speaking on your behalf. The ECT procedure is performed under general anesthesia, so you won't feel any sensation. A mouth guard protects your teeth, while a mask covers your face to provide oxygen. An anesthesiologist injects an esthetic into your vein with a needle. When you're asleep, electrodes will be placed on both sides of your head (depending on whether you suffer from bilateral or unilateral ECT). These deliver small electrical pulses to the brain that cause an instant seizure. It lasts between 20 and 60 seconds, and you'll be able to get up shortly after. You can revoke your consent to ECT at any time, even before the first treatment. This is your right under Care Quality Commission (CQC) regulations and your doctor should always take into account your wishes when considering ECT for you. ECT can be a beneficial treatment option for people who have 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 danger to others or yourself and can't wait for the effects of medication to begin. The majority of patients will have to attend multiple ECT sessions over a period of three to six weeks. Light therapy Light therapy helps to compensate for the absence of sunlight. This is a factor that could contribute to the development of seasonal affective disorder (formerly known as major depression). It can be utilized as a stand-alone treatment or as an addition to other treatments, such as psychotherapy or medication. When you undergo light therapy you are seated next to a light box that emits white light that is bright and bright. The light intensity is typically between 10,000 and 2,500 light lux. In each session, you'll be sitting for 30 minutes near the lamp. The light can help improve your mood and alleviate symptoms of SAD like being constantly tired and sleeping too much. Although researchers don't know exactly how light therapy can help treat SAD, they do know that it has an immediate influence on the circadian rhythms. Circadian rhythms influence sleep patterns, hormones and other functions. Light therapy can reset the internal clock of your body through influencing melatonin release, an ingredient that regulates sleep-wake cycles. It also impacts neurotransmitter function by affecting the production of serotonin a chemical that lifts your mood. Iampsychiatry of studies have proven that light therapy improves depression symptoms and boosts the effectiveness of antidepressant drugs. In addition, some studies have found that light therapy is effective in treating bipolar disorder. These results are encouraging and suggest that light therapy could be a viable option for people who suffer from bipolar disorder and depression. Speak to your physician or a mental health professional prior to you start using light therapy. They can assist you in choosing the right device and give you guidelines on how to use it. They can also inform you if it interferes with other medications you are taking. Light therapy is an effective treatment that does not cause any serious side negative effects. It is best to only take it if your doctor prescribes. If you're suffering from severe depression, it's essential to seek treatment right away. Depression is a serious condition, and it can have grave consequences for your physical and mental well-being. In severe cases, depression may result in suicidal ideas. If you are experiencing suicidal thoughts or feelings, seek help immediately from an expert in mental health.