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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 might also suggest psychotherapy.

The latest psychotherapy techniques, such as augmented depression treatment offer empirical support and can help reduce depression symptoms. These treatments concentrate on identifying and solving the specific ways depression affects your daily activities.

Transcranial magnetic stimulation (TMS)

A type of noninvasive brain stimulation, TMS employs magnetic impulses to influence the brain's neurons that are that are responsible for mood. It is usually prescribed to treat depression treatment drugs if medication fails or is not appropriate for the individual. It is used to treat PTSD, and is sometimes combined with psychotherapy. TMS is an effective and safe treatment that doesn't trigger serious side effects.

During the session, the healthcare professional will position an electromagnetic coil on your scalp to the region of the brain that regulates mood. In the case rTMS this is called the dorsolateral frontal cortex (dLPFC). This is a small area located on the front of your head. You will hear a click sound and feel a tapping sensation as the device delivers pulses to your brain. The healthcare professional will adjust the settings medicine to treat anxiety and depression stimulate the specific areas of your brain.

The healthcare professional will measure the amount of energy needed to trigger the thumb to flick. This is crucial because it helps them know how much power they are using and ensures the safety of the patient. In the past, pulses were delivered at 120 percent of the threshold for motor. But, current research is focused on accelerating TMS therapy to reduce the time required to treat and improve response rates.

In a randomized control trial researchers have demonstrated that TMS can aid people suffering from major depressive disorder (MDD) who are unable to respond to antidepressants. The study found that those treated with rTMS experienced significant improvements in symptoms like anxiety depression treatment sadness, depression, changes in appetite, and a loss of enjoyment or enthusiasm for activities. The study also showed improvements that lasted a long duration.

TMS is not like other types of brain stimulation, such as electroconvulsive treatment and vagus nerve stimulator. It 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 the scalp beneath the magnet during treatment.

Typical TMS treatments last for about half an hour. The doctor will inform you of how long the treatment is and may also pause the pulses to allow the magnet to cool down.

Vagus nerve stimulation (VNS)

VNS (also called Vagus Nerve Stimulation) is a treatment that uses timed electrical signals in order to change brainwave patterns and decrease depression symptoms. This device is surgically implanted, and it uses a small generator that's connected to a wire that is wound around the left Vagus nerve of 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 therapy and medications. It is also approved for seizure control in a few epileptic patients.

In the largest study of VNS researchers compared its effectiveness against a sham device in people who had treatment-resistant unipolar or depressed-phase bipolar disorder. The VNS group was given a low dose, medium dose or high dosage of electrical stimulation over a 22-week period. The primary endpoint was changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS groups showed improvement significantly more than those in the sham groups. At 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 scored 4.2 points.

The VNS treatment was well tolerated. The most frequent adverse effects were voice changes hoarseness, a feeling of numbness, and a sensation on the chest. Other reported side effects were tingling, headaches fatigue, tiredness, and changes in speech or swallowing. Certain of these were more often in the higher dose groups, while others occurred at all doses. The frequency of AEs in this study was comparable to other studies, and they generally cleared by the end the study period of acute.

Psychiatrists from Ohio State Wexner Medical Center are frequently invited to participate in national discussions on the best approach to treat mood disorders and depression. Our experts help shape national standards of care and are currently a site for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial to further investigate VNS as a treatment option for treatment-resistant depression. This is an important research project, as the evidence available now suggests that VNS can offer improving benefit and hope to this difficult-to-treat chronic patient.

Electroconvulsive therapy (ECT)

ECT is an effective treatment for depression that is advanced and suitable for those who can't get better with medications. It's especially useful for those who are suicidal or cannot wait for their medication to kick in.

During ECT, doctors send small electrical currents to the head to trigger a short seizure. This is believed to alter brain chemical structure and improve symptoms of certain mental health conditions. ECT has been used since the 1930s. Despite the stigma attached to the treatment it has helped many people.

If you are to receive ECT your doctor will require an extensive psychiatric evaluation. They will review your medical records and conduct several tests, including an electrocardiogram, blood tests, and maybe the chest X-ray. They will ask you about how you are feeling about ECT, and consider any opinions of family members or friends representing you.

The ECT treatment is performed while you sleep under general anesthesia, which means you won't feel anything during the procedure. A mouth guard is placed to protect your teeth and the mask is placed over your face to provide oxygen. An anesthesiologist injects an esthetic into your vein by using a needle. Once you've fallen asleep, electrodes will be placed on one or both sides of your head (depending on whether you suffer from unilateral or bilateral ECT). These electrical pulses send tiny impulses to the brain, which triggers an instant seizure. It lasts for 20 to 60 seconds and you wake up soon after it's over.

It is important to keep in mind that you can revoke your consent to ECT at any time, even just before the first treatment. This is your right under the Care Quality Commission (CQC) regulations and your doctor should always consider your wishes when considering ECT for you.

Some people find that ECT is a viable alternative after having tried other treatments but failed to see improvements, but it is also a viable option to treat mild depression or severe psychosis, or when you are risky to others or yourself and can't wait for medication to begin working. In most cases, you'll need to undergo several ECT sessions spread over three to six weeks.

Light therapy

Light therapy helps to compensate for the absence of sunlight, a factor that could contribute to major depressive disorder that has seasonal patterns (formerly known as seasonal affective disorder). It can be used as a standalone treatment or in conjunction with other treatments such as psychotherapy and medications. During light therapy, you sit in front of a light box or lamp which emits bright light generally in the range of 2,500-10,000 luminosity. In each session, you will sit for 30 minutes in front of the lamp. The light can aid in improving your mood and ease other symptoms of SAD, such as feeling tired all the time and sleeping too much.

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 impact sleep patterns, hormones, and other functions. Light therapy can alter the internal clock of your body by influencing the release of melatonin, an ingredient that regulates sleep-wake cycles. It can also impact neurotransmitter function by affecting the production of serotonin which is a chemical that improves your mood.

Several studies have shown how light therapy can reduce depression symptoms and boost the effectiveness of antidepressant drugs. In addition, some studies have demonstrated that light therapy is effective in treating bipolar disorder. These results are encouraging and suggest that 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 guide you in selecting the best device and provide guidelines on how to use it. They can also inform you whether it interacts with other medications you are taking.

Light therapy is a safe treatment that does not cause serious adverse side effects. It is best to only take it if your doctor prescribes. If you're experiencing severe depression, it is crucial to seek treatment as soon as you notice it. Depression is a serious condition and can have serious consequences for your emotional and physical well-being. In severe cases, depression may lead to suicidal thoughts. Seek immediate assistance from a mental healthcare professional in the event that you feel suicidal.