Non-drug Therapies to Treat Depression

Reviewed May 15, 2017

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Summary

  • Electroconvulsive therapy
  • Vagal nerve stimulation
  • Repetitive transcranial magnetic stimulation
  • Magnetic seizure therapy
  • Deep brain stimulation

Five non-drug therapies are available to treat depression.

Electroconvulsive therapy (ECT)

Seizures like those seen in people with epilepsy happen when the electrical activity of the brain goes out of control. Seizures can be a sign of illness, but they can also be a tool for improving health.

As early as 1934, a Hungarian psychiatrist named von Meduna found ways to cause seizures in mentally ill people. He had a theory that induced seizures would treat mental disorders in a way that was safer and more controlled than the seizures that occurred within the illness. In 1938, two Italian psychiatrists began using electric current to cause the seizures. This was a safer way that was easier to control. This treatment is called electroconvulsive therapy because it uses electrically-caused seizures, which are also called convulsions, in a way that is therapeutic.

ECT has been portrayed as a violent treatment in some movies, but the modern form of treatment is safe for most people. There are some health conditions (such as brain tumor) that make ECT more dangerous or too unsafe to try. ECT is not painful. The seizure takes place after medications have been used to put the person to sleep. Many people who have been helped by ECT ended up thinking it was not a bad experience. Some people felt their memories were harmed either for a short time or a longer time. The short-term memory problems, which are more common, usually go away after a few weeks.

ECT is useful when drugs have not helped or when delusions are present. It is also used when a person is so unhappy that he will not eat or stay safe. Sometimes, when treatment needs to work quickly, ECT can help a person regain safety in a hurry. We do not know for sure how ECT works, but one idea is that the seizures jumpstart the brain cells so that they make more of the chemicals that the brain needs. Most people who get ECT are able to stop after a small number of sessions. Some people are helped by longer and less frequent sessions.

Vagal nerve stimulation (VNS)

You may have heard about the vagus nerve because of how it is involved in certain types of fainting. People who faint at the sight of blood, for example, are having signs that involve activity of the vagus nerve. It is a very long nerve that connects the brain with internal organs such as the stomach and intestines. It carries messages from the brain to these organs, and also from the organs to the brain. 

For the treatment called VNS, an electrical machine that sends a small electrical impulse to the brain is put under the person’s skin. VNS was created as a treatment for epilepsy, but some research shows that sending an electrical impulse up the vagus nerve into the brain can also help depression in some people. Like ECT, VNS can help increase brain chemicals that help fight depression.

VNS is approved by the U.S. Food and Drug Administration to treat some depressions. It is approved when the depression has lasted at least two years, is very bad or keeps returning, and has not gotten better after at least four other treatments. Not all care providers agree about the value of VNS. It calls for surgery to put the impulse generator in place. Side effects of VNS include infection, voice changes, neck pain, or changes in breathing and swallowing.

Repetitive transcranial magnetic stimulation (rTMS)

In high school, you likely learned about how you can make electricity flow in a wire that is moved through a magnetic field. In rTMS, a magnetic device is used to make electrical currents flow in the brain. Some, but not all of the studies show that rTMS works well. The FDA has approved its use to treat depression that has not gotten better after use of at least one antidepressant.

In the U.S., rTMS is sometimes used as an alternative to ECT, though many experts think ECT is a stronger treatment. Also, the number of people who know how to give rTMS is limited. The good points about rTMS are that no anesthesia is needed and there are no drug side effects. Sometimes rTMS can cause a headache, tingling, or even a seizure, though this is rare.

Magnetic seizure therapy (MST)

In MST, a strong magnetic field (stronger than in rTMS) is used to cause a seizure like that in ECT. This treatment is still experimental, but studies show that it is a good treatment for depression. With MST, it is necessary for the person to be put to sleep before the seizure, but researchers are hoping that MST will help treat depression faster and with fewer side effects than when ECT is used.

Deep brain stimulation (DBS)

DBS is another experimental treatment. It may turn out to be very powerful in helping people whose depression did not get better with the other treatments. Wires are put into special areas of the brain that are important for the control of mood. Electrical signals are sent from a generator in the person’s chest through the wires and into the brain.

DBS is a harder treatment to get because a smaller number of experts have been trained to use it. Also, DBS calls for brain surgery to put the wires in place and also surgery to put the impulse generator in place. These operations, and the use of the DBS stimulator, can have side effects including brain bleeding, infection, confusion, and changes in movement or sleep.

Still, DBS is an important advance because some people whose depressions did not get better with lots of other treatments have gotten much better this way.

Resource

National Institute of Health
www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

By James M. Ellison, MD, MPH
Source: Seiner SS, Burke A. "Electroconvulsive therapy and neurotherapeutic treatments for late-life mood disorders" in Ellison JM, Kyomen HH, Verma S. Mood Disorders in Later Life. Informa Healthcare, 2008, pp 29-314; http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

Summary

  • Electroconvulsive therapy
  • Vagal nerve stimulation
  • Repetitive transcranial magnetic stimulation
  • Magnetic seizure therapy
  • Deep brain stimulation

Five non-drug therapies are available to treat depression.

Electroconvulsive therapy (ECT)

Seizures like those seen in people with epilepsy happen when the electrical activity of the brain goes out of control. Seizures can be a sign of illness, but they can also be a tool for improving health.

As early as 1934, a Hungarian psychiatrist named von Meduna found ways to cause seizures in mentally ill people. He had a theory that induced seizures would treat mental disorders in a way that was safer and more controlled than the seizures that occurred within the illness. In 1938, two Italian psychiatrists began using electric current to cause the seizures. This was a safer way that was easier to control. This treatment is called electroconvulsive therapy because it uses electrically-caused seizures, which are also called convulsions, in a way that is therapeutic.

ECT has been portrayed as a violent treatment in some movies, but the modern form of treatment is safe for most people. There are some health conditions (such as brain tumor) that make ECT more dangerous or too unsafe to try. ECT is not painful. The seizure takes place after medications have been used to put the person to sleep. Many people who have been helped by ECT ended up thinking it was not a bad experience. Some people felt their memories were harmed either for a short time or a longer time. The short-term memory problems, which are more common, usually go away after a few weeks.

ECT is useful when drugs have not helped or when delusions are present. It is also used when a person is so unhappy that he will not eat or stay safe. Sometimes, when treatment needs to work quickly, ECT can help a person regain safety in a hurry. We do not know for sure how ECT works, but one idea is that the seizures jumpstart the brain cells so that they make more of the chemicals that the brain needs. Most people who get ECT are able to stop after a small number of sessions. Some people are helped by longer and less frequent sessions.

Vagal nerve stimulation (VNS)

You may have heard about the vagus nerve because of how it is involved in certain types of fainting. People who faint at the sight of blood, for example, are having signs that involve activity of the vagus nerve. It is a very long nerve that connects the brain with internal organs such as the stomach and intestines. It carries messages from the brain to these organs, and also from the organs to the brain. 

For the treatment called VNS, an electrical machine that sends a small electrical impulse to the brain is put under the person’s skin. VNS was created as a treatment for epilepsy, but some research shows that sending an electrical impulse up the vagus nerve into the brain can also help depression in some people. Like ECT, VNS can help increase brain chemicals that help fight depression.

VNS is approved by the U.S. Food and Drug Administration to treat some depressions. It is approved when the depression has lasted at least two years, is very bad or keeps returning, and has not gotten better after at least four other treatments. Not all care providers agree about the value of VNS. It calls for surgery to put the impulse generator in place. Side effects of VNS include infection, voice changes, neck pain, or changes in breathing and swallowing.

Repetitive transcranial magnetic stimulation (rTMS)

In high school, you likely learned about how you can make electricity flow in a wire that is moved through a magnetic field. In rTMS, a magnetic device is used to make electrical currents flow in the brain. Some, but not all of the studies show that rTMS works well. The FDA has approved its use to treat depression that has not gotten better after use of at least one antidepressant.

In the U.S., rTMS is sometimes used as an alternative to ECT, though many experts think ECT is a stronger treatment. Also, the number of people who know how to give rTMS is limited. The good points about rTMS are that no anesthesia is needed and there are no drug side effects. Sometimes rTMS can cause a headache, tingling, or even a seizure, though this is rare.

Magnetic seizure therapy (MST)

In MST, a strong magnetic field (stronger than in rTMS) is used to cause a seizure like that in ECT. This treatment is still experimental, but studies show that it is a good treatment for depression. With MST, it is necessary for the person to be put to sleep before the seizure, but researchers are hoping that MST will help treat depression faster and with fewer side effects than when ECT is used.

Deep brain stimulation (DBS)

DBS is another experimental treatment. It may turn out to be very powerful in helping people whose depression did not get better with the other treatments. Wires are put into special areas of the brain that are important for the control of mood. Electrical signals are sent from a generator in the person’s chest through the wires and into the brain.

DBS is a harder treatment to get because a smaller number of experts have been trained to use it. Also, DBS calls for brain surgery to put the wires in place and also surgery to put the impulse generator in place. These operations, and the use of the DBS stimulator, can have side effects including brain bleeding, infection, confusion, and changes in movement or sleep.

Still, DBS is an important advance because some people whose depressions did not get better with lots of other treatments have gotten much better this way.

Resource

National Institute of Health
www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

By James M. Ellison, MD, MPH
Source: Seiner SS, Burke A. "Electroconvulsive therapy and neurotherapeutic treatments for late-life mood disorders" in Ellison JM, Kyomen HH, Verma S. Mood Disorders in Later Life. Informa Healthcare, 2008, pp 29-314; http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

Summary

  • Electroconvulsive therapy
  • Vagal nerve stimulation
  • Repetitive transcranial magnetic stimulation
  • Magnetic seizure therapy
  • Deep brain stimulation

Five non-drug therapies are available to treat depression.

Electroconvulsive therapy (ECT)

Seizures like those seen in people with epilepsy happen when the electrical activity of the brain goes out of control. Seizures can be a sign of illness, but they can also be a tool for improving health.

As early as 1934, a Hungarian psychiatrist named von Meduna found ways to cause seizures in mentally ill people. He had a theory that induced seizures would treat mental disorders in a way that was safer and more controlled than the seizures that occurred within the illness. In 1938, two Italian psychiatrists began using electric current to cause the seizures. This was a safer way that was easier to control. This treatment is called electroconvulsive therapy because it uses electrically-caused seizures, which are also called convulsions, in a way that is therapeutic.

ECT has been portrayed as a violent treatment in some movies, but the modern form of treatment is safe for most people. There are some health conditions (such as brain tumor) that make ECT more dangerous or too unsafe to try. ECT is not painful. The seizure takes place after medications have been used to put the person to sleep. Many people who have been helped by ECT ended up thinking it was not a bad experience. Some people felt their memories were harmed either for a short time or a longer time. The short-term memory problems, which are more common, usually go away after a few weeks.

ECT is useful when drugs have not helped or when delusions are present. It is also used when a person is so unhappy that he will not eat or stay safe. Sometimes, when treatment needs to work quickly, ECT can help a person regain safety in a hurry. We do not know for sure how ECT works, but one idea is that the seizures jumpstart the brain cells so that they make more of the chemicals that the brain needs. Most people who get ECT are able to stop after a small number of sessions. Some people are helped by longer and less frequent sessions.

Vagal nerve stimulation (VNS)

You may have heard about the vagus nerve because of how it is involved in certain types of fainting. People who faint at the sight of blood, for example, are having signs that involve activity of the vagus nerve. It is a very long nerve that connects the brain with internal organs such as the stomach and intestines. It carries messages from the brain to these organs, and also from the organs to the brain. 

For the treatment called VNS, an electrical machine that sends a small electrical impulse to the brain is put under the person’s skin. VNS was created as a treatment for epilepsy, but some research shows that sending an electrical impulse up the vagus nerve into the brain can also help depression in some people. Like ECT, VNS can help increase brain chemicals that help fight depression.

VNS is approved by the U.S. Food and Drug Administration to treat some depressions. It is approved when the depression has lasted at least two years, is very bad or keeps returning, and has not gotten better after at least four other treatments. Not all care providers agree about the value of VNS. It calls for surgery to put the impulse generator in place. Side effects of VNS include infection, voice changes, neck pain, or changes in breathing and swallowing.

Repetitive transcranial magnetic stimulation (rTMS)

In high school, you likely learned about how you can make electricity flow in a wire that is moved through a magnetic field. In rTMS, a magnetic device is used to make electrical currents flow in the brain. Some, but not all of the studies show that rTMS works well. The FDA has approved its use to treat depression that has not gotten better after use of at least one antidepressant.

In the U.S., rTMS is sometimes used as an alternative to ECT, though many experts think ECT is a stronger treatment. Also, the number of people who know how to give rTMS is limited. The good points about rTMS are that no anesthesia is needed and there are no drug side effects. Sometimes rTMS can cause a headache, tingling, or even a seizure, though this is rare.

Magnetic seizure therapy (MST)

In MST, a strong magnetic field (stronger than in rTMS) is used to cause a seizure like that in ECT. This treatment is still experimental, but studies show that it is a good treatment for depression. With MST, it is necessary for the person to be put to sleep before the seizure, but researchers are hoping that MST will help treat depression faster and with fewer side effects than when ECT is used.

Deep brain stimulation (DBS)

DBS is another experimental treatment. It may turn out to be very powerful in helping people whose depression did not get better with the other treatments. Wires are put into special areas of the brain that are important for the control of mood. Electrical signals are sent from a generator in the person’s chest through the wires and into the brain.

DBS is a harder treatment to get because a smaller number of experts have been trained to use it. Also, DBS calls for brain surgery to put the wires in place and also surgery to put the impulse generator in place. These operations, and the use of the DBS stimulator, can have side effects including brain bleeding, infection, confusion, and changes in movement or sleep.

Still, DBS is an important advance because some people whose depressions did not get better with lots of other treatments have gotten much better this way.

Resource

National Institute of Health
www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

By James M. Ellison, MD, MPH
Source: Seiner SS, Burke A. "Electroconvulsive therapy and neurotherapeutic treatments for late-life mood disorders" in Ellison JM, Kyomen HH, Verma S. Mood Disorders in Later Life. Informa Healthcare, 2008, pp 29-314; http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

The information provided on the Achieve Solutions site, including, but not limited to, articles, quizzes, and other general information, is for informational purposes only and should not be treated as medical, health care, psychiatric, psychological or behavioral health care advice. Nothing contained on the Achieve Solutions site is intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. Please direct questions regarding the operation of the Achieve Solutions site to Web Feedback. If you have concerns about your health, please contact your health care provider.  ©2017 Beacon Health Options, Inc.

 

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