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Advanced Depression Treatment If you don't experience any improvement with an antidepressant that you first try, your doctor could increase the dosage or suggest another type of medication. They may also recommend psychotherapy. Modern psychotherapy techniques like augmented depression therapy have empirical support and can aid in reducing depression symptoms. These therapies focus on identifying and resolving the ways in which depression affects your daily activities. Transcranial magnetic stimulation (TMS) TMS is a non-invasive brain stimulation technique that utilizes magnetic pulses to stimulate neurons that are responsible for mood. It is typically 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 a reliable and safe treatment with no significant negative side effects. During the session, the healthcare professional will place an electromagnetic coil on your scalp over the region of the brain that controls mood. In the case of rTMS, this is the dorsolateral prefrontal cortex (dLPFC). This is a small area situated in front of your brain. The device will deliver electrical impulses to your brain. You will hear clicking sounds and feel a tingling sensation. The healthcare professional will adjust settings to stimulate specific areas of the brain. The healthcare professional will measure the amount of energy required to cause a thumb twitch. This is important as it helps them to know how much power they're employing and ensures the safety of the patient. In the past, the pulses were given at 120 percent of the threshold of motor. However, current research is focusing on speeding up TMS therapy to reduce the treatment length and improve response rates. In a controlled, randomized study researchers have proven that TMS can help people with major depressive disorder (MDD) who do not respond to antidepressants. The study revealed that patients who were treated with rTMS saw significant improvements in symptoms such as sadness and low mood as well as changes in appetite, the loss of enthusiasm or enjoyment in activities. The study also found that the improvements were long-lasting. TMS is not like other types of brain stimulation, such as vagus nerve stimulator. It is not a factor with psychotherapy. It is safe for pregnant women and has a low risk of seizure. However, some patients may suffer from discomfort or pain on the scalp underneath the magnet during treatment. Typical TMS treatments last around half an hour. Your doctor will let you know the length of the treatment and may pause pulses to allow the magnet to cool down. Vagus Nerve Stimulation (VNS) VNS (also known as Vagus Neuro Stimulation Therapy) is a treatment option that sends timed electrical signals to change brain wave patterns and reduce depression symptoms. It's an implanted surgical device that employs a tiny pulse generator that is connected to a wire that is placed beneath the skin and wrapped around the left vagus nerve in the neck. The procedure is FDA-approved for treatment-resistant depression in people who haven't found relief from other treatments, like psychotherapy or medications. It's also approved for seizure control in certain epileptic patients. Researchers compared the effectiveness of VNS with a sham-device for patients with bipolar disorder or unipolar disorder that is resistant treatment. depression. The VNS group was given an extremely low, medium dose or high dose of electrical stimulation over a 22-week period. The primary end-point was a change in the Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score over the course of the study. Patients in the VNS group had significantly better results than those in the group of sham. At a 12-month check-up the VNS group had a mean IDSSR30 of 9.3 while the group of sham scored 4.2. The VNS therapy was well tolerated with the most common adverse effects being voice changes or hoarseness, as well as an impression of weight on the chest. Other reported side effects were tingling, headache, fatigue, and changes in swallowing or speech. Some of these happened more often in the higher dose groups, while others were seen at all doses. The rate of AEs was similar to that in other studies, and they were usually resolved by the end of the acute study period. Psychiatrists at Ohio State Wexner Medical Center regularly participate in national discussions on the best ways to treat depression and other mood disorders. Our experts contribute to shaping 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 depression. This is an important research study, as the available evidence suggests that VNS could provide a better treatment for patients suffering from chronic illness. Electroconvulsive therapy (ECT) ECT is an effective advanced depression treatment for those who can't get better with medications. It is particularly helpful for those who are suicidal or who are unable to wait for their medication to start working. During ECT doctors use small electrical currents to the head to trigger a short seizure. This is believed to alter brain chemical structure and improve symptoms of a variety of mental health conditions. ECT has been used since the 1930s and despite the stigma associated with the treatment, a lot of people have successfully benefited from it. Your psychiatrist will need to perform a thorough psychiatric evaluation before making a recommendation for ECT. Then they will review your medical history and conduct a series of tests which include an electrocardiogram (EKG) as well as blood tests, and perhaps an X-ray of your chest. They will also ask you what you think about the possibility of having ECT and take into consideration any opinions from friends, family, or advocates who are supporting or advocating for you. The ECT treatment is performed when you're asleep under general anesthesia. This means that you won't feel anything during the procedure. A mouth guard is put on to protect your teeth. an air mask is placed over your face to allow oxygen. An anesthesiologist injects an anesthetic into your vein by using a needle. When you are asleep, electrodes are placed on either one or both of your head depending on whether you are receiving unilateral or bilateral ECT. These electrical pulses send tiny impulses to the brain, causing a short seizure. It lasts for 20 to 60 seconds and you wake up shortly after it's over. It is important to remember that you are able to revoke your consent to ECT at any time, even just 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 deciding on ECT for you. Some people find that ECT is a viable option for them after they've tried other treatments but did not see any improvement. However, it is also a viable option for mild depression or severe psychosis or if you're risky to others or yourself and you are unable to wait for medication to begin working. In most instances, you'll have to have several ECT sessions spread over three to six weeks. Light therapy Light therapy is a way to compensate for the lack 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 stand-alone therapy or as an add-on to other treatments, such as psychotherapy or medication. In light therapy you sit in front of an illuminated box that emits white light with bright colors. depression treatment advancements is usually between 10,000 and 2,500 in lux. Each time you undergo a treatment, you sit for about 30 minutes at the light. The light can help improve your mood and alleviate symptoms of SAD like feeling exhausted all the time and sleeping excessively. Although researchers don't know exactly how light therapy works to treat SAD but they do know that it has a direct influence on the circadian rhythms. Circadian rhythms are biological cycles that impact the patterns of sleep, hormone levels, and other vital functions. Light therapy can reset the internal clock of your body by altering the release of melatonin. It is the chemical that regulates sleep and wake cycles. It also affects neurotransmitter functions through the alteration of production of serotonin. Numerous studies have demonstrated that light therapy can improve depression symptoms and boosts the effectiveness of antidepressant medications. Numerous studies have also demonstrated that light therapy can be used to treat 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. Consult your physician or a mental health professional prior to you begin using light therapy. They can guide you in selecting the best device and give you instructions on how to use it. They can also tell whether it interacts with other medications you are taking. Light therapy is a successful treatment that has no negative side negative effects. You should only take it if your doctor prescribes. It is essential to seek treatment as soon as you can if suffering from depression that is severe. Depression is a serious illness and can have severe consequences for your physical and mental well-being. In severe cases, depression can result in suicidal ideas. If you're having suicidal thoughts, seek help immediately from a mental health professional.