Electroconvulsive therapy (ECT) is the treatment of last resort for severe, chronic depressive symptoms. ECT is never the initial treatment for depression, and there are serious questions regarding memory loss which have yet to be adequately answered by the research literature. Please see ECT.org for more information about ECT. rTMS (below) is now the preferred treatment method over ECT.
Reptitive transcranial magnetic stimulation (rTMS) utilizes an electromagnet placed on the scalp that generates magnetic field pulses roughly the strength of an MRI scan. The magnetic pulses pass readily through the skull and stimulate the underlying cerebral cortex. Low frequency (once per second) TMS has been shown to induce sustained reductions in cortical activation in multiple studies.
In use for the treatment of depression, rTMS is generally used with high frequencies, stimulating the left dorsolateral prefrontal cortex of the brain. This gives positive results with significant decrease of scores on depressive scales applied to resistant and non-resistant depressions.
rTMS given to the front of the brain is generally not painful, but can be uncomfortable insofar as a tingling or knocking sensation is produced against the scalp. Scalp and facial muscle contractions sometimes occur during TMS. There is a very small risk of seizure associated with TMS, but for the frequency of stimulation used in this study (one stimulation per second), the risk is significant only for patients who have a prior history of seizures.
NeuroStar TMS Therapy is specifically indicated for the treatment of major depressive disorder in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. In clinical trials with NeuroStar TMS Therapy, these patients had been treated with a median of 4 medication treatment attempts, one of which achieved criteria for adequate dose and duration. It is a 40-minute outpatient procedure that is prescribed by a psychiatrist and performed in a psychiatrist’s office. The treatment is typically administered daily for 4-6 weeks.
The benefits of TMS observed in its clinical trials include:
- No systemic side effects, such as weight gain, sexual dysfunction, sedation, nausea, or dry mouth
- No adverse effects on concentration or memory
- No seizures
- No device-drug interactions
- The most common adverse event related to treatment was scalp pain or discomfort at the treatment area during active treatments, which was transient and mild to moderate in severity. The incidence of this side effect declined markedly after the first week of treatment.
- There was a less than 5% discontinuation rate due to adverse events.
- During a 6-month follow-up period, there were no new safety observations compared to those seen during acute treatment.
Self-help methods for the treatment of this disorder are often overlooked by the medical and psychological professions because very few professionals are involved in them. Depression-oriented support groups (in-person or online) are especially effective, since they allow the individual an opportunity to socialize and be with others who suffer from similar feelings. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.
There are many useful self-help books (such as The Feeling Good Handbook) that are available on the market today to help an individual overcome depression on their own. Some of these may be effective for some people and no other type of treatment may be needed, especially for people who suffer from a mild case of this disorder. Some books emphasize a cognitive-behavioral approach, which is similar to those used within individual therapy and therefore may be of use to an individual before they even begin therapy.
Patients can be encouraged to try out new coping skills and explore their emotions with people they meet within online support groups. They can be an important part of expanding the individual’s skill set and develop new, healthier social relationships.
Herbal supplements — including St. John’s wort and kava — have both extensive clinical research demonstrating their effectiveness and safety for the treatment of mild to moderate clinical depression. While they should not be taken if a person is already taking an antidepressant medication, many people turn to supplements as a first-line treatment, especially if their episode isn’t severe. Like medications, they may or many not work for you, but are generally safe to try. Always talk to your doctor first before starting any regular supplements or other kinds of alternative treatments, as some may interact with other medications or treatments you may be on.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Beck, A.T., Rush, A.J., Shaw, B.F. & Emery, G. (1987). Cognitive Therapy of Depression. New York: Guilford.
Gelenberg, A.J. et al. (2010). Practice Guideline for the Treatment of Patients With Major Depressive Disorder. American Psychiatric Association.
Gotlib, I.H. & Hammen, C.L. (2015). Handbook of Depression: Third Edition. New York: Guilford.
National Institute of Mental Health. (2018). Depression. Retrieved from https://www.nimh.nih.gov/health/publications/depression/index.shtml on February 27, 2018.
Muneer, A. (2018). Major Depressive Disorder and Bipolar Disorder: Differentiating Features and Contemporary Treatment Approaches. In Understanding depression. New York: Springer.