Treatment of Major Depression
Compare TMS Therapy to Other Treatment Options
Depression symptoms are most often treated with psychotherapy and antidepressant medications. It is believed that antidepressant medications work by increasing the levels of neurotransmitters in the brain. These changes have a positive effect on mood and on reducing feelings of depression and anxiety. Unfortunately, treating major depression is sometimes more complicated and requires more than antidepressant medication alone.
Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, since antidepressant medications are typically taken by mouth, they circulate in the bloodstream throughout the body, and may result in unwanted side effects such as weight gain, sexual problems, upset stomach, sleepiness, and dry mouth, among others. TMS (transcranial magnetic stimulation) therapy provides hope to patients with difficult to treat depression.
Psychotherapy
There are several types of psychotherapy that have been shown to be effective for depression including cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that some individuals with mild to moderate depression can at times be treated successfully with either of these therapies used alone. Other research on Major Depressive Disorder has indicated that the use of medication and psychotherapy together is more useful than either one utilized alone.
- Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while training people how to break the behavioral patterns that contribute to their illness.
- Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life situations that may have contributed to an individual’s depression.
Medications
The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neuro- transmitters like serotonin, dopamine and norepinephrine can be modulated with antidepressants. The response to medication is gradual often taking 4-6 weeks to fully respond. Five groups of antidepressant medications are most often prescribed for depression:
- Selective serotonin reuptake inhibitors (SSRIs) – useful as a first-line treatment, they act specifically on the neurotransmitter serotonin. In general, SSRIs cause fewer side effects than TCAs and MAOIs.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – useful as first-line treatments in people taking an anti-depressant for the first time and for people who have not responded to other medications. In general, SNRIs cause fewer side effects than TCA and MAOIs.
- Dopamine reuptake blocker – a newer antidepressant medication, it acts on the neurotransmitters dopamine and norepinephrine. In general, this class of medication causes fewer side effects than TCAs and MAOIs.
- tricyclic antidepressants (TCAs) – still widely used for severe depression. TCAs elevate mood in depressed individuals, re-establish their normal sleep, appetite and energy level. The often times greater side effects of the tricyclic antidepressants may limit their usefulness in some individuals
- Monoamine oxidase inhibitors (MAOIs) – are often effective in individuals who do not respond to other medications or who have "atypical" depressions with marked anxiety, excessive sleeping, irritability, hypochondria or phobic characteristics. These medications are harder to use and require following a low tyramine diet.
ECT
Electroconvulsive Therapy
ECT is an effective treatment for severe depressive episodes. ECT employs the use of anesthesia and muscle relaxers during the procedure which involves the application of an electrical field to the head in order to produce a physical seizure. These treatments are given in the hospital.
For individuals where medication, psychotherapy, and a combination of the two prove to be ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT is often used. ECT may also be indicated for those who are not able to take antidepressant medications and do not respond to psychotherapy. Side effects on memory recall are troublesome for some individuals.
VNS
Vagus Nerve Stimulation
VNS Therapy is a non-drug treatment available specifically for treatment-resistant depression. The actual procedure takes about an hour and is usually performed under general anesthesia on an outpatient basis. Two small incisions are required: one on the upper chest area for the pulse generator and one on the left neck for the thin, flexible wires that connect the pulse generator to the vagus nerve. This treatment is infrequently utilized.
TMS Therapy
Trancranial Magnetic Stimulation
Neurostar TMS Therapy is a new treatment cleared by the US Food and Drug Administration (FDA) for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment.
TMS Therapy is a treament that can be performed in a psychiatrist's office, under their supervision, using medical device called the NeuroStar TMS Therapy system.
NeuroStar TMS Therapy is:
- Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
- Non-systemic, meaning that it is not taken by mouth and does not circulate in the blood stream throughout the body.
The typical initial treatment course consists of 5 treatments per week over a 4-6 week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 40 minutes.
