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Advanced Depression Treatment If you don't experience any improvement after taking a first-line antidepressant your doctor may increase the dose or add another type of medication. They might also suggest psychotherapy. The latest psychotherapy techniques, such as enhanced depression treatment have scientific support and can help reduce depression symptoms. These therapies are focused on identifying and resolving the specific ways that depression interferes with your daily routine. Transcranial magnetic stimulation (TMS) TMS is a non-invasive brain stimulation that uses magnetic pulses to affect neurons that are responsible for mood. It is often advised to treat depression if medication has failed or is not suitable for a person. It can also be used to treat PTSD and is often combined with psychotherapy. TMS is an effective and safe treatment, with no significant negative side negative effects. During the session, the healthcare professional will position an electromagnetic coil on your scalp to the brain region that controls your mood. In the case of rTMS, it is called the dorsolateral frontal cortex (dLPFC). It is a tiny region located at the front of your brain. The device will deliver signals to the brain. You will hear clicking sounds and feel tapping sensations. The healthcare expert will adjust the settings to stimulate the specific areas of your brain. The healthcare professional will assess the amount of energy required to trigger the thumb to flick. This is important because it allows them to determine the amount of power they are using and ensures the security of the patient. In the past, pulses were delivered at 120% of the threshold for motor. But, current research is focusing on speeding up TMS therapy to reduce time required to treat and improve the rate of response. 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 found that those treated with rTMS showed significant improvement in symptoms like low mood sadness, depression, changes in appetite, and decreased enjoyment or interest in certain activities. The study also revealed that the improvement was long-lasting. In contrast to other forms of brain stimulation like vagus nerve stimulation and electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for women who are pregnant and has a low risk of seizures. However, some patients may feel pain or discomfort on the scalp beneath the magnet during treatment. TMS treatments typically last about 30 minutes. The doctor will inform you of how long the treatment is and may pause pulses to allow the magnet to cool. Vagus nerve stimulation (VNS) VNS (also known as Vagus Nerve Stimulation) is an approach that utilizes timed electrical signals in order to change brainwave patterns and reduce depression symptoms. This device is surgically implanted and consists of tiny generators that are connected to a wire that is wound around the left Vagus nerve in the neck. FDA approved the procedure for people with treatment-resistant depression who have not been able to get relief from other treatments such as psychotherapy and medication. It's also approved for seizure control in certain epileptic patients. Researchers evaluated the effectiveness of VNS with a sham-device for patients with bipolar disorder that is resistant to treatment or depression. The VNS group was given an extremely low, medium dose, or high dose of electrical stimulation over a period of 22 weeks. The primary goal was a change in the Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score throughout the study. Patients in the VNS group had significantly better results than those in the group of sham. At the 12-month check-up the VNS group had an average IDSSR30 score of 9.3 while the sham group scored 4.2. The VNS treatment was well-tolerated. The most frequent side effects were voice alteration hoarseness and a sensation on the chest. Other reported side effects were tingling, headaches, tiredness, and changes in speech or swallowing. Certain of these were more frequently in higher dose groups, and others occurred at all doses. The frequency of AEs was similar to that in other studies, and they were typically resolved by the end of the acute study period. The psychiatrists at Ohio State Wexner Medical Center regularly participate in national conversations about the best methods to treat depression and other mood disorders. Our experts help establish national standards for health care. We are also the site for an international clinical trial, called RECOVER, which is being conducted by the Centers for Medicare & Medicaid Services. The goal of this study is to assess VNS for treating resistant depression. This is a very important research endeavor, since the evidence available suggests that VNS may offer a better treatment for patients who are chronically ill. Electroconvulsive therapy (ECT) ECT is a potent treatment for depression that doesn't improve through medication. It is particularly helpful for those who are suicidal or are unable to wait until their medication to start working. During ECT doctors use small electrical currents to the head to deliberately cause a brief seizure. This appears to alter brain chemistry, and improve symptoms of some mental health conditions. ECT has been in use since the 1930s, and despite the stigma associated with the treatment, numerous people have successfully benefited from it. If you are to receive ECT your doctor will require an extensive psychiatric evaluation. They will review your medical records and run several tests, including an electrocardiogram, blood tests, and maybe an X-ray of your chest. They will also ask you what you think about the possibility of having ECT and consider any views from friends, family, or others who are supportive or advocating for you. The ECT procedure is done under general anesthesia. This means that you will not feel anything. A mouthguard protects your teeth, and masks cover your face to provide oxygen. An anesthesiologist injects a local anesthetic into your vein by using needle. When you are asleep, electrodes are placed on one side or both sides of your head depending on whether you're receiving bilateral or unilateral ECT. These deliver small electrical pulses to the brain, which trigger a short seizure. It lasts for 20 to 60 seconds, and you awaken soon after it's over. You can revoke your consent to ECT at any time prior to the first treatment. You have the right to withdraw your consent under Care Quality Commission (CQC), and your doctor must always take your preferences into consideration when deciding whether or not to make use of ECT. Certain people find ECT is a good option after having tried other treatments and failed to see improvement. However, it is also a viable option to treat mild depression or severe psychosis or when you pose at risk to others or yourself and are unable to wait for treatment to begin working. In the majority of instances, you'll need have several ECT sessions over the course of three to six weeks. Light therapy Light therapy is a way to compensate for the lack of sunlight, a factor that can contribute to major depression disorder that has seasonal patterns (formerly called seasonal affective disorder). It can be used as a stand-alone treatment or in conjunction with other treatments like psychotherapy and medications. In light therapy you sit in front of an illuminated box that emits bright, white light. The light intensity is typically between 10,000 and 2,500 light lux. Each session, you'll sit for 30 minutes at the lamp. depression treatment approaches can boost your mood and alleviate symptoms of SAD like feeling tired all the time and sleeping too much. Researchers aren't sure what the effects of light therapy on SAD. However, they are aware that it can have an impact on the circadian rhythms. Circadian rhythms affect the patterns of sleep, hormones, and other functions. Light therapy can reset your internal clock by influencing the release of melatonin which is a chemical that regulates your sleep-wake cycle. It can also impact neurotransmitter functions by altering the production of serotonin, an ingredient that boosts your mood. Numerous studies have demonstrated that light therapy can improve depression symptoms and increases the effectiveness of antidepressant drugs. In addition, a few studies have shown that light therapy is effective in treating bipolar disorder. These findings are encouraging and suggest light therapy could be a viable option for those with bipolar and depression disorder. Before you begin using light therapy, speak to your physician or mental health professional about it. They can help you find the best device for your needs, and provide guidelines on how to make use of it. They can also inform you whether it interacts with other medications you take. Light therapy is a secure treatment that doesn't cause serious side effects. You should only take it if your doctor prescribes. It is crucial to seek treatment as soon as you can if suffering from depression that is severe. Depression is a serious disease that can cause serious consequences on your physical and mental well-being. In severe instances, depression can lead to suicidal thoughts. If you are experiencing suicidal thoughts, seek help immediately from an expert in mental health.