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Advanced Depression TreatmentIf your depression isn’t responding to a first-line antidepressant, your doctor might suggest increasing the dosage or adding a different type of medication. They may also recommend psychotherapy.The newer psychotherapy techniques like augmented depression treatment offer empirical evidence-based support and could help alleviate depression symptoms. These treatments focus on identifying and resolving the specific ways that depression interferes with your daily routine.Transcranial magnetic stimulation (TMS)A form of non-invasive brain stimulation, TMS utilizes magnetic impulses to influence the brain’s neurons that are responsible for mood. It is often recommended to treat depression when medication has failed or is not suitable for the individual. It is used to treat PTSD and can be combined with psychotherapy. TMS is an effective and safe treatment, with no significant side negative effects.During the session, a medical professional will install an electromagnetic coil on the region of your brain which controls mood. In the case of rTMS, this is the dorsolateral prefrontal cortex (dLPFC). This is a small region situated in front of your brain. You will hear a clicking sound and feel a thumping sensation as the device delivers pulses to your brain. The healthcare professional will adjust the settings to stimulate desired areas of the brain.The healthcare professional will assess the strength of the pulses by determining the amount of energy required to trigger the thumb to twitch. This is crucial because it lets them know the amount of power they’re employing to ensure the safety of patients. In the past, the pulses were given at 120 percent of the threshold of motor. Current research focuses on accelerating TMS treatment to decrease the duration of treatment and increase response rates.In a controlled, randomized study researchers have demonstrated that TMS can aid people suffering from major depressive disorder (MDD) who are unable to respond to antidepressants. The study found that those who were treated with rTMS saw significant improvements in symptoms like sadness and low mood as well as changes in appetite and the loss of interest or enjoyment of activities. The study also revealed that the improvement was long-lasting.Contrary to other forms of brain stimulation, like vagus nerve stimulation or electroconvulsive therapy, TMS does not interfere with psychotherapy. It is also safe for women who are pregnant and has a very low risk of seizures. Some people may feel pain or discomfort on their scalps beneath the magnet while they are receiving treatment.TMS treatments typically last about 30 minutes. The provider will inform you what the duration of the treatment will last and may even stop the pulses in this period to allow the magnet to cool down.Vagus Nerve Stimulation (VNS)VNS (also called Vagus Nerve Stimulation Therapy) is a treatment option that transmits timed electrical signals to change brain wave patterns and lessen depression symptoms. This is a surgically implanted device that uses a small pulse generator that connects to a wire that’s placed beneath the skin and wound around the left vagus nerve of the neck. FDA approved the procedure for patients suffering from treatment-resistant depression who haven’t experienced relief from other treatments, such as psychotherapy and medication. It is also approved for seizure control in certain epileptic patients.Researchers compared the efficacy of VNS with a sham device in people with bipolar disorder or unipolar disorder that is resistant treatment. depression. Patients in the VNS group received a low, medium or high dose of electrical stimulation over the 22-week “acute phase.” The primary goal was changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group showed improvement significantly more than those in the group of sham. After a 12-month follow-up patients in the VNS group had a mean IDS-SR30 score of 9.3 points, whereas those in the group with a sham score scored 4.2 points.The VNS treatment was well-tolerated and the most frequent adverse effects being voice changes or hoarseness and a feeling of weight on the chest. Other reported side effects included tingling, headaches fatigue, fatigue, and changes to swallowing or speech. Some of these happened more often in the higher dose groups, whereas others were seen at all doses. The frequency of AEs was similar to those seen in other studies, and were typically eliminated by the end of the acute study period.Psychiatrists from Ohio State Wexner Medical Center are regularly invited to take part in national discussions on the best way to treat depression and other mood disorders. Our experts are helping to shape national standards of health care. We are also a site for an international clinical trial, called RECOVER which is being conducted by the Centers for Medicare & Medicaid Services. The aim of this study is to examine VNS for treating resistant depression. This is a crucial research endeavor, since the evidence available today suggests that VNS could provide better benefits and hope for this difficult to treat chronic population.Electroconvulsive Therapy (ECT)ECT is a highly effective treatment for depression that doesn’t improve by taking medication. It is particularly helpful for people who are suicidal or can’t wait for their medication to start working.During the ECT procedure doctors send tiny electric currents through the brain to deliberately cause a brief seizure. The result is that the brain changes chemistry, and improve symptoms of some mental health issues. ECT has been used since the 1930s. Despite the stigma associated with the treatment it has helped a lot of people.Your doctor will first have to conduct a thorough psychiatric evaluation before recommending ECT. They will then go through your medical records and conduct a series tests, including an electrocardiogram, blood tests, and perhaps an X-ray of your chest. They will ask you how you think about ECT, and take into account any opinions from family members, friends, or advocates who are speaking on your behalf.The ECT procedure is performed under general anesthesia. This means that you won’t feel any sensation. A mouth guard protects your teeth, while a mask covers your face to provide oxygen. The anesthesiologist will inject an the anesthetic via a needle into your vein. After you fall asleep, electrodes will be placed on either one side or both of your head depending on whether you’re receiving unilateral or bilateral ECT. They send small electrical impulses to the brain that cause brief seizures. It only lasts 20 to 60 seconds and you awaken within a few minutes after it’s finished.You are able to revoke your consent to ECT at any time, even before the first treatment. You are entitled to revoke your consent under the Care Quality Commission (CQC) and your doctor should always take your preferences into consideration when deciding whether or not to make use of ECT.Some people find ECT is a good option after having tried other treatments and failed to see improvement, but it is also a viable option for mild depression or severe psychosis, or when you are at risk to yourself or others and you are unable to wait for medication to begin working. In most cases, you’ll need to take several ECT sessions over three to six weeks.Light therapyLight therapy helps to compensate for the absence of sunlight. This is a factor that could cause seasonal affective disorder (formerly known as major depression). It is utilized as a stand-alone treatment or as an addition to other treatments, like psychotherapy or medication. When you undergo light therapy you sit in front of a light box that emits white light with bright colors. The light usually has between 10,000 and 2,500 in lux. Each session, you’ll be sitting for 30 minutes at the lamp. The light may help improve your mood and ease other symptoms of SAD that can be a problem, like being tired all the time and sleeping too much.Researchers aren’t aware of how light therapy treats 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 alter your internal clock by influencing the release of melatonin, an ingredient that regulates the sleep-wake cycle. It can also affect neurotransmitter functions through the alteration of production of serotonin.Several studies have shown that light therapy improves depression symptoms and boosts the effectiveness of antidepressant drugs. In depression treatment for adults , some studies have shown that light therapy is effective in treating bipolar disorder. These results are encouraging and they suggest that light therapy could be an option for those with depression and bipolar disorder.Speak to your physician or a mental health professional prior to you begin using light therapy. They can help you find the appropriate device for your needs and offer guidance on how to utilize it. They can also tell you whether it interacts with any other medications you are taking.Light therapy is a secure treatment that does not cause serious adverse side negative effects. However, you should use it as prescribed by your doctor. If you’re suffering from severe depression, it is important to get treatment immediately. Depression is a serious illness that can cause serious consequences on your mental and physical well-being. In severe cases, it can even cause thoughts of suicide. If you are experiencing suicidal thoughts, seek assistance immediately from an expert in mental health.