Researchers are working on new approaches to treatment-resistant depression. They offer hope to people who haven't been able to relieve their depression with traditional methods. Currently, some of these approaches are available for people with depression only through research studies.
Here are some of the newest advances for tackling treatment-resistant depression.
If you’ve ever taken an antidepressant, you know that the first several days or even weeks can be rough. Antidepressants take time to work and some can cause unpleasant side effects like dizziness, nausea, sweaty palms, and diarrhea. When you put all that together, you may start to doubt the value of a medication that takes a month to make you feel better.
Chances are good that you will feel better, eventually. If your response to medication is inadequate after 6-8 weeks, talk with your doctor about...
Transcranial Magnetic Stimulation (TMS, or rTMS) sends bursts of energy -- from electromagnets -- to specific areas of the brain. This treatment is thought to affect nerve cell communication in the brain that may play a role in depression.
The procedure is fairly simple and can be done in a doctor's office. It was approved by the FDA as a standard (nonexperimental) treatment for depression in October, 2008. The TMS device itself has two parts: an insulated wire coil (that can look like a paddle) and a box that supplies the power. During the procedure, the doctor or a technician will place the "paddle" against your scalp. The specific area of your scalp depends on what part of the brain your doctor is trying to affect. When switched on, the wire coil creates a magnetic field that can painlessly penetrate your brain. This magnetic field excites the targeted brain areas. Sessions often last about 30 minutes. You might be treated 5 days a week for 4 to 6 weeks.
While more research needs to be done, TMS seems to have few risks and side effects, and it doesn't require hospitalization. Some people feel muscle contractions in the scalp. Rarely, TMS causes headaches or dizziness. But no evidence suggests that it affects the memory, like electroconvulsive therapy (ECT) sometimes can. However, TMS is a different treatment than ECT and has not been shown to have comparable efficacy to ECT. TMS could cause a seizure, but experts say that's very unlikely with a risk of about 1 in a thousand people.
Magnetic Seizure Therapy (MST) is an experimental procedure that uses strong magnetic fields to trigger a controlled seizure in the brain. The effects are similar to those of ECT. For reasons that doctors don't entirely understand, these seizures can relieve the symptoms of depression rapidly. MST requires a stay in the hospital. During the procedure, you would need to be under general anesthesia. Doctors hope that because the stimulation can be more accurately targeted than ECT, it may have less of an effect on memory.
Deep Brain Stimulation (DBT) is an invasive surgical procedure in which electrodes implanted in specific brain areas deliver a targeted electric current to relieve the symptoms of depression. It is already used as a treatment for Parkinson's disease. The electrodes that are surgically implanted in certain regions of the brain are powered by a battery pack implanted in the chest or abdomen. While there has so far been only very limited research on this approach for treatment-resistant depression, the limited results have been promising. A randomized controlled trial of DBS in 25 patients with treatment-resistant major depression, published in JAMA Psychiatry in 2016, reported a 40% positive response rate.
While these new treatments are exciting, most are still experimental. Doctors aren't sure yet how well they work long term or what the effects will be. But if you're interested in trying one, talk to your doctor about signing up for a clinical trial.
American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000.
Avery, D.H., "A Controlled Study of Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Major Depression," Biological Psychiatry, August 31, 2005.
Cadieux, R.J. American Family Physician, December 1998; vol. 58: pp. 2059-62.
Depression and Bipolar Support Alliance web site, "Finding Peace of Mind: Treatment Strategies for Depression and Bipolar Disorder," "New Technologies in the Treatment of Mood Disorders."
Fochtmann, L.J. and Gelenberg, A.J. Focus, Winter, 2005; vol 3: pp 34-42.
Holtzheimer, P.E. et al., "Focal Brain Stimulation for Treatment-Resistant Depression: Transcranial Magnetic Stimulation, Vagus-Nerve Stimulation, and Deep-Brain Stimulation," Primary Psychiatry, February 2005; vol 12: pp 57-64.
Keller, M.B., Journal of Clinical Psychiatry, 2005; vol. 66 (supp. 8): pp 5-12.
Mayberg, H.S. et al., "Deep brain stimulation for treatment-resistant depression," Neuron, March 3, 2005; vol 45: pp 651-660.
Stanford, A.D."Magnetic Seizure Therapy and Other Convulsive Therapies," Primary Psychiatry, October 2005; vol 12: pp 44-50.
Stimmel, G., "Options for Treatment-resistant Depression," Psychiatric Times, July 2002; vol 19.