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Treatment-Resistant Depression: Your Continuum of Care

Brain Stimulation for Treatment-Resistant Depression continued...

What are the disadvantages? While studies show that TMS can help, it has not been proven to be as effective as ECT in controlling depression. Researchers are still trying to sort out who might be most likely to benefit from it. As of now, they believe that  TMS might work best in people with moderate symptoms who have only had one unsuccessful round of treatment with an antidepressant. 

VNS (vagus nerve stimulation). This approach began as a treatment for epilepsy, but it's since become an approved treatment for resistant depression. A surgeon implants a small device -- like a pacemaker -- in your chest. It's connected to some wires that run under the skin and up to the vagus nerve in the neck. Once switched on, the device sends regular pulses of electricity to the nerve.

While there was a lot of initial excitement about VNS for treatment-resistant depression, Cook says the enthusiasm has faded. VNS requires surgery, which always poses some risks. And while studies have shown that it can help, it seems to work only in a minority of people. As of now, insurance companies generally don't cover VNS therapy unless it is used to treat seizures.

Experimental treatments. Researchers are looking at other methods of using electrical stimulation for treatment-resistant depression. Deep brain stimulation has shown promising results in early studies, but it requires surgically implanting electrodes in the brain. MST (magnetic seizure therapy) triggers a controlled seizure in the brain. The hope is that it will have some of the benefits of ECT but with fewer side effects.

These treatments have not been approved for treatment-resistant depression. If you’re interested in trying them, talk to your doctor about joining a clinical trial.

Recovering From Treatment-Resistant Depression

By definition, treatment-resistant depression is hard to control. And the more treatments you try that don't help, the more you might despair. You might have seen other people -- relatives, friends, or co-workers -- go through a depression and snap back after a couple of months. Why is it so different for you?

But experts say that while you might have a tough case, lots of other people do, too.

"People who don't respond to an antidepressant sometimes jump to the conclusion that they're doomed," says Cook. "But that's not true at all, and their depression is coloring their outlook."  In fact, the majority of people who are depressed don't get better with the first prescription. The key is to stick with treatment and to keep trying.

"When I see new patients with treatment-resistant depression, I tell them that if they want to borrow some of my optimism, they're welcome to it," says Cook. While they might have lost hope, Cook says that he's seen many people who were just as depressed recover.

"Despite how it feels, lots of people have been through this," says Cook, "and lots of people get better."

Reviewed on May 02, 2011

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