Electroconvulsive Therapy and Other Depression Treatments
Who Might Benefit From ECT?
According to the American Psychiatric Association, ECT can be beneficial and safe in the following situations:
- When a need exists for rapid treatment response, such as in pregnancy
- When a patient refuses food and that leads to nutritional deficiencies
- When a patient's depression is resistant to antidepressant therapy
- When other medical ailments prevent the use of antidepressant medication
- When the patient is in a catatonic stupor
- When the depression is accompanied by psychotic features
- When treating bipolar disorder, including both mania and depression
- When treating mania
- When treating patients who have a severe risk of suicide
- When treating patients who have had a previous response to ECT
- When treating patients with psychotic depression or psychotic mania
- When treating patients with major depression
- When treating schizophrenia
What Is Transcranial Magnetic Stimulation (TMS)?
While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness. The current is caused by the magnetic field created by an electromagnetic coil that delivers the pulses through the forehead.
Approved by the FDA in 2008 for treatment-resistant depression, TMS works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis. Patients undergoing TMS must be treated four or five times a week for four to six weeks.
Research has shown that TMS produces few side effects and is both safe and effective for medication-resistant depression. However, its effectiveness as currently performed appears to be less than that of ECT.
What Is Vagus Nerve Stimulation (VNS)?
A vagus nerve stimulator (VNS) device was approved by the FDA for adult patients with long-term or recurrent major depression. Some of these patients take seven to 10 drugs at a time and continue to suffer with depression.
How VNS works: The small stimulator is implanted under the skin of the collarbone and runs under the skin to the vagus nerve in the neck. The device emits electrical pulses to stimulate the brain.
What Alternative Treatments Are Used for Depression?
Alternative treatments can sometimes provide relief that traditional Western medicine cannot. While some alternative therapies have become accepted as part of modern health care practice, others still have not been proven safe or effective.
Whether or not they are scientifically proven, alternative therapies, by providing forms of relaxation and relief from stress, may have a place in healing and general health and well-being. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, and massage.
In general, alternative therapies by themselves are reasonable to use for mild but not more severe forms of clinical depression.