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ECT (Electroconvulsive Therapy) for Depression

This is a safe and effective treatment for people with depression that's resistant to multiple medications. It's typically used on people who haven't been helped by medicines or therapy.

In ECT, the doctor uses a small electric current to cause a brief controlled seizure. A course of ECT-induced seizures, done over a few weeks, seems to affect areas of the brain involved in controlling mood. It may sound scary, but during the procedure, a person receives anesthesia and a muscle relaxant, so they're asleep and won't feel anything.

ECT tends to work very quickly. It also works well -- about 70%-90% of people who receive it show improvement. The most common side effect is temporary memory loss.

You might have up to 12 sessions or more over a few weeks. Some people get further treatment with ECT to prevent depression from returning.

Transcranial Magnetic Stimulation (TMS) for Depression

TMS is another nondrug approach for depression that's mildly resistant to drug treatment. Unlike ECT, it uses an electromagnetic device held to the forehead to induce a much smaller electric current in the region of the brain that controls mood -- without causing a seizure or loss of consciousness.

TMS works best in people who haven't been helped by one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS doesn't require sedation, and is given on an outpatient basis. Side effects, if any, are minimal. They might include discomfort at the site where the magnet is placed and mild headache.

People who get TMS must be treated four or five times a week for 4 weeks.

Research hasn't shown whether TMS works best alone or combined with medication. It's FDA-approved for treatment of depression and is considered safe and effective. A study funded by the National Institute of Mental Health concluded that active TMS treatment for 5-6 weeks seemed to have the most benefit, especially for people whose depression was mildly resistant to drug treatment.

Vagus Nerve Stimulation (VNS) for Depression

VNS is an option for people with severe, treatment-resistant depression. 

It's a surgical procedure that involves implanting a small electrical generator in the chest, like a pacemaker. The device is attached with wires to the vagus nerve, which runs from the neck into the brain. Once implanted, the device sends electrical pulses to the vagus nerve every few seconds. The pulses are then delivered via the vagus nerve to areas of the brain thought to control mood. The electrical charges may change the how well things work in these brain regions and thereby relieve depression. It usually takes at least several months after the procedure until results can be seen.

The device must be implanted by a surgeon, but patients can usually go home the same day.