Transcranial Magnetic Stimulation (TMS)
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 necessarily 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 4 or 5 times a week for 4-6 weeks.
Research hasn't shown whether TMS works best alone or combined with medication. It also has not been shown to be as effective as ECT for major depression. 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)
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 are thought to stimulate 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.
Alternative Treatments for Depression
Some people use herbs, supplements, and other alternative treatments for depression. None of these approaches has been conclusively proven to work. Supplements -- like SAMe and St. John's wort -- can have side effects and cause interactions with other medicines. Never start taking a supplement without talking to your doctor first.
Other alternative treatments -- like acupuncture, hypnosis, and meditation -- may help some people with their symptoms. But they haven't been proven to be as effective as traditional medication treatments. Since they have few risks, you might want to try them, provided that your doctor says it's OK.