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Brain Stimulation for Treatment-Resistant Depression

There's another very different approach to tackling treatment-resistant depression: electrical stimulation of the brain. Doctors have long known that using electrical impulses can sometimes relieve the symptoms of depression.

Some of these approaches have been around for decades, such as ECT, which was once called electroshock therapy. Others are cutting-edge and only in clinical trials now. Here's a rundown of the various approaches for treatment-resistant depression.

ECT (electroconvulsive therapy). ECT uses electrical impulses to trigger a controlled seizure in the brain. It's generally reserved for severe or life-threatening cases of depression where nothing else has helped. But it works well and takes effect much faster than medication.

If you're considering ECT, Cook advises that you go to a specialty center if possible. ECT can result in memory loss and confusion, which may take a few weeks or months to clear up. You might get better results with health care professionals who do the procedure regularly.  

TMS (transcranial magnetic stimulation). This approach was approved by the FDA in 2008 for treatment-resistant depression in people with severe depression. Using an electromagnet, your doctor sends bursts of energy to specific parts of the brain.

TMS has some advantages over other electrical stimulation treatments. It's done on an outpatient basis -- usually four to five sessions a week for four weeks. You could get it right in the doctor's office; the doctor just holds a small device against your scalp. It's painless, doesn't require surgery, and has few side effects and risks. Some insurance plans will cover TMS treatments if a person is diagnosed with severe major depressive disorder, and Medicare programs in some eastern and southern states recently began covering the therapy.

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. 

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