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Advanced Depression Treatment If your depression isn't responding to a first-line antidepressant your doctor might suggest increasing the dose or adding another type of medication. They may also recommend psychotherapy. Newer psychotherapy methods like augmented depression therapy have empirical support and can aid in reducing depression symptoms. These treatments concentrate on identifying and solving the specific ways that depression interferes with your daily routine. Transcranial magnetic stimulation (TMS) TMS is a noninvasive brain stimulation that uses magnetic pulses to stimulate the brain's neurons that control mood. It is usually prescribed to treat depression if medication fails or is not appropriate for the individual. It is used to treat PTSD, and is sometimes combined with psychotherapy. TMS is a safe and safe treatment that has no adverse negative side negative effects. During the session, a healthcare professional will position an electromagnetic coil on your scalp to the region of the brain that controls mood. In the case of rTMS, this is called the dorsolateral frontal cortex (dLPFC). It is a tiny region situated in front of your brain. The device sends electrical impulses to your brain. You will hear clicking sounds and feel a tingling sensation. The healthcare expert will adjust the settings to stimulate the desired areas of your brain. The healthcare professional will determine the amount of energy needed to trigger the thumb to flick. This is important as it helps them to know how much power they're using and ensures the security of the patient. In the past, the pulses were delivered at 120 percent of the threshold of motor. But, current research is focusing on speeding up TMS treatment to decrease the treatment length and improve response rates. Researchers have demonstrated in a randomized controlled study that TMS can be used to assist people suffering from MDD who are not responding well to antidepressants. The study found that patients treated with rTMS saw significant improvement in symptoms like depression and sadness, as well as changes in appetite, and a loss of enjoyment or enthusiasm for activities. The study also showed improvements that lasted for a long duration. In contrast to other types of brain stimulation like vagus nerve stimulation or electroconvulsive therapy, TMS does not interfere with psychotherapy. It is safe for women who are pregnant and has a low risk of seizures. However, some people can experience pain or discomfort on the scalp beneath the magnet during treatment. TMS treatments usually last around 30 minutes. The provider will inform you what the duration of the treatment will be and may pause the pulses during this time to allow the magnet to cool down. Vagus Nerve Stimulation (VNS) VNS (also called Vagus Nerve Stimulation) is an approach that utilizes timing of electrical signals to change brainwave patterns and reduce depression symptoms. This device is surgically implanted and uses tiny generators that are connected to a wire that is wound around the left Vagus nerve at the neck. The procedure has been FDA-approved for treating depression that is resistant to treatment in patients who have not received relief from other treatments, such as psychotherapy or medication. It is also approved as a seizure treatment option for those suffering from epilepsy. Researchers evaluated the effectiveness of VNS with a sham-device in patients suffering from bipolar disorder or unipolar disorder that is resistant treatment. depression. The VNS group was given moderate, low, dose, or high dose of electrical stimulation over a period of 22 weeks. The primary endpoint was the changes in the Inventory of Depressive Symptomatology (IDS-SR30). Patients in the VNS group showed improvement significantly more than those in the group with a sham. After a 12-month follow-up patients in the VNS group had an average IDS-SR30 score of 9.3 points, while those in the sham group scored 4.2 points. The VNS treatment was well-tolerated. The most frequent side effects were voice distortion hoarseness and a sensation on the chest. Other reported side effects included headache, tingling fatigue, fatigue, and changes in swallowing or speech. Some of these side effects were observed more frequently in the higher dose groups while others were seen at all doses. The frequency of AEs in this study was comparable to previous studies and usually resolved by the end the acute study time. Psychiatrists from Ohio State Wexner Medical Center are regularly invited to take part in national discussions on the best approach to treat depression and mood disorders. Our experts are helping to define national standards for health treatment. We are also a site for an international clinical trial, called RECOVER which is being conducted by the Centers for Medicare & Medicaid Services. The aim of this study is to assess VNS for treating resistant depression. This is a crucial research project, as the evidence available suggests that VNS may offer a better treatment for this chronically ill population. Electroconvulsive Therapy (ECT) ECT is a highly effective advanced depression treatment for people who don't get better on their medications. It's particularly helpful for those who are suicidal or unable to wait for their medication to kick in. During the ECT procedure doctors send tiny electric currents through the brain to trigger an instant seizure. This is believed to alter brain chemistry, and improve symptoms of certain mental health issues. ECT has been in use since the 1930s, and despite the stigma associated with the treatment, many people have seen positive results from it. Your psychiatrist will need to conduct a thorough psychiatric assessment before suggesting ECT. They will then review your medical history and do various tests that include an electrocardiogram (EKG) and blood tests, and possibly an X-ray of your chest. They will also ask you about your thoughts about having ECT and will consider any opinions from family members, friends or advocates who are supporting or speaking on your behalf. The ECT procedure is done under general anesthesia so you won't feel any sensation. A mouthguard protects your teeth, while masks protect your face to supply oxygen. An anesthesiologist injects a local anesthetic into your vein using needle. After you fall asleep, electrodes are placed on one side or both sides of your head based on whether you are receiving bilateral or unilateral ECT. These electrical pulses send tiny impulses to the brain, which triggers an instant seizure. It only lasts 20 to 60 seconds, and you awaken soon after it's over. It is important to keep in mind that you are able to revoke your consent to ECT at anytime, even prior to the first treatment. You have a right to withdraw your consent under Care Quality Commission (CQC) and your doctor should always take your preferences into consideration when deciding whether or not to use ECT. Some people find ECT is a viable option for them after they've tried other treatments and haven't seen any improvement. However, it is also a viable option for mild depression or severe psychosis or when you are at risk to yourself or others and can't wait for medication to begin working. The majority of people have to attend multiple ECT sessions spread out over three to six weeks. Light therapy Light therapy is a way to compensate for the lack of sunlight, which can contribute to major depression disorder that has seasonal patterns (formerly known as seasonal affective disorder). It can be used as a standalone treatment or in conjunction with other treatments such as psychotherapy and medications. When you undergo light therapy you sit in front of a light box that emits white light that is bright and bright. The light is usually between 10,000 and 2,500 lux. During each treatment session, you sit for about 30 minutes in front of the light source. The light can improve your mood and alleviate symptoms of SAD such as being constantly tired and sleeping excessively. Researchers don't yet know what the effects of light therapy on SAD. However, they are aware that it can have an impact on the circadian rhythms. Circadian rhythms are biological cycles that influence sleep patterns hormone levels, as well as other important functions. Light therapy can alter your internal clock by altering the release of melatonin, a chemical that regulates the sleep-wake cycle. It can also impact neurotransmitter function by affecting the production of serotonin an ingredient that boosts your mood. holistic depression treatment of studies have proven that light therapy can help improve depression symptoms and increase the effectiveness of antidepressant medication. In addition, a few studies have found that light therapy is effective in treating bipolar disorder. These results are encouraging, and they suggest that light therapy may be an option for those with depression and bipolar disorder. Before you start using light therapy, consult your physician or a mental health professional about it. They can guide you in choosing the right device and give you guidelines on how to use it. They can also let you know whether it is incompatible with other medications that you're taking. Light therapy is a safe treatment that doesn't cause serious side effects. It is best to only take it if your doctor prescribes. If you are experiencing severe depression, it's important to get treatment immediately. Depression is a serious disease and it can result in serious consequences for your physical and mental well-being. In extreme cases, depression may cause suicidal thoughts. If you're having suicidal thoughts or feelings, seek help immediately from a mental health professional.