Treatment Options for Depression: Part 2

Welcome and thanks for coming back for part 2 of our discussion of Treatment Options for Depression. The recent, apparent suicide of Robin Williams has generated a lot of interest and discussion regarding depression and what can be done about it. Yesterday we looked at the current mainstream treatment protocols for depression and today we’ll discuss some secondary, but still highly effective treatments. At first these may seem a little radical, but keep in mind that these protocols are used only when the depression is extremely severe and other treatments have proven less effective than desired.
This blog was originally posted on my website on 5/23/13:

Depression: Treatment and Options – Part 2

Welcome to the third part in our series on Depression: Treatments and Options. Yesterday we discussed the two most common, first-line treatments for depression; psychotherapy and antidepressant drugs. Today we’re going to shift our focus to what might seem more radical forms of treatment; however, let me say at the outset that all these treatments have been thoroughly researched and found to be safe and highly effective.
The first, and the one most widely misunderstood and reviled by the general public is Electroconvulsive Therapy (ECT), also known as electroshock therapy. Nowadays when most people hear ECT they immediately think of “Mac” McMurphy, and Nurse Ratched from One Flew Over the Cuckoo’s Nest; unfortunately, nothing could be farther from the truth regarding ECT.
ECT is generally used when severe depression is resistant to other forms of treatment, or if the patient poses an immediate and significant threat to themselves or others. During ECT, a doctor administers a brief electric current into the brain while the patient is under sedation, inducing a brief seizure. ECT is highly effective at treating depression.
It is important to note that the patient is under general anesthesia and then given a muscle relaxant. Because the muscles are relaxed, the seizure is usually limited to slight tremors in the hands or feet. Patients are carefully monitored during the treatment and wake several minutes later with little or no memory of the procedure. The patient is often confused, but this confusion typically lasts for only a short period of time. A normal course of ECT usually consists of three treatments per week for two to four weeks.
Another highly effective and widely misunderstood treatment option is Transcranial Magnetic Stimulation (TMS). It’s the least invasive of the brain stimulation techniques used in drug-resistant depression.
Unlike ECT which 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 TMS electromagnetic coil, is placed against the scalp near the forehead, sending pulses that stimulate nerve cells in the brain’s prefrontal cortex.
TMS does not require the patient to be sedated and is usually done on an outpatient basis. A normal course of TMS consists of four or five sessions per week for up to six weeks.
Yet another “non-traditional” treatment which is gaining popularity (at least in medical circles) is Vagus Nerve Stimulation (VNS). Unlike the other treatment options we’ve discussed VNS is an invasive surgical procedure where a small pacemaker-like device is implanted in the chest and a wire is run to the vagus nerve in the neck. The device then sends regular pulses of electricity into the nerve thereby regulating the patient’s mood. The actual way this procedure works is not fully understood, but the most widely accepted hypothesis is that the current helps regulate norepinephrine release in the brain.
Ok, now for the controversial one; Ketamine therapy. Let me begin by stating clearly that I am not endorsing or recommending ketamine for the treatment of depression, but rather informing you of recent and highly promising studies which tend to indicate that Ketamine may become the newest and most exciting intervention for severe, treatment-resistant depression in decades. An informed consumer is a powerful consumer.
Ketamine is an anesthetic (and unfortunately an increasingly popular party drug). Several studies have shown that when administered intravenously, patients had significant relief, (in some cases total elimination) of their depression in as little as one hour. Data across the studies are fairly consistent, indicating 63.8 percent effectiveness for Ketamine as opposed to a 28 percent effect for the placebo. The problem with Ketamine is that it is a short-acting drug which must be administered regularly to remain effective. However, preliminary data from a new study indicate that patients taking a couple of puffs from an asthma-like inhaler once every three to five days maintain the antidepressant effects of the drug.
I have one more blog on treatment options for depression up my sleeve. This one involves unusual or experimental treatment protocols, but you’ll have to come back on Monday for that one.
In the meantime, have an intentionally great and happy day.
Rich

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