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Advanced Depression Treatment If you don't notice any improvement from the first-line antidepressant, your doctor might increase the dosage or suggest another type of medication. They may also suggest psychotherapy. The latest psychotherapy techniques, such as augmented depression treatment offer empirical evidence-based support and could help alleviate depression symptoms. These treatments are focused on identifying and resolving the specific ways that depression affects your daily life. Transcranial magnetic stimulation (TMS) A type of noninvasive brain stimulation, TMS uses magnetic impulses to alter the brain's neurons that are that are responsible for mood. It is often advised to treat depression if medications have failed or are not appropriate for a particular person. It is used to treat PTSD, and is sometimes combined with psychotherapy. TMS is an effective and safe treatment that does not cause serious side effects. During the session, a healthcare professional will install an electromagnetic coil over the area of your brain which controls mood. In the case rTMS this is known as the dorsolateral forefrontal cortex (dLPFC). This is a small area located at the front of your brain. You will hear a click sound and feel a tapping sensation as the device delivers pulses to your brain. The healthcare professional will adjust settings to stimulate desired areas of the brain. The healthcare professional will assess the strength of the pulses by determining how much energy is required to induce an itch in the thumb. This is important as it allows them to determine how much power they're using and to ensure the safety of the patient. In the past, pulses were delivered 120% of the motor threshold. However, current research is focusing on speeding up TMS therapy to reduce duration of treatment and increase response rates. In a controlled, randomized study, researchers have shown that TMS can aid people suffering from major depressive disorder (MDD) who are unable to respond to antidepressants. The study showed that patients who were treated with rTMS saw significant improvements in symptoms such as sadness and low mood, changes in appetite and the loss of enthusiasm or enjoyment for activities. The study also showed improvements that lasted a long duration. TMS is different from other forms of brain stimulation such as vagus nerve stimulator. It does not interfere in psychotherapy. It is safe for pregnant women and has a low chance of seizures. However, some individuals may experience pain or discomfort on the scalp underneath the magnet during the treatment. TMS treatments usually last around 30 minutes. The doctor will inform you of how long the treatment is and may stop the treatment to allow the magnet to cool down. Vagus Nerve Stimulation (VNS) VNS (also known as Vagus Nerve Stimulation) is a treatment that makes use of controlled electrical signals that are timed to change brainwave patterns and reduce depression symptoms. This is a surgically implanted device that employs a tiny pulse generator that is connected to a wire that's wrapped under the skin and wound around the left vagus nerve in the neck. The procedure is FDA-approved for people suffering from depression that is treatment-resistant who haven't found relief from other treatments, such as psychotherapy or medication. It is also approved for seizure control in certain epileptic patients. Researchers compared the efficacy of VNS with a sham-device for patients suffering from bipolar disorder or unipolar disorder that is resistant treatment. depression. The VNS group received moderate, low, dose, or high dose of electrical stimulation over a 22-week period. The primary goal was a change in Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score during the course of the study. Patients in the VNS groups had significantly better results than patients in the sham group. At the 12-month check-up the VNS group scored an average IDSSR30 score of 9.3 while the sham group scored 4.2. The VNS treatment was well tolerated. The most common adverse effects were voice changes, hoarseness, and a sensation on the chest. Other reported side effects were headaches, tingling fatigue, tiredness, and changes in speech or swallowing. Certain of these side effects occurred more frequently in higher dose groups whereas others were seen at all doses. The frequency of AEs in this study was comparable to other studies, and they usually resolved by the end the study period of acute. Psychiatrists from Ohio State Wexner Medical Center are frequently invited to participate in national discussions about the best method to treat depression and mood disorders. Our experts contribute to shaping the standards of care for all Americans and are currently a participant for the Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial that will further study VNS as a treatment for treatment-resistant depression. This is an important research study, as the available evidence suggests that VNS may offer a better treatment for this chronically ill population. Electroconvulsive therapy (ECT) ECT is a highly effective treatment for advanced depression for those who aren't getting better with medication. It is particularly helpful for those who are suicidal or can't wait for their medication to take effect. During the ECT procedure, doctors send small electric currents to the brain to intentionally trigger an instant seizure. The brain is reportedly altered by this chemical structure and speedily improve symptoms of certain mental health disorders. ECT has been used since the 1930s, and despite the stigma associated with the treatment, numerous patients have benefited from it. If you are to receive ECT, your psychiatrist will require an extensive psychiatric evaluation. They will then go through your medical records and perform various tests, such as an electrocardiogram, blood tests, and maybe the chest X-ray. They will ask you about how you are feeling about ECT and consider any opinions from family members or friends who are speaking on your behalf. The ECT treatment is performed while you are asleep under general anesthesia, which means you won't feel any pain during the procedure. A mouth guard is used to protect your teeth, while a mask covers your face to supply oxygen. An anesthesiologist injects a local anesthetic into your vein by using a needle. When you're asleep, electrodes will be placed on one or both sides of your head (depending on whether you suffer from bilateral or unilateral ECT). They send small electrical impulses to the brain which cause brief seizures. It lasts for 20 to 60 seconds and you are awake shortly after it's over. It's important to remember that you are able to revoke your consent for ECT at any time, even just prior to the first treatment. This is your right under Care Quality Commission (CQC) regulations and your doctor should always take into account your wishes when considering ECT for you. ECT can be a beneficial treatment option for people who tried other treatments but failed to see any improvement. It can also be helpful those suffering from mild depression, severe psychosis or when you're a risk to others or yourself and can't wait for the effects of medication to take effect. In most instances, you'll have to undergo several ECT sessions spread over three to six weeks. Light therapy Light therapy compensates the lack of sunlight. This is a reason that can cause seasonal affective disorder (formerly known as major depression). It can be utilized as a stand-alone treatment or as an add-on to other treatments, like psychotherapy or medication. In light therapy you are seated next to an illuminated box that emits bright, white light. The light usually has between 2,500 and 10,000 in lux. In each session you are seated for approximately 30 minutes at the light. The light could aid in improving your mood and ease other symptoms of SAD like feeling tired all the time and having trouble sleeping. Researchers aren't sure how light therapy can treat SAD. However they do are aware that it has an effect on the circadian rhythms. Circadian rhythms impact sleep patterns, hormones, and other functions. Light therapy can alter the internal clock of your body by influencing melatonin release, a chemical which regulates sleep-wake cycles. It can also impact neurotransmitter functions by altering the production of serotonin which is a chemical that improves your mood. Numerous studies have demonstrated that light therapy improves depression symptoms and enhances the effectiveness of antidepressant medications. Several studies have also shown that light therapy can be used to treat bipolar disorder. These results are encouraging and suggest that light therapy could be a viable option for those who suffer from bipolar and depression disorder. Before you begin using light therapy, talk to your physician or a mental health professional about it. They can guide you in selecting the appropriate device and provide instructions on how to use it. depression treatment for elderly can also let you know if it interferes with other medications you are taking. Light therapy is a safe treatment that does not cause serious side effects. It is best to only use it if your doctor prescribes. If you're experiencing severe depression, it's important to get treatment immediately. Depression is a serious illness and it can result in serious consequences for your emotional and physical well-being. In severe instances, it may result in thoughts of suicide. Seek immediate assistance from a mental healthcare professional if you have suicidal feelings.