Newer Approaches - Treating Depression: Depression
Content provided by the Faculty of the Harvard Medical School
Newer approaches
Two newer treatments are geared toward people who haven't responded well to other, more traditional approaches. While they are somewhat similar to ECT, in that they rely on delivering impulses (electrical or magnetic) to achieve results, neither has the proven track record of ECT.
Vagus nerve stimulation
In the summer of 2005, the FDA approved a device known as a vagus-nerve stimulator as a treatment for adults with depression who haven't responded to four or more other therapies. Extending from the brain through the chest cavity, the vagus nerve helps control your breathing and is linked to the amygdala, hypothalamus, and other parts of the brain that modulate mood and anxiety. A vagus-nerve stimulator is a surgically implanted device similar to a pacemaker that delivers a small electrical impulse to this nerve for about 30 seconds every five minutes. Although vagus nerve stimulation (VNS) was initially developed as a method for controlling epilepsy, researchers found that it improved mood in some people.
The FDA based its approval on research showing that VNS was safe and effective. One study cited in the FDA approval documents showed that 31% of people getting VNS responded well to the treatment in the first 12 weeks of therapy and 45% did after one year. The most common side effects are cough and neck pain. Many people also find that their voice often becomes hoarse while the stimulator is delivering its impulse. Between impulses, though, the person's voice returns to normal.
Although the VNS device is on the market, VNS is a relatively untested treatment that has not yet been proved effective by randomized, controlled trials. For this reason, the consumer group Public Citizen petitioned the FDA not to approve it. The FDA has mandated that Cyberonics, the company that makes the device, conduct studies to monitor its effectiveness. For the most part, this treatment should be reserved for exceptional cases where many other therapies have been tried without success.
Repetitive transcranial magnetic stimulation (rTMS)
Another treatment for people whose depression has not responded to traditional therapy, called repetitive transcranial magnetic stimulation (rTMS), is also being tested in several centers. During rTMS, a donut-shaped wand passed along the surface of the scalp focuses magnetic pulses on a small part of the brain. This technique isn't invasive and doesn't cause seizures or require anesthesia, as ECT does. A person undergoing rTMS can sit comfortably in a chair and remain awake during the whole procedure, which takes 30–45 minutes. Usually, it is done once a day for 10 days.
Although results in trials are still inconsistent, the news from what now amounts to a large number of controlled studies is getting better. For example, in one study, using rTMS at different frequencies on different areas of the brain improved depression in people who had not responded to drugs. Researchers have also found weekly rTMS helpful to adults with bipolar disorder who are taking lithium.
What if my depression doesn't go away?Until doctors have a way to test people ahead of time to see which treatment will work for each individual, finding the right approach is a matter of trial and error. For some people, that process may be quick and simple: The first treatment used is successful, or only some minor tweaking of medications or dosages is needed. But for others, it takes a good deal of patience and willingness to try several different approaches before an effective treatment is found. What might be a typical course of treatment if your depression doesn't respond well to the initial choice? If the first medication you try doesn't work after 6–12 weeks of treatment, your doctor may increase your dosage. If that doesn't work, he or she may suggest that you switch to another drug in the same class or a drug in a different class. Your doctor may also recommend adding psychotherapy if that hasn't been part of your treatment plan. If you still don't respond to these therapies, your doctor may prescribe an additional medication, such as lithium, to be taken with the antidepressant. The next step may be trying ECT or light therapy. Newer therapies, such as vagus nerve stimulation or magnetic stimulation, are other options for you and your doctor to discuss. Having to go through all of these steps may sound discouraging, but finding the treatment that works for you will be worth the effort. Also, keep in mind that there are some things you can do to improve your chances for success, including making sure you take medication as directed and keeping up with therapy appointments (see "Sticking with treatment"). |
| Last updated: | January 23, 2007 |
|---|
Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
This information is not intended to replace the advice of a doctor. By using AOL Body, you indicate that you have read, understood, and agreed to our Terms of Service, Use of Content Agreement and AOL Body Advertising Policy. Read more about our content partners.
Search
Related Articles
Where Does it Hurt?
If you're experiencing aches and pains we can help you find answers. Find out what your symptoms mean for your health.
