One of the chapters in my new book Managing the Depression Puzzle is focused on somatic treatments for depression, which involve the application of energy to the brain. These types of treatment are used less commonly than medications or therapy, but they do have a role to play, particularly when it comes to treatment-resistant depression.
Out of this group of treatment, electroconvulsive therapy (ECT) is probably the most recognized. It involves the application of an electrical stimulus to induce a seizure. This is done under anaesthetic, and a muscle relaxant so there’s no visible seizure activity. ECT is very effective, and it starts to work much faster than antidepressants do.
The most problematic side effect is memory loss. Some people receiving ECT have no memory loss, while for others it can be quite significant.
I did a guest post recently on Renard’s World that went into greater depth about ECT.
Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) involves applying a magnetic field across the brain to stimulate certain structures under the surface. It has been growing in popularity in recent years. It has demonstrated effectiveness in both bipolar and unipolar depression. It’s considered to be less effective than ECT.
Treatments are done 5 days a week for a period of 6 weeks. Unlike ECT, no anaesthetic is required, so there are no restrictions in activity following the treatment.
Deep brain stimulation
Deep brain stimulation (DBS) is done using electrodes that are surgically implanted into the brain and connected to a stimulator device implanted below the collarbone. DBS is most often used in Parkinson’s disease, and while there is some evidence of benefits in depression, it hasn’t been used enough to get a really clear picture of its effectiveness.
Transcranial direct current stimulation
In transcranial direct current stimulation (tDCS), electrical current is passed through electrodes placed on the scalp. Treatments are performed daily over a period of several weeks. It’s been used in a number of conditions in addition to depression, but overall there hasn’t been a lot of research, and results have been mixed in depression,.
Vagus nerve stimulation
The vagus nerve is a major nerve that runs through the neck (but not the spine). Vagus nerve stimulation is done by connecting lead wires to the vagus nerve in the neck. Those lead wires are connected to an impulse generator that’s implanted below the collarbone. It takes months to see a therapeutic effect, and side effects are common, so understandably it’s not used very commonly.
While none of these somatic treatments are going to be a go-to right out of the gate, they do provide some extra options to consider. TMS is something I’m guessing will continue to grow in popularity. Where I live, TMS isn’t covered by the provincial medical plan or most extended health insurance plans. Hopefully, that will change in the near future, as it really should be more widely available.
Do you have experience with any of these treatments?
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