- Mental Health
Depression: Treatments Beyond Medication for Severe Depression
Part II of Depression Treatment Without Medication
Note: Depression is a serious medical condition. This article is for entertainment purposes only and not meant to replace any advice or treatment from your health care providers.
In Part I, we’ve been talking about people with significant depression who are none the less able to function with outpatient treatment and probably haven’t tried and failed multiple drugs and drug combinations. But what if you are someone who is on a lot of medication and still having severe depression symptoms? Do you have any options? Yes, you do. You may benefit from adding some of these treatments to your regimen, probably while continuing some of your other treatments.
The first and best option is electroconvulsive therapy (ECT). Sometimes know as “shock therapy” this very effective treatment unfortunately gets a very sensationalized treatment in popular culture such as the movies. The reality is much more mundane; patients are given anesthesia and a drug to paralyze the muscles, and then someone presses a button to send an electric current briefly through the head, inducing seizure activity in the brain—very boring to watch however as the person's body doesn't react. ECT is safer than medications for pregnant women and people with certain medical conditions, but it does have some side effects. You will definitely have a headache after each session and some confusion/memory loss for the period right around the treatments. Some people feel they can also have longer term memory loss, but this is a difficult question to investigate—right now pick a random month in your life from ten years ago where nothing happened—how much do you remember?
ECT is usually given in 8-15 treatments at a rate of 2 to 3 times a week. It can be done as an outpatient, but it will still suck up all your time and energy while the treatments are taking place.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Magnets! In rTMS a powerful magnetic field is pulsed through your brain for about 40 minutes a day, usually about 5 days a week for three weeks. It’s a somewhat cumbersome device—you sit in a dental-type chair with your head in one place with the “coil” held up against it. You don’t need anesthesia or seizures, but it is still obviously time consuming. Sending a magnetic current through your head does have risks; headaches are common, seizures can happen occasionally.
Vagus Nerve Stimulation
Approved for treatment resistant depression by the FDA in 2005, VNS involves implanting a pacemaker like device in your upper chest area with wires that are run up to the neck where the surgeon makes another cut and wraps them around your left vagus nerve there. It’s surgery, but usually can be done as a same day outpatient procedure. A non-invasive stimulator has been developed recently but doesn’t seem to be used for depression yet. After it’s turned on, the device sends regular stimulating pulses to the vagus nerve. Side effects can include hoarseness (common) and also sleep apnea. Why does it sometimes help with depression? No one really knows.
Deep Brain Stimulation
Now this is serious stuff. In deep brain stimulation a set of electrodes attached to a power source are implanted in your brain and when activated send electrical pulse to the areas in which they are implanted. This is used only on very severe cases, and although results have been mixed, some people have had remarkable improvements.
Anterior Capsulotomy/Anterior Cingulotomy
Most people don’t realize that the infamous “lobotomy” of the past was originally designed to treat sever anxiety and depression. Neurosurgery and our understanding of the brain as advanced since those days, so now some people with intractable anxiety (especially obsessive compulsive disorder) and depression may elect to have only certain much smaller brain areas destroyed to relieve symptoms.
Cost: For treatments such as ECT, VNS, DBS and so on… if you have to ask….For US residents this is a health insurance matter, and for other countries something that you would probably have to get through your national health system, unless you are significantly well-to-do.
In summary, there are many treatments for depression that have studies showing they are effective besides medications. Which treatment and whether it involves medication or not is right for you would depend on your particular needs and symptoms.
Check out part I Depression Treatments Beyond Medication (Mild to Moderate Depression)