Depression_4Depression affects the quality of life and can even lead to suicidal thoughts, suicide attempts or even actual suicide. It is very different from an occasional feeling of sadness and feeling blue that usually pass in some time. While there may be specific reasons for depression like physical or psychological stress or illness, or hormonal problems (especially in women), clinical depression has specific causes and parameters that the psychiatrist uses to diagnose depression.

According to statistics released by CDC in 2012, one in ten American suffered from depression. Depression is also most prevalent in people between the ages of 45 and 64 and affects more women than men. Percentage wise, depression increases by 20 percent every year and often goes untreated.

When depressive patients do seek help, they are usually prescribed one of many from a host of anti depressant oral drugs. These drugs work in different ways and include common remedies like Budeprion, Amitriptyline, Celexa, Desipramine, Effexor, Nardil,  Prozac, Tofranil, Wellbutrin among others. While there are many medicines and psychotherapies to treat depression, sometimes nothing works because there are some people who suffer from drug resistant depression. Many depression drugs also cause numerous side effects and often patients try one medication after the other in the quest for something that will work. They try all kinds of medications and therapies, but don’t feel any better. Now there are different electrical treatments that do not involve oral medication and offer hope to these patients.

What is rTMS is and how does it work

The treatment is repetitive transcranial magnetic stimulation (rTMS) that is approved by the authorities in the U.S. and in Europe. An electromagnetic coil isolated by a plastic shell and a white fabric cap are placed on the patient’s head usually on the left dorso-lateral prefrontal cortex or another area, depending on where the stimulation is needed. A current passes through the coil and generates a magnetic field that passes through the skull and soft tissue. This causes neuronal polarization and depolarization and helps with depression. The patient simply feels a tingling sensation at the time when the stimulation occurs.

Treatment is needed for half an hour daily, five days a week for three to six weeks. There are no procedures to undergo, no anesthesia or drip given, as it is a non-invasive treatment. Those patients who benefit from this treatment may need a further once a week or fortnightly maintenance sessions for more lasting effects.  More studies are underway regarding the efficacy of this treatment and a trial is currently recruiting.

Another electric treatment

Helen Mayberg, a neurologist at Emory University in Atlanta in the United States, and her team have researched deep brain stimulation devices (DBSD) that are implanted in the brains of patients of depression and bipolar disorder. These deliver stimulation constantly and the effects have been very encouraging: 92 percent of the patients treated by this responded to the treatment while 58 percent appeared to be in complete remission.

However, the study featured only 17 participants. A study with more participants is currently ongoing and results should be out in 2014. The treatment is not yet approved and can only be undergone by a patient who is enrolled in a clinical trial. There is no clarity on the mechanism of action of this device Mayberg says, ‘Either an abnormal signal is on and DBS turns it off, or a normal signal is being sent but not received, and DBS helps that information go through. I’m inclined to think it’s a combination of the two, that DBS cancels the depressive “noise,” but also enables the rest of the brain to do its thing.’

Trigeminal nerve stimulation (TNS) for depression

A clinical trial led by Dr. Ian A. Cook, the Miller Family Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA in 2010 showed that TNS achieved a 70 percent reduction in symptoms of depression and 80 percent patients went into remission.

The trigeminal nerve stimulator is a device with two wires from the device connected to electrodes attached to the forehead by adhesive. The electrodes transmit electrical currents that send signals to the nerves in the brain. All the patients in the trial used the device for approximately eight hours every night while asleep so the treatment is easy to undergo. It may be possible to have electrodes implanted under the skin and used as required instead of using fresh electrodes daily.

More trials are underway and recruiting.

How the brain works is still not understood very well, and that is why researchers, too, look at many different approaches to treat or mitigate depression that is a mental disorder. Whether it has a chemical etiology, is internal brain signal issue or is purely a psychological problem is still not known.

U.S. National Institutes of Health
American Psychological Association

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