Treating depression using Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT).

Understanding depression and your options for treatment

If you are suffering from depression, you will understand how debilitating it is.  It is a complex condition affecting millions of people across the US.  We recognize that thousands of people are suffering from this condition in Colorado and that many are struggling to find effective treatment options.  Of course, pharmaceuticals have their place in the treatment of depression. However, there are ways that you can alleviate the symptoms of depression and improve your quality of life without committing to taking medication.  In this article, we are looking at some of the more advanced options available here in Colorado:  Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT).

Am I depressed or just sad?

We all feel sad sometimes or have an odd bad day.  With depression, however, this sadness deepens and persists over long periods.  This negatively impacts a person’s moods, thoughts, behavior, and physical and mental health.  Over time a person becomes less able to manage daily life or to meet obligations.  Depression can show different symptoms for everyone, but some of the most common ones include:

• Ongoing and persistent feelings of sadness and low mood
• No interest in activities you used to enjoy
• Loss of appetite or overeating
• Not being able to sleep or sleeping too much
• Feeling fatigued, unable to get up in the morning, and generally low in energy
• Not being able to concentrate on tasks or make the most basic decisions
• Loss of libido
• Feeling guilty or worthless
• Thinking about death or suicide

Just as the symptoms of depression are many, so are the causes.  These causes can often be a combination of biological, environmental, social and psychological factors.  Therefore, the treatment must be tailored to meet the needs of each person.  A one-size-fits-all approach is unlikely to be successful.

Treatment for depression

Traditional options

Most people are familiar with the traditional treatment options.  These are mainly based on pharmaceutical cures, talking therapies or lifestyle changes.  Antidepressant medications are effective for some people, but they do not suit everyone.  Some people find them ineffective or that the side effects are not something they can tolerate.

Another option used traditionally in the treatment of depression is psychotherapy or other talking therapies.  These therapies aim to help people to address the root causes of their depression.  Again, there is no one-size-fits-all, so shopping around to find a therapist and a modality to suit oneself can be problematic.  It is also unlikely to be effective in severe cases of depression, where the person is unable to concentrate or find it difficult to interact others.

A generally good diet, good sleep routines, exercise, and managing stress are all helpful habits to adopt in life.  Not only are they good for your physical health, they also help maintain a more stable mood and many people find these measures helpful.

So, as you can see, many options are available and if traditional methods are not suitable, the more modern methods can prove life-changing.  This is where more advanced treatments like TMS and ECT come into play.

Modern options

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a new technology that uses magnetic fields across the brain to stimulate the nerve cells.  It is used by people who have had no success with traditional forms of treatment.

How does it work?

TMS works by passing magnetic pulses through the skull and into the brain.  These pulses stimulate nerve cells located in the pre-frontal cortex and these cells act in turn to influence the deeper structures of the brain that control mood and emotion.  As the pulses start to impact the activity of the nerve cells they start to alleviate depressive symptoms.  Since TMS is delivered using a magnetic coil outside the skull, this is a non-invasive treatment.

What can I expect?

TMS is usually delivered daily during the week with a break at the weekend.  The sessions last about 20-40 minutes and typically take place over several weeks.  For most people there is minimal discomfort.  During the session, you will sit in a comfortable chair while the coil is placed on your scalp and will be fully supported at all times.

Benefits of TMS

• It is non-invasive – anaesthesia is unnecessary. You will be awake and alert throughout and can go about your day once the treatment is complete.
• Few/minimal side effects – some people complain of scalp discomfort or a headache, but these are short-lived.
• No need for hospital admission. TMS is an out-patient procedure.
• Effective for people who have not responded well to traditional treatments.

Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT) is a treatment that causes a controlled seizure within the brain and is therefore more invasive than TMS.  Due to the way ECT has been portrayed, there is often a stigma associated with its use.  However, it is a highly effective treatment in cases of severe depression where other treatments have failed.

How Does ECT Work?

When patients come in for ECT treatment, they are given a muscle relaxant and a light general anesthetic.  The patient feels no discomfort during the procedure.  Two electrodes placed on the scalp pass a brief electrical current through the brain, which causes a seizure that typically lasts between 30 and 60 seconds.  This seizure aims to cause a change in brain chemistry and activity. ECT has been shown to rapidly resolve some of the worst cases of depression.

What can I expect?

ECT is administered in the hospital and usually involves several weeks of treatment, during which it is delivered two or three times each week.  After each session, you will not be able to drive due to the anesthetic and should have someone with you at home.  Feeling a little groggy and confused is normal, and you may have short-term memory loss, which will improve over time.

Benefits of ECT

• Rapid relief compared to other treatments.
• Effective for people who have not responded to other forms of treatment.
• Useful for severe cases of depression.

How do I choose the proper treatment?

A decision about which treatment to use should be made in discussion with a mental health professional.  Much will depend on your individual response to previous treatments and how severe your depression is.  By looking at your specific needs, you can work with your doctor to decide the best way forward.

TMS and ECT – a comparison

While both ECT and TMS are effective treatments, there are key differences that you should consider.

 

TMS	ECT
Non-invasive	Invasive
No general anesthesia required	General anesthesia
Few/mild side effects	Short-term memory loss/confusion
Outpatient procedure	Hospital admission
Start to improve within a few weeks	Start to improve after 2-4 treatments

 

Although the treatment of depression may be a challenge for some people, there are effective treatments available.  Understanding the difference between these treatments will help you and your doctor work together to decide what is right for you.