In the past twenty years, researchers and therapists have made incredible strides in the treatment of mood disorders. Medications have gotten more specific and potent. Side effects have been minimized. The variety of medications and their use in combination have helped millions. Sometimes, however, patients do not respond to medication and/or therapy to the extent they would like. In these cases, individuals explore the possibility of technological treatments to relieve symptoms and treat the illness itself.
Research has proven that depression and bipolar disorder result from an imbalance of brain chemicals called neurotransmitters. Medications balance neurotransmitters like serotonin, epinephrine and nor-epinephrine to improve mood. Therapists credit medication with elevating an individual’s mood enough so the individual can not only get therapy, but get out with friends and interact with family in a reasonable way.
Medication is the only way to physically change brain chemistry, however, researchers in the 1930s discovered that applying a small amount of electric current to the brain relieves severe depression in some cases. Now called Electroconvulsive Therapy or ECT, a significant number of individuals with treatment- or medication-resistant-depression call it a god-send. Because the past eighty years of modification has rendered it milder and easier for patients to tolerate, 100,000 people in the United States elect to use it each year. It is usually administered in a hospital under general anesthesia.
Recent Technological Progress
Not only has ECT been significantly improved, but its development has spawned even more research into the concept of using external stimulation to alter brain chemistry. Several organizations are now testing these new technologies, most of which target severe depression and the depressive phase of bipolar disorder. A patient should always work with his or her doctor before undergoing these treatments or signing up for a study. Because each human is so unique, different people have different responses to these cutting edge approaches.
Transcranial Magnetic Stimulation
Currently the FDA is reviewing Transcranial Magnetic Stimulation (TMS). Studied since 1995, TMS has showed some promise for patients for whom medication has been less effective (TRD: treatment-resistant depression). Patients that find medication side effects intolerable also benefit from TMS. In fact, one in two patients reported improvement in their symptoms without any of the typical side effects medication provokes. These patients tolerated the treatment well, with only 8% choosing to leave after the trial got underway. Six months after treatment, the patients who benefitted initially from TMS still experienced symptom relief.
Process: Because it is an outpatient procedure, TMS does not require surgery, hospitalization or anesthesia. The doctor places a hand-held tool against the patient’s scalp. Short magnetic pulses focus on a specific area of the brain known to regulate mood. Research has indicated that to be most effective, TMS should be applied five days each week for four to five weeks. Each session lasts 40 minutes.
Side Effects: While they may be mild and infrequent, some patients report:
a slight knocking or tapping sensation on the head, possibly caused by the instrument
muscle contractions on the scalp
- mild headache or dizziness, which often subsides after treatment concludes
Any medical procedure involves risks, but seizure--the main risk associated with TMS--is rare. It’s up to you to determine whether this risk justifies the benefits you’ll receive. That said, in a recent trial involving 325 patients, no seizures occurred. Unlike ECT, TMS does not appear to causes memory loss or difficulty in concentrationVagus Nerve StimulationVagus Nerve Stimulation (VNS) assails mood disorders two ways: by stimulating the Vagus nerve and affecting neurotransmitters. While the vagus nerve carries signals from the major organs to the brain, researchers have found that it also communicates with areas of the brain that affect mood, particularly depression. Because it does not contain pain fibers, stimulating it does not cause pain. Studies have demonstrated thatVNS can alleviate some symptoms, particularly for those who have not responded well to medications. More encouraging, these beneficial results improve over time and continue long-term. While the FDA approved the use of VNS for anyone over eighteen experiencing medication resistant depression, researchers are still studying its use in patients effected by bipolar disorder.Procedure: Unlike ECT and TMS, surgery is required for vagus nerve stimulation. The surgeon implants a small pulse generator (like a pacemaker) in the left side of the chest. The electrical pulses are carried through wires to the vagus nerve in the left of the neck. Programmed by a doctor, the pulse generator sends small pulses to the vagus nerve, which in turn delivers these signals to the brain. The dose can be adjusted to avoid or decrease any side effects a patient may experience.Once the pulse generator is in place, the patient can use a special magnet to shut it off if certain situations or events arise.
Sides Effects: VNS side effects, which occur only during the treatment, have proven to be mild to moderate. Even these tend to become less noticeable over time. Nevertheless, patients report experiencing:
- temporary hoarseness or a change in voice tone
- increased coughing
- shortness of breath
- tickle in the throat
- weight gain and sleep disturbance occurs in less than 2% of patients
Common Concerns: VNS does not affect sexual function or memory. Airport security systems, microwave ovens and cellular phones typically do not interfere with the function of the pulse generator. Travelers are wise, however, to carry an ID card indicating they’re VNS patients in case of any concern or hassle by security personnel.
Risks: The risks involved in VNS therapy have more do to with convenience than health. Remember to always inform your healthcare provider of your VNS device.
once the pulse generator is implanted, it is difficult to remove
mammography will require special positioning
patients will be warned to AVOID:
-therapeutic ulatrsound diathermy
For more information, visit www.vnstherapy.com or call 1-877-NOW-4VNS (877-669- 4867.
Magnetic Stimulation Therapy
Studies involving Magnetic Stimulation Therapy (MST) have been ongoing for a while now, but the FDA only recently approved trials involving humans. MST uses powerful magnetic fields to actually induce a seizure. Because MST can focus on very specific areas of the brain, however, it may not affect memory or concentration, the negative side effects experienced by those who undergo ECT. The treatment takes place in a hospital under general anesthesia.
For more information, visit: www.neuronetics.com or call 877-RTMS-4U2 (877-786- 7482).
The Future of Technological Treatments
Those with treatment challenges like resistance to medication or severe side effects find hope and relief in emerging treatments like TMS, VNS and MST. Research continues, with new findings presented to the FDA every year. Until the benefits and risks are thoroughly understood, however, promising treatments must be applied very cautiously.