Depression, part 4 (conclusion)

By Alan Koenigsberg, M.D.

To end this mini-series, I’ll discuss the non-medication treatments available for depressive disorders.

By somatic treatments, we mean physical treatment of some sort. The most common ones are ECT or EST, TMS and vagal nerve stimulation.

ECT, or electroconvulsive therapy (also known as EST, or electroshock therapy), has been around for decades. When properly done, it is extremely effective and safe. The most common side effect is memory loss for the duration of the treatment.

It is done in a specifically designated surgical suite, and comprises an anesthesiologist, the psychiatrist doing the procedure and nursing staff. Typically, treatments are done in a local hospital, three days each week, for one month, for a total of 12 treatments.

Each treatment session takes about an hour. It can be done with the person in the hospital during the entire month, or the person can go home, as long as someone can drive them home and be with them.

I have referred an average of one or two patients for ECT every few years, and they have all done very well. When I consider a patient for this procedure, I refer them to a colleague for evaluation for ECT.

The second treatment mentioned is TMS, or transcutaneous magnetic stimulation. This is an office treatment, has few if any side effects and can be done with the person driving to and from the session.

A magnetic helmet is placed over the person’s head, and brief, intense pulses of magnetism are produced for about an hour. The only side effect I have heard of is occasional headache from the noise of the machine.

Treatments are typically five days per week for a few weeks. This is a fully FDA-approved treatment, and continues to be refined.

Vagal nerve stimulation is a surgical procedure in the chest, whereby a pacemaker is installed and wrapped around the person’s vagus nerve, which is connected directly to the brain. This procedure has been shown to be effective.

The last group is psychotherapy. As one of the dinosaurs of psychiatry, I am a psychiatrist who also does substantial psychotherapy, so I can attest to its value.

For some people with relatively mild forms of depressive disorders, psychotherapies alone have been shown to be very effective. Cognitive behavioral therapy is probably the best known of these.

Other forms of psychotherapy help a person to become more aware of their psychological blind spots, experience increased self-awareness and make better life decisions. These forms of psychotherapy can be particularly beneficial for people with depression and low self-esteem.

It is probably important to clearly express that for many people, a combination of medication treatment and psychotherapy may be optimal.

So that’s a brief, high-level overview of the depressive disorders and their treatments. The same paradigm is applicable for many other conditions, such as chronic anxiety disorders, ADHD, alcohol and other drug disorders and so on.

Please continue to stop me in the hallway, store or shul, and let me know if you have specific questions or concerns that I might have only touched on, or new topics.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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