Researchers are constantly at work on new treatments for depression. These can offer hope to people who haven't yet been able to relieve their symptoms. Some approaches may only be available through research studies, and even then only when other treatments don’t work well (treatment-resistant depression.)
If you’re having trouble treating your symptoms, ask your doctor whether you might be a good candidate for one of these approaches.
Here are some of the newest advances for tackling depression:
Electroconvulsive therapy (ECT) uses electrical stimulation on people with depression and other mental illnesses. Your medical team for ECT generally includes a psychiatrist, anesthesiologist, and other nurses or assistants. They will put you to sleep before they apply the electrical pulses through electrodes they place on your head. You will typically get six to 12 total treatments, depending on how well you respond.
Research shows real promise in the use of ECT, particularly for treatment-resistant depression. Still, it’s important for your doctor to tell you and your loved ones about all of the risks and benefits of the treatment. Some people have noticed memory problems and other issues after ECT.
Transcranial magnetic stimulation (TMS, or rTMS) sends bursts of energy -- from electromagnets -- to specific areas of the brain. Scientists think it affects nerve cell communication in the brain that may play a role in depression.
The procedure is fairly simple and can be done in a doctor's office. It was approved by the FDA as a standard (nonexperimental) treatment for depression in October 2008. The TMS device itself has two parts: an insulated wire coil (that can look like a paddle) and a box that supplies the power. During the procedure, the doctor or a technician will place the "paddle" against your scalp. The specific area of your scalp depends on what part of the brain your doctor is trying to affect. When switched on, the wire coil creates a magnetic field that can painlessly penetrate your brain. This magnetic field excites the targeted brain areas. Sessions often last about 30 minutes. You might be treated 5 days a week for 4 to 6 weeks.
While more research needs to be done, TMS seems to have few risks and side effects, and you don’t need a stay in the hospital for it. Some people feel muscle contractions in the scalp. Rarely, TMS causes headaches or dizziness. But no evidence suggests that it affects memory, the way electroconvulsive therapy (ECT) sometimes can. However, TMS is a different treatment than ECT and has not been shown to have comparable efficacy to ECT. TMS could cause a seizure, but experts say that's very unlikely, with a risk of about 1 in 1,000 people.
Magnetic seizure therapy (MST) is an experimental procedure that uses strong magnetic fields to trigger a controlled seizure in the brain. The effects are similar to those of ECT. For reasons that doctors don't entirely understand, these seizures can relieve the symptoms of depression rapidly. MST requires a stay in the hospital. During the procedure, you would need to be under general anesthesia. Doctors hope that because the stimulation can be more accurately targeted than ECT, it may have less of an effect on memory.
Deep brain stimulation (DBS) is an invasive surgical procedure in which electrodes put into specific brain areas deliver a targeted electric current to relieve the symptoms of depression. It is already used as a treatment for Parkinson's disease. The electrodes that are surgically implanted into certain regions of the brain are powered by a battery pack put into the chest or abdomen. While there has so far been only very limited research on this approach, the results have been promising. A randomized controlled trial of DBS in 25 patients with treatment-resistant major depression, published in JAMA Psychiatry in 2016, reported a 40% positive response rate.
Intranasal and intravenous ketamine have been found to be effective for treating severe depression. An anesthetic agent, it has been shown in preliminary studies to produce a rapid (within hours) improvement in depression for some patients. comes in several forms. The FDA has approved it as a nasal spray for adults who either haven’t been helped by antidepressant pills, have major depressive disorder, or are suicidal. Other forms of ketamine not approved by the FDA for mental health conditions include IV infusion
Vagus nerve stimulation (VNS) is a surgical procedure in which a pacemaker-like device delivers electrical impulses to the vagus nerve, which connects to areas of the brain believed to help regulate mood. For reasons that doctors don't completely understand, these electrical impulses sent via the vagus nerve to the brain can relieve the symptoms of depression. The impulses may affect the way nerve cell circuits transmit signals in areas of the brain that affect mood. It usually takes several months before you feel the effects.
While these new treatments are exciting, most are still experimental. Doctors aren't sure yet how well they work long term or if there are other long-term negative effects. But if you're interested in trying one, talk to your doctor about whether you qualify and, where necessary, how to sign up for a clinical trial.