what non drug treatments are used for depression when is electro convulsive treatment used

What is electroconvulsive therapy for depression?

Currently, there are two main treatments to fight depression, antidepressants and psychotherapy, while a third approach, electroconvulsive therapy (ECT), is regarded as a second- or third-line therapy that is usually resorted to in cases where medication and psychotherapy have failed ( Kellner et al., 2016b; Karayagmurlu et al., 2019 ).

What are the treatment options for depression after ECT?

Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).

Are there any experimental treatments for depression?

Experimental therapies are treatments that are not regularly used by doctors. Their safety and effectiveness are still being studied. Some experimental therapies currently being investigated for treatment of depression include: Hormone replacement therapy (HRT) in women: Depression is more common in women than in men.

What are the different types of treatments for depression?

1 Repetitive transcranial magnetic stimulation (rTMS). This type of treatment uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. ... 2 Ketamine is a medication that's delivered through an IV in low doses. ... 3 Electroconvulsive therapy (ECT). ... 4 Vagus nerve stimulation (VNS). ...

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Why would one choose electroconvulsive therapy over other treatments for depression?

In reality, it is a painless medical procedure performed under general anesthesia that is considered one of the most effective treatments for severe depression. It can be lifesaving. ECT works quickly, which is why it's often the treatment of choice for people with highly severe, psychotic, or suicidal depression.

When is ECT used for depression?

ECT is used to treat: Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat. Treatment-resistant depression, a severe depression that doesn't improve with medications or other treatments.

What is ECT not used for?

ECT Is Not a Last Resort. For patients with psychotic depression and catatonia, and an accompanying high risk of complications such as self-harm, ECT should be considered as a first-line treatment.

Is electroconvulsive therapy non pharmacological?

Electroconvulsive therapy (ECT) is the most widely used and effective non-pharmacological biological treatment for depression and remains the most effective treatment for difficult-to-treat depression.

When is electroconvulsive therapy used?

Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia.

When should ECT not be used?

The following strategies should not be used routinely: augmentation of an antidepressant with a benzodiazepine for more than 2 weeks as there is a risk of dependence. augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use.

What are the indications for electroconvulsive therapy ECT?

Indications. ECT is indicated for selected patients with catatonia, major depressive disorder, bipolar disorder, schizophrenia, and other disorders. Considered one of the most lethal psychiatric disorders, few treatments are currently available for the treatment of catatonia.

How do you treat mental illness without medication?

Things like therapy, brain stimulation, supplements, and self-care are scientifically-backed as effective ways to reduce the symptoms of certain mental illnesses.

What is TMS treatment for depression?

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven't been effective.

For which disorder was electroconvulsive therapy ECT originally developed as a treatment?

Electroconvulsive therapy was born. In 1938, Cerletti and his psychiatrist colleague Lucio Bini developed the first ECT device and treated their first human patient, a diagnosed schizophrenic with delusions, hallucinations, and confusion.

Why is ECT used as a last resort?

“The seizure is induced in a very controlled fashion, using a fairly precise delivery of an electric current.” Dr Davey says ECT is seen as a treatment option of last resort, to be used when nothing else has worked, or when there isn't time to find the right medication for a patient, a process that can take months.

Is shock therapy still used today?

Electroconvulsive therapy (ECT) is a procedure used to treat certain psychiatric conditions. It involves passing a carefully controlled electric current through the brain, which affects the brain's activity and aims to relieve severe depressive and psychotic symptoms. Modern day ECT is safe and effective.

What Alternative Treatments Are Used for Depression?

Alternative treatments can sometimes provide relief that traditional Western medicine cannot. While some alternative therapies have become accepted as part of modern health care practice, others still have not been proven safe or effective.

What Is Electroconvulsive Therapy (ECT)?

ECT is among the safest and most effective treatments available for depression. With ECT, electrodes are placed on the patient's scalp and a finely controlled electric current is applied while the patient is under general anesthesia. The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It's also very effective for patients who suffer from mania or a number of other mental illnesses.

Who Might Benefit From ECT?

According to the American Psychiatric Association, ECT can be beneficial and safe in the following situations:

What Is Transcranial Magnetic Stimulation (TMS)?

While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness. The current is caused by the magnetic field created by an electromagnetic coil that delivers the pulses through the forehead.

What Is Vagus Nerve Stimulation (VNS)?

A vagus nerve stimulator (VNS) device was approved by the FDA for adult patients with long-term or recurrent major depression. Some patients who undergo VNS may have been taking many medications for depression yet continue to suffer with its symptoms.

Can Depression Return if You Stop Treatment?

Even when treatment such as ECT, TMS, vagus nerve stimulation, or other alternative therapies is successful, depression can return. Psychotherapy and/or maintenance antidepressant medication can help prevent depression from coming back. Psychotherapy does this by correcting the beliefs, perceptions, and behaviors that contribute to your depression. If you do experience recurring symptoms, don't hesitate to seek help again.

What Is the Outlook for Depression?

The outlook for depressed people who seek treatment is very promising. By working with a qualified and experienced mental health care professional, you can regain control of your life.

What type of therapy is used to help with depression?

Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression. Family or marital therapy. This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression.

What is the best treatment for depression?

Psychological counseling. Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression.

What is ECT therapy?

Electroconvulsive therapy (ECT). While you're asleep, a carefully measured dose of electricity is passed through your brain, intentionally triggering a small, brief seizure. ECT seems to cause changes in brain chemistry that can relatively quickly reverse symptoms of major depression. Although there are potential side effects, such as temporary confusion or temporary memory loss, a series of ECT treatments may provide significant relief of severe depression.

What to ask a psychiatrist about depression?

Consider your response to treatment, including medications, psychotherapy or other treatments you've tried.

How does transcranial magnetic stimulation work?

This type of treatment uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. An electromagnetic coil is placed against your scalp near your forehead. The electromagnet used in rTMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression. Typically, this treatment is delivered over 30-minute sessions in rapid bursts. This treatment can now be delivered over briefer sessions with dosing called intermittent theta burst stimulation.

What to do if counseling doesn't work?

If counseling doesn't seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else. As with medications, it may take several tries to find a treatment that works. Psychotherapy for depression may include:

What are some physical conditions that can cause depression?

Consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems

What is treatment resistant depression?

The procedure is most commonly used to alleviate what medical professionals refer to as “treatment-resistant depression” — depression which hasn’t responded to other forms of help such as medications.

What is ECT used for?

ECT can help people with major depressive disorder or bipolar disorder. It’s also used to treat catatonia, a potentially life-threatening state in which people have trouble controlling their movements to the point where they stop eating or talking altogether.

Why do people take ECT?

There’s likely more than one reason. Like antidepressants, ECT can trigger the production of important brain chemicals like serotonin, which regulates mood. It also boosts the output of dopamine, a neurotransmitter linked to the brain’s pleasure center.

What movie was shock therapy in?

It’s impossible to talk about ECT without referencing the 1975 movie, “One Flew Over the Cuckoo’s Nest” in which “shock therapy” is portrayed as a form of punishment for people with mental illness.

When did Kivler have her last ECT?

She had ECT again and her depression skulked away — only to rear its head twice more over the years. Yet after her last treatment in 1999, it took 5 more years to simply admit she had the procedure. “I was fearful about being labeled. I didn’t want to be ‘damaged goods,’” Kivler says.

Is electroconvulsive therapy a cure for depression?

Is Electroconvulsive Therapy a Miracle Cure for Depression? The controversial treatment is often considered a last resort when antidepressants fail. In 1990, life was good for Carol Kivler. At age 40, she was happily teaching business skills at a college near her home in Lawrence, New Jersey, raising three healthy tweens, ...

Does ECT help with inflammation?

Recent research published in The Journal of Clinical Psychiatry shows that identifying markers of brain inflammation may help pinpoint the people who will benefit most from having ECT.

How does electroconvulsive therapy work?

How Electroconvulsive Therapy Works. With ECT, an electrical stimulation is delivered to the brain and causes a seizure. For reasons that doctors don't completely understand, this seizure helps relieve the symptoms of depression. ECT does not cause any structural damage to the brain.

What is the best treatment for depression?

Electroconvulsive Therapy (ECT) for Depression. For some people with severe or hard-to-treat depression, electroconvulsive therapy (ECT) is the best treatment. This treatment, sometimes referred to as "electroshock therapy," is often misunderstood and incorrectly portrayed by popular media as a harsh, cruel treatment.

How many ECT sessions are needed?

The number of required sessions varies. Many people have six to 12 sessions administered 2-3 times per week over a period of several weeks. After initial treatment, you might require further ECT treatments in addition to depression medicine and therapy to prevent your depression from returning.

What are the risks of ECT?

Risks and Side Effects of ECT. The most common side effect of ECT is short-term memory loss. However, some people report that they have long-term memory loss, as well. ECT also causes a brief rise in heart rate and blood pressure during the procedure, so it may not be recommended in people with unstable heart problems.

Does ECT work for depression?

Studies have shown that ECT works for many people who have treatment-resistant depression. One study of 39 people with treatment-resistant depression compared the effects of an antidepressant with ECT. After two to three weeks, 71% of people who received ECT had a positive response to treatment.

Does ECT cause brain damage?

ECT does not cause any structural damage to the brain. The procedure itself typically requires a stay in the hospital, although more and more it is being performed on an outpatient basis. During the procedure, you will be put to sleep under general anesthesia. You won't feel anything.

Is electroshock therapy a painless procedure?

In reality, it is a painless medical procedure performed under general anesthesia that is considered one of the most effective treatments for severe depression. It can be lifesaving.

Evolution of Electro Therapy

Initially the author used behavioral modification along with a very crude, ancient electrical stimulator, the Electreat®, together with acupuncture. After the first year, the author was introduced to the concept of biofeedback and continued that with other forms of behavioral modification.

Stimulating Normalization of Neurochemicals

The author’s earliest studies revealed that 24 hour output of 5-hydroxyindoleacetic acid, the metabolic byproduct of serotonin, was elevated in 40% of patients, below normal in 40% of patients and had an average normal production in 20% of patients.

Multi-Modal Therapies

By 1988, the author was using only the Liss Cranial Stimulator, Shealy Series, for an hour every morning, the photostimulator for an hour sometime during the day and, in the author’s earliest research on some 400 patients, found that 85% were out of depression within two weeks using this approach.

Validation Testing

In 2004, in order validate the therapeutic effectiveness of the Liss Stimulator and RelaxMate II™—exclusive of the multi-modal interventions taking place simultaneously in the more intense treatment protocols—the author treated 200 patients having unequivocal depression as demonstrated both by the Zung Test for Depression and the MMPI.

Summary

This simple, non-pharmaceutical protocol for depression appears to be safe, essentially free of complications or side effects, and twice as effective as the best antidepressant drugs. The protocol consists of the use of

What is electroconvulsive therapy?

Electroconvulsive therapy is a procedure that applies electrical stimulation to produce a generalized seizure. Though first introduced more than half a century ago, ECT is reserved as the last resort in treating severe mental disorders, such as depression or bipolar disorder ( Husain et al., 2004; Schoeyen et al., 2015; Malhi and Mann, 2018 ). The reason for this difference between ECT and other remedies is partly due to its unfavorable procedure and side effects. Indeed, compared with antidepressant drugs, induced seizures is required to deliver an electrical stimulus. Moreover, ECT recipients endure more headaches and muscle aches ( Husain et al., 2004 ). However, when anesthesia is applied and improved apparatus, such as the unilateral device, is applied, ECT results are encouraging ( Liang et al., 2018; Osler et al., 2018 ). Recently, extensive studies have suggested that ECT is highly effective in ameliorating depression symptoms with fewer unwanted effects ( Liang et al., 2017, 2018; Karayagmurlu et al., 2019 ). Similar findings were also reported in animal studies using electroconvulsive seizures (ECS, an animal model for ECT) ( Jonckheere et al., 2018; Alemu et al., 2019 ). Therefore, this review was aimed to interpret recent clinical and preclinical ECT studies and its potential mechanism on depression to provide clinicians and patients with greater appreciation of this approach to defeat depression.

How does ECS remodel neuroplasticity?

Therefore, Figure 1 shows that ECS remodels neuroplasticity by mediating the balance between mGluR1/5 and AMPA receptors. ECS induced a fast-response antidepressant effect. Upon ECS application, the presynaptic glutamatergic neurons are activated while GABAergic neurons are inhibited. Glutamate is then released into the synaptic cleft and AMPAR is activated. Meanwhile, NMDAR is inhibited. Later, AMPAR releases BDNF to interact with TrkB. Next, activated Akt passes the signal to mTORC1 and promotes neurogenesis. On the other hand, Homer1 disrupts dysfunctional Homer1b/c and mGluR1/5 complexes and partially opens the BK channel by IP3R-released Ca 2+. The BK channel leads the hyperpolarization of the postsynaptic neuron to present the antidepressant effect.

Does ECT increase volume?

First, individuals with major depressive disorder (MDD) subject to brief-pulse bilateral ECT showed significant volume increases in the bilateral medial temporal cortices, inferior temporal cortices, and right anterior cingulate after ECT, and the increased ratio was correlated with the clinical improvement measured by the HAM-D ( Ota et al., 2015 ). With respect to 12 treatment-resistant depressed patients who received brief-pulse bifrontotemporal ECT, bilateral medial temporal lobe and perigenual anterior cingulate cortex volume increases were archived after ECT, and left medial temporal lobe volume increase was associated with significant clinical improvement ( Cano et al., 2017 ). The hippocampus, which plays an essential role in memory formation and emotional plasticity, was the primary focus of MRI changes. Small hippocampal volume at baseline predicted more profound symptom improvement, and the hippocampal and the amygdala volume increases with ECT were correlated with symptom improvement ( Joshi et al., 2016 ). After a series of ECT with a predominately right placement of a unilateral electrode, the volume increases in the right hippocampal cornu ammonis (CA2/3), dentate gyrus (DG), and subiculum regions were correlated with depression reduction and the method of electrode placement ( Abbott et al., 2014 ). In addition, the volume of the CA subfields, granule cell layer, molecular layer, and subiculum of the hippocampus increased in severe MDD patients, and is possibly attributable to neurogenesis ( Cao et al., 2018 ). However, with 7.0 T MRI applied to detect hippocampal volume changes in MDD patients who underwent ECT, a large and significant increase was observed after ECT in only the DG of the hippocampal volume. Furthermore, the increase in DG volume was related to a decrease in depression scores ( Nuninga et al., 2019 ). However, in a study of longitudinal MRI and clinical data from the Global ECT-MRI Research Collaboration (GEMRIC), the subcortical gray matter increase was found to be negatively associated with total ventricle volume, while total white matter volume remained unchanged after ECT. In particular, the gray matter volumetric enlargements may not be predictive of a favorable outcome, though this was partially attributed to the heterogeneity among patients and the procedure and apparatus used ( Ousdal et al., 2019 ). Moreover, a retrospective study revealed that though gray matter was enlarged, the changes may not correlate with psychopathology, age, gender, or number of ECT sessions ( Sartorius et al., 2019 ), as did a longitudinal study of severe late-life unipolar depression ( Bouckaert et al., 2016 ).

Is ECT better for elderly?

As CORE demonstrated that elder depressed individuals may respond better to bilateral ECT ( Husain et al., 2004 ), Spaans et al. (2015) suggest that geriatric depression also responds rapidly to unilateral ECT. A double-blind, randomized controlled trial of ultrabrief- and brief-pulse unilateral EC found no differences between the two groups, and that if high dosage was applied in an ultrabrief pulse, less cognitive impairment was seen ( Loo et al., 2014 ), and this pattern may apply to bilateral ECT as well ( Martin et al., 2019 ). Similarly, high-dosage brief-pulse unilateral ECT may not be inferior to bitemporal ECT based on the 24-item Hamilton Depression Rating Scale (HAM-D) score, while the unilateral ECT group showed a more favorable cognitive portrait ( Semkovska et al., 2016 ). According to a 17-year retrospective study of 1571 ECT recipients, psychiatric individuals who received ECT had lower mortality than those who did not, though nested social and physical parameters affected the results ( Liang et al., 2017 ), and another multistate observation study showed the effect of ECT in reducing short-term readmission risk among those with server affective disorders ( Slade et al., 2017 ). With respect to effects on memory, Brus et al. (2017) used national register-based information to inquire about the rate of subjective memory worsening (SMW) reported with ECT, suggesting that patients who were female, young, less cognitively impaired before ECT, treatment-resistant, and experiencing wider pulse width were more likely to be subject to SMW, and their SMW reported rate was not low. However, this study had such limitations as significantly heterogeneous interference, subjective report collection, and the details of the ECT procedure. Furthermore, many patients referred to ECT may complain of short-term memory deterioration ( Nuninga et al., 2018) or no significant alteration compared to treatment with antidepressants ( Bjoerke-Bertheussen et al., 2018; Osler et al., 2018 ), and for those who were afflicted with cognitive decline before ECT, evidence of cognitive improvement was presented ( Socci et al., 2018 ). In relation to suicide, large-scale nationwide studies performed retrospectively indicate that in patients with unipolar disorder and bipolar depression, ECT had superior anti-suicidal effects ( Liang et al., 2018 ). However, for adolescent and young adult females with a history of non-suicidal self-injury, lower odds of response and remission and great mean times of treatment were observed ( Rootes-Murdy et al., 2019 ).

Is ECT better than antidepressants?

In short, the CORE/PRIDE studies found that ECT was not inferior to and possibly had more preferable outcomes than anti depressants in certain circumstances. Although a bilateral electrode apparatus may perform better than a unilateral one, application of a special algorithm made the unilateral apparatus easier to implement in clinical practice. Continuation ECT meaningfully maintained remission and, combined with medication, may maximize the benefits of ECT without increases in memory loss ( Omori et al., 2019 ).

Is ECT safe for depression?

Briefly, ECT was found to be relatively safe and effective in treating depression and may be superior to medication in symptom improvement, especially for those who failed to recover after rounds of medication ( Husain et al., 2004; Schoeyen et al., 2015; Spaans et al., 2015; Slade et al., 2017 ). Continuation ECT should be employed to prevent relapse if possible ( Kellner et al., 2006, 2016a ). Unilateral ultrabrief-pulse ECT may result in less cognitive declination when advanced procedures are applied ( Semkovska et al., 2016 ). Controversies over cognitive decline following ECT may partially be due to heterogeneous factors, such as aging and quantitative measurements. More studies should be conducted to investigate the relationship between ECT and memory plasticity.

Is electroconvulsive therapy a first line therapy?

This situation is partially due to limited studies and uncertainty regarding its mechanism. However, decades of increased research have focused on the effects of ECT on depression and its potential mechanism. Furthermore, these investigations may suggest that ECT should be a first-line therapy for depression due to its profound effects in relieving desperation in certain situations. Here, we outline recent clinical and preclinical studies and summarize the advantages and disadvantages of ECT. Thus, this review may provide some hints for clinical application.

Which type of therapy is the best studied brain stimulation therapy?

While these types of therapies are less frequently used than medication and psychotherapies, they hold promise for treating certain mental disorders that do not respond to other treatments. Electroconvulsive therapy is the best studied brain stimulation therapy and has the longest history of use.

What is the treatment for a rTMS?

repetitive transcranial magnetic stimulation (rTMS) magnetic seizure therapy (MST) deep brain stimulation (DBS) A treatment plan may also include medication and psychotherapy. Choosing the right treatment plan should be based on a person's individual needs and medical situation, and under a doctor's care.

How does brain stimulation work?

Brain stimulation therapies involve activating or inhibiting the brain directly with electricity. The electricity can be given directly by electrodes implanted in the brain, or noninvasively through electrodes placed on the scalp. The electricity can also be induced by using magnetic fields applied to the head.

What is MST in ECT?

Magnetic seizure therapy (MST) borrows certain aspects from both ECT and rTMS. Like rTMS, MST uses magnetic pulses instead of electricity to stimulate a precise target in the brain. However, unlike rTMS, MST aims to induce a seizure like ECT. So the pulses are given at a higher frequency than that used in rTMS. Therefore, like ECT, the patient must be anesthetized and given a muscle relaxant to prevent movement. The goal of MST is to retain the effectiveness of ECT while reducing its cognitive side effects.

Why is VNS used?

VNS: Why it’s done. VNS was originally developed as a treatment for epilepsy. However, scientists noticed that it also had favorable effects on mood, especially depressive symptoms. Using brain scans, scientists found that the device affected areas of the brain that are involved in mood regulation.

What is DBS treatment?

Deep brain stimulation (DBS) was first developed as a treatment for Parkinson's disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest.

How does the vagus nerve work?

Vagus nerve stimulation (VNS) works through a device implanted under the skin that sends electrical pulses through the left vagus nerve, half of a prominent pair of nerves that run from the brainstem through the neck and down to each side of the chest and abdomen. The vagus nerves carry messages from the brain to the body's major organs (e.g. heart, lungs and intestines) and to areas of the brain that control mood, sleep, and other functions.

Why It's Done

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