Depression is most often treated with antidepressant medications. Although antidepressants are often effective, they do not work for everyone. Also, since antidepressants are taken by mouth, they enter the bloodstream and circulate throughout the body, often resulting in unwanted side effects such as weight gain, sexual problems, upset stomach, sleepiness, and dry mouth. More than 4 million patients do not receive adequate benefit from antidepressants and/or cannot tolerate the side effects caused by them.
The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of antidepressant medications for patients diagnosed with major depression who have failed to reach remission after the initial antidepressant medication trial. This was the largest and longest study ever conducted for this purpose; it spanned over 7 years and evaluated over 4000 patients. This study found that:
- Approximately only 30% of patients achieve remission with the 1st antidepressant medication.
- The likelihood of remission decreases with each failure of an antidepressant medication.
- After 3 antidepressants, the likelihood of remission with additional antidepressants is only 10%.
- 15% of patients never achieve remission no matter how many medications are tried.
Psychotherapy can be an effective adjunct therapy in the treatment of depression. While there are distinct biological causes for depression, a person’s thoughts, behaviors, as well as situational factors can contribute to the development of depression and a person’s ability to cope with and recover from depression. In psychotherapy, a trained therapist helps patients to identify negative or unhealthy thoughts and behaviors and other causes of their depression. The therapist then helps to guide patients as they develop heathy thoughts and behaviors. Psychotherapists also help patients to develop problem solving and coping skills.
Electroconvulsive Therapy (ECT) remains one of the most effective treatments for severe depression. ECT, which sends electrical currents throughout the entire brain, stimulates the neurons of the brain to provide immediate relief from depression. While very effective, ECT is known to have many debilitating and sometimes serious side effects. A patient must be placed under anesthesia to receive ECT, which can make some patients nauseous and fatigued after treatment. ECT also strains the cardiovascular system and causes temporary confusion and memory loss.
Vagus Nerve Stimulation
Vagus Nerve Stimulation (VNS) is a highly invasive neurosurgical procedure which has many risks and its effectiveness remains under controversy.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a new treatment for depression, however like VNS, it is a highly invasive treatment. It requires an electrode to be surgically implanted directly in the brain. At this time, DBS seems to be an effective treatment, but it is not widely used at this time due to its invasive nature.
Transcranial Magnetic Stimulation Therapy
Approved by the FDA in 2008, Transcranial Magnetic Stimulation (TMS) Therapy is a non-invasive treatment which uses focused magnetic pulses to stimulate the prefrontal cortex of the brain–a part of the brain known to be instrumental in regulating mood. Daily treatments over the course of 4 to 6 weeks stimulates these neurocircuits to the point where they are able to function normally on their own. In May 2010, a National Institute of Mental Health study verified earlier studies and recommended that TMS be recognized as a standard psychiatric treatment for depression. In October 2010, another study at Rush University found that, for most patients, the benefits of TMS are long lasting.