When Depression Doesn’t Budge, Alternative Treatments Are Available

Depression is a serious brain disorder that will impact nearly 17 percent of Americans during their lifetime, according to the Anxiety and Depression Association of America. As you know, often depression can be managed successfully with medication or a combination of medication and therapy. For some, however, these standard therapies aren’t effective, and symptoms persist despite multiple attempts at treatment.

“Approximately one-third of patients with depression will be diagnosed with treatment-resistant depression,” says UVA psychiatrist David Hamilton, MD. “That’s millions of people dealing with debilitating, unrelenting symptoms, many of whom may feel as if they’ve run out of options.”

As providers, it’s important to know when to move beyond pharmacotherapy and recommend alternative treatments. One to consider is transcranial magnetic stimulation (TMS), which was approved by the Food and Drug Administration in 2008 for the treatment of depression.

TMS: How It Works

The part of the brain called the left dorsolateral prefrontal cortex is one of the areas that is thought to be a thermostat for our emotions. “When you get upset, this is the area of the brain that allows you to cool down again,” says Hamilton. With TMS, rhythmic pulses of electromagnetic energy are introduced to this portion of the brain so that cells begin to fire more rapidly, regulating the connectivity between the emotional and control portions of the brain. Over time, these cells are retrained to synchronize on their own so the “thermostat” works more efficiently.

Patients approved for TMS (those who have tried two or more medications and have not adequately responded) typically require daily treatments for four to six weeks. Each 37-minute session involves sitting in a chair much like a dentist’s chair while wearing a coil device around the head. Through this device, a series of electromagnetic pulses are delivered every few seconds, resulting in a knocking sensation on the head that dissipates over time. Patients typically begin feeling the effects of treatment by week four.

Although TMS is not meant to be a substitute for medication, for some (especially people under 25 who have a chance of experiencing increased suicidal thoughts and pregnant mothers), this can be a viable alternative to treat depression. And unlike other procedural approaches to treat depression, including electroconvulsive therapy, there are minimal side effects. “At UVA, we have a skilled team of psychiatrists and neuropsychologists that carefully evaluates each patient to determine the best approach to treat mental and emotional challenges,” says Hamilton.

If your patient is not responding to standard treatments for depression, call 800.552.3723 to make a referral to a UVA mental health specialist.