Electroconvulsive Therapy
And Other Brain Stimulation Treatments for Depression
Everyone uses electricity today without much thought, plugging in computers, lights, toasters, and now even cars. But few think of their own bodies as walking grids of electricity, biologically wired to power the most powerful of all devices or gadgets on earth – the brain.
Except, of course, the neuroscientists and psychologists who spend their lives studying the brain and its mass of pathways that electrically and chemically send thoughts, sensations, and emotions through a complex network of approximately 10 billion neurons.
Mental Health Resource Links
Today, several of these brain scientists are working to understand the brains of more than 20 million American adults suffering with depression (see Depression) – and more specifically the 7 million suffering with a severe depression that is resistant to medications and other forms of psychotherapy.
These scientists are focusing on how to use electricity and other forms of energy, such as magnetic energy, to correct malfunctions in the brain’s circuits. They surmise that if energy powers thinking and behaviors, then energy should be used to correct dysfunctional thinking – or depression.
Questions remain, however, on which circuits or parts of the brain are dysfunctional, and how the wiring of these circuits go off course from normal functioning. And these scientists also question how to best access the parts of the brain that need repair – either through invasive or noninvasive techniques.
Electroconvulsive Therapy
One of the oldest methods, electroconvulsive therapy (ECT), is still used on an estimated 100,000 U.S. patients annually, according to the website ect.org. Also called shock therapy, ECT uses an electric current to cause a seizure, a controversial practice for many years because of its detrimental side effects. Scientists now report in peer-reviewed journals on the reduction of side effects, and the increased safety of this procedure.
The blog Healthy Aging: Body, Mind & Spirit quotes Duke University Medical Center Psychiatry Chairwoman Sarah Lisanby, stating: “The reason we still have ECT is that we need it. It’s the most rapidly acting, highly effective, and approved treatment we have for major depression.”
Lisanby also states that she fears a rise in suicides if ECT were unavailable.
The MayoClinic.com website states that it’s still not completely understood how the procedure actually works but that it’s thought to affect the brain’s neurotransmitters. The website also reports that the most common side effect is confusion, but that this side effect is usually temporary. Some individuals might also suffer some memory loss.
Anesthesia is required to perform ECT, and some individuals also report side effects from the anesthesia – the same side effects associated with receiving it for surgery.
Transcranial Magnetic Stimulation
A relatively new procedure for treating unipolar, nonpsychotic major depressive disorder, (see article on Types of Depression), transcranial magnetic stimulation (TMS) uses a large, magnetic coil to stimulate the brain’s circuitry.
The magnet is placed on the forehead, over a part of the brain’s prefrontal cortex believed to be associated with depression. Quick electromagnetic pulses go through the skull, stimulating the nerve cells and circuits of this brain area.
Neuronetics, Inc., the manufacturer of the device, states on its website that it clinically tested TMS at “23 premier research institutions internationally” evaluating the efficacy of this treatment. It found that in over 10,000 treatments in approximately 3,000 patients, those with major depression benefited from the procedure. Other researchers have also studied the procedure, reporting remission in about 30% of depressed patients.
However, the clinical trials completed by Neuronetics only took place on those who had tried only one antidepressant medication and failed to receive any relief.
Psychiatrists must prescribe TMS treatments, which take place once a week for 37 minutes, lasting for four to six weeks. Patients are awake and do not require anesthesia. It is the least invasive brain stimulation treatment currently available.
Approved by the Food and Drug Administration (FDA) in 2008, many practitioners and scientists believe that more studies using the treatment need to be completed to fully understand and prove its long-term effectiveness, and to further understand the side effects.
Vagus Nerve Stimulation
One of the most invasive brain stimulation treatments for depression, Vagus Nerve Stimulation (VNS) requires surgery.
First approved in 1997 by the FDA to treat epilepsy, it received FDA approval in 2005 to treat severe depression. It involves implanting a pulse generator in the chest, which connects via a wire to the left vagus nerve at the base of the neck.
The body has two vagus nerves, on both the right and left sides of the body, running from the brainstem through the neck and into the chest and abdomen. These nerves move incoming information from the nervous system to the brain, and then from the brain out to many areas and organs of the body.
The device emits repeated, mild electrical signals to the brain, which the manufacturer Cyberonics states improves major depression for those who have unsuccessfully tried at least four or more antidepressant medications.
On the Cyberonics website, the company states that although the VNS procedure does not involve the brain, “stimulation to the left vagus nerve has been shown to induce widespread bilateral effects in areas of the brain implicated in seizures and mood disorders and responsible for modulation of key neurotransmitters such as serotonin and norepinephrine.”
The results for VNS used for epilepsy have shown to produce positive results, but used for depression, the results are mixed, according to the MayoClinic.com website. Its efficacy for depression differs dramatically among individuals, and many mental health practitioners don’t recommend the procedure unless many other treatment options, including ECT, have been tried and all have failed.
Side effects are similar to those of other surgeries, such as infection, nausea, and incision scarring. After surgery, about half of those receiving the treatment report some voice changes. Other side effects are usually treatable, or the device can be shut off or removed.
Deep Brain Stimulation
Another treatment requiring surgery, Deep Brain Stimulation (DBS) is still considered experimental for depression, and has not been approved by the FDA. According to the Dana Foundation, a private philanthropic organization that supports brain research through grants, the procedure is already used on an estimated 60,000 patients worldwide - mostly Parkinson’s patients - and is currently aggressively researched and studied for use with resistant depression.
The Dana Foundation website states that a simple search on “deep brain stimulation on PubMed, the public database of peer-reviewed journals, brings up nearly 4,000 articles” in 2009, substantially more than the five previous years. This provides a clear indicator that researchers hope to find a DBS solution for depression.
DBS involves surgically implanting a battery-operated device called a neurostimulator, about the size of a stopwatch, in an individual’s chest. A wire extends from the device to wires or electrodes that are placed directly on parts of the brain suspected to control mood.
The electrical pulses directly affect neurons and neurotransmitters. It is also being studied to treat other conditions and mental health disorders, such as obsessive compulsive disorder, obesity, Tourette’s Syndrome, brain injuries, anorexia, chronic pain, tinnitus, and addiction, according to the Dana Foundation, which also educates the public about the successes and potential of brain research.
Initial research results show promise for treating depression, yet scientists still are investigating the proper places in the brain for the electrodes.
Side effects from the surgery parallel those of other surgeries, and post-surgery, some side effects include seizures, insomnia, and allergic reactions to the device and/or electrodes.