When you hear the words "electroconvulsive therapy," you can imagine the scene in One flew over the cuckoo's nest in Jack Nicholson's character, Randle Patrick McMurphy, an unjustified barbaric, Shockless treatment is subjected to punishment rather than mental health therapy . Cultural presentations such as these have stigmatized electroconvulsive therapy (ECT) and other brain stimulation treatments, but the reality is different. For starters, people suffering from ECT are sedated – Randle was not ̵
It is estimated that is 30 percent of humans with ] Depression does not respond to typical antidepressants. This is known as treatment-resistant depression and brain stimulation therapies can be life-changing for people experiencing them.
"Brain stimulation therapies involve the application of [electric] energy via certain brain regions to modulate neuronal circuit function," says Joshua Berman MD, PhD, assistant professor of psychiatry at Columbia University's Irving Medical Center, to SELF. This may help alleviate the symptoms of depression or other mental illnesses that do not respond to typical treatments, such as: B. bipolar disorder .
The five main types of brain stimulation therapies treat mental illness are electroconvulsive therapy, vagus nerve stimulation, deep brain stimulation, repetitive transcranial magnetic stimulation, and magnetic therapy. Let's examine what they are, how they work and what their risks are.
Electroconvulsive Therapy (ECT)
In addition to severe or treatment-resistant depression, ECT can be used to treat conditions such as schizophrenia and bipolar disorder if you do not respond to treatment or if you need extremely fast treatment for suicidal thoughts, according to Mayo Clinic . While many insurers currently cover ECT for the treatment of certain conditions, the FDA proposed to change the classification of ECT devices in 2015 from Class III medical devices to Class II medical devices therapy (due to potential risks that may arise) we will discuss shortly). The proposed reclassification is still ongoing .
Let's say your healthcare team has decided that you are a good candidate for ECT. In each session, you are anesthetized for the prevention of pain and treated with a muscle relaxant, explains the National Institute of Mental Health (19459034) (NIMH). Then, doctors use electrodes on your scalp to expose you to direct electrical current. The current triggers a brief seizure, usually less than a minute. Again, you should not feel uncomfortable, which is hard to believe. But that's the beauty of anesthetics.
Five to ten minutes later, you will wake up and should be able to return to normal activities within an hour, according to NIMH . Although it obviously depends on what your doctor thinks best, a person receiving ECT will usually receive a few treatments a week and possibly less severe depression (or other mental symptoms) within six to twelve treatments.
I know the exact mechanisms that ECT works on, "says Dr. One theory states that the seizures alter the blood flow in different parts of the brain, such as the amygdala associated with your emotions. There is also evidence that ECT affects neurotransmitters that affect your mood, such as serotonin and dopamine, which some antidepressants also target. The difference is that ECT seems to have the same brain systems as traditional antidepressants, possibly stronger, and possibly faster, Dr. Berman.
The most common side effects anyone can experience after ECT are headache, an upset stomach, muscle pain, and memory loss, says NIMH . Memory loss may sound alarming, but it is usually transient, and it seems less severe when the ECT electrodes are on one side of the head and not on both. This is referred to as unilateral ECT, and it is the more modern version of bilateral ECT, the older form of treatment associated with more intense memory problems, says NIMH .
Vagus Nerve Stimulation (VNS))
Vagal nerve stimulation was originally developed for the treatment of seizure disorder epilepsy and in a lucky accident scientists discovered that they could also help with depression NIMH . explained. Thus, the FDA admitted VNS 2005 for treatment-resistant depression.
Although VNS is a brain stimulation treatment, it actually starts outside your head. When you receive this type of therapy, doctors surgically implant an instrument called a pulse generator in the upper left part of your chest, as explained in NIMH . An electrical wire connects the pulse generator to your vagus nerve, which runs from your brain through your neck to your chest and abdomen. From its command center in the chest, the pulse generator sends electrical impulses into your brain every few minutes. According to NIMH
it seems that pulse generators normally operate for about ten years before they need to be replaced. It appears that VNS can improve problems such as severe depression by altering the levels of neurotransmitters in your brain, including serotonin. Norepinephrine, GABA and glutamate, which explains NIMH . A 2018 study published in The Journal of Clinical Psychiatry analyzed the quality of life reports of 599 people with treatment-resistant depression and found that people who combined VNS with other antidepressant treatments even experienced significant improvements in their quality of life her symptoms have not completely disappeared.
This points to an important fact regarding VNS: Anyone who receives them must continue their other treatments (such as taking antidepressants), explains the NIMH . However, it can take months to make a difference using VNS, and the device could shift or malfunction, potentially requiring more surgery.
Doctors do not know any long-term side effects of VNS, but only for a short time These include voice changes, neck pain coughing or sore throat, malaise or tingling in the chest, breathing problems (especially during exercise) and difficulty swallowing according to NIMH . Your doctor should give you a special magnet that you can hold over the pulse generator to temporarily stop it, if the side effects are really annoying, as the Mayo Clinic explains.
The NIMH states that the conditions of some people worsen after the attempt of the VNS, no better. It is not a surefire solution, which is why it is recommended only for cases in which a person's depression has not diminished after at least four other treatments have been attempted, says NIMH .
Deep Brain Stimulation (DBS)
This began as a treatment for Parkinson's disease according to the American Association of Neurological Surgeons . Then the doctors realized that it was promising to relieve depression and also obsessive-compulsive disorder . (DBS is approved by the FDA for OCD but is not yet available for Depression .)
Like VNS, deep brain stimulation uses pulse generators in the chest to send electrical impulses to the brain , Unlike VNS, which delivers stimulation in bursts, DBS involves more continuous stimulation, explains [NIMH but you should be able to adjust the exact frequency with the help of your doctor. DBS also includes an operation in which two electrodes are placed on either side of the brain and two generators in the chest.
If you get DBS, you're actually awake for the brain surgery which yes sounds terrifying. But anesthetics will numb your head, and your brain will not really feel pain (nerves in other parts of the body are transmitting pain messages to your brain). Being awake for this part should not hurt, and it gives your doctors the opportunity to ask you questions so they can make sure they are targeting the right areas of your brain.
It seems that the DBS pulses are "reset". the parts of the brain that cause symptoms are explained by NIMH . For example, if you have treatment-resistant depression, doctors may target your subgenual cingulate cortex, which is involved in depression along with other parts of your brain. If OCD is your problem, it may focus on a part of the brain called the ventral capsule / ventral striatum.
Even if you feel no pain during brain surgery to maintain the DBS, you may experience related issues such as infection, confusion, mood swings, movement problems, drowsiness, sleep disturbances, and, in severe cases, cerebral hemorrhage or stroke says of NIMH . According to the Mayo Clinic .
The stimulation can lead to numbness and tingling, muscle tension in the face or arm, to speech and balance disorders, dizziness and mood swings. It is quite regrettable that mood swings occur A potential side effect of both brain surgery and stimulation should help with mental illness. This shows that deep brain stimulation, like the other therapies on this list, can be helpful, but not perfect.
Repetitive Transcranial Magnetic Stimulation (rTMS) [2008-05-05] 2008 repetitive transcranial magnetic stimulation (rTMS) was approved by the FDA for the treatment of people with depression who do not respond to antidepressants. In August 2018, the approval was extended to the treatment of obsessive-compulsive disorder .
A less invasive brain stimulation therapy than the above options. RTMS uses an electromagnetic coil to deliver short electromagnetic pulses to specific areas of the brain for 30 to 60 minutes, explains the NIMH . According to the Mayo Clinic of 19459004, this is usually administered five times a week for four to six weeks.
When you receive this treatment, you are awake during each session and should not feel any serious pain; The impulses go seamlessly from the spiral through your skull into your brain. You might feel a knocking or knocking sensation.
"[rTMS] is very well tolerated and there are no cognitive side effects such as associated memory loss." Irving Michael Reti MBBS, MD, Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University and Director of the brain stimulation program at Johns Hopkins Hospital, says SELF.
However, possible side effects may be tingling or tightness in the brain. Muscles of the scalp, jaw, and face, says the NIMH . You may also feel uncomfortable at the stimulation site and headache during or after the procedure . A much rarer potential side effect is seizures, d. H., RTMS may not be suitable for people at high risk, such as people with epilepsy, a history of head injuries or other serious neurological problems.
A NIMH study of 190 in  Archives of General Psychiatryin 2010 found that 14 percent of people who received rTMS had less intense depression, compared to 5 percent who had one in essence received fake treatment. In the second phase of the study, anyone (including those who had received the wrong treatment) could try rTMS, and about 30 percent of the subjects had less intense depressive symptoms. Although it is a small study, it is promising.
However, NIMH states that physicians are still not sure which parts of the brain are best targeted and whether rTMS alone or when is most effective in a number of more traditional therapies such as therapy and medication added, further research is needed.
Magnetic Seizure Therapy (MST)
One of the newest brain stimulation therapies, Magnetic Seizure Therapy (MST), is a mix of electroconvulsive therapy and repetitive transcranial magnetic stimulation. Like ECT, MST induces a seizure, but like rTMS, it uses magnetic impulses over certain parts of the brain that are involved in mental illness, rather than electrical currents. Because these pulses are more intense than rTMS, if you have MST you need to be anesthetized and given a muscle relaxant as if you were undergoing ECT. So far, the only known side effects are those associated with anesthesia and seizure induction, says NIMH .
MST was developed to address the remaining concerns about the impact of other brain stimulation therapies on perception. A Review in the Year Neural Plasticity examined eight different studies on MST, depression, and bipolar disorder with 40 to 60 percent of patients with treatment-resistant depression finally being referred to MST. 15 to 30 percent experienced significant relief from depressive symptoms, and this could be helpful in treating bipolar depressive episodes. The review also found that people could recover faster than ECT after receiving the MST and that the cognitive risk was not as high as in the ECT when it comes to functions such as memory . While all this is exciting, experts are not yet sure if there is a standard protocol on how often to administer MST for mental illness, as explained by NIMH and it has not yet been approved by the FDA Service.
Science has only scratched the surface when it comes to the potential of brain stimulation therapies to treat mental illness.
Although they are not a first-line treatment for depression and other psychiatric conditions, they may be promising in other conditions. Treatment methods do not work. If you think that you are a good candidate for any of these treatments, consult a psychiatrist who can help you to go through which option is best for you and how much your can help and what you can expect from your new treatment regimen.