Many people have to try several antidepressant medications before finding one that helps. Adding another antidepressant, called augmentation therapy, may help. Combining two medicines from different drug classes can target a wider range of brain chemicals that regulate mood. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy also can help ease depression symptoms. Adding a second psychotherapy has been shown to be more effective than medication alone.
ECT sends a brief controlled electric current through electrodes placed on the head to prompt a seizure. It is usually performed under anesthesia and a muscle relaxant. The Treatment Resistant Depression works by stimulating one side or both sides of the brain, depending on the person’s symptoms. Typically, patients receive ECT several times a week for up to 12 treatments. While doctors don’t know exactly how ECT works, they think it resets the brain’s activity and improves mood by boosting certain chemicals and enhancing communication between different parts of the brain. Compared to antidepressants, ECT is very effective and often produces results within weeks. ECT can be used to treat severe depression, suicidal ideation, mania, catatonia, and more. It is a safe and effective procedure, whereas it requires careful coordination between psychiatrists, anesthesiologists, and nurses to prevent medical complications. Informed consent is required before a patient undergoes ECT. The informed consent process includes comprehensive physical and mental health tests to ensure the patient is healthy enough for the procedure. Vagus nerve stimulation is a Treatment Resistant Depression that involves electrically stimulating the vagus nerve through an implanted device. This device is usually smaller than a pacemaker and is placed under the skin in the chest. It works by sending pulses of electric current to the nerve in a cycle, on/off sequence. The pulses can be adjusted by the healthcare provider to fit the symptoms and side effects. A 5-year observational study found that VNS improves depression symptoms in people who are nonresponsive to traditional treatment methods. These improvements include antidepressant, antisuicidal, and quality of life effects. However, the VNS therapy isn’t effective in everyone. It is also not a cure for depression, and most people with VNS continue to take antidepressant medications and attend psychotherapy. It is also important to avoid certain medical tests, such as an MRI, that could interfere with the device. TMS uses an electromagnetic coil to deliver pulses of magnetic stimulation. The pulses stimulate nerve cells in a brain region known to control mood. The treatment focuses on the dorsolateral prefrontal cortex. This area of the brain has been linked to depression symptoms like changes in appetite, low energy levels, and feelings of worthlessness or guilt. TMS has been shown to be effective in reducing the severity of symptoms in patients with Treatment Resistant Depression. It can be used in conjunction with psychotherapy to help patients find relief from their symptoms. It is a safe and non-invasive alternative to electroconvulsive therapy (ECT) and comes without the memory and cognition impairments associated with that procedure. Cognitive behavioral therapy (CBT) can help people who have Treatment Resistant Depression. It helps to identify and change unhelpful thoughts, feelings and behaviors. It also teaches skills that can help cope with difficult situations. A recent study found that adding group CBT to medication improved depressive symptoms in adults with a history of treatment resistant depression. The study found that the improvements were maintained over a year.
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