When most people think depression treatment, they think therapy and pills. In most cases, these two options represent the first line of offense in the fight against depression. And in many cases, they can be enough to help someone alleviate the symptoms of their depression, and live better lives. But therapy and antidepressants don’t always work, for a myriad of reasons.
For one, it’s hard for one to work without the other. Depression is a very complex condition, not caused by any single thing but by a series of issues weighing in on a person’s mood in different ways. It’s what we call a biopsychosocial disorder – a condition that requires a treatment approach that considers a person’s biological, psychological, as well as social factors.
To give an example, depression can be caused by a hormone imbalance. Sometimes, the brain and body don’t work in a “normal” way, and some girls struggle with abnormally low moods and suicidal thoughts whenever their hormone levels fluctuate, such as around their period. However, there are other factors affecting them as well. They could be experiencing a serious amount of stress, perhaps due to problems at home, at work, or at school. They could be nursing an injury or a physical disease, leaving them in pain, and irritated. These factors could all feed into their lifestyle habits, causing weight gain and poor nutritional habits. In turn, they’ve begun ignoring or avoiding social events, and are becoming lonely.
These factors come together in a single example to cause a compounded list of issues that all feed into a person’s mood and psychological state. They suffer from a form of depression with a biological cause, but their mood is also affected and strained due to other factors, existing outside of that initial cause, or because of it. This is why depression treatment must always be comprehensive – but that doesn’t mean it always works the first time around.
Antidepressants and Treatment-Resistant Depression
Antidepressants affect the serotonin levels within a person’s brain by slowing the speed at which the brain’s cells reabsorb serotonin released over the course of a day. This allows for more serotonin to roam free within the brain, generally causing an uplifted mood. However, the way this works differs from drug to drug, as each brand and drug utilizes a different mechanism to achieve the same thing.
People react to these drugs differently – some see no alleviation of symptoms while experiencing a series of side effects, while others experience no side effects, and feel better. There are some who do feel better but are also struggling with side effects. It takes weeks for these drugs to completely take effect, and another few weeks to wean off them and try another drug, so psychiatrists have to be careful about which antidepressant they prescribe, and why.
SSRIs are the most common kind, but if a patient fails to feel better after trying several different brands, a doctor may ask the patient to try a completely different class of antidepressant, including SNRIs, MAOIs, TCAs, and atypical antidepressants.
In some cases, a patient may not respond to any antidepressants in a favorable way. While therapy can help, it’s hard to make breakthroughs and help a patient cope with their depression simply through therapy when they’re consistently bombarded with negative thoughts caused by an overall pervasive low mood. These patients are experiencing a treatment-resistant depression.
It’s in cases like this where other treatment options have to be considered. While antidepressants and therapy can help many people suffering with depression today find their way to living a better life, these approaches don’t work for everyone. Alongside a myriad of different therapies – including art therapy, writing, or music – there are various more invasive forms of treatment, as well as non-invasive treatments, that try to directly affect the brain in ways a pill couldn’t.
What is Invasive Depression Treatment?
Usually reserved as a last resort, there are forms of depression treatment that involve minor anesthesia, and an injection or installation. These treatments are all as safe as any other form of surgery but carry the implied risks that surgery can carry. Some forms of invasive depression treatment include:
Vagus Nerve Stimulation
First developed for the treatment of epilepsy, vagus nerve stimulation involves sending electrical signals to the left vagus nerve located within your brainstem, sometimes alleviating the symptoms of depression. This is done by installing a device within a person’s chest or abdomen, with electrodes attached directly to the nerve. Although originally requiring surgery, there are new upcoming devices for vagus nerve stimulation that will be non-invasive.
Ablative neurosurgery is very rarely used in the treatment of treatment-resistant depression and OCD and has largely been replaced with deep brain stimulation or neuromodulation. However, it is sometimes still carried out in highly-specialized centers, with over 50% success. The exact nature of the surgery depends entirely on a patient’s case, but common forms of ablative neurosurgery include stereotactic bilateral anterior cingulotomy (carefully severing a circuit in the cingulate gyrus), and bilateral anterior capsulotomy.
Direct Cortical Stimulation
More an investigational approach or diagnostic tool than a treatment, direct cortical stimulation involves applying electrodes directly onto, or just outside the cortex of the brain to determine how a patient responds.
How Does TMS Differ?
While these invasive depression treatments come with some risk, they’re all safe and effective. That being said, they don’t have to be the next step going forward. Invasive treatments are still invasive, and doctors will always rely on these treatments as a last resort when other, less risky options have been exhausted. Among these options is transcranial magnetic stimulation, a non-invasive form of neuromodulation that directly affects the brain’s pathways with magnetic pulses, utilizing a coil within a helmet placed on a patient’s scalp.
The coil sends pulsing magnetic waves just a few centimeters under the skin, directly into the frontal cortex of the brain, alleviating the symptoms of depression in many patients with treatment-resistant depression. It takes several sessions for the treatment to fully take effect, but it is quite promising, has no lasting side effects, requires no injections or cuts, and is completely risk-free and non-invasive.
Transcranial magnetic stimulation is fast growing as an approved alternative treatment for patients seeking help for depression.