By Joshua Bess, M.D.
The first line of treatment for patients suffering from anxiety and depression is typically antidepressant medication and psychotherapy. If these treatments have not been as effective as hoped, it may be time to consider brain stimulation therapy.
There are two kinds of brain stimulation technologies that are FDA-approved for depression. One is Transcranial Magnetic Stimulation (TMS) and the other is Electroconvulsive Therapy (ECT). TMS and ECT are safe and effective treatment options for adults who have tried medication and psychotherapy for anxiety or depression without seeing good results.
Both TMS and ECT work by stimulating specific areas of the brain that regulate mood. In most cases, it makes sense to try TMS first because TMS can improve brain function without cognitive side effects and does not require anesthesia.
TMS involves placing an insulated coil over the scalp to deliver electromagnetic pulses to specific areas of the brain that impact depression. Patients remain awake throughout the treatment, which is non-invasive. The most common side effects are slight discomfort at the site where the coil sits on the scalp during treatment and a mild headache afterward. Patients can resume their usual daily activities, including driving, immediately after a treatment.
Studies have shown that TMS is highly effective for treating medication-resistant depression, with response rates between 40 and 60 percent and remission rates between 35 and 40 percent. While some patients see results in just two weeks, an average treatment course is four to six weeks.
TMS is almost always the first choice for brain stimulation treatment. If a patient is suffering from severe depression and is perhaps even suicidal, ECT may be an appropriate treatment option. ECT is also considered when a patient does not respond to TMS. ECT involves passing electrical pulses through a person’s brain to produce intense brain activity during a brief period of time.
Between 80 and 90 percent of our patients who undergo ECT treatment see improvement. We typically see positive clinical response and substantial reduction in suicidal thoughts among our patients within one to three weeks.
Most of our patients tolerate ECT remarkably well. Immediate side effects can include nausea, headache, jaw pain, muscle ache and muscle soreness, as well as confusion. Patients may also experience memory loss, although memory problems from ECT usually resolve within a couple of months after completing treatment.
Both TMS and ECT can be used in combination with medication and psychotherapy. Many patients have better results when brain stimulation is used to augment existing therapies.
SeattleNTC is the only medical group in the Seattle area that offers both TMS and ECT. We work closely with patients and their referring providers to determine the most appropriate course of treatment.