Alternative Treatments & Therapies for Depression

If you search the Internet for “depression treatments,” you get about 336 million results. How do you know which one is right for you?

Depression treatments are chosen based on a variety of factors:

• Severity and duration of symptoms
• Other mental health or physical conditions
• Medications being taken, and
• A variety of other factors, including what a patient is comfortable with.

According to the Cleveland Clinic, “The most common treatment for depression includes the combination of antidepressant medicine and psychotherapy.”

Yet only about a third of patients diagnosed with major depressive disorder (MDD) find a medication that works for them on the first try, according to Ann McDonald on the Harvard Health Blog. However, the Mayo Clinic says: “If you’ve already tried an antidepressant and it didn’t work, don’t lose hope. You and your doctor simply may not have found the right dose, medication or combination of medications that works for you.”

Pharmacogenomic testing can help determine the right medication for you based on your genetic makeup.  One example of pharmacogenomics testing is the GeneSight^® test. Using the GeneSight test report, your doctor can personalize your treatment plan, finding the right medication faster, and avoiding medicines that may cause side effects.

The other part of a typical treatment plan is psychotherapy (often called “talk therapy”). According to the American Psychological Association, psychotherapy enables patients to “identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes.” By working with a licensed therapist, patients can work to:

1. Determine which life problems can be solved or improved
2. Identify and correct negative thinking patterns
3. Explore other learned behavior that create problems and contribute to depression
4. Regain a sense of control

In addition to medication and psychotherapy, there are many other depression treatments shaking up treatment as usual patterns.  Here’s a brief primer on some of the most promising:

Brain Stimulation Therapies

Electroconvulsive therapy (ECT) has been used in some form since the late 1930s. Today, approximately 100,000 Americans receive this type of therapy annually. ECT and other brain stimulation therapies involve stimulating the brain with electricity, magnets or implants. It is typically used in people who have not responded to other depression treatments.

According to the National Alliance on Mental Illness (NAMI), ECT is a “procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. This results in a brief, controlled seizure that affects neurons and chemicals in the brain.” People wake up approximately 10 minutes later and can resume normal activities an hour later. According to NAMI, most people have 4-6 treatments before “major improvement is seen.”

Transcranial Magnetic Stimulation (TMS) is another brain stimulation therapy. NAMI describes this treatment as a “procedure that creates magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. With TMS, a large electromagnetic coil is placed on a person’s forehead and short pulses are directed into an area of the brain believed to control moods.” Unlike ECT, TMS does not require a person to be placed under general anesthetic and the procedure takes approximately 40 minutes.

Acupuncture and Vagus Nerve Stimulation

Additional alternative treatments currently being studied include acupuncture and vagus nerve stimulation (VNS).

In acupuncture, needles are inserted into the skin in points of the body that link with specific organs. According to Scientific American, “Western research suggests the needles may activate natural painkillers in the brain; in traditional Chinese medicine, the process is believed to improve functioning by correcting energy blocks or imbalances in the organs.” However, a review by Rand Health Quarterly of 18 studies on acupuncture for depression did not find conclusive evidence of its effectiveness. Few studies reported patients achieving remission and relapse rates could not be determined.

Vagus Nerve Stimulation is rarely used but has been approved by the FDA for treatment resistant depression. According to NAMI, “VNS uses a pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses.”

Recently, a new non-invasive way of VNS has been developed called transcutaneous vagus nerve stimulation (tVNS), in which the pulse generator is placed on the ear. In a tVNS study on 38 participants, this noninvasive type of brain stimulation showed promising results for treating major depressive disorder.

Ketamine

According to the Ketamine Advocacy Network, ketamine was developed in the early 1960s and is FDA-approved as an anesthetic.

In 2000, researchers started studying ketamine as a potential depression treatment. According to WebMD:

“The most recent research on ketamine, as well as a statement from experts on its use published in April, finds the drug works quickly, makes dramatic improvements in mood, and can work on people who haven’t gotten better with other depression treatments. The evidence is so enticing that the FDA has granted two ketamine-based drugs breakthrough therapy status and fast-tracked them to market. Yet the studies done so far on ketamine have been small, and its availability is so far limited mainly to ketamine clinics and research studies.”

The Boston Herald recently reported that a new trial found that ketamine may provide “instant relief to those who have been failed by other treatment methods, which can take two to six weeks to work even if they are effective.”

During the Massachusetts General Hospital trial, ketamine was administered to depressed patients in small doses both through a slow IV drip and through the nose. The IV drip produced instant results that lasted two to three weeks, while the nasal option lasted a matter of days.

Ketamine is the “hottest thing on the horizon” for depression treatment, said Dr. Gary Sachs, a Harvard University psychiatrist. “The idea that you could take someone who is suicidal today and have them feel better in the same day…that’s what we’ve been looking for years in psychiatry.”

Finding the Depression Treatment that Works Best for You

If you’re suffering from depression and current treatments aren’t working, don’t lose hope. There’s no such thing as a one-size-fits-all solution for depression. Talking with your doctor about treatment options and doing your own research are great ways to start. Below are some sources for more information about the types of depression treatments:

–          Cleveland Clinic: Treatment Options for Depression and Alternative Therapies for Depression

–          Mayo Clinic: Depression Treatment Options

–          NAMI: ECT, TMS And Other Brain Stimulation Therapies

–          Anxiety & Depression Association of America: Treatment

By knowing your options, talking with your healthcare provider and a positive outlook, you can tackle depression head-on and, hopefully, get the relief you need.