Major depression is the most severe form of depression and involves most or all of the symptoms associated with clinical depression. Although all the symptoms have to be taken seriously, recurring thoughts of suicide perhaps give the most concern.
The symptoms of major depression can sometimes appear fairly rapidly. In situations like this the usual pattern of prescribed antidepressant medication may not be enough. Partly, this is due to the fact that antidepressants can sometimes take weeks before any therapeutic effects are felt and partly because not everyone responds to antidepressants. This gap between the onset of treatment and the waiting time for a possible therapeutic outcome is a worrying and possibly dangerous period. Talk therapies such as cognitive behavioral therapy can be very effective in the treatment of depression but this does rely on the ability of the patient to be receptive.
In these circumstances physical methods of treatment such as electroconvulsive therapy (ECT) or the newer transcranial magnetic stimulation (TMS) may be considered. ECT is the older more controversial of these treatment options. Since first tested for a variety of mental health issues, the use of ECT has become more refined and better targeted. The basic procedure involves giving the patient an anesthetic and muscle relaxant followed by passing an electric current through the brain. Treatments are usually carried out two or three days a week for several weeks. There is evidence supporting the often fairly rapid improvement in mood using ECT but side effects relating to memory loss, ability to concentrate, headaches and confusion have all been reported – plus the relapse rate is high.
TMS is a relatively new and non-invasive form of treatment that uses targeted pulses of magnetic energy to stimulate certain areas of the brain associated with mood. The basic procedure involves two small electric coils being placed on the head whilst the patient, who remains awake, sits or reclines. Few if any side effects are reported and the benefits appear as effective, or more so, than ECT. Whilst this may sound impressive the down-side is that TMS is a treatment not a cure. However, in avoiding the side effects associated with ECT the choice, if it is available, points to TMS over ECT.
In describing these alternatives I wouldn’t want to leave you with the impression that these are the only alternatives. Various clinical trials have pointed to effective outcomes with deep brain stimulation (DBS), nutritional changes and light therapy. Narrowing down the best option for depression is often helped by the knowledge and skills of a trained neurologist.