Depression looks different in every person with unique causes, symptoms, and manifestations in that person’s brain and life. (See: My Depression Is Not Your Depression)
For some people, breaking a sweat, making dietary changes, practicing meditation regularly, or writing in a gratitude journal helps lift the dark cloud. For others, talking with a therapist or taking medication can bring relief. And still for some, a combination of these do the job, while nothing seems to help an unfortunate few.
While antidepressants and therapy are the first line treatments for major depression, they don’t work for everyone. In these instances, alternative therapies may be used instead of or in addition to standard treatments. Practices which treat depression by modifying brain activity, called neuromodulation, have been found to be beneficial in relieving stubborn cases.
Neuromodulation medicine techniques have been around since the 1960s, have drastically improved with the aid of computers, and are used to successfully treat chronic pain, epilepsy, functional restoration, and movement, cardiovascular, gastrointestinal, and psychiatric disorders. For treating depression, neuromodulation techniques range from experimental to proven and noninvasive to surgical procedures.
Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation (TMS) is a noninvasive procedure which uses magnetic pulses to alter neural activity. During a TMS procedure, a magnetic coil is placed near the head. The coil is connected to a generator and produces small electrical currents in the region of the brain just under the coil via electromagnetic induction. TMS has proven successful in treating major depressive disorder, migraines, symptoms of schizophrenia, and stroke damage.
To simplify greatly, depression is a dysfunction in the communication between the brain’s frontal lobe, the thinking brain, and limbic system which controls autonomic bodily functions, like breathing and heart beat, and endocrine function, particularly in response to emotional stimuli. TMS has been shown to increase dopamine release and help restore better communication and balance between the brain’s frontal lobe and limbic system.
Neurofeedback is a specialized form of biofeedback therapy, a mind-body technique where people learn to influence their autonomic nervous systems, that focuses on helping a person’s brain learn at a subconscious level to permanently alter their own brainwaves. Although it sounds like science-fiction, neurofeedback has been around since the 1950s and is a reputable, scientifically proven modality practiced by specially trained psychotherapists.
Neurofeedback is a noninvasive therapy where EEG sensors are placed on the scalp and ears to read the electrical activity of the brain. Brainwaves are monitored by a computer which gives real-time feedback to the person training in the form of an auditory or visual reward, like a video game. The person plays the video game with their brain. With consistent repetition, the brain learns to self-regulate and makes permanent physiological changes to perform more optimally which continues even when not training. Because it’s a learning process, the results of neurofeedback occur gradually over time.
Neurofeedback has been used successfully for many conditions including depression, anxiety, autism, ADD and ADHD, brain injuries, stroke recovery, addictions, seizure disorders, learning disabilities, and more. Because neurofeedback fine tunes the brain’s performance, it can also be used to heighten focus and concentration such as required for school, playing golf, or other sports.
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) is a surgical procedure that can be used for treatment-resistant depression. A pacemaker-like device about the size of a silver dollar is implanted in the chest and attached to a wire that is threaded along and delivers impulses to the vagus nerve. The vagus nerve travels up the neck to the brain where it connects to areas involved in mood regulation.
VNS was originally developed to treat epilepsy and for reasons not completely understood, electrical impulses transmitted via the vagus nerve to the brain, affect the neurochemicals, specifically norepinephrine and GABA, and can relieve epilepsy and the symptoms of depression. VNS has been shown to have a positive effect on mood in people who have tried antidepressant medications without relief. However, VNS isn’t a quick answer as it can take several months before the effects are felt.
Electroconvulsive Therapy (ECT) is a technique in which electricity is delivered to the head causing a brief, therapeutic seizure. ECT got a bad reputation from negative media portrayal, like in One Flew Over The Cuckoo’s Nest, and because early treatments administered high doses of electricity without anesthesia, leading to memory loss, fractured bones, and other serious side effects.
ECT was developed in the 1930s when there were few alternatives for treating psychiatric conditions. Since the 1950s, ECT has been performed using anesthesia, is FDA approved, and has advanced so that there a few side effects.
Like antidepressants, the exact reason ECT works is not fully understood, but it has broad effects on the brain impacting many neurochemicals and brain cell growth. ECT can quickly treat severe depression, reverse symptoms of certain mental illnesses, and often works when other treatments are unsuccessful.
Transcanial Direct Current Stimulation
Transcanial Direct Current Stimulation (tDCS) is a simple technique using constant, low current delivered to areas of the brain via electrodes on the scalp to either excite or inhibit neuronal activity.
Although tDCS is still an experimental form of neuromodulation and not currently FDA-approved, it potentially has several advantages over other brain stimulation techniques because it’s cheap, non-invasive, painless, and safe.
Several studies suggest tDCS may be a valuable tool for the treatment of neuropsychiatric conditions such as depression, anxiety, Parkinson’s disease, and chronic pain. Research has also demonstrated cognitive improvement, such as quicker learning and improved memory, in some patients undergoing tDCS.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) involves surgically implanting an electrodes in the brain which modify and regulate brain activity. Similar to VNS, a pacemaker-like device is placed in a person’s chest with a wire that travels under the skin connected to the electrodes in the brain which controls the amount of stimulation delivered to the electrodes.
DBS is not yet FDA approved, but is currently used to treat a number of neurological conditions including essential tremor, Parkinson’s disease, dystonia, a neurological movement disorder, obsessive compulsive disorder, and epilepsy. DBS is being studied for cluster headaches, Tourette’s syndrome, chronic pain, addiction, obesity, anorexia, Alzheimer’s, and major depression. DBS has shown potentially dramatic success with depression.
Ultimately, recovering from depression involves altering the brain circuits contributing to the condition which can be done in many ways including lifestyle, behavior, prescription medications, and neuromodulation. The only way to find out what is right for any particular person to ease depression is to consult a mental health professional and try various treatments until something works.