Technological Alternative Treatments

Treatment for depression and bipolar disorder usually includes talk therapy, medication, peer support, and a personal wellness plan. Sometimes, however, people don't respond to these traditional treatments or need additional help managing their illness. That's why, in search of more effective treatments, researchers are turning to technological alternatives. For people experiencing treatment challenges, this technology offers hope on their road to recovery.

Where We've Been & Where We're Going

Scientists believe that depression and bipolar disorder are caused by an imbalance of brain chemicals called neurotransmitters. Medications used to treat mood disorders work to correct this imbalance by changing brain chemistry.

In the 1930s, for example, researchers discovered that applying a small amount of electrical current to the brain caused small seizures that changed brain chemistry. Over the years, much has been done to make this form of treatment—electroconvulsive therapy (ECT)—milder and easier for patients to tolerate. Performed in a hospital with general anesthesia, ECT is now used to treat about 100,000 patients with depression each year, and is very effective in treating severe depression. ECT can have side effects like confusion and memory loss.

The concept that ECT is based on—altering brain function and chemistry with external stimulation—has led to the development of several technologies, like those listed below. Most of the research has focused on treating depression or the depressive phase of bipolar disorder. As with any form of treatment, technological alternatives undergo rigorous testing to determine their safety and effectiveness.

Transcranial Magnetic Stimulation (TMS)

In 2008, the U.S. Food and Drug Administration (FDA) approved transcranial magnetic stimulation (TMS) as a treatment for depression for those who haven't adequately benefited from previous antidepressant medications. Research on TMS as a treatment for mental illnesses began in 1995, and clinical trials have shown it to be safe and effective. TMS can be performed in a physician's office and doesn't require hospitalization, surgery, or anesthesia.

TMS works by using a special electromagnetic device that's placed on the scalp and sends short bursts of energy to the brain (see photo). These pulses of energy stimulate nerve cells in the part of the brain that's associated with mood regulation. A TMS treatment session lasts 30–40 minutes, and individuals usually have five sessions a week over the course of 4–6 weeks.

Clinical trials have shown that TMS doesn't have the side effects that accompany some psychiatric medications (for example, weight gain, dry mouth, sleepiness, and trouble with memory or concentration). The most common side effect reported was mild to moderate scalp pain or discomfort during the TMS session. There is a very small risk of seizure associated with TMS, but the risk seems to exist only for individuals with a prior history of seizures.

Listen to a 2002 TMS clinical trial participant describe her positive experience with this treatment.

Vagus Nerve Stimulation (VNS)

The vagus nerve is one of the primary communication pathways from the major organs of the body to the brain. Vagus nerve stimulation (VNS) is delivered through a small pulse generator, similar to a pacemaker, which is inserted into the left chest area and connected to the vagus nerve in the left side of the neck. The pulse generator sends small pulses to the vagus nerve, which then delivers these pulses directly to the brain.

Because the vagus nerve does not contain pain fibers, stimulation is typically painless. VNS therapy targets specific areas of the brain that affect mood and other symptoms of depression. It also influences the activity of neurotransmitters, such as serotonin and norepinephrine.

The pulse generator is programmed by a doctor to deliver mild electrical stimulation to the brain at regular intervals. A person with VNS therapy can also use a special magnet to temporarily stop stimulation during certain situations or activities if needed.

The FDA has approved VNS therapy for people 18 years of age or older who are experiencing chronic or recurrent treatment-resistant depression (depression that has not responded adequately to multiple treatment attempts). The treatment has been shown to be equally effective in both unipolar depression and bipolar disorder. VNS studies are ongoing for rapid cycling bipolar disorder.

Side effects of VNS therapy are mild to moderate. They occur only during stimulation and typically become less noticeable over time. The most common VNS side effects include temporary hoarseness or a slight change in voice tone, increased coughing, a feeling of shortness of breath during physical exertion, and a tickling in the throat. The dose can be adjusted to avoid or reduce any troublesome side effects in many cases.

VNS therapy is not associated with sexual dysfunction or memory impairment. Incidence of weight gain and sleep disturbance is less than 2%. Electric and electronic equipment, such as microwave ovens and cellular phones, generally will not affect the pulse generator. Airport security systems should not affect the pulse generator either; however, patients should carry the ID card they receive after the procedure.

People with VNS therapy should not use short-wave diathermy, microwave diathermy, or therapeutic ultrasound diathermy. For clear imaging, individuals may need to be specially positioned for mammography procedures due to the location of the pulse generator in the chest. Once the device is inserted, it can be difficult to remove. Inform your health care professional that you have a VNS device before having any medical procedure, especially magnetic resonance imaging (MRI).

Studies have shown that VNS therapy can have beneficial results, especially for individuals who have not found relief with other treatments. These studies have also shown that these beneficial results improve over time and are sustained long-term.

Magnetic Stimulation Therapy (MST)

Another procedure being investigated for the treatment of mood disorders is magnetic stimulation therapy (MST). MST uses powerful magnetic fields to induce a seizure, similar to what ECT produces. Researchers believe MST will be able to focus its treatment on specific areas of the brain. It is hoped that this treatment will not affect memory or concentration. However, because the procedure causes a seizure, general anesthesia is required.

NOTE:
As with any treatment or medical procedure, different people will have different responses. DBSA does not endorse or recommend the use of any specific treatment or medication. For advice about specific treatments or medications, individuals should consult their health care providers.