Depression: More Than 16 Million US Cases Per Year, What Can Be Done?

A couple of sad days can easily turn into weeks, months and even years of mental discomfort for the 6.7% of Americans who are diagnosed with major depressive disorder (MDD). Many do not even realize they are suffering from depression. Learning how to deal with depression first requires coming to the realization that one is experiencing depressive symptoms. After this realization, the sufferer must then want to discover how to fight depression, which can be a daunting task. The answer to how to fight and, ultimately, how to overcome depression is a process that can vary greatly from patient to patient. However, there are many strategies and promising new treatments, such as transcranial magnetic stimulation (TMS), available to help patients fight depression and find happiness again.

 

What Is Major Depressive Disorder?

Major depressive disorder (MDD), also known as clinical depression, is a mood disorder that significantly affects the lives of those afflicted by it. The exact causes of depression are not known, but it is commonly related to a change or changes in brain chemistry. These changes can be brought on by stress, hormonal imbalances, certain medications, or sudden life changes.

Depression comes in a variety of forms, including but not limited to:

  • Seasonal Affective Disorder (SAD), a recurring type of depression, distinct from MDD, that comes during the months of the year when the days are shorter. SAD is characterized by the predictable timing of its repeated onset, and symptoms typically include excessive sleeping, weight gain, and withdrawn behavior.
  • Psychotic depression, which is MDD accompanied by a prevalent skewed reality. Patients with psychotic depression will display symptoms of depression along with hallucinations or false beliefs.

Many patients dealing with depression display a few common symptoms, in addition to any of those mentioned above. Often, patients experiencing depression will decline to get help that they need because of social pressures, and even because of the depression itself. Patients are usually diagnosed with MDD when they display one of the following symptoms:

  • Irregular sleep patterns, either sleeping too much or not at all.
  • Irregular eating patterns.
  • Excessive exhaustion.
  • Withdrawal from friends and family.
  • Unexplained aches and pains.
  • Loss of control or the slowdown of the physical body, such as finding physical movement or speech increasingly difficult to initiate, also known as psychomotor agitation or retardation.
  • Recurring feelings of guilt without reason, worthlessness, or a general feeling of malaise.
  • Thoughts of death or suicidal ideation, which may or may not be followed by specific plans to commit suicide.
  • Difficulty concentrating or making decisions, sometimes accompanied by other cognitive difficulties such as impaired situational assessment.

Suffering from symptoms such as these for days or even weeks can have a negative effect on many aspects of a person’s life. Friendships may be damaged, jobs can be lost, and school performance may decline. Dealing with depression is not easy, but there are many options available to teach patients how to deal with depression in ways that will work for them.

Many of these symptoms and types of depression can persist for quite some time going largely unnoticed. Often it will be the patient’s friends or family who first notice something is amiss. This is a hard situation for many people to be in: those who have never experienced depression may struggle to understand what it is like, and may be therefore unable to express appropriate empathy. Friends and family need to understand that the person affected by MDD means them no harm, even if some things they say and do may be hurtful. It may take some time and patience to bring someone with MDD to the realization that help may be the best thing for them.

MDD and other forms of depression go beyond just having the blues for a few days, so it is important to observe how regular habits are changing and over time, in order to know when to seek help on how to deal with depression. As with any type of sickness, the sooner depression is caught, the easier it will be to remedy. Many cases can be solved with minimal intervention. For people experiencing symptoms of depression, the first step is to find a professional to speak with about a treatment plan.

 

Common Treatment Options for Major Depressive Disorder

People seeking relief from the debilitating symptoms of depression usually start their journey by seeking a professional to talk to. A patient may choose to visit their primary care doctor, despite the fact that primary care doctors are, by definition, not specialists in mental health. They may lack granular knowledge about the many different medications available for depression treatment and how they can synergistically treat different depressive symptoms. Patients with insufficient or incorrect medications can end up experiencing a worsening of their condition instead of an improvement.

Once the patient is started on medication, their follow-up visits with their prescribing doctor revolve around progress checks for the medication’s efficacy. Patients must be able to advocate for themselves in this situation, however, so if the medication is proving ineffective, it will be the patient’s responsibility to be sure the clinician knows this. Patients with depression tend not to be forthcoming because withdrawal is one of the symptoms of depression. Finding the right medication for a deeply depressed patient can therefore be a difficult and prolonged process.

In addition to the time it takes to select the appropriate medication for a particular patient and condition, the medications themselves are also fraught with side effects. There are four major groups of antidepressants: SSRIs, tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and lithium.

In rare cases, especially in young people,  SSRIs have been known to increase suicidal thoughts. Other, more common side effects include nausea, insomnia, restlessness, sleepiness, dry mouth, dizziness and decreased sexual desire.

Tricyclic antidepressants have many of the same side effects as SSRIs, with the added risk of experiencing confusion, racing heart, urinary retention, constipation, weight gain, erectile dysfunction, tremors, increased appetite, and low blood pressure.

MAOIs were among the first antidepressants developed. Side effects specific to this class of drug are involuntary muscle movements, rash, muscle cramping, and tingling sensations. In addition, patients on MAOIs have to be on a prescribed, tyramine-free diet or they risk a dangerous reaction that results in extremely high blood pressure, which can lead to a heart attack or stroke.

Lithium is not used only for the treatment of depression. Usually, it is administered as a mood stabilizer for people who cycle in and out of depressed modes. Side effects are similar to the medicines listed above, and can also include loss of bladder or bowel control, increased urination, shortness of breath, dehydration, headaches, and a feeling of uneasiness.

In addition to medicines, there are other treatments available for patients with MDD. Some clinicians prefer to go the all-natural route before prescribing anything. If a patient’s depression has not become too severe, these methods can work along with talk therapy sessions. Talk therapy can be hard for people dealing with depression, however, as the process of finding the perfect therapist and keeping up with visits can demand a lot of energy, and lack of energy is a symptom of depression.

Another way particularly severe depression is treated is through electroconvulsive therapy (ECT). ECT is a process through which electrodes are placed on the head and an electric current is sent into the brain. Much lower doses of electricity are used now in comparison to the procedure’s inception in the 1950s, but this treatment has obvious risks, and is generally only used when the depressive case exhibits psychotic features or poses a safety risk to the patient. Transcranial magnetic stimulation (TMS) is a similarly effective treatment, and is much less intensive than ECT while also having fewer side effects than ECT or antidepressant medications.

 

TMS Treats Major Depressive Disorder

TMS is a non-invasive treatment for depression,  It was approved by the Food and Drug Administration (FDA) for the treatment of depression in 2008, although there have been neurologists testing this type of stimulation since the 1990s. Dr. Mark George has been a leader in this field and conducted early clinical trials between 2004 and 2009 on patients with MDD. Over the course of his study, he found that there was a 30% remission rate for patients experiencing MDD symptoms after six weeks of TMS treatments. The patients in these original studies were patients  with severe types of treatment-resistant depression. They were also taken off all of their medications, which is not necessary with current TMS treatment. More recent longerterm clinical studies have shown response rates to be 58%[2] or greater. 

TMS is most commonly used in patients who do not respond well to antidepressants or other types of therapy. Many patients wondering how to fight depression that persists in spite of treatment are likely not aware TMS is an option. When patients are faced with MDD symptoms that will not subside, clinicians will often recommend ECT. The word “electroconvulsive” can be scary enough to patients as to  prevent them from pursuing it as a treatment option. In addition, patients are not able to drive themselves home after ECT treatment, nor are they able to work during the treatment period, which usually lasts weeks.

Now that the FDA has approved TMS treatment, many insurance companies will now cover the cost as a depression treatment. TMS sessions are not significantly invasive or debilitating and patients are not expected to find a ride home or take time off. After leaving treatment, some people may experience a tingling sensation or discomfort where the magnet was placed. Some people experience mild headaches and dizziness. Unlike ECT, there are no electrodes being placed on the head, nor is there any need for anesthesia.  All of these factors make TMS a much more tolerable option for patients and their families.

The underlying mechanisms of how TMS works are not exactly known — the same can be said of ECT— but many clinicians refer to this type of treatment as a rewiring of the brain. When a magnetic field is placed or altered around an electric source, the magnetic field wil drive the current in a particular way. Neuronal firing is induced by electric current. When a magnetic field is applied to the brain, it induces the brain cells to fire, but only in specific, targeted areas of the brain, as opposed to  ECT, during which the entire brain is stimulated, resulting in a seizure. Both methods can cause cells or cell connections that have not been active for a period of time to “wake up,” but the side effects of the TMS method are much lower because the treatment is targeted to particular malfunctioning areas of the brain. These effects can be similar to the effects of cognitive behavioral therapy (CBT), as well. In CBT, patients engage in repetitive positive actions to rewire the brain and relieve MDD symptoms. One way to think of this is to imagine a person’s habitual, ingrained thinking pathways like riverbeds eroded into the side of a mountain. What CBT and TMS do, one through repeated behaviors and the other through repeated magnetic stimulation, is carve out new paths of thinking for the patient. The advantage to TMS is that using outside stimulation to help create new pathways makes the change less time-intensive. Repeated treatments are necessary; just like in any other rehabilitative context, the brain needs to be stimulated in similar ways over and over again to form new connections andperform new functions. Along with other treatments and practices, TMS can be very helpful for patients trying to figure out how to overcome depression.

TMS treatments are fairly relaxed and the first treatment typically lasts one hour. During this time, the doctor or clinician will find the best location upon which to apply the stimulation and determine what signal strength works best for the patient. The patient will be given earplugs and instructed to sit in a comfortable chair. The doctor will place an electromagnetic coil on the head of the patient and test the dosing size. The dose is slowly increased until the patient’s fingers move involuntarily. This is referred to as the patient’s threshold. Once this point is found, the patient is ready to undergo full treatment. During the treatment, the patient will hear a clicking noise. This is normal and is caused by the magnetic signal being transmitted from the machine. After the first visit, subsequent treatments usually last between 20 and 40 minutes.

After a patient’s initial TMS treatment, their clinician evaluates them to decide how to further proceed with TMS treatment. The clinician needs to determine if the therapy is working if the threshold needs to be retested, or if other options need to be explored.

Many patients find TMS treatment much more tolerable than ECT, harsh pharmaceuticals, and other solutions that require energy and dedication that sufferers of depression, by definition, are not likely to have. Clinical studies demonstrate, through patient reactions, that TMS is effective. In one of the largest clinical studies done on TMS, 58% of patients showed improvement after TMS treatment, and 37% went into complete remission. Most patients will know if TMS treatment works for them by the end of the first month.

Depression Affects Millions in the US, but There Are Options

There are over 16 million people in the United States alone dealing with depression today. Many of these patients are not aware of this relatively new non-invasive treatment for depression. TMS works to alleviate symptoms of depression by stimulating the brain and can help patients who are not responding to medications and talk therapy alone. The procedure does not require the implantation of electrodes or result in memory loss or confusion so, before turning to treatments like ECT, talk to your provider about TMS, a safer and more appropriate option.

 


FAQ’s

What are the main treatments for depression?

Depression can be treated with lifestyle changes, talk therapy, antidepressants, ECT, and TMS.

Are there lifestyle changes that can help alleviate depression?

Yes. Sleeping well, eating a nutritious balanced diet, and incorporating exercise into your lifestyle will help.

Can depression be cured?

Unfortunately there is no universal cure or treatment. Symptoms can be managed and there are a variety of therapies and treatments that can be used to improve the lives of sufferers.

Can depression be treated with more than one therapy at once?

Yes, a multi treatment approach is more effective. Talk therapies and lifestyle changes are often used alongside drug therapy and non invasive treatments like TMS.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Recovery TMS website is solely at your own risk.

Meet Jonathan Horey, MD

Dr. Jonathan Horey became familiar with TMS while training and working at Columbia University in New York City where many of the early and important studies on TMS were conducted. Dr. Horey has since completed more extensive training in TMS and keeps himself up-to-date with the latest research on brain stimulation techniques, including TMS.