In the past, the term “brain stimulation therapy” was almost synonymous with shock therapy or electroconvulsive therapy (ECT). While ECT remains a viable treatment option for depression, the landscape of brain stimulation therapies has greatly expanded. Today, these therapies are used to address not only depression but other mental health conditions as well.
Understanding Brain Stimulation Therapy
Per the National Institute of Mental Health (NIMH), brain stimulation therapies function by either activating or inhibiting the brain directly via electric currents. “The electricity can be provided directly by electrodes inserted in the brain or non-invasively through electrodes placed on the scalp. Additionally, the electricity can be induced through magnetic fields applied to the head.”
While not as commonly employed as medication or psychotherapy, brain stimulation therapies can be highly beneficial in addressing depression and other disorders that are not adequately responsive to other forms of treatment.
Varieties of Brain Stimulation Therapy
Electroconvulsive Therapy (ECT) is a medical procedure that triggers a short series of seizures to stimulate the brain and modify neural functioning. Initially used to treat schizophrenia, from the 1960s to the 1980s, ECT was discovered to be especially effective in treating mood disorders, specifically depression.
Nowadays, ECT is recognized as one of the most potent treatments for severe depression and for treatment-resistant cases where other first-line treatments like selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy fail to bring about sufficient relief.
Despite its efficacy, ECT does present several drawbacks. The therapy requires the use of anesthesia, which leads to a longer and more complicated recovery process. The anesthetic requirement also prevents patients from driving immediately post-treatment. ECT can also cause significant side effects like short-term memory loss, which may discourage some individuals from considering it.
The NIMH characterizes ECT treatment as follows: “The patient is sedated with general anesthesia and administered a muscle relaxant to prevent movement during the procedure. Electrodes are positioned at specific points on the head, through which an electric current is passed, inducing a seizure that lasts less than a minute. Within 5 to 10 minutes post-procedure, the patient regains consciousness and can resume normal activities once the anesthesia has worn off.”
A typical ECT regimen is administered three times a week until the patient’s depression symptoms alleviate, usually within six to 12 treatments. Maintenance ECT treatment may be necessary. Patients often pair ECT with antidepressant medication.
What is Vagus Nerve Stimulation?
Vagus nerve stimulation is an invasive procedure utilizing a device to stimulate the vagus nerve with electrical impulses. Initially devised to treat epilepsy, researchers found that the device also influenced areas of the brain involved in mood regulation. As per the NIMH, “The pulses seemed to modify the levels of certain neurotransmitters (brain chemicals) linked with mood, including serotonin, norepinephrine, GABA, and glutamate.”
In 2005, the U.S. FDA approved this form of brain stimulation for treatment-resistant depression.
Vagus nerve stimulation necessitates a device to be surgically implanted under the skin on the chest, with a wire threaded under the skin linking the device to the left vagus nerve. When activated, the device sends electrical signals along the left vagus nerve to the brainstem, which then dispatches signals to the brain.
The operation usually lasts an hour or more, with incisions made on the chest or armpit and another on the left side of the neck. A pulse generator battery is implanted in the upper left side of the chest. A lead wire connects the pulse generator to the left vagus nerve in the neck.
The Mayo Clinic suggests that research results on the benefits of vagus nerve stimulation for depression are varied, with some studies indicating that symptom improvement can take months and doesn’t provide relief for all patients.
In Europe, new noninvasive vagus nerve stimulation devices that don’t require surgical implantation are available. Still, these have not yet been cleared by the FDA in the U.S. for depression treatment. Vagus nerve stimulation is often used for severe depression patients who have not responded to antidepressant medications, psychotherapy, and ECT.
rTMS: Repetitive Transcranial Magnetic Stimulation
Repetitive transcranial magnetic stimulation (rTMS), also known as transcranial magnetic stimulation (TMS), is a noninvasive brain stimulation technique that uses electromagnetic fields to stimulate specific areas of the brain. Repeating this process has been found to decrease the severity of symptoms for certain mental health conditions, such as depression. Currently, there are two forms of TMS available, usually referred to as traditional TMS and Deep TMS™, each with its own unique approach to treating the targeted condition.
Traditional Transcranial Magnetic Stimulation (TMS)
Traditional transcranial magnetic stimulation relies on a standard figure-8-shaped device to deliver its electromagnetic pulses to the brain. Although effective, the focal nature of traditional TMS can encounter targeting issues and risk missing critical brain structures during treatment. Traditional TMS has been FDA-cleared since 2008 to treat depression.
What is Deep TMS?
Deep Transcranial Magnetic Stimulation (Deep TMS) addresses some of the issues raised by its predecessor, traditional TMS. Specifically, Deep TMS uses patented H-Coil technology to transmit its electromagnetic pulses from within a uniquely designed helmet. These electromagnetic pulses reach wider and deeper areas of the brain, avoiding the targeting issues of traditional TMS.
Owing to its clinically proven safety and effectiveness, Deep TMS was FDA-cleared to treat major depressive disorder in 2013. The treatment is also FDA-cleared to treat anxious depression, obsessive-compulsive disorder (OCD), and smoking addiction. Deep TMS is CE-marked in Europe as a treatment for the aforementioned as well as several other conditions.
How is TMS Different from ECT?
TMS is sometimes likened to ECT because both treatments use electrical currents. However, TMS and Deep TMS are noninvasive, do not require anesthesia, and do not typically lead to any lasting or adverse side effects. TMS and Deep TMS can be combined with other forms of treatment, such as pharmacotherapy or psychotherapy, and can be incorporated into the patient’s daily routine.
A typical course of Deep TMS lasts for about six weeks, with most patients reporting symptom improvement approximately halfway through the treatment course. During each treatment session, a patient wears a cushioned, cooled helmet containing the H-Coil technology. As the H-Coil is activated, the patient feels a tapping sensation on their head. Each treatment session lasts around 20 minutes (or less if the healthcare provider is using intermittent Theta Burst Stimulation), and patients can drive themselves afterward.
There are more brain stimulation therapies in the research phase. However, they have not yet been approved by the FDA to treat depression patients.
If you or a loved one is struggling with depression and medication and therapy are not offering sufficient relief, consider discussing alternatives such as Deep TMS with your healthcare provider.