Side Effects. Side effects of ECT may include temporary confusion, memory lapses, headache, nausea, muscle soreness, and heart disturbances. Administering the drug naloxone immediately before ECT may help reduce its adverse effects on concentration and some (but not all) memory impairment. Concerns about permanent memory loss appear to be unfounded. One study that used brain scans before and after ECT found no evidence of cell damage. In another small study of teenagers who had undergone ECT for severe mood disorders, only 1 of 10 reported memory impairment more than 3 years after the treatment.
Phototherapy
Phototherapy is recommended as the first-line treatment for seasonal affective disorder (SAD).
The Procedure. The procedure is noninvasive and simple. It is best performed immediately after waking in the morning. The patient sits a few feet away from a box-like device that emits very bright fluorescent light (10,000 lux) for about 30 minutes every day.
Some people report mood improvement as early as 2 days after treatment. In others depression may not lift for 3 - 4 weeks. (If no improvement is experienced after that, the depression is probably caused by other factors.)
Side Effects. Side effects include headache, eye strain, and irritability, although these symptoms tend to disappear within a week. Patients taking light-sensitive drugs (such as those used for psoriasis), certain antibiotics, or antipsychotic drugs should not use light therapy. Patients should be examined by an ophthalmologist before undergoing this treatment.
Cingulotomy
A surgical technique called cingulotomy interrupts the cingulate gyrus, a bundle of nerve fibers in the front of the brain, by applying heat or cold. A variation of this procedure using MRI scans to guide the surgeon produced long-term improvement in 53 - 78% of patients with severe intractable depression. The procedure is generally safe with few serious complications. It does not affect intellect or memory.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) employs high frequency magnetic pulses that target affected areas of the brain. The intention is similar to electroconvulsive therapy (ECT) but, unlike ECT, it is more precise and has the potential of having the same benefits as ECT. A 2001 review reported that it was superior to sham treatments, although it was not clear whether benefits were significant. Investigators continue to try various techniques that might produce consistent improvements.
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) is a procedure that is effective for certain patients with epilepsy, and is now showing some success in patients with treatment-resistant depression
VNS involves implanting a battery-powered device under the skin in the upper left of the chest. The neurologist programs the device to deliver mild electrical stimulation to the vagus nerve. (The patient may also pass a magnet over the device to give it an extra dose if they sense a seizure coming on.) The two vagus nerves are the longest nerves in the body. They run along each side of the neck, then down the esophagus to the gastrointestinal tract. The vagus nerve travels to areas of the brain that control functions such as sleep and mood.
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