Major depression is a common mental health disorder that people in the United States struggle with. 7.8% of US adults have had at least one major depressive episode. Antidepressants are a common treatment for major depression but 30-40% of patients do not respond to antidepressant medication.
Augmented stimulation therapies are a recommended treatment for those 30 to 40% of people who have not responded to antidepressant therapy. Two augmented stimulation therapies that have been approved by the FDA for people who are not responding to antidepressants might include Vagus Nerve Stimulation (VNS) and Transcranial Magnetic Stimulation (TMS).
Overview of VNS
Vagus Nerve Stimulation (VNS) is stimulation of the vagus nerve in an attempt to modify central brain activity. VNS therapy has been approved by the FDA to be used to treat patients who suffer from chronic depression and in people who have not responded to antidepressants.
VNS is an invasive technique where a surgeon wraps a wire around the vagus nerve in your neck. The wire is connected to a battery-operated generator that is implanted under the skin in the left chest wall. The generator sends an electrical current through to the nerve that then sends a signal through neural impulses into the brainstem.
The left vagus nerve is the focus of VNS and the right is untouched because of the risk of potentially causing your heart to slow down or beat irregularly. The left vagus nerve is closely linked to mood and is the reason for the clinical effects of VNS.
The treatment usually begins two weeks after the surgery has taken place. The patient should be seen weekly during the first month of treatment to be observed and every other week during the second month. The standard dosing is 30 seconds every 5 minutes. Significant improvements are seen by patients typically after a year of treatment.
The most common side effects from VNS are hoarseness, troubled or labored breathing, and cough. Hoarseness or voice altercation are the most persistent problems experienced by people who are treated with VNS with between 30 to 60% of people experiencing it during times of stimulation. Most side effects decrease over time and side effect intensity is dependent on the dose of VNS and stimulation intensity.
Overview of TMS
Transcranial Magnetic Stimulation (TMS) is another form of therapy that has been approved by the FDA for people with treatment-resistant depression. TMS is a stimulation therapy involving an induction of an electrical current within the brain using pulsating magnetic fields that are generated outside the brain near the scalp. TMS creates its clinical effects from the electricity induced from the pulsating magnet and can help with mood.
TMS treatment typically lasts for 5 days a week for 4 to 6 weeks, but each patient will be given an individualized treatment plan. Sessions last anywhere from 15 to 45 minutes depending on the protocol. Like in VNS, significant improvements in the patient’s depression can be seen after a year of treatment.
Unlike VNS, TMS is non-invasive and does not require surgery or anesthesia. The magnetic fields used in TMS target the prefrontal cortex of the brain which is where most people with depression usually have lower activity.
TMS has reportedly low or even non-existent side effects and the most common side effect is slight discomfort. Some people may become lightheaded or have a slight headache, but there are no long-lasting side effects. The severe side effect of a seizure can occur as a result of TMS but that only happens in less than 0.1% of patients.
Choosing Between VNS or TMS
Choosing what treatment method is right for you and your treatment-resistant depression is between you and your doctor. Before deciding which option you want to go with, it’s important to consider all aspects that are relevant to your health and situation.
TMS therapy offers a non-invasive option to treatment-resistant depression. TMS also does not have long-lasting side effects and the side effects tend to be mild. VNS is an invasive but effective option for treatment-resistant depression. Both stimulation methods take time to feel the effects but are effective FDA-approved options if you have not seen results with antidepressants.
Here at Brain Center TMS, we offer TMS therapy and we do not offer VNS. We respect your right to make an informed health decision that best works for you. Here at Brain Center TMS, our mission is to help people become the best person they can be, and we respect any treatment that will get a person there.
If you would like to learn more about TMS therapy and what it can do for you, feel free to give us a call at 619-419-0901 to talk to a specialist.