Magnetic Seizure Therapy: A New Treatment For Depression
UT Southwestern is the only clinical trial site in the country using a new form of brain stimulation to treat major depression. Preliminary findings indicate that magnetic seizure therapy can ease depression without the cognitive side effects associated with electroconvulsive therapy.
MST is similar to ECT but uses magnets in place of electrical currents to stimulate the brain. We know that bilateral ECT is superior to MST and unilateral ECT . Preliminary data suggests that right-unilateral ECT and MST are comparable, but MST carries fewer memory-loss symptoms. We are excited about this trial because we hope to, in the future, offer magnetic therapy as an alternative for patients who are concerned about cognitive side effects of ECT.
Another therapy for treatment-resistive depression is repetitive transcranial magnetic stimulation , which does not carry some of the side effects of ECT. While rTMS is not as effective as ECT, there is exciting research in progress that could lead to rTMS becoming a more effective option for patients in the future.
Additionally, the drug ketamine was approved by the FDA in as a therapy for treatment-resistant depression. Ketamine is still being studied for other major depressive disorders clinical studies are currently being conducted at UT Southwestern.
The Electroconvulsive Therapy Process
An ECT treatment regimen will typically include sessions two to three days a week for a total of six to 12 treatments. The schedule works out to about one month of treatment, although the course may continue for longer.
During ECT, you will be under general anesthesia. You will not be aware of what is going on while you are undergoing the treatment.
Once you are under anesthesia, electrodes will be attached to your scalp in specific locations. The brain is then stimulated with a brief amount of electricity to induce a seizure that will last less than a minute.
Your healthcare provider will closely monitor you to make sure that the anesthesia and a muscle relaxant are working and that you are not experiencing any complications.
When shock therapy was first used 80 years ago, patients needed to be strapped to the table to keep them from moving during the seizure. Today, an anesthesiologist will give you a muscle relaxant to keep your body from shaking uncontrollably, reducing the risk of injury.
The entire process lasts about one minute. When the procedure is finished, you will rest in a recovery room until you wake up from the anesthesia, which typically takes about five to 10 minutes. You should be able to go home within an hour.
For the most part, you can go about the rest of your day, although because you had anesthesia, you will need someone to accompany you home since you will be advised not to drive.
What Happens During This Procedure
ECT involves multiple healthcare providers, including a psychiatrist, anesthesiology specialist and other trained personnel.
Anesthesia and other preparations
ECT procedures start with general anesthesia, which puts you into a deep sleep and keeps you from feeling any pain, discomfort or anxiety during the procedure. Providers will also give you a muscle relaxant to avoid any injuries or strain that might happen during the seizure.
Providers will also insert a bite guard into your mouth to protect your teeth, and also insert an intravenous needle into one of your veins . The IV allows quick injection access for medications for anesthesia reasons or to counteract any side effects.
Electrode placement
A healthcare provider will then place electrodes, which are contact points for the electric current to travel through, against the skin of your head. The placement depends on your specific needs, and providers will choose a placement with the lowest chance of causing side effects. There are three different ways that providers can place the electrodes.
A healthcare provider will coat the electrodes in a conductive gel that should prevent irritation and burns to your skin. While the electrical current involved is very low, skin irritation and burns are still possible.
Electricity requirements
The electrical current duration for ECT is also very brief. For most treatments, delivery of electrical current to your brain only lasts a few seconds.
Induced seizure
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What Does Ect Look Like
ECT is a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. When undergoing ECT, patients are asleep and their muscles are completely relaxed. Depending on condition severity, patients often go in for sessions weekly, biweekly, or monthly, and end treatment when in remission.
What Is Ect And Why Is It Used
ECT is an effective treatment for some types of severe mental illness. It is usually considered when other treatment options, such as psychotherapy or medication, have not been successful or when someone is very unwell and needs urgent treatment.
ECT is given as a course of treatments, typically twice a week for 38 weeks. If you have ECT, it will take place under general anaesthetic. This means that you will be asleep while it happens.
While you are asleep, your brain will be stimulated with short electric pulses. This causes a fit which lasts for less than two minutes. As well as an anaesthetic, you will be given a muscle relaxant which reduces how much your body moves during the fit.
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Medications Dont Always Work For Mental Health Issues
Mandal said research is clear that people experiencing mental health issues often experience treatment resistance after three novel treatments. By the time a patient tries a fourth medication, theres only a 7-to-10% chance that it will work.
Its understandable to keep fighting for something that will help, Mandal said. But once youve exhausted that track with medication, you need to look at neuromodulation therapies.
Unlike medications that run through the entire body, neuromodulation therapies deliver electrical or pharmaceutical agents directly to a target nerve area in the brain. These therapies, such as Ketamine, deep-brain stimulation and ECT, aggressively change how specific neurons interact with other neurons, Mandal said.
ECT is an option for any reversible short circuit in the brain, which is any mood disorder, he said. It does not work for hardwire illnesses, such as multiple sclerosis, dementia or strokes because in such illnesses, the wires themselves are problematic, not the fuse box. These fuse box, or short-circuit conditions include psychotic disorders, hallucination-based disorders, migraines, epilepsy and Parkinsons.
The Future Of Severe Depression Treatment
As effective as ECT can be for treatment-resistant depression, there is room for improvement and UT Southwestern is leading the charge. We are the only medical center in the U.S. participating in a National Institute of Mental Health-funded clinical study for magnetic seizure therapy . Along with the University of Toronto Centre for Addiction and Mental Health , we are enrolling patients to compare the effectiveness of right-unilateral ECT and MST.
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Ect Is Part Of A Whole
Along with the ECT schedule, Mandal works with patients to develop an exercise and psychotherapy plan. With this combination, patients have an 80% chance of staying in remission years after ECT, Mandal said.
Its like the mind is a garden with tons of weeds, he explained. ECT clears the weeds, it tills, it brings the water and all of that, but it doesnt plant anything. ECT is only as good as the therapy that follows it. Thats where patients make enduring changes in their brain.
Talk therapy is proven to be the best intervention to rewire the brain. The problem, Mandal explained, is that a persons brain needs to be functioning well for talk therapy to work.
If a person has severe depression, there is not a lot of electricity in the frontal lobe, which is what we use to retrieve memories, put things together with meaning, and understand vocal inflections, he said. When you have a severe illness, you cant do any of that. You can give a person all the talk therapy you want, but they cannot do anything with it. They will just be stuck in therapy for years. Thats where ECT comes in. It gets you out of that cycle. ECT builds that engine and talk therapy pushes on the gas pedal.
Hannah continues to meet with Mandal for medication management. She also sees a talk therapist.
Her advice to others is to seek help.
Hannah can now move forward. Im looking into the next steps of life. What can I be successful at, and what can I do to be helpful to others? she said.
Does Depression Look The Same In Everyone
Depression can affect people differently, depending on their age.
Children with depression may be anxious, cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
Older children and teens with depression may get into trouble at school, sulk, be easily frustrated feel restless, or have low self-esteem. They also may have other disorders, such as anxiety and eating disorders, attention-deficit hyperactivity disorder, or substance use disorder. Older children and teens are more likely to experience excessive sleepiness and increased appetite . In adolescence, females begin to experience depression more often than males, likely due to the biological, life cycle, and hormonal factors unique to women.
Younger adults with depression are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, and substance use disorders.
Middle-aged adults with depression may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning awakening. They also may more frequently report having gastrointestinal symptoms such as diarrhea or constipation.
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Why Does Ect Work For Depression Other Mental Health Conditions
ECT is one of the most evidence-based interventions available to get a client into remission, Mandal said. Remission is not only feeling better. It is being indistinguishable from someone who does not have an illness. It is not a cure but total control of the illness. No other treatment in psychiatry has better data to return a person to their pre-illness functioning.
ECT works in the same way a defibrillator or pacemaker helps restore a normal rhythm to a persons heart, he said. Heart heart arrhythmia occurs when electrical signals that coordinate heartbeats beats dont work correctly, mental illness occurs when electrical signals in the brain dont function properly.
Its not that the healthy wires arent there, its just that electricity is not going through the wires for whatever reason, Mandal said.
ECT has excellent results for those over age 65 but has amazing data for younger people too, Mandal said.
He explained that the more genetic loading a person has of a specific illness meaning a strong family history the earlier in life the condition will appear for that person. ECT data shows high remission rates for people in their 20s, setting them on a positive course for the rest of their life by significantly decreasing the likelihood theyll ever have to deal with that illness again.
Minimal Improvement At Six Weeks Requires A Change In Treatment
Except for PTSD and OCD , patients whose illness shows little improvement in depression or anxiety despite six weeks at a maximum-tolerated dose should be switched to an alternative medication or psychotherapy.22 Failure of one SSRI does not preclude trial with a second SSRI, but two SSRI treatment failures should definitely lead to a medication switch with a different mechanism of action.23
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Mild Shock Therapy May Ease Anxiety And Depression But Not Chronic Pain
By Lisa Rapaport, Reuters Health
4 Min Read
– People with anxiety and depression might feel a little better after they get mild electric shock therapy, but its unclear how much it will help or whether this treatment might ease other conditions, researchers say.
The therapy, known as cranial electrical stimulation, delivers a current similar to that of a 9-volt battery through electrodes on skin to the brain. Researchers examined data from 26 clinical trials that randomly assigned some patients with a variety of chronic painful conditions to receive this therapy and others to get a placebo or dummy treatment or stick with usual care.
Most of these trials were too small or brief to offer conclusive evidence that cranial electrical stimulation works for headache, joint pain, musculoskeletal pain, headache, fibromyalgia, insomnia, or depression alone, the analysis found.
For people with both depression and anxiety, however, researchers found low-strength evidence of a modest benefit.
If there is a benefit, it is probably not on average a large benefit, because when a treatment has an average benefit that is large this is usually pretty obvious even from a small number of studies or even studies of a small number of patients, said lead study author Dr. Paul Shekelle, of the West Los Angeles Veterans Affairs Medical Center.
Cranial electrical stimulation appeared safe, or at least the review didnt find evidence of serious side effects.
Can Ect Be Used To Treat Anxiety
Anxiety disorders are common psychiatric illnesses and include:
ECT is not used to treat anxiety and therefore does not have a role in people who have solely an anxiety disorder. ECT may have a role in people who have comorbid depression and anxiety. The concern of some psychiatrists is that while ECT may help with depressive symptoms, it could worsen anxiety symptoms, including obsessional thoughts or panic attacks.
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Why Is Ect Controversial
The use of ECT can be controversial for several reasons:
- It was used unethically in the past. ECT was used far more in the 1950s to 1970s than it is today, and it was used without anaesthetic and often without consent. This has sometimes been shown in films and TV shows, which may not reflect how ECT is carried out today.
- It can sometimes cause memory loss. This is often short-term, but can be longer-lasting as well. See our page on the side effects of ECT for more information.
- Some people are offered ECT without being offered other treatments they may prefer to try first, such as talking therapies for depression.
- Professionals disagree about whether to use it. Some healthcare professionals see ECT as a helpful treatment, while others say it should not be used.
How Does Shock Therapy Work
Even though ECT has been around for nearly 90 years, scientists still are not quite sure why or how it benefits some people with depression.
What researchers do know is what neurons do, which is send electrical signals back and forth. These signals tell the brain to release specific chemicals. When the brain undergoes ECT, an increase in beneficial neurochemicals like serotonin or dopamine may be released.
ECT may also impact the neurons in other ways, such as by stimulating the development of new brain cells or connections, or by affecting the electrical activity in the parts of the brain that are associated with mood regulation.
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Whats The Outlook For People With Anxiety Disorders
Anxiety disorders can often go undiagnosed and untreated. Fortunately, treatment can help. The right treatment can help improve your quality of life, relationships and productivity. It can also support your overall well-being.
You dont need to live with constant worry and fear. If you notice symptoms of an anxiety disorder, talk to your healthcare provider. Its best to get diagnosed and treated as soon as possible. Doing so can limit the problems that anxiety disorders can cause. Often, a combination of medications and counseling for anxiety can help you feel your best.
Selective Serotonin Reuptake Inhibitors
If a GP thinks you’d benefit from taking an antidepressant, you’ll usually be prescribed a modern type called a selective serotonin reuptake inhibitor .
Examples of commonly used SSRI antidepressants are paroxetine , fluoxetine and citalopram .
They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a “good mood” chemical.
SSRIs work just as well as older antidepressants and have fewer side effects, although they can cause nausea, headaches, a dry mouth and problems having sex. But these side effects usually improve over time.
Some SSRIs are not suitable for children and young people under 18 years of age. Research shows that the risk of self-harm and suicidal behaviour may increase if they’re taken by under-18s.
Fluoxetine is the only SSRI that can be prescribed for under-18s and, even then, only when a specialist has given the go-ahead.
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What Problems Can Ect Treat
The National Institute for Health and Care Excellence recommends that ECT is only used to achieve quick, short-term improvements if you have:
- severe or life-threatening depression and your life is at risk so you need urgent treatment
- moderate to severe depression and other treatments such as medication and talking therapies haven’t helped you
- a severe or long-lasting episode of mania.
Repeated ECT is only recommended if you have previously responded well to it, or if all other options have been considered.
ECT is not recommended for ongoing management of schizophrenia, or as a routine treatment for mild to moderate depression.
You can read full guidelines on the NICE website for using ECT to treat catatonia, mania or schizophrenia, and as one of the treatments for moderate or severe depression.
What Can Happen If You Dont Have Ect
You and your doctor will need to balance the risk of you experiencing side effects from ECT with the risk of you not having ECT. Not having ECT may mean that you are more likely to have:
- prolonged and disabling mental illness
- serious physical illness from not eating or drinking
- an increased risk of death from suicide.
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