Depression looks different in every person and has a unique blend of causes, symptoms, and manifestations in that person’s brain and life. (See: My Depression Is Not Your Depression)
For some people, breaking a sweat, making dietary changes, practicing meditation regularly, or writing in a gratitude journal helps lift the cloud of depression. For others, talking or texting with a therapist online or in person or taking medication can bring relief. And still, for some, a combination of these does the job, while nothing seems to help an unfortunate few
While antidepressants and therapy are traditionally the first-line treatments for major depression, they don’t work for everyone. Studies indicate that 29 to 46 percent of patients with major depressive disorder (MDD) show partial or no response to treatments. And a research review published recently in the British Journal of Sports Medicine looked at 97 studies and concluded that exercise is more effective than the leading medications or counseling in treating depression and other mental health disorders.
What do you do when nothing works?
In the hard-to-treat cases of MDD, alternative therapies may be used instead of or in addition to standard treatments. Practices that treat depression by modifying brain activity, called neuromodulation, have been found to be beneficial in relieving stubborn cases of depression.
At the most basic level, depression is just the routine activation of certain brain circuits, in specific patterns that result in depression for you. So, changing the way your brain functions, can be effective in alleviating depression.
Neuromodulation medicine techniques have been around since the 1960s and have drastically improved in recent decades with the aid of computers. They are successfully used today to treat many conditions, including chronic pain, epilepsy, functional restoration, and movement, cardiovascular, gastrointestinal, and psychiatric disorders, and more. For treating depression, neuromodulation techniques range from experimental to proven and noninvasive to surgical procedures.
Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation (TMS) is a noninvasive procedure that uses magnetic pulses to alter neural activity. During a TMS procedure, a magnetic coil is placed near the head. The coil is connected to a generator and produces small electrical currents in the region of the brain just under the coil via electromagnetic induction. TMS has proven successful in treating major depressive disorder, migraines, symptoms of schizophrenia, and stroke damage.
To simplify greatly, depression is a dysfunction in the communication between the brain’s frontal lobe, the thinking brain, and the limbic system which controls autonomic bodily functions, like breathing and heartbeat, and endocrine function, particularly in response to emotional stimuli. TMS has been shown to increase dopamine release and help restore better communication and balance between the brain’s frontal lobe and limbic system.
One researcher looked at the studies so far and concluded:
…rTMS is rapidly gaining popularity as a treatment modality for depression. There is growing evidence to support its use in patients with depression as a monotherapy or as adjunct with pharmacotherapy. Additionally, rTMS has been found to be safe and effective in pregnant patients and elderly patients, that use of either pharmacotherapy or ECT is challenging because of possible risk of adverse reactions.”
Neurofeedback is a specialized form of biofeedback therapy, a mind-body technique where people learn to influence their autonomic nervous systems, that focuses on helping a person’s brain learn at a subconscious level to permanently alter their own brainwaves. Although it sounds like science fiction, neurofeedback has been around since the 1950s and is a reputable, scientifically proven modality practiced by specially trained psychotherapists.
Neurofeedback is a noninvasive therapy where EEG sensors are placed on the scalp and ears to read the electrical activity of the brain. Brainwaves are monitored by a computer which gives real-time feedback to the person training in the form of an auditory or visual reward, like a video game. The person plays the video game with their brain. With consistent repetition, the brain learns to self-regulate and makes permanent physiological changes to perform more optimally which continues even when not training. Because it’s a learning process, the results of neurofeedback occur gradually over time.
Neurofeedback has been used successfully for many conditions including depression, anxiety, autism, ADD and ADHD, brain injuries, stroke recovery, addictions, seizure disorders, learning disabilities, chronic pain, dementia, and more. Because neurofeedback fine-tunes the brain’s performance, it can also be used to heighten focus and concentration such as required for school, playing golf, or other sports.
Many scientific studies have confirmed the effectiveness of neurofeedback for treating mild to treatment-resistant depression as being much better than medication. One study found the response and remission rates to be 58 and 50 percent respectively after only 12 weeks of neurofeedback training. Professor Eun-Jin Cheon, Yeunggnam University Hospital, South Korea, project leader of the study said:
Neurofeedback has been trialed with psychological conditions in the past, but as far as we know this is the first time that anyone has succeeded in achieving remission and overall recovery (functional recovery) with treatment-resistant depression. This is particularly important because this is an otherwise untreatable group of patients…The most promising thing about neurofeedback is it doesn’t cause even mild side effects. It could also improve self-efficacy by participating in active, voluntary treatment.”
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) is a surgical procedure that can be used for treatment-resistant depression. A pacemaker-like device about the size of a silver dollar is implanted in the chest and attached to a wire that is threaded along and delivers impulses to the vagus nerve. The vagus nerve travels up the neck to the brain where it connects to areas involved in mood regulation.
VNS was originally developed to treat epilepsy and for reasons not completely understood, electrical impulses transmitted via the vagus nerve to the brain, affect the neurochemicals, specifically norepinephrine and GABA, and can relieve epilepsy and the symptoms of depression. VNS has been shown to have a positive effect on mood in people who have tried antidepressant medications without relief. However, VNS isn’t a quick answer as it can take several months before the effects are felt.
One study found a 40 percent reduction in depression scores rate in patients with MDD treated with VNS. However, a review of the research concluded:
The efficacy and safety of VNS for depression are still unclear. Further randomized controlled trials are needed to confirm the efficacy and safety of VNS.”
Electroconvulsive Therapy (ECT) is a technique in which electricity is delivered to the head causing a brief, therapeutic seizure. ECT got a bad reputation from negative media portrayal, like in the movie One Flew Over The Cuckoo’s Nest, and because early treatments administered high doses of electricity without anesthesia, leading to memory loss, fractured bones, and other serious side effects.
ECT was developed in the 1930s when there were few alternatives for treating psychiatric conditions. Since the 1950s, ECT has been performed using anesthesia, is FDA-approved, and has advanced so that there a few side effects. The American Psychiatric Association says on its website:
Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients.”
Like antidepressants, the exact reason ECT works is not fully understood, but it has broad effects on the brain impacting many neurochemicals and brain cell growth. ECT can quickly treat severe depression, reverse symptoms of certain mental illnesses, and often works when other treatments are unsuccessful.
Transcranial Direct Current Stimulation
Transcranial Direct Current Stimulation (tDCS) is a simple technique using constant, low current delivered to areas of the brain via electrodes on the scalp to either excite or inhibit neuronal activity.
Although tDCS is still an experimental form of neuromodulation and is not currently FDA-approved, it potentially has several advantages over other brain stimulation techniques because it’s cheap, non-invasive, painless, and safe. Many affordable devices are available now for at-home use.
Several studies suggest tDCS may be a valuable tool for the treatment of neuropsychiatric conditions such as depression, anxiety, Parkinson’s disease, and chronic pain. Research has also demonstrated cognitive improvements, such as quicker learning and improved memory, in some patients undergoing tDCS.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) involves surgically implanting electrodes in the brain which modify and regulate brain activity. Similar to VNS, a pacemaker-like device is placed in a person’s chest with a wire that travels under the skin connected to the electrodes in the brain which controls the amount of stimulation delivered to the electrodes.
DBS is not yet FDA-approved, but the FDA has granted “Breakthrough Device Designation” for some companies to study it. It is currently used to treat a number of neurological conditions including essential tremor, Parkinson’s disease, dystonia, a neurological movement disorder, obsessive-compulsive disorder, epilepsy, and more. DBS is still being studied for cluster headaches, Tourette’s syndrome, chronic pain, addiction, obesity, anorexia, Alzheimer’s, and major depression.
DBS has shown potentially dramatic success with depression, but the studies have been all over the place too. One research review of 125 studies of the highest scientific standard concluded:
While enthusiasm for DBS as a therapy for TRD has been tempered by recent randomized trials, this meta-analysis reveals that active stimulation significantly ameliorates depression in patients with TRD.”
Ultimately, recovering from depression involves altering the brain circuits contributing to the condition which can be done in many ways including lifestyle, behavior, prescription medications, and neuromodulation. The only way to find out what is right for any particular person to ease depression is to consult a mental health professional and try various treatments until something works.
Eye Movement Desensitization and Reprocessing
Eye movement desensitization and reprocessing (EMDR) is an intervention for treating many mental health conditions, including depression, that utilizes eye movements in conjunction with guidance from a therapist to help you process traumatic memories. It is most often used to treat trauma-related disorders. EMDR improves the symptoms of depression by targeting underlying life events, childhood memories, negative beliefs, and triggers and guiding your brain to process and store the events differently — with less stress response from your brain and body.
EMDR was devised by Francine Shapiro in 1987 while she was walking in a park and noticed that her upsetting thoughts and feelings had suddenly disappeared. She was puzzled by this and as a graduate student studying psychology, she decided to research what was happening more closely. She eventually developed the EMDR protocol that could be duplicated and studied and began working with people Post Traumatic Stress Disorder (PTSD). Since its discovery, EMDR Therapy has become one of the most recommended and researched psychotherapeutic treatments for trauma and PTSD.
It is highly effective in treating depression — because a lot of depression is related to trauma. One 2022 study stated:
The findings of our observational study confirm reports of earlier studies in patients with depression, showing that EMDR therapy leads to a high rate of remission, and is associated with a decreased number of relapses. Patients with depression receiving EMDR treatment may be more resilient to stressors.”
Here is a great video explaining EMDR:
When you’ve tried conventional treatments for depression and are still struggling, it may be beneficial to explore one of the neuromodulation therapies listed above which target depression by actually making changes to your brain. While some are backed by a wealth of solid research and others are still being studied, the real question is “Does it work for you?”
You will never know until you try.Share this article!