Myths, facts and other treatment options for depression

By Nicholas Mischel, MD, Interventional Psychiatrist, Department of Psychiatry and Behavioral Health

Myths

• Depression is only feeling sad.
• Depression is only feeling stressed.
• Depression is only feeling like you want to give up.

Facts

• Depression affects brain and nervous system function (neuro-physiology).
• Depression affects how we control our thoughts and feelings about ourselves and others (neuro-psychology).
• Most of the time, a treatment plan can be individualized that ends up working well (personalized medicine). If first- or second-line treatment is not effective, there are newer options.

Other treatment options

There are new options to treat depression when usual first or second line treatment is not effective. One new option that involves direct stimulation of the brain is called repetitive transcranial magnetic stimulation (rTMS). rTMS is very different from ECT, electroconvulsive therapy, which is also popularly known as “shock therapy”. ECT is the most potent and effective treatment for depression, however it’s somewhat invasive procedure limits it’s use to severe and life-threatening cases. rTMS uses an electro-magnet to create small, localized electrical currents in brain and nerve tissue. Repeated stimulation (the ‘repetitive’ part) with an electro-magnet causes persistent changes in brain and nerve activity to reduce or reverse the neuro-physiologic effects of depression for a period of time following stimulation.

Consecutive rTMS sessions increase the durability of this effect, and 30-40 consecutive sessions can produce a persistent anti-depressant effect. There is also a new class of medications for depression called “rapid-acting antidepressants” or “RAADs”. RAADs are medicines that are administered, usually by infusion, to a person in a doctor’s office while they are monitored for a period of time. These medicines can relieve depression and suicidal thinking as quickly as within 1 to 3 days although the effects of one infusion usually does not last more than two to three weeks. Procedures involving RAADs commonly include adjunctive, or, additional combined treatment with RAADs plus psychotherapy or RAADs plus a traditional antidepressant medicine.

Wayne Health has a long history of research and treatment patients with TRD, and Wayne State University was the first group in southeast Michigan to establish an academic interventional psychiatry service to provide rTMS and RAAD treatments. Wayne Health offers both rTMS and RAAD procedures as well as general evaluation and treatment recommendations for “treatment-resistant depression”, TRD, or depression that doesn’t respond to traditional medicines and psychotherapy. Wayne Health refers to community partners for ECT when indicated.

Wayne Health Interventional Psychiatry is a sub-specialty referral service. Patients being treated for TRD with rTMS or RAAD procedures need to maintain a primary psychiatrist or other provider to continue medication management and/or psychotherapy for depression. rTMS is approved for other psychiatric conditions, including obsessive-compulsive disorder (OCD), and WSU is involved in clinical research to develop additional protocols and indications.

To set up an appointment with Dr. Mischel, or another Wayne Health provider, visit our appointment page or call (877) 929-6342.