Wednesday, July 1, 2015

ECT, TMS, and DBS, modern therapeutic strategy of depression

Today, I listened to some researchers in an academic conference. I learned about several themes.

One of interesting topics is physical therapy for mental disorders. Conventionally, mental disorders has been treated with medication of psychotropic drugs and psychotherapy using conversation with therapists. However, some patients never respond to such therapies. In addition, medication is difficult to be encouraged to pregnant women. And psychotherapy is time consuming.

Physical methods were repeatedly attempted in the history of psychiatry. Unfortunately, most of them have been proven not to be beneficial, rather harmful. Besides infamous lobotomy, there were several methods buried in the horizon of psychiatry, such as insulin shock, malaria therapy, and so on.

Electro-Convulsive Therapy (ECT) is the only exception. It is well known as an effective alternative to treat depressive disorders. The ECT can improve the mental state of the patient who is suffering from life-threatening depression. Nowadays, the safety of electric shock is adequately certified.

However, the indication of ECT is becoming rare in Europe. There are some reasons. Modern medicines are so powerful that we need not to try ECT for most patients. However, not a few people are still treatment-resistant. One of the speaker estimated that only 3% of such patients get ECT. It means that the other 97% of patients with severe depression are forced to bear the long-lasting suffering.

The majority of the audience looked supportive to utilize ECT more frequently. I agree with this opinion. The speaker introduced a scientific article in which the author claimed to abolish ECT, but it too was arbitrary, according to the speaker.

Recently, some other methods to stimulate the brain tissues directly or indirectly are focused. Repetitive Transcranial Magnetic Stimulation (rTMS) has been introduced also in Japan. It is easier to implement than ECT, but its effect is weaker. Transcranial Direct Current Stimulation (tDCS) is able to use much more casually.

On the other hand, Deep Brain Stimulation is considered not having been established as a treatment for depression. Another speaker said that one large clinical trial was terminated on the way because of the poor outcome. I think DBS is potentially hopeful as a treatment, because some patients with Parkinson's disease experience an elevated mood after DBS. The procedure of the operation may have to be more sophisticated to ensure the effectiveness.

Treatment of mental disorders with a brain surgery or similar means sounds horrible. But the matters are the benefit to the patients and risk of adverse effects. We are keep to develop new therapeutic strategies for the patients' well-being.

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