TMS & Other Therapies

Bringing Focus to the Brain: Non-Drug, Alternative Stimulation Therapies to Electroconvulsive Therapy (ECT)

September 18, 2020

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Electroconvulsive therapy (ECT) has encountered a lot of backlash and stigma throughout the years. Arguably the most stigmatizing of all medical treatments, many patients are very opposed to the treatment even when their life may be at risk. The interesting part is that ECT is actually an extremely effective treatment, with remission rates for severe depression as high as ninety to ninety-five percent in some studies. That being said, the film industry and the media have managed to portray ECT in a frightening and unrealistic way, so much that it continues to contribute to patients’ reluctance to accept the treatment. 

ECT has arguably become a bit more accepted in recent years, and this is likely due to the increased amount of research and information published regarding the misconceptions and true effectiveness of the treatment. That being said, there are a variety of reasons as to why a patient who has an accurate understanding of ECT might still want to seek out alternative treatment routes. Fortunately, there are a couple of different types. 

Though there are certainly more commonly explored options such as various talk therapies or antidepressant medications, there are also some non-drug therapies that are of particular interest to patients with treatment-resistant depression. These alternative therapies to ECT can still involve brain stimulation, which aim to have the same results as ECT. 

What is ECT and Why is It So Stigmatized? 

ECT has been portrayed inaccurately in movies and other sources and has become a frightening treatment option for patients with treatment-resistant depression. 

ECT, sometimes referred to as shock treatment, has become one of the most controversial medical treatments despite its success in treating severe depression. It is important to first understand what ECT is and how it works, as this aids in the understanding of how it has gained so much stigma over time. 

ECT involves passing electric currents through the brain while a patient is under general anesthesia. By doing so, this treatment induces a brief, controlled seizure that changes the chemistry of the brain. This event ultimately has an effect on the neurons themselves and levels of various neurotransmitters in the brain. It is thought that the process of the brain attempting to stop or control the induced seizure actually functions as an antidepressant. 

By no means is ECT a first option for depressed patients, as it is still a more involved, complex procedure that poses some risks. Usually, patients are offered ECT after they have exhausted most treatment options without success, and are still suffering from severe, life-threatening depression symptoms. Some of the notable side effects of ECT are nausea, headaches, muscle pain, confusion following treatment, and memory loss. Interestingly enough, the memory loss is attributed specifically to the anesthesia and not to ECT itself. 

There are a few reasons as to why patients are still afraid of ECT. One reason is that decades ago, ECT was done involuntarily as a punishment in state institutions without the use of an anesthetic. Additionally, it was previously associated with lobotomies, so it too fell out of favor when lobotomies rightfully did. Another reason why ECT has come to be feared is because of the media and film industry, specifically with movies such as One Flew Over the Cuckoo’s Nest, which portrayed a very frightening and unrealistic episode of ECT. The dramatized portrayals of the treatment have unfortunately been more accessible to patients than having a more realistic understanding, which has induced a lot of fear and reluctance toward ECT.  

Pictured is a scene from the movie "One Flew Over the Cuckoo's Nest," which contains dramatic portrayals of ECT.
Movies such as One Flew Over the Cuckoo’s Nest have provided examples of unrealistic, dramatized portrayals of treatments like ECT. Though the basis of ECT involves inducing seizures, patients undergoing this procedure might only have an observable tremor in their feet for example, rather than convulsions throughout the entire body. Image courtesy of IMDb

Transcranial Magnetic Stimulation (TMS) Therapy: An Alternative Physical Treatment to ECT 

TMS therapy still involves electrical stimulation of the brain, but has been observed to have less side effects relative to ECT. 

As mentioned previously, stigma around ECT has luckily been reduced in more recent years. However, this doesn’t necessarily mean that patients don’t wish to explore an alternative treatment route when ECT is suggested to them. There are other physical treatment options that even apply the principle of electrical stimulation to treat depression, one of them being transcranial magnetic stimulation (TMS) therapy.  

TMS therapy for depression is non-invasive and FDA-approved. It involves using magnetic fields to stimulate certain nerve cells in the brain. A large, electromagnetic coil is placed on a person’s forehead, and areas of the brain thought to be involved in mood control are specifically stimulated. This, ideally, lessens symptoms of severe and treatment-resistant depression over time in order to improve the overall health and well-being of the patient. 

Overall, there are no major safety concerns with TMS therapy. It is also noted that it may be more or less successful between different patients. The advantage to taking the treatment route of TMS is that it does not involve the use of a general anesthetic during treatment, as the patient gets to stay awake and alert the whole time. It also does not typically cause seizures, unless a patient has a history of epilepsy. Overall, a major benefit of TMS therapy is that it is not thought to cause memory loss, which is a notable side effect of ECT. 

Some of the side effects associated with TMS include muscle contractions or tingling in the face or jaw, and headaches or lightheadedness. In general however, the most notable difference between TMS and ECT is the smaller amount of side effects that accompany TMS, which may be one justification for a patient seeking this treatment route instead. 

A patient receives TMS therapy.
TMS therapy also involves stimulation of the brain, but it uses magnetic coils to target certain nerve cells and allows the patient to stay awake during the procedure. It is thought that TMS has an advantage over ECT through its smaller range of side effects that accompany treatment. Image courtesy of HelpGuide

Other Non-Drug Treatment Alternatives to ECT: Deep Brain Stimulation (DBS) and Vagus Nerve Stimulation (VNS)

Outside of TMS therapy, there are a couple of other possible treatment routes that provide non-drug alternatives to ECT. 

Though ECT and TMS are the most widely used brain stimulation therapies, there are still two others that tend to come up when looking for alternative treatment routes. They have not been as extensively studied, so it is a bit more unclear on their exact effectiveness. 

The first alternative treatment outside of the previously mentioned treatment types is Deep Brain Stimulation (DBS). DBS was originally used for the treatment of tremors in Parkinson’s Disease. This treatment involves surgically placing two electrodes directly into the brain, along with a pulse generator in the patient’s chest. Essentially, the electrical stimulation is programmed into you. This type of treatment has in fact been used in cases where a patient with long-term treatment-resistant depression cannot find relief in any other type of treatment. 

Some of the side effects of DBS include mood swings, breathing issues, speech problems, infection, stroke, and insomnia. The fact that this treatment involves an actual surgery definitely poses more risks, though it can offer a successful alternative in more rare cases of severe depression. 

The second alternative treatment in this category is Vagus Nerve Stimulation (VNS). This is another type of brain surgery that involves implanting a device in the patient’s chest that has electrodes which connect to the vagus nerve. The vagus nerve is involved in the control of mood and sleep, which is why it is thought to be effective in treating severe depression. 

Some of the side effects of VNS include coughing, neck pain, headaches, changes in voice, or difficulty breathing. Again, surgery poses some other separate risks as well, which is why VNS, along with DBS, aren’t necessarily the first suggested options.  

Pictured is a model of the location of the implanted device that is involved in deep brain stimulation.
Deep brain stimulation and vagus nerve stimulation are two other alternative treatments to ECT. Though they are not as common as ECT and even TMS, these treatment routes offer even more options for those suffering from severe or treatment-resistant depression. Image courtesy of SciTechDaily.  

In conclusion, though ECT has received a lot of unwarranted disapproval and stigma over the years, there are still plenty of other reasons a patient may want to seek alternative treatments. The most common, non-drug treatment that offers an alternative to ECT is TMS therapy, which involves less side effects but employs the same neurological principles. DBS and VNS are two others that involve an actual surgery, but offer other potential routes a patient can take if they need a long-term treatment for their severe depression. Given that there are many options outside of the traditional treatments like talk therapy and antidepressants, it gives patients suffering from severe and treatment-resistant depression hope that they will be able to find a treatment that works for them. 

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