Different therapies for depression

DEAR DR. ROACH >>

I am an ex-medical/surgical nurse.

I have a daughter-in-law who was treated for depression with magnetic therapy. My psychiatric exposure in the 1950s was with electroshock therapy and insulin shock therapy. Can you explain how the new magnetic therapy works for depression, compared with the other two treatments?

P.S. Is electroshock therapy still being used?

— N.P.

DEAR READER >> Electroconvulsive therapy (ECT) is still used for treatment of drug-resistant severe depression. However, despite decades of use, the exact mechanism of how it works is not understood. ECT does increase neurotransmitters like dopamine, serotonin and norepinephrine (as do some medications). ECT also releases hormones such as prolactin, thyroid-stimulating hormone and endogenous endorphins, and it has anti-seizure properties as well.

A newer theory is that ECT increases the ability of the body to respond to brain atrophy that is often caused by long-standing depression. I have hardly ever seen it used. Of nearly a million people treated for depression in a 2014 study, only 1/4 of 1% were treated with ECT. Still, I have seen remarkable success with this treatment, which works far faster than medication. Meanwhile, insulin shock therapy was first tried in the 1930s, but was discredited and abandoned in the 1960s.

Transcranial magnetic stimulation (TMS) is a new treatment that has been shown to be relatively safe. The major serious side effect is seizures, although these are uncommon. It may also cause headache and temporary hearing loss.

Unfortunately, I can’t tell you exactly how TMS works either. The strong magnetic field of the TMS machine (very similar to an MRI machine) rapidly alternates, generating electrical currents in the brain — both on the surface of the brain and the deep brain in some cases. TMS is in some ways similar to ECT.

TMS and ECT are appropriate to consider if medications are ineffective or can’t be used and when psychotherapy (the other mainstay of depression treatment) can’t be accessed. Unfortunately, this is a common problem.