TMS | Behavioral Treatment | Melville
TMS | Behavioral Treatment | Melville
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TMS | Behavioral Treatment | Melville
Depression ?

What is Major Depressive Disorder
Major depression is a common and serious medical illness affecting more than 13 million Americans, or approximately 6.6 percent of the population in a given year. Unlike the normal ups and downs of everyday life, Major Depression is persistent and can significantly interfere with an individual's thoughts, behavior, mood, and even physical health. Mental illness is the leading cause of disability in the U.S. often impairing social, academic and work functioning and causing significant emotional distress. Depression is the most predominant illness within the mental health arena.

Women are almost twice as likely as men to suffer from depression. However, some experts feel that depression in men is significantly under-reported. Major depression can occur at any age, including childhood, the teenage years and adulthood. Major depression has no racial, ethnic, or socioeconomic boundaries. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. It is not unusual for depression sufferers to have more than one episode in any given year.

Major depression, also known as unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (a type of chronic depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). Individuals suffering from bipolar disorder experience both depression and mania in a cyclical fashion. Mania often involves abnormally and persistently elevated mood or irritability, elevated activity, grandiosity, rapid speech and racing thoughts.

Causes of Major Depressive Disorder
Scientists have not yet determined the root cause of major depression. However, there is strong evidence there may be several contributors to the illness. Psychological, biological and environmental factors may all contribute to its development. Whatever the specific causes, research has firmly established that major depression is a biological brain disorder.

Serotonin, norepinephrine and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Several theories attempting to explain depression are based on an imbalance of these chemical messengers. It is thought that most antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemicals.

Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression. Life events, such as the death of a loved one, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger a depressive episode. Often, however, depressive episodes occur spontaneously and are not triggered by a life crisis or physical illness.

Symptoms of Major Depressive Disorder
The onset of the first episode of major depressive disorder may not be obvious if it is gradual or mild. The symptoms of this disorder characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression may include:

  • Feelings of Worthlessness, Hopelessness, Helplessness or Guilt
  • Persistently Sad or Irritable Mood
  • Pronounced Changes in Sleep Habits and Energy Levels
  • Pessimistic Feelings About the Future
  • Trouble Making Decisions
  • Significant Weight Gain or Loss
  • Difficulty Thinking or Concentrating
  • Low libido
  • Increased Agitation
  • Lack of Interest in or Pleasure From Activities Typically Enjoyed
  • Recurrent Thoughts of Death and/or Suicide

When several of these symptoms occur at the same time, last longer than two weeks, and interfere with ordinary functioning, individuals should seek professional advice and treatment. If left untreated, major depression can lead to attempted suicide.

Treatment for Major Depressive Disorder
Several types of treatment for major depression are available, and the type chosen depends on the individual and the severity of their illness. There are three basic types of treatment for depression in common use today: psychotherapy, medications and electroconvulsive therapy (ECT). They may be used singly or in combination. NeuroStar® TMS Therapy is currently testing a fourth type.

Psychotherapy: There are several types of psychotherapy that have been shown to be effective for depression including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that some individuals with mild to moderate depression can at times be treated successfully with either of these therapies used alone. Other research on Major Depressive Disorder has indicated that the use of medication and psychotherapy together is more useful than either one utilized alone.

Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while training people how to break the behavioral patterns that contribute to their illness.

Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life situations that may have contributed to an individual’s depression.

Medication: The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neuro- transmitters like serotonin, dopamine and norepinephrine can be modulated with antidepressants. The response to medication is gradual often taking 4-6 weeks to fully respond. Five groups of antidepressant medications are most often prescribed for depression:

Selective serotonin reuptake inhibitors (SSRIs) – useful as a first-line treatment, they act specifically on the neurotransmitter serotonin. In general, SSRIs cause fewer side effects than TCAs and MAOIs.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) – useful as first-line treatments in people taking an antidepressant for the first time and for people who have not responded to other medications. In general, SNRIs cause fewer side effects than TCA and MAOIs.

Dopamine reuptake blocker – a newer antidepressant medication, it acts on the neurotransmitters dopamine and norepinephrine. In general, this class of medication causes fewer side effects than TCAs and MAOIs.

Tricyclic antidepressants (TCAs) – still widely used for severe depression. TCAs elevate mood in depressed individuals, re-establish their normal sleep, appetite and energy level. The often times greater side effects of the tricyclic antidepressants may limit their usefulness in some individuals

Monoamine oxidase inhibitors (MAOIs) – are often effective in individuals who do not respond to other medications or who have "atypical" depressions with marked anxiety, excessive sleeping, irritability, hypochondria or phobic characteristics. These medications are harder to use and require following a low tyramine diet.

Electroconvulsive therapy (ECT) - ECT is an effective treatment for severe depressive episodes. ECT employs the use of anesthesia and muscle relaxers during the procedure which involves the application of an electrical field to the head in order to produce a physical seizure. These treatments are given in the hospital.

For individuals where medication, psychotherapy, and a combination of the two prove to be ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT is often used. ECT may also be indicated for those who are not able to take antidepressant medications and do not respond to psychotherapy. Side effects on memory recall are troublesome for some individuals.

Vagus Nerve Stimulation (VNS Therapy™) – is a non-drug treatment available specifically for treatment-resistant depression. The actual procedure takes about an hour and is usually performed under general anesthesia on an outpatient basis. Two small incisions are required: one on the upper chest area for the pulse generator and one on the left neck for the thin, flexible wires that connect the pulse generator to the vagus nerve. This treatment is infrequently utilized.

Transcranial Magnetic Stimulation (TMS Therapy):

Neurostar TMS Therapy is a new treatment cleared by the US Food and Drug Administration (FDA) for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment. TMS stands for "transcranial magnetic stimulation."

TMS Therapy is a treatment that can be performed in a psychiatrist's office, under their supervision, using medical device called the NeuroStar TMS Therapy system. NeuroStar TMS Therapy is:

  • Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
  • Non-systemic, meaning that it is not taken by mouth and does not circulate in the blood stream throughout the body.
  • The typical initial treatment course consists of 5 treatments per week over a 4-6 week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 40 minutes.

Note: Information on this site is for reference purposes only. It is not intended to be nor should it be taken as medical advice. Individuals who think they may suffer from major depressive disorder should see a medical professional regarding their symptoms


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