Does Brain Stimulation Work Better Than Medication?

Summary

Dr. Tracey Marks, a psychiatrist, discusses various devices and procedures used to treat mental health conditions, answering viewer questions. These include Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), Trigeminal Nerve Stimulation (eTNS), and Neurofeedback. Each treatment targets different brain regions to improve neuroplasticity and address conditions like depression, OCD, ADHD, and more. Dr. Marks highlights the effectiveness, risks, and benefits of these methods, emphasizing their role in treatment-resistant cases and explaining how each works in a straightforward, accessible way.

Takeaways

• 😀 ECT (Electroconvulsive Therapy) is an effective treatment for severe depression, bipolar disorder, and psychotic disorders, with a success rate of 70-80%.
• 😀 ECT works by using electrical pulses to induce seizure activity, which improves neuroplasticity and may stimulate neuron growth.
• 😀 ECT requires general anesthesia, and patients typically experience short-term memory loss around the treatment period.
• 😀 TMS (Transcranial Magnetic Stimulation) is used for treatment-resistant depression and OCD, using magnetic pulses to stimulate specific brain regions.
• 😀 TMS is non-invasive, with sessions lasting 20-30 minutes, and is performed 5 times a week for 6 weeks.
• 😀 Vagus Nerve Stimulation (VNS) involves implanting a small device that delivers electrical pulses to the vagus nerve, primarily used for treatment-resistant depression.
• 😀 VNS can take 6-9 months to show effectiveness and is considered invasive due to the surgical implantation process.
• 😀 Trigeminal Nerve Stimulation (eTNS) is a non-invasive device for children with ADHD, delivering electrical pulses through the trigeminal nerve while the child sleeps.
• 😀 Neurofeedback uses brainwave activity to teach individuals how to regulate their mental state, providing real-time feedback to encourage positive brain activity.
• 😀 Neurofeedback is non-invasive but can be costly, and insurance coverage may vary. Its effectiveness is still debated due to the lack of standard protocols.

Q & A

What is Electroconvulsive Therapy (ECT) and how does it work?

Electroconvulsive Therapy (ECT) is a procedure where electrical pulses are used to stimulate the brain, inducing seizure activity. It was initially thought to work by increasing brain chemicals like serotonin, but recent research suggests it may work by enhancing neuroplasticity, which helps improve the connections between neurons and may stimulate neuron growth.

What are the side effects of ECT?

The primary side effect of ECT is memory loss, particularly for the time just before and after the procedure. Some people experience longer-term memory issues, and others may not remember what happened around the treatments at all. These memory problems typically clear up after a few days, but some people report ongoing memory issues.

What are the different phases of ECT treatment?

ECT treatment is given in two phases: the acute phase, where patients receive 3 treatments per week for 6 to 12 weeks, until symptoms resolve, and the maintenance phase, where treatments are reduced to once a week or every other week, depending on whether the patient stays on medication or prefers to rely on ECT alone.

How effective is ECT compared to antidepressants?

ECT is effective in 70-80% of cases, which is significantly higher than the 30-65% success rate of antidepressants, especially for treatment-resistant depression.

What is Transcranial Magnetic Stimulation (TMS) and how is it different from ECT?

TMS is a non-invasive procedure that uses magnetic pulses to stimulate specific areas of the brain, particularly the left dorsolateral prefrontal cortex, which is underactive in people with depression. Unlike ECT, TMS does not induce seizures and is generally well tolerated, with fewer side effects like memory loss.

What are the risks associated with TMS?

While TMS is generally safe, there is a risk of seizures, scalp pain, and headaches following the procedure. However, these side effects are typically mild compared to the more significant side effects of ECT.

What conditions can be treated with Vagus Nerve Stimulation (VNS)?

Vagus Nerve Stimulation (VNS) is primarily used for treatment-resistant depression and was initially approved for epilepsy. It involves implanting a device that sends electrical pulses through the vagus nerve, though it can take 6-9 months to see noticeable improvements.

Why is VNS not used as frequently as other treatments?

VNS is less commonly used due to its invasive nature, requiring a surgical procedure to implant the device. Additionally, it takes a long time (6-9 months) to see significant results, which may deter patients from opting for this treatment.

What is Trigeminal Nerve Stimulation (eTNS) and how does it work?

Trigeminal Nerve Stimulation (eTNS) involves delivering low-level electrical pulses through the trigeminal nerve during sleep. It was approved in 2019 for treating ADHD in children aged 7 to 12 who are not taking medication. It is thought to help regulate brain regions responsible for attention, emotion, and behavior.

How is Neurofeedback used to treat mental health conditions?

Neurofeedback is a type of biofeedback that trains individuals to regulate their brain activity by monitoring brainwaves through electrodes placed on the scalp. It provides feedback through video images or sound, reinforcing desired brain activity and discouraging negative activity. It is non-invasive but can be costly and may take time to show results.

Why is Neurofeedback not widely accepted as a standard treatment?

Neurofeedback is not widely accepted due to the lack of standard treatment protocols, varying effectiveness, and the high cost of sessions. There is also debate within the research community about its overall validity, as it is not always covered by insurance and can require many sessions with unclear long-term benefits.

What is the typical duration and frequency of TMS treatment?

The standard course of TMS treatment for depression involves five sessions per week for six weeks, with each session lasting around 30 minutes. For obsessive-compulsive disorder (OCD), treatments last about 20 minutes, and patients are encouraged to think about their obsessions just before the treatment to enhance the brain's response.

Can patients continue medication while receiving TMS?

Yes, patients undergoing TMS for depression or OCD are typically advised to continue their medication throughout the treatment. TMS is used in conjunction with medications to provide an additional therapeutic benefit.