According to the World Health Organization, depression affects roughly 350 million people and is the leading cause of disability worldwide. Similarly, approximately 800,000 people die each year by suicide. Depression is arguably the greatest public health issue we face today.
Treatments for depression are generally classified into psychosocial (e.g. psychotherapy, support groups), complementary and alternative (e.g. meditation, nutrition, recreation therapy) somatic (e.g. electroconvulsive therapy, deep brain stimulation), and pharmacological (e.g., antidepressant medications).
Each category of treatment boasts relative “winners and losers” depending on which study or studies one references (or personal biases one listens to).
Indeed, research on talk therapies such as cognitive therapy, interpersonal therapy, and behavioral activation have yielded robust results. Meditative-based practices appear to stand out among alternative treatments. Transcranial magnetic stimulation is growing in popularity and research support. And serotonergic antidepressants are considered the gold standard in the pharmacological management of depression.
Although a review of all four categories would potentially yield an interesting and useful article, the current piece is restricted to emerging somatic and pharmacological treatments for three primary reasons.
First, somatic and pharmacological treatments tend to have greater financial costs compared to psychosocial and alternative treatments.
Second, somatic and pharmacological treatments are more invasive and carry much greater risk for adverse effects.
And lastly, in the spirit of full disclosure, as a prescribing psychologist my interests currently align more with biological based interventions. For a comprehensive review of depression treatments, see Gotlib (2014).
The 1900s played host to countless elixirs, procedures, and contraptions that were touted as effective cures for myriad “neurotic” conditions.
Desperate people spent untold amounts on opium laced syrups, violet ray wands and electricity laden belts in hopes of gaining control over their emotional ailments.
Fortunately, as medical science progressed, these methods and means gave way to more effective treatments, albeit many would argue medical science has advanced very little in the area of psychiatry.
Two of the more popular somatic treatments being used today, Transcranial Magnetic Stimulation (TMS) and Cranial Electrotherapy Stimulation (CES), may seem reminiscent of the old days.
Indeed, magnets and low-grade electrical current are gaining a large market share of patients seeking alternative methods for treating depression.
TMS is a non-invasive procedure that stimulates nerve cells in various regions of the brain by manipulating magnetic fields. Small magnets or “coils” placed on the head deliver pulses to the patient’s brain, which is reported to alleviate even the most severe forms of depression.
The neurobiological and neurophysiological mechanics associated with reported improvements are not fully known.
One popular theory is that the magnetic pulses excite underactive neurons in the prefrontal cortex which is believed to be responsible for low or dysregulated mood.
The research supporting its effectiveness is mixed (Janicak & Dokucu, 2015); however, in depressed patients who have failed antidepressant medications, TMS is considered an effective and safe alternative (Gaynes et al, 2014).
As with any treatment, there are risks. Some patients report lightheadedness, headache, twitching of facial muscles, and scalp tingling or discomfort.
CES is also a non-invasive intervention employed in the treatment of depression. Instead of using magnets like with TMS, CES delivers low levels of electrical current to the brain via electrodes attached to the ear lobes.
As with TMS, the neurobiological and neurophysiological mechanisms associated with reported improvements are not known.
One theory proposed by the manufacturer of the CES proprietary machine “Fisher Wallace Stimulator” is that use of the device produces neurochemicals hypothesized to be responsible for mood (e.g. serotonin).
However, it should be noted that the “chemical imbalance” theory of depression has been met with harsh criticism for good reason (Lacasse & Leo, 2005; Pies, 2011). Research on the effectiveness of CES for depression is less than with TMS (Kavirajan, Lueck, & Chuang, (2014). Risks associated with CES include headache, insomnia, and skin irritation.