TMS THERAPY
FDA-cleared, non-medication depression treatment
Depression Treatment Options: Beyond Medication and Therapy
Erika Krull, MSEd, LMHP
Medically reviewed on 12/28/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director
Trying different depression treatment options can sometimes be a lengthy process. Once you've been through a few that haven't been right for you, it's natural to feel frustrated. You may know someone who found one medication helpful or made great progress with their once-a-week therapy sessions, but for many people those treatments can prove ineffective.
However, that doesn't mean you have to continue experiencing depression symptoms indefinitely. Your choices for MDD treatment aren't limited to traditional therapy and medications—and in fact, there are more treatment options now than ever before. As you learn more about these treatment options, remember that your search for an effective depression treatment can have a positive ending.
Medical Treatments for Depression
Antidepressant medication is the most commonly used medical treatment for depression, but it's far from the only effective method. Several medical treatments beyond medications have been developed and modernized in recent years, providing more hope for people seeking MDD treatment. The following are evidence-based treatment methods, and most people try them in approximately this order:
1. TMS Therapy
2. Spravato
Spravato is an FDA-approved form of a substance called esketamine that is delivered as a nasal spray. Because it is a controlled substance that can cause disorientation or confusion, Spravato can only be administered by a doctor in a medical clinic or hospital. While there is still more to learn about how Spravato can help people, it stands out as a fast-acting, effective medication for short-term use. It can provide quick relief, and it holds promise for people with a high risk of suicide.
3. ECT (Electroconvulsive Therapy)
Electroconvulsive therapy (ECT) delivers brief electrical currents through the brain while a person is under anesthesia. These currents intentionally create a mild seizure, which is believed to affect the chemistry in a person's brain. For some people, this treatment can reverse the effects of severe depression when other methods have failed. It is much safer than in years past, but ECT can cause some side effects and isn't right for everyone.
4. VNS (Vagus Nerve Stimulation)
Vagus nerve stimulation (VNS) treatment begins with surgically implanting a small device in the chest. This device is programmed to deliver cycles of stimulating pulses to the vagus nerve, which runs down the left side of the body. Experts don't completely understand how VNS helps depression symptoms, but they believe the stimulation may change the way that nerve cells communicate to regulate mood. For some people, vagus nerve stimulation can provide depression relief. While it's rarely used, experts are encouraged by its potential benefits and safety for long-term use.
Alternatives to Traditional Talk Therapy Settings
Traditional talk therapy generally consists of weekly appointments at an office with a therapist, or counselor. This person may be a Psychiatrist, Psychologist, LCSW, or other Mental Health therapy specialist. While this approach helps many people through depression, some people respond better to a different approach. Effective talk therapy can take place in a variety of settings that offer more flexibility and support:
- Non-Residential Therapy
- Intensive Outpatient Therapy (IOP). IOP programs, usually include individual therapy sessions and group or family sessions a few times a week. Most sessions are offered during evening hours or weekends for IOPs to fit around work and school schedules.
- Home-Based Therapy. For some, getting to an office every week for therapy can be tough. Home-based therapy brings treatment to a person in the comfort of their home. These sessions can be individual, or they can include family members, if appropriate. This can allow people with mobility issues, severe symptoms, or difficulties regarding transportation to receive depression treatment with fewer barriers.
- Partial Hospitalization/Day Treatment. Partial hospitalization can help a person transition from 24-hour care to a less intense level of care. Alternatively, a day treatment program could serve as a stand-alone treatment. Partial hospitalization offers intensive therapy in a structured setting while allowing for independent living on evenings and weekends. Treatment can include medication management, group or family therapy, yoga, art therapy, and social interaction. For children and adolescents, there is usually a classroom setting each day so that children can complete their schoolwork.
- Residential Therapy. Residential therapy can be beneficial for a person with multiple mental health needs or strong, persistent symptoms. Residential treatment can last for a few weeks or several months, depending on a person's needs. With 24-hour access to support and medical care, the patient can take the time they need to try medications or other treatments until their symptoms improve. Additional therapeutic techniques, such as outdoor exercise, music therapy, meditation, or nutritional support may also be included.
Depression Treatment Options to Consider
If the depression treatments you've tried don't seem to help, take a closer look at TMS therapy and other treatments to see if they might work for you. The path to recovery may have bends, but don't lose hope. If you persist in your search, you will likely find a treatment that gives you relief.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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