Depression treatment | TMS for depression in Montreal | PSYSOL
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Depression treatment

Depression


Depression is a disorder characterized by long-lasting sadness and loss of pleasure that is disproportionate to the triggering factor, if there is one. It is a very common condition, but it can hide behind physical symptoms or an unexplained change in personality. It requires careful assessment so that these “masked” cases aren’t missed. It can negatively impact quality of life on several levels, but it is treatable in the majority of cases.

Conventional treatments generally consist of psychotherapy for mild to moderate cases, and antidepressant treatment for moderate to severe cases. The best results are achieved by combining psychotherapy and antidepressants, or psychotherapy and some alternatives to antidepressants.

At Psysol, we offer alternative treatments to antidepressant. These include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), dynamic neurofeedback (dNFB) and light therapy. These effective and nearly side effect-free alternatives are offered to patients who don’t respond, or respond poorly to antidepressants, who can’t tolerate them due to their side effects, or who can’t take them due to a medical condition or pregnancy.

These alternatives are generally much better tolerated and have fewer or no side effects compared to antidepressants. They can be used depending on the case to optimize the effects of antidepressants, reduce their doses, or even stop them completely when possible.

What is depression?

 

Depression is an illness like any other, and it can affect anyone. Nobody is too intelligent, rich, educated, strong to be immune to depression.

 

Depression is marked by a sad (depressed) mood that differs from a normal reaction to a life event that is emotionally difficult to experience. The sadness is persistent and can be triggered by an anxiety-causing event or even spontaneously, without any trigger. It is often accompanied by a loss of pleasure, motivation, and interest.

 

Other symptoms are often present, such as: trouble sleeping, trouble eating with a weight gain or loss, unexplained physical and mental fatigue, and a tendency to procrastinate. Trouble concentrating is common, as is poor work performance. Depressed people can become impatient, irritable, and sometimes even aggressive. They have a tendency to isolate themselves and prefer solitude.

Their self-esteem decreases and feelings of guilt may also appear. Depressed people have a tendency to think that they are useless or even a nuisance. Feelings of hopelessness and incurability can settle in. Dark or even suicidal thoughts are possible and require particular attention.

The signs of depression are not always evident. They often exist in the background, behind physical symptoms such as persistent headaches, significant and unexplained fatigue, or digestive symptoms, hence the importance of careful assessment of depression before the unusual physical symptoms. It’s estimated that 50% of all cases of depression are undiagnosed.

Your healthcare professional will help you make the distinction between depression and other illnesses or conditions such as: hypothyroidism, another physical illness, a reaction to a stressful life event, grief, post-traumatic stress disorder, or adjustment disorder, among others.

It often happens that depression is associated with other illnesses (addiction,  chronic physical illness, etc.). Left untreated, depression can negatively affect quality of life and cause difficulties at work or at home. The ultimate risk of depression remains suicide.

The different forms of depression

  • Major depression : The symptoms are intense and present almost all day long and almost every day for at least 2 weeks.

 

  • Dysthymia (persistent depression) : This is less intense than major depression, but the symptoms last for more than 2 years.

 

  • Major depression associated with bipolar disorder : It alternates with episodes of manic or hypomanic episodes.

There are several other forms of depression, but any unusual and persistent low mood, especially if it isn’t a normal reaction to a life event or if it is an exaggerated and disproportionate reaction to the causal event, should lead to an assessment by a healthcare professional.

What is happening in a depressed person’s brain?

Current imaging technology allows us to identify some areas of the brain that are less active in depressed subjects compared to normals. Furthermore, the electrical or magnetic stimulation of these areas helps improve the condition of the depressed subjects. This is the principle utilized in electroconvulsive (electroshock) therapy and in more modern and nearly side effect-free technologies such as transcranial magnetic stimulation or cranial electrotherapy stimulation. Certain chemical substances have been identified over the decades that have allowed for the development of effective medications for treating depression.

 

It’s interesting to note that these observable biological disturbances fade or disappear following treatments, whether they are biological such as antidepressants, physical such as transcranial magnetic stimulation, or psychological such as psychotherapy.

What are the causes?

No definite cause is known at present, but certain risk factors have been identified. They may be genetic, medical, environmental, or social in nature. They include :

  • Presence of previous depressive episodes ;
  • History of depression in the family ;
  • Female;
  • Period surrounding childbirth (peripartum);
  • Childhood trauma;
  • Stressful life events ;
  • Weak social support network ;
  • Serious physical illness ;
  • Dementia ;
  • Substance abuse.

Treatments

Several treatments are available for depression :

  • Conventional treatments: psychotherapy and antidepressants ;
  • Modern treatments grouped under the categories of “neuromodulation” or “neurotherapy”.

These are techniques that aim to improve brain activity by means other than medication. Among these techniques are :

  • Repetitive transcranial magnetic stimulation (rTMS);
  • Cranial electrotherapy stimulation (CES);
  • Light therapy;
  • Neurofeedback ;
  • Vagus nerve stimulation (VNS) ;
  • Deep brain stimulation ;
  • Electroconvulsive therapy, commonly called electroshock (this technique is reserved for resistant cases and life-threatening situations and is only used in hospitals);
  • Additional treatments, such as: relaxation, meditation, Tai Chi, yoga, and a healthy lifestyle, including a balanced diet, moderate physical activity, social and familial involvement, etc.

In cases of mild to moderate depression, psychotherapy may be enough. In cases of moderate to severe depression, biological treatment becomes essential. Antidepressants are the leading choice. There are several categories of these that doctors are familiar with. The therapeutic responses to them are generally favourable, but certain cases don’t respond to initial attempts with antidepressants and require other options.

At Psysol, we specialize in therapeutic alternatives to medication. These include:

  • Repetitive transcranial magnetic stimulation (rTMS);
  • Cranial electrotherapy stimulation (CES);
  • Light therapy;
  • Neurofeedback.

These alternatives are effective, almost without side effects, and should be considered for people who :

  • don’t respond to antidepressants ;
  • can’t tolerate antidepressants ;
  • present contraindications to antidepressants ;
  • don’t want to take antidepressants and whose condition is deemed safe.

These therapeutic alternatives may be used in combination with conventional treatments (therapy and antidepressants) or alone, depending on the patient’s condition.

These techniques help:

  • optimize the effects of existing treatments with antidepressants or by other means ;
  • reduce the doses of the medications taken or even stop them entirely ;
  • treat, by themselves, cases of light, moderate, and sometimes even severe depression. In certain studies, cases of depression that were resistant to antidepressants responded to rTMS, for example.

These techniques can be used individually or in combination with others (i.e., light therapy and rTMS). The use of these techniques is preceded by a comprehensive evaluation to ensure :

  • that there are no contraindications ;
  • that there is a potential benefit to integrating them into the treatment plan ;
  • that the benefits of the existing treatments, if applicable, are not lost ;
  • that they are suitable to the patient’s condition ;
  • that there is a medical reason to use them or privilege them for a given patient.

In all cases, it’s regular monitoring that will let you optimize the treatment. You should always keep in mind that :

  • We can’t precisely predict the effects of a treatment for depression, whether it’s drugs, psychotherapy, or neuromodulation ;
  • No therapeutic method is guaranteed to produce results ;
  • Each person is different. What works for one person won’t necessarily work for another, despite the similarity of symptoms, diagnoses, trigger factors, or sharing the same family.

The alternative methods of neuromodulation fit well within the existing therapeutic arsenal for treating depression and can achieve significant results virtually without side effects. They should not, however, be considered foolproof treatments to replace everything that already exists. They enrich the range of choices and allow certain patients who don’t respond to conventional treatments or who can’t tolerate them to relieve their suffering gently and safely.

You need information or wish to make an appointment? Don’t hesitate to contact us !