Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today I'm talking about devices that we use
to treat mental health conditions.
And this video is based on several viewer questions
for me to talk about this.
To keep this from being too long and complicated,
I'm gonna talk briefly about a number of devices
that are used and in later videos
I can have more details about the devices.
The devices or procedure that I'm talking about today
are transcranial magnetic stimulation or TMS,
electroconvulsive therapy or ECT,
vagus nerve stimulation or VNS,
neurofeedback and trigeminal nerve stimulation or eTNS.
I'll start with ECT because it's still
the best treatment we have, even better than medication.
But it's an aggressive treatment,
it uses electrical pulses to stimulate the brain
and produce seizure activity.
We used to think the seizure improved depression
by creating an electrical storm
that would increase the brain chemicals like serotonin.
And there may still be some of this going on,
but it looks more like it works through
a mechanism of increasing neuroplasticity.
That is, it improves the connections between the neurons
and may even stimulate neuron growth.
I talk about neuroplasticity in a video that I did
on how we define depression.
ECT requires general anesthesia,
which means you're completely asleep
and you're unaware of what's happening.
Also, you're given a medication to keep your body
from convulsing and moving around,
so the seizure activity is measured
by looking at your brain waves.
If you were standing in the room
watching someone getting the treatment,
you'd just see the person lying on the table
as if they were getting surgery.
The procedure lasts about 10 to 15 minutes.
Electroconvulsive therapy works about 70 to 80% of the time.
And this is in contrast to 30 to 65%
rate of success with antidepressants.
A downside to ECT is because of the anesthesia
and the way that your brain is stimulated,
you tend to have memory loss for the time
just before and just after the procedure.
The memory problems and the disorientation
usually clear up after a few days,
but some people have reported longer term memory problems.
And some people never remember what happened
around the treatments.
It's like it just stays a blur for them.
But changes in the way that we do ECT
have improved the memory problems over the years.
ECT is not just used for depression, it's also used
to treat bipolar disorder, psychotic symptoms,
and it's given in two phases:
an acute phase and a maintenance phase.
During the acute phase you get three treatments a week
until your symptoms resolve,
and the average amount of time is about six to 12 weeks.
Then you would adjust your medications
for whatever condition that was being treated.
If you prefer not to get back on medication,
you could get maintenance ECT which would be treatments
like once a week at first, and then every other week.
Some people prefer to stay on their medications
and then get some occasional maintenance treatments,
and then some people prefer not to get back on medication
and use ECT as their only maintenance.
Transcranial magnetic stimulation is a procedure
that stimulates the brain by using a magnetic device,
and this device is similar to the one that you get
with magnetic resonance imaging or an MRI.
We use TMS treatment
for treatment-resistant depression and OCD.
TMS also helps improve depression
by improving neuroplasticity.
When we look at the brain using functional imaging studies,
we see that the left dorsolateral prefrontal cortex
is underactive when someone's depressed.
So that's the area of the brain that's stimulated for TMS.
TMS was first approved in 2008
for anyone who had failed treatment with one medication.
More recently it was approved
for obsessive-compulsive disorder.
The standard course of treatment for depression
is five days a week for six weeks,
and the sessions are usually about 30 minutes.
There's a newer version though, an express TMS,
that lasts about three minutes,
and it has a stronger intensity.
For OCD, the area of the brain targeted
is the anterior cingulate cortex.
The sessions last about 20 minutes,
and you're asked to think about your obsessions
just prior to the treatment because thinking about them
activates this brain region and produces a better response.
For both depression and OCD you stay on your medication.
You don't get the same memory issues with TMS
as you do with ECT, but you are at a higher risk
of having a seizure after the procedure,
and some people can have scalp pain and headaches.
Next is vagus nerve stimulation.
In 2005, the FDA approved vagus nerve stimulation
for treatment-resistant depression.
With this, a small stimulator device
is surgically implanted into your chest
with connecting leads placed on the left side of your neck.
Think of it as like a pacemaker placement
that's for your heart.
The device sends pulses through your vagus nerve,
and this procedure was originally approved
for treatment refractory epilepsy
and then later on for depression.
It's not used a whole lot and I think partly because
it's very invasive and you have a have a surgical procedure.
And it takes a long time to see improvement.
One study showed that it took six to nine months
to see some improvement
after you finished getting the treatment.
Trigeminal nerve stimulation was approved in April 2019
for treating ADHD in children seven to 12
who are not taking medication.
It works by delivering a low-level electrical pulse
through the trigeminal nerve while the child sleeps.
It's thought to help ADHD but stimulating brain regions
that are important in regulating attention,
emotion, and behavior.
And it's a device that requires a prescription,
so that suggests that it could be used at home.
But at the time of this video, the approval was so new
that the manufacturer didn't have a lot of details
about how it will be used, so more on that to come.
Neurofeedback is a type of biofeedback
that uses your brainwave wave activity to teach you
to regulate brain functions.
You're set up with electrodes on your head
similar to if you were getting an EEG.
An EEG is what we use to detect seizures activity
and look at brainwave activity during a sleep study.
Biofeedback is used to teach you how to control
internal body functions using special instruments.
So for whatever system that you're monitoring,
you watch the instruments to see how the things that you do
change your vital signs.
So if your heart rate is fast, say,
you would learn how to do things
to bring down your heart rate.
So think of neurofeedback as this same kind of process,
but using brainwaves to monitor certain mental activities.
The feedback is given with either video images or sound.
You get positive imagery or sound to reinforce
desired brain activity and negative imagery or sound
to extinguish negative brain activity.
It's noninvasive so you don't need to take
medication for it,
however, it can take a while to work, and it can be costly.
And your insurance may not pay for it.
In fact, some researchers question how valid it really is,
so it's not a widely accepted treatment.
When things are not widely accepted
they tend lack standard protocols.
So one of the reasons that this can be more costly,
is because it's not clear how many treatments you need.
How long does it last before you need to get another one?
But that's not to say that this can't be helpful.
These questions are just something to think about
when you're seeking out a provider
so you can ask these questions
and at least know what you're getting into.
That's it. See you next time.