Brain Stimulation Therapies For Mood Therapies Flashcards
What are brain stimulation therapies for Mood Disorders?
• Electroconvulsive therapy
• Repetitive transcranial magnetic stimulation
• Vagus nerve stimulation
• Experimental
– Magnetic seizure therapy
– Deep brain stimulation
Note: Brain stimulation therapies are usually used as an adjunct to medications and/or psychotherapies
What is electroconvulsive therapy ?
- Involves electrical induction of a generalized seizure
* A patient is pre-treated with a muscle relaxant to prevent injury and an anesthetic to reduce consciousness
What is the mechanism of action and indications of ECT?
Mechanism of Action of ECT
•multiple and indiscriminate CNS effects
•therapeutic mechanism has not been isolated
Indications
•treatment-resistant depression and/or mania
•severe depression (or mania)
What are the procedures and contraindications of ECT?
ECT Contraindications: Vascular disease (due to blood pressure increase during a seizure)
Procedure
•electrode placement:
■frontotemporal
■unilateral (fewer side effects) vs bilateral (more effective)
- generalized seizure for >30 seconds
- 3 treatments/week for 6-12 treatments
What is the initial side effect of ECT?
Initial Side Effects of ECT
- headaches
- some memory loss for recent long-term memory and some consolidation difficulties surrounding ECT sessions
What are the long term side effect of ECT?
Long-Term Side Effects of ECT
•no permanent memory system problems (still debated):
▪ Typically memory abilities normalize after a few months post-treatment
Efficacy of ECT
•rapid clinical improvement of mood episode
▪ progressive symptomatic improvement after 1st session to complete remission within 3-4 wks)
▪ generally considered “safe & rapidly effective”
•used to treat acute illness, not as prophylaxis
Describe Repetitive Transcranial Magnetic Stimulation (rTMS)?
•Magnetic pulses are generated and used to stimulate the prefrontal cortex
Side Effects: Usually minimal (e.g., scalp discomfort at stimulation site)
•Sessions: 40 mins, 5xs/wk
▪ usually takes 4-6 wks of sessions before
therapeutic benefits seen
•Available to patients who have failed at least 1
medication trial
What is vagus nerve stimulation?
•Intermittent electrical stimulation of the vagus nerve (via an implanted wire and pacemaker)
▪ For treatment-resistant depression
▪ Risks of surgery/implantation
▪ “Mild” effects of stimulation (e.g., coughing)
- Therapeutic effect takes several months
- Under investigation: Transcutaneous VNS
What is Magnetic Seizure Therapy (MST)?
– Similar to ECT treatment except seizures induced by rTMS
– Focal seizure induction
– Goal: Retain ECT effectiveness but reduce
memory side effects
What is Deep Brain stimulation?
As described for OCD
– Several target sites experimented with (e.g., subcallosal cingulate white matter)
