Physical non-drug treatments for major depressive disorder

Introduction to this topic

Dr David M B Christmas
Consultant Psychiatrist, Advanced Interventions Service

Updated: Tuesday, 14th November 2017
Last Checked: Tuesday, 14th November 2017 Current

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Chronic depression affects approximately 20% of all depressed patients, and many of these will not respond to conventional pharmacological and psychological treatment strategies. This topic covers a number of interventions that might be considered for the small number of depressed patients for whom traditional treatments don’t work. First, some concepts behind treatment-refractory depression are discussed along with some information on where specialist treatments might have a place. Second, the evidence supporting the use of ECT is reviewed along with considerations on predicting outcome and minimising adverse effects. Next, more experimental treatments such as Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS) are discussed, with reviews of the evidence supporting their use. A range of DBS targets are presented along with key studies. Finally, the role of neurosurgical treatment (Anterior Cingulotomy) is considered and up-to-date evidence on effectiveness and adverse effects is presented. Overall, a number of options are available for chronic, treatment-refractory depression and for the overwhelming majority of people the potential benefits are likely to outweigh the adverse effects.

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Sections in this Topic

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Treatment-Refractory Depression

Duration: 05m 39s
No. of slides: 9 - View Slide List

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Electroconvulsive Therapy (ECT)

Duration: 06m 07s
No. of slides: 11 - View Slide List

Play the video for Section

Vagus Nerve Stimulation (VNS)

Duration: 10m 32s
No. of slides: 20 - View Slide List

Play the video for Section

Deep Brain Stimulation (DBS)

Duration: 08m 00s
No. of slides: 14 - View Slide List

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Ablative Neurosurgery and Anterior Cingulotomy

Duration: 16m 40s
No. of slides: 25 - View Slide List