Depression Treatment

Still struggling with depression, even with medication and counseling? Rest assured that there is still hope. Advanced, effectivetreatment options are available which may help you. A Prisma Health psychiatrist can help you determine if one of these treatments is right for you.

Electroconvulsive therapy (ECT)

Many advancements have been made to ECT since its first use in the 1930s. In fact, ECT is 70–90% effective in treating depression. In addition, results often are more rapid than other treatment options. Sadly, fear and misconceptions about ECT prevent some people from trying it.

ECT at Prisma Health involves a series of treatments in which an electric current causes a seizure while you are asleep under anesthesia. In addition to treating depression, ECT can also be used to treat bipolar disorder, catatonia, and other psychotic disorders. ECT may be recommended if your illness is severe, life-threatening and/or if other treatment options have failed. ECT is typically covered by insurance.

Safety

Of all the procedures performed under general anesthesia, ECT is one of the safest. If you have a severe heart and/or lung problem, the procedure may be riskier for you. That’s why all patients undergo a medical evaluation and lab testing before starting ECT.

What to expect

ECT can be performed in an inpatient or outpatient setting. Prisma Health–Upstate offers ECT for inpatients at Prisma Health Greenville Memorial Hospital. Outpatient ECTs are performed at Prisma Health Baptist Easley Hospital.

Typically, patients start out getting three treatments a week (Monday/Wednesday/Friday). The number of ECT treatments required varies for each person, but most people start to see improvement after 6–12 treatments. Treatments are then slowly tapered in order to prevent symptoms from returning.

When you arrive for ECT, a doctor and nurse will ask you some questions to make sure you are ready for your treatment. A nurse will also start an IV by putting a needle into a vein in your arm. This is how you will receive medications during the procedure.

Once you are ready for your treatment, the ECT team will connect you to devices that monitor your heart rate, blood pressure, and oxygen level. Electrodes will also be placed on your head. These monitor your brain activity.

A medication is then given to make you go to sleep. Once asleep, you are given medication to relax your muscles. This medicine prevents your whole body from moving during the treatment. Your doctor induces a seizure using a small amount of electrical current after you are completely asleep and relaxed. Most seizures last 15 to 70 seconds before your body stops it on its own. Sometimes, a medication is given to stop the seizure.

The actual treatment lasts just a few minutes, recovery from anesthesia takes longer. You may wake up a little tired and confused. Other common side effects may include headache, nausea, and muscle aches. Because of these side effects, you must have a responsible adult accompany you and drive you home from the procedure.

Side effects

Side effects from ECT may include headache, nausea and muscle aches. They usually are managed with medications during the procedure or with over-the-counter pain relievers at home. Another side effect that you may experience is memory loss. Confusion and memory loss tend to stop within weeks to months after finishing your treatments. Patients should not drive or make major decisions until ECT treatment ends.

Ketamine infusions

Ketamine is a medication that has been used for anesthesia since the 1970s. In the 1990s, researchers realized that ketamine could have a positive impact on mood. Compelling evidence now exists that supports the use of intravenous ketamine to treat depression and suicidal thoughts. Though it is not yet approved for this use, studies show that ketamine may improve depressive symptoms within hours of receiving an infusion. Ketamine infusions may be recommended if your depression is severe and resistant to other treatments.

What to expect

Prisma Health offers ketamine infusions at the Center for Perioperative Optimization (CPO), located at the Verdae Medical Center. Clients usually receive six infusions of ketamine over 2–3 weeks.

Once you arrive for your treatment, a needle ( or “IV”) will be inserted into a vein in your arm. We suggest wearing a short sleeve shirt or sleeves that can be pushed above the elbow. This allows you to remain comfortable in your clothes while you are receiving medicine. The ketamine will then be given through your IV by a board-certified anesthesiologist. The infusion lasts 40–60 minutes. During this time, you may have bizarre thoughts or feel like you are in a dreamlike state. Your blood pressure, heart rate and oxygen level will be monitored while you receive the infusion.

Side Effects

You may feel like you are having bizarre thoughts after your infusion too – these usually resolve within four hours. Unusual sensations, blurred vision and/or drowsiness may also occur. Because of these, you must have a responsible adult accompany you and drive you home from your infusion.

Ketamine can rapidly improve depression, although relapse is common. Continuing prescribed anti-depressants, in addition to receiving ketamine infusions, may be helpful in treating your depression. It is also important to see your regular psychiatric provider while undergoing treatment.

Insurance does not cover ketamine infusion therapy. That means patients pay all treatment costs.

Transcranial magnetic stimulation (TMS)

TMS treatment at Prisma Health involves a small electrical pulse that passes through a metal coil on the scalp, creating a magnetic field that stimulates parts of the brain linked to depression. Many insurance companies cover TMS.