In addition to the pharmacological and psychotherapeutic treatment of depression, other methods have been proposed for its treatment.
Such methods, often effectively combined with pharmacotherapy and psychotherapy, include: intravenous laser irradiation of blood, magnetic stimulation (transcranial therapy with alternating low-frequency magnetic field, right-handed para-polarization therapy), extracorporeal detoxification (plasmapheresis), periodic normobaric hypoxia; sleep deprivation, diet therapy (including its discharge options), balneotherapy (warm baths have been used for a long time to softening state of a person who is depressed), massage and exercise therapy (breathing exercises and physical activity contributes to the weakening of symptoms of depression).
Among the biological treatments for depression, a special place
takes electroconvulsive therapy.
Intravenous laser blood irradiation
According to the recommendations of domestic scientists, intravenous laser irradiation of blood should be carried out on a low-intensity helium-neon apparatus (FALM-1). The laser wavelength of 0.63 microns. The radiation power at the fiber output is 8 mW. The duration of the session is 15 minutes, the course of therapy is 8-12 sessions. It is noted that after conducting laser therapy in the presence of psychopharmacological drugs, the severity of depressive symptoms in almost 60% of persons suffering from depression decreases almost twice. Patients with manifestations of apathy and melancholy are especially sensitive to laser therapy, less pronounced effect is observed in complex depressive syndromes, including symptoms of depersonalization, obsessive states and hypochondria.
Laser therapy is ineffective in anxiety and depressive states. It should be borne in mind that the effect of laser therapy, as well as of antidepressant therapy, may be delayed and appear some time after the completion of the course of treatment. Currently, there are various upgrades of laser therapy. An example of this is the differential method of low-intensity magnetic laser therapy.
This method of treatment includes an individual stage program of course combined laser exposure, which is a continuous blood irradiation with continuous red light (0, 63 µm) and transcutaneous irradiation with pulsed infrared light (0.89 µm) projections of a number of biologically active zones and organs using standard magnetic nozzles. Laser irradiation usually does not cause side effects and complications.
Extracorporeal Detoxification
Extracorporeal detoxification is used in combination therapy for resistant depression and can be combined with transfusion of fresh frozen plasma or albumin in order to normalize protein metabolism. For this, usually 2-3 plasmapheresis procedures are performed.
Electroconvulsive therapy
Currently, one of the most effective methods for treating depression is electroconvulsive therapy, which is used both as an independent method of treatment and in combination with other methods of therapy.
Electroshock therapy was used in ancient Greece. In the temples of Asclepius, depression was treated with electric snakes. In the Middle Ages, it was also believed that a strong shock to the patient could bring him out of the state of depression.
Treatment of depression with electric shock recommended Hill in 1814 Of particular interest in this method of treatment of depression was noticeable in the early 40s of the XX century. With the advent of neuroleptics in the 50s of the 20th century, ECT was used less frequently, but since the 1970s, with the advent of safe ECT methods, interest in this method of treating mental disorders has increased again.
It is now widely recognized that the treatment of depression with electroconvulsive therapy is highly effective. It should be noted the effectiveness of ECT not only in severe depressions, but also in its unsharply expressed forms. In the case of suicidal thoughts that require quick medical intervention, ECT can be an indispensable treatment method, since it acts faster than antidepressants.
It is difficult to overestimate the importance of electroconvulsive therapy for those patients for whom pharmacological treatment is contraindicated (pregnancy, certain somatic diseases, etc.), as well as, if necessary, to overcome depression that is resistant to other types of therapy.
The question of the optimal placement of electrodes during ECT is controversial. It is assumed that the bilateral placement of electrodes (both electrodes are located in the temporal region, one above each hemisphere) is more preferable than the unilateral (one electrode along the middle line, the other over the temporal region). However, with bilateral placement of electrodes, there are more side effects of ECT than with unilateral. In a number of publications, it is recommended to start ECT with a unilateral placement of electrodes, and later switch to a bilateral arrangement.
Usually, to obtain a therapeutic effect from electroconvulsive therapy, about 8-10 shocks of electric shock with a frequency of 3 sessions per week are needed.
In the process of ECT therapy, objective signs of improvement in the patient’s condition usually precede his subjective impressions; changes occur earlier in the vegetative nervous system. In the absence of a rapid effect of ECT, the patient may discontinue therapy.
Subject to monitoring patients, it is possible to treat ECT in an outpatient or day hospital setting.
According to the latest publications, this treatment option is more preferable than treatment in a 24-hour hospital setting, provided the patient observes the doctor’s recommendations regarding food intake before the ECT session. Previously, it was not recommended to combine EST with antidepressants, since the latter most often lower the threshold of seizure activity, increase the duration of a convulsive seizure, and may cause its delayed variant. In the literature, an adverse combination of amitriptyline and ECT has been noted in terms of cardiotoxicity of the antidepressant.
Recently, interest in the combined use of EST and psychotropic drugs has increased. However, it should be borne in mind that it is undesirable to combine some drugs with ECT. So, for example, when combining this method of treatment with lithium preparations or some neuroleptics, their neurotoxic effect is noticeably enhanced.
Complications of electroconvulsive therapy include spinal injury (ECT without anesthesia) and circulatory disorders, states of confusion after convulsive seizures, as well as periods of anterograde and retrograde memory disorders. The latter may persist for a month or more after the end of the ECT. Impaired ability to form new memories can last about 3 months after the course of ECT.
Initially, electrical stimulation leads to bradycardia. After a convulsive seizure, ECT causes a temporary rise in blood pressure (often up to quite high numbers) and increases the heart rate.
Relative contraindications for ECT include ischemic heart disease and arrhythmia (in some cases beta blockers are used here), gastroesophageal reflux (the possibility of aspiration), recent limb fractures, and also some localization of a brain tumor.
The majority of patients are afraid of this method of therapy, so the importance of previous professional psychotherapeutic work with the patient, as well as its subsequent use during the therapy itself, should be emphasized. Supportive ECT should also be accompanied by psychotherapy.