3 Brain-Stimulating Therapies for Depression That Can Work

The downsides: Many patients relapse after about six months and need repeat treatments. ECT is also associated with short-term memory loss. “We do our best to minimize that with the electrical settings that we use nowadays,” Reti says. “Still, it can be a significant side effect for some patients.”

ECT also causes surges in blood pressure, which may be problematic for some older people. “We particularly worry about delirium in older patients," which can result from the seizure, Reti adds. “That puts them at risk of a fall during the weeks they are receiving ECT, which can be dangerous.” Luckily only about 6 percent of patients experience high blood pressure as a result and fewer experience delirium.

Transcranial magnetic stimulation, or TMS

With TMS, a coil that generates a magnetic field is placed on a patient’s head, sending electric pulses to the prefrontal cortex, the brain region associated with planning and regulation of emotion. How it works isn’t completely understood, but it’s thought to activate regions of the brain that become muffled as a result of the depression. 

The Food and Drug Administration approved TMS for treatment-resistant depression in 2008. But interest has surged more recently due to new treatment protocols that are better at boosting mood in less time.  With conventional TMS, patients receive treatment once a day, five days a week, over four to six weeks. With the new protocols, researchers are administering more electrical pulses per session and more sessions in a day over five days total. “People have a rapid improvement in mood over that period,” Reti says. For one of the new protocols, approved by the FDA in 2022, almost 80 percent of patients experienced relief from their symptoms, with older people as likely to benefit from the treatment as younger ones. 

When compared with electroconvulsive therapy, TMS holds several advantages. “TMS is nonconvulsive, there is no anesthesia or memory loss involved and no cognitive side effects,” Reti says. That may make it more appealing to older adults. Side effects most often seen with TMS, such as scalp pain and headaches, are generally mild. More serious side effects, such as seizures and hearing loss, are very rare.  

“This is a real game changer,” says George, who conducted some of the studies that led to FDA approval.

Vagus nerve stimulation, or VNS

Like other brain stimulation techniques, this therapy — approved by the FDA for chronic or recurrent depression in 2005—is also getting renewed interest for recurrent and treatment-resistant depression. It involves implanting a device in the chest that emits electrical pulses through a wire to the vagus nerve in the neck.

“The vagus nerve is an information superhighway that takes information from your body and goes into your brain,” George says. “Sending a signal up that nerve into the base of the brain causes the release of chemicals that seem to have an antidepressant and mood-regulating effect.” The treatment has up to a 67 percent positive response rate. Some patients experience relief for up to five years.  

After its 2005 approval, Medicare and private insurers chose not to cover vagus nerve stimulation and interest waned. However, positive data on its effectiveness has accumulated, George says, and Medicare and medical device companies are conducting a new study on it. Results are expected next year.

“If that research is positive, then Medicare would pay for VNS for any chronic, recurrent or treatment-resistant depressed patient,” he says.

Having to live with a device implanted in the chest is a significant drawback for this approach. But unlike with other brain stimulation therapies, the mood changes are long lasting, says George, adding: “We have better treatments now than we have ever had before.”