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About 16 million Americans experience major depression each year, and many are treated with antidepressant medication. It’s important to remember, though, that there are alternatives. One of these is psychotherapy, which generally has been found to be as effective as medication in mild to moderate depression. Another is transcranial magnetic stimulation (TMS). What they have in common are that they are non-medicine approaches to depression.

Let’s look at both of them:

Psychotherapy: There are many forms of psychotherapy for depression, but the two
whose benefits have been best confirmed by research studies are Cognitive
Behavioral Therapy (CBT) and interpersonal therapy. CBT was originally developed
as a treatment for depression, and later its use expanded to insomnia, PTSD, anxiety
and some forms of substance abuse. It is very action-oriented, and involves
developing coping strategies for specific problems, as well as identifying patterns of
thinking which may perpetuate the disorder. Interpersonal therapy is built on the
idea that relationships and events in one’s life influence, and in turn are influenced,
by one’s mood. Therapy involves dealing with problems in relationships and
exploring their connection to symptoms. Both forms of therapy are time-limited,
usually 3-4 months or less. In general, they have been found to be as effective as
medications with the exception of the more severe forms of depression.

Psychotherapy can be particularly useful in persons who have difficulties with
medication side effects, as well as an alternative treatment during pregnancy. It can
also be done concurrently with medication, and often is used in this manner.

Transcranial Magnetic Stimulation (TMS): TMS has been found to be helpful when
a person has not benefitted from antidepressant medications. It is a relatively new
treatment which involves using an electromagnet to send magnetic pulses to the
parts of the brain involved in depression. It has been found to be helpful in persons
who have not responded to medicines or psychotherapy. Unlike some alternative
procedures such as vagal nerve stimulation, it does not require surgery of any kind.

In a typical session, a person sits in a chair for about 60 minutes, while a magnetic coil placed against the head is turned on and off repeatedly, producing a clicking sound. Typically, it is done five times a week for 4-6 weeks. Like any procedure, it can have side effects, which in this case include headaches, dizziness or twitching of facial muscles. It is not for everyone and should be avoided in persons with stents or metal aneurysm clips or pacemakers. Benefits usually appear only after several weeks. It is not known whether maintenance treatment after one has become well will help prevent future episodes, but if depression reappears in the future, new
treatments can be given.

The thing to remember is that when a person has depression, there are many
options out there. Some involve medications, and some do not. Learning about
each, how they work, and their benefits and limitations are the first step to making
good choices.

About the Author:

Wallace B. Mendelson is a Professor of Psychiatry and Clinical Pharmacology, Distinguished Fellow of the American Psychiatric Association, and author of UnderstandingAntidepressants.

InUnderstanding Antidepressants, Dr. Mendelson
makes sense of the many treatments for depression and shows that understanding how antidepressants work can help in making better decisions. Written with both scientific rigor and compassion, Understanding Antidepressants is a useful guide for anyone suffering
from depression, as well as their families.



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