Neurostimulation – electroconvulsive therapy (ECT)

Other than psychotherapy, non-pharmacological therapy options for the treatment of MDD include brain stimulation methods, such as electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), and transcranial magnetic stimulation (TMS).^1,4 The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders give the following recommendations:⁴

• Electroconvulsive therapy – among the indications for ECT as a first-line treatment are:
  • severe major depression with psychotic features
  • severe major depression with psychomotor retardation
  • ‘true’ treatment-resistant major depression
  • refusal of food intake or in other special situations when rapid relief from depression is required (e.g., in severe suicidality) or when medication is contraindicated (e.g., in pregnancy)
  • patients who have experienced a previous positive response to ECT, and patients who prefer ECT for a specific reason.
• Vagus nerve stimulation – VNS may be an option in patients with depression with insufficient response to trials of pharmacotherapy.
• Transcranial magnetic stimulation – there is currently insufficient evidence to recommend the clinical efficacy of TMS in the standard clinical setting. Further research is needed.

References:

1.Sadock BJ, Sadock VA, Ruiz P (eds). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th edition. Vol 1–2. © Lippincott Williams & Wilkins, 2017.

2.Milev RV, Giacobbe P, Kennedy SH, et al.; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4. Neurostimulation treatments. Can J Psychiatry 2016; 61 (9): 561–575.

3.Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults: Réseau canadien pour les traitements de l’humeur et de l’anxiété (CANMAT) 2023: mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry 2024; 69 (9): 641–687.

4.Bauer M, Pfennig A, Severus E, et al.; World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Unipolar Depressive Disorders. WFSBP guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14 (5): 334–385.