Brain Stimulation Therapy

Brain stimulation therapy is a procedure that uses electrodes or magnets in the brain or on the scalp to treat some serious mental disorders that do not respond successfully to commonly used psychotherapies and medications. There are several types of brain stimulation therapies, including electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS).

Of these, ECT is the oldest and most widely used procedure. The other brain stimulation therapies are interventions that are sometimes used to treat other medical conditions, or they are newly developed therapies, but more research needs to be done to determine their effectiveness and safety in treating mental disorders.

ECT is used to treat severe depression and depression accompanied by psychosis that does not respond to medication. It may also be used to treat bipolar disorder and schizophrenia.

VNS is a treatment developed for symptoms of epilepsy and other medical conditions that may also be considered for hard-to-treat depression.

TMS and rTMS are also being studied for use as a treatment for certain types of depression. DBS is a procedure originally developed to treat physical symptoms of Parkinson’s disease, and has also been used experimentally to treat obsessive-compulsive disorder as well as depression. 

ECT is performed in a hospital by a psychiatrist, with the aid of an anesthesiologist and nurse. Prior to the administration of therapy, the patient is given a muscle-relaxing drug and general anesthesia. Through electrodes positioned on the scalp, electric current moves through the brain, intentionally causing a brief seizure. ECT treatments are usually administered three times a week for up to about a dozen treatments. After each treatment, patients can usually leave the recovery room and resume normal activities within half an hour. Any minimal side effects, or after-effects, such as short-term memory loss, are usually temporary, especially now that more refined techniques are used to administer ECT. Follow-up maintenance treatments and medications are often required.

Like ECT, rTMS does not require invasive surgery, but this procedure uses magnetic pulses, rather than electric currents, to stimulate the brain without inducing a seizure. Like rTMS, MST also uses magnetic pulses instead of electricity but, like ECT, causes intentional seizure. VNS, on the other hand, requires an electrical device to be surgically implanted under the skin to send impulses through the vagus nerve to the brain. In DBS, electrodes are surgically implanted in the brain and controlled by a generator implanted in the chest.

Brain stimulation therapies are thought to produce both chemical and functional changes in the brain. Earlier in its use, ECT developed a bad reputation as “electric shock therapy.” The procedure has been greatly refined over the years, however, and while it is still a therapy of last resort, it is considered a safe and effective treatment for severe cases of depression that may lead to life-threatening circumstances such as starvation or suicide. Other brain stimulation therapies that are still being studied for effectiveness and safety may or may not replace ECT in the future.

Look for a brain stimulation therapist who is a licensed psychiatrist with a background in neuroscience and experience in electroconvulsive therapy and other brain stimulating therapies. He or she should be affiliated with a reputable hospital and brain stimulation program. A physician or psychiatrist who is familiar with the patient’s medical and psychiatric background generally refers candidates for brain stimulation therapy to a hospital program.