Page 1214 - TNFlipTest

PS50 Psychiatry
Somatic Therapies Toronto Notes 2019 Magnetic Seizure Therapy (Experimental)
• generalizedseizureinductionusingstrongmagneticcurrent
• earlystudiesdemonstrateefficacyfordepressionaswellasanxiety,withreducedmemoryeffectsvs.ECT
Neurosurgical Treatments
Ablative/Lesion Procedures
• usedforMDDorOCDunresponsivetoallotherformsoftreatment;efficacyrangesfrom25-75% depending on procedure
• adverseeffects:relatedtolesionlocationandsize,highriskofsuicideinthosewhoarenothelpedby surgery
Deep Brain Stimulation (Experimental)
• placementofsmallelectrodeleadsinspecificbrainareastoalterneuronalsignaling,usuallyforMDD unresponsive to all other forms of treatment
• responserates(>50%symptomreduction)of40-70%,adverseeffectsrelatedtosurgicalrisksandpoor treatment response
Vagus Nerve Stimulation
• direct,intermittentelectricalstimulationofleftcervicalvagusnerveviaimplantedpulsegenerator • usedforchronic,recurrentMDDwithpoorresponsetoprevioustherapyandECT;slowonset,
approximately 30% response rate after 1 yr
Other Therapy Modalities
Phototherapy (Light Box Therapy)
• brightlightsourceexposure(usually10000lux)for30-60min;bestinmorning
• proposedmechanisms:reversespathologicalalterationsincircadianrhythmthroughactionon
suprachiasmatic nucleus
• indications:SAD,non-seasonaldepression(asaugmentation),somesleepdisorders
• adverseeffects:maniainduction,reactionwithphotosensitizingdrugorphotosensitiveeyeorskin
conditions
Aerobic Exercise
• moderate-intenseaerobicexerciseisassociatedwithacuteincreasedreleaseofserotonin, phenethylamine, brain-derived neurotrophic factor, endogenous opioids, and cannabinoids (likely this combination is what contributes to the “runner’s high”)
• longtermincreasesgreymatterinmultipleareas,aswellasimprovementsincognition,memory,and stress tolerance
• indications:monotherapyformild-moderateMDD;adjunctivetherapyformoderate-severeMDD; research suggests 30 min of supervised moderate-intensity exercise at least 3 times weekly for a minimum of 9 wk is as effective as psychotherapy of antidepressant medications
• maybehelpfulinPTSD,schizophrenia