Today the most common therapy for clinical depression is medication.  There are many antidepressants on the market.  Some are stimulating such as Bupropion (Wellbutrin). Others are more or less anxiety reducers like Fluoxetine (Prozac).  And some combine the two actions Venlafaxine (Effexor).  Antidepressants can work well for about 50% of patients; 35% have some partial response, and about 15% get no benefit at all. Clearly, we do not understand entirely the biochemistry of depression.

Increasingly, therapies involving electricity and magnetism are being used for the 50% of patients who do not do well on their first course of antidepressants.   These include the old Electro Convulsive Therapy (ECT or shock treatment); Transcranial Magnetic Stimulation (TMS); Cranial Electrotherapy Stimulation (CES); and Deep Brain Stimulation (DBS). 

ECT involves running an electric strong enough to produce major seizures or convulsions.  Some memory loss can occur too. ECT is effective about 50% of the time.  It is quite an extreme treatment but mostly safe. In comparison, TMS and CES pass very small doses of magnetic or electric current through the brain. 

Ultimately, pills, magnetism, and electricity must work to change something about the neurotransmitters and functional processes of some or all of the brains specialized regions.  My next blog will address the question of how current therapies work to change the brain.

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