Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Nancy Reid


Major depressive disorder (MDD) is a common psychiatric disorder that significantly contributes to morbidity and mortality. Presently, the gold standard for treating MDD entails psychotherapy and pharmacotherapy management. Though effective, some individuals are intolerant to medications and or reluctant to engage in therapy. More so, some individuals regularly participate in treatment and yet, fail to respond. Treatment resistant depression (TRD) is defined as having failed two medication trials. Clinically speaking, patients with TRD might feel averse to continue with traditional treatment options. For these specific patients, treatment is still warranted and treatment alternatives should be suggested. Electroconvulsive Therapy (ECT) made its debut in 1938 and is widely known as “shock therapy.” Over the years it has gained notoriety for being an effective intervention when treating MDD. However, there is criticism as ECT involves anesthesia which imposes risk to the patient and it induces seizure activity. Over the years technological advances have been made when it comes to treating both MDD and TRD. Transcranial Magnetic Stimulation (TMS) is a relatively new treatment option for MDD that has demonstrated promising results. With less reported side effects and depressive symptoms resolving at a fraction of the price than that of ECT, TMS is gaining acceptance in the mental health arena. For this literature review, it was elected to review current research findings to determine which treatment modality, ECT or TMS is superior when treatment TRD. With limited research available, it was determined that ECT is highly successful when treating TRD. Though, this success comes at a cost. Side effects, costs and patient preferences are influential items that clinicians should consider when recommending a particular course of treatment. This literature review serves as a mere stepping stone to offer clinicians relative clinical information to discuss with patients so that an informed decision can be made when it comes to treating TRD.


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