The Role of Nonpharmacological Interventions in Treatment-resistant Depression

In approximately 50% of patients suffering from major depressive disorder (MDD), first-line antidepressant treatment is ineffective, and in about 30% of MDD patients, even four treatment steps yield insufficient antidepressant response. Stimulation of the human cerebral cortex with electrical currents was first described in 1874. In 1938, electroconvulsive therapy (ECT) was first used for the treatment of depression and about 50 years later transcranial magnetic stimulation (TMS) for the same purpose was successfully accomplished. Today, ECT is established as one of the main columns in treatment-resistant depression (TRD) therapy. However, due to cognitive side effects and stigmatization, ECT is often used as a treatment of last resort. In recent years, novel techniques using electrical and magnetic fields to stimulate the brain have been developed. This chapter examines the use of ECT, TMS, vagus nerve stimulation (VNS), deep-brain stimulation (DBS) and magnetic seizure therapy (MST).