ECT is covered by Medicare and most insurance companies, and is available to patients who need it, he said.
Although deep brain stimulation, another brain stimulation technology, is getting more popular, it’s still not approved as a treatment option for depression.
“If [deep brain stimulation] works … it’ll be appropriate for those patients who have failed multiple medication trials and possibly even ECT,” he said. “These are patients who are most treatment resistant.”
In DBS, holes are drilled into the skull, electrodes are placed in a specific brain region, and a battery pack is implanted in the chest so that it can deliver constant stimulation to the electrodes that are attached to it, Holtzheimer said.
It is more invasive than the other therapies because of the surgery involved. Although the ongoing brain stimulation appears to be safe, the surgery to implant the devices can have complications, like infection, bleeding, hemorrhages and strokes, he said.
“Deep brain stimulation is only investigational, so the only way to get DBS currently is either in a clinical trial or to convince a neurosurgeon to implant the device under compassionate use,” Holtzheimer said.
Another brain stimulation technology is vagus nerve stimulation, which is approved for use by the FDA.
“You attach a wire around the nerve in the neck that actually projects into the brain,” Holtzheimer said. This therapy is not covered by Medicare and not by most insurance companies, he added.
Transcranial direct current stimulation is another investigational brain stimulation technology that Holtzheimer said is similar to the Fisher Wallace Cranial Stimulator device because it delivers stimulation to two electrodes on the scalp. However, it uses a direct current, while the Fisher Wallace device uses an alternating current.
The above technologies can be expensive and oftentimes inaccessible to the general population because of the costs, but in some cases the therapies save money long-term, considering the comparative cost of taking antidepressants for the rest of one’s life with sometimes negative side effects.