The psychiatric disturbances associated with
seizure disorders often originate in a deep, difficult to
treat depression. A pharmacological treatment using
antidepressants is usually the first step in dealing with
the depression. This section discusses some alternative
forms of treatment. The physician needs to be consulted
before considering any of the alternative approaches.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is normally used in severely
depressed patients for whom psychotherapy and medication
have not been effective. The basic premise of the treatment
is that ECT acts by temporarily altering some of the brain’s
electrochemical processes. Dramatic improvements in
alleviating depression often occurs, but with a potential
side effect of memory loss. ECT is considered the most
effective approach in dealing with deep depression.
The procedure is usually performed in a hospital. An
intraveneous (IV) is inserted to provide anaesthetic
medication. Vital signs are taken initially and continuously
through the procedure. An anesthesiologist administers
anesthesia and places a tube in the throat after the patient
is asleep. A paralyzing agent called succinylcholine is then
administered to present the seizure from spreading to the
body. Electrodes are then applied to the head with
conducting jelly and a brief shock (less than 2 seconds) is
administered. A grand mal seizure is produced. As the
patient wakes, there may be headache, nausea, temporary
confusion and muscle stiffness. There can be a loss in the
short-term memory, but this usually clears up with time.
A single treatment can be effective. However, the original
depressive condition may return and periodic treatments may
be required.
Additional information can be obtained at:
http://www.healthyplace.com/Communities/depression/treatment/ect/index.asp
Magnetic Seizure Therapy
A new method for treating deep depression is magnetic
seizure therapy. This method uses high intensity repetitive
transcranial magnetic stimulation to induce focal seizures
from targeted portions of the brain. The treatment is
performed in a setting similar to that used for ECT. The
major advantage of magnetic seizure therapy is that it
produces the same benefits of ECT without a lot of the side
effects. There is much less concern about amnesia since less
electricity is used and the seizure is limited to targeted
areas.
Magnetic seizure therapy is still in a development stage and
there are relatively few locations where the equipment and
technology are available. The consensus, however, seems to
be that this technology holds a lot of promise and will be
commonly available within the next few years.
Additional information can be obtained at:
http://neuropsychiatryreviews.com/sep04/sep04_npr_magnetic.html
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) has been used for suppression
of seizures and for the treatment of deep depression. The
VNS device is sometimes referred to as “pacemaker for the
brain”. It is placed under the skin on the chest wall and a
wire runs from it to the vagus nerve in the neck. The vagus
nerve is part of the autonomic nervous system, which
controls functions of the body that are not under voluntary
control (e.g., heart rate). Surgery is required to implant a
flat, round battery about the size of a silver dollar.
The VNS device is programmed to periodically provide a pulse
to the vagas nerve. The device typically provides 30 seconds
of stimulation followed by 5 minutes of no stimulation.
Additional information about vagus nerve stimulation can be
found at:
http://www.vnstherapy.com/.
Dr. Blumer (2000) indicates that severe
psychiatric complications can occur by treatments that
eliminate or greatly reduce seizures. He specifically cited
a study showing that 9% of those treated with vagus
stimulation had worsened psychiatric symptoms. We are also
aware of a recent blotched VNS surgery that resulted in the
severing of one of the vocal cords. Based upon these
citations, we would consider vagus nerve stimulation to have
low potential for treatment of seizure-related psychiatric
disturbances.
Mifepristone
Research at Stanford University has indicated that a high
percentage of those dealing with psychotic depression have
high and disordered patterns of cortisol. Cortisol is a
hormone produced by the adrenal gland that plays a role in
the way the body reacts to stressful situations. Their
research has shown promising results with Mifepristone,
commonly known as the RU-486 abortion pill. The preliminary
research shows that Milepristone can dramatically improve
symptoms within days, resulting in a greatly reduced need
for antidepressants.
This product is now undergoing research trials by a company
by the name of Corcept to evaluate the product. If
successful, it will eventually be made available to the
public.
Additional information about the use of Mifepristone for
psychotic depression can be found at:
http://www.corcept.com/
Our studies indicate that various natural products (e.g. Relora) and Remeron are effective in lowering cortisol levels. It is not known if such products are helpful in dealing with psychotic depression. A brief description of the research findings on Remeron may be found at: http://www.biopsychiatry.com/mirtazremeron.htm