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Depression: Has brain network modulation come of age?

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Treatments such as electroconvulsive therapy (ECT) and surgery to change the brain networks that underlie mood disorders have come a long way since the late 1930s.

In the 80 years since its controversial beginning, “neuromodulation” has become a safe and effective form of therapy for mental health conditions. Modern techniques include vagus nerve stimulation and noninvasive procedures such as transcranial magnetic stimulation (TMS). A newly published review charts the history of neuromodulation, looks at new developments in the field, and considers possible future directions.

About 1 in 6 adultsTrusted Source in the United States will experience clinical depression at some point during their life. Every year, the condition affects approximately 16 million adults in the U.S. alone. Mainstream treatments do not work well for everyone — researchers estimate that 1–3%Trusted Source of people in the U.S. have treatment-resistant depression.

Currently, the two main treatment approaches for mental health conditions are drugs, such as antidepressants, and psychotherapies — also known as “talking therapies” — such as cognitive behavioral therapy (CBT). However, there is a third approach that is much less widely used than either drugs or psychotherapy.

Known as neuromodulation, it aims to correct abnormal communication between the parts of the brain that regulate moods, thoughts, and behaviors.

Scientists pioneered this approach in the late 1930s in the form of brain surgery and ECT. However, it fell out of favor with the development of the first drug treatments.

A newly published review by two psychiatrists charts the troubled history of neuromodulation and looks ahead to its promising future. The article appears in The American Journal of Psychiatry.

“Older approaches, based on an extremely limited understanding of the brain regions involved in psychopathology, were crude and (at best) appropriate only for the most severely ill patients,” write Dr. Susan K. Conroy, Ph.D., of Indiana University School of Medicine in Indianapolis, and Dr. Paul E. Holtzheimer, of Geisel School of Medicine at Dartmouth, NH.

However, they also describe a range of surgical and nonsurgical techniques that have emerged over the past 20–30 years that are much safer and more effective.

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