Approximately one-third of patients with depression don’t respond to standard treatments.
Learn more about an alternative treatment called transcranial magnet stimulation, or TMS, from Dr. David Hamilton, a UVA psychiatrist who specializes in this treatment.
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Alternative Treatment for Depression
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Learn more about Dr. David Hamilton
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David V. Hamilton, MD
Dr. David Hamilton is a board-certified psychiatrist whose specialties include TMS therapy for depression.Learn more about Dr. David Hamilton
Learn more about UVA Psychiatry
Transcription:
Alternative Treatment for Depression
Melanie Cole (Host): Approximately 1/3 of patients with depression don’t respond to standard treatments. When should you consider alternative treatments for depression? My guest today is Dr. David Hamilton. He’s a board certified psychiatrist whose specialties include TMS therapy for depression at UVA Health Systems. Welcome to the show, Dr. Hamilton. So, what are some of the standard therapies that you prescribe for depression that generally the population would hear about?
Dr. David Hamilton (Guest): I think the mainstay of the treatment of depression is really two-fold. It’s medication on the one hand and there are a variety of medication classes of anti-depressants and other classes of medications that we use in addition to anti-depression medications that have been shown to augment their response. The second thing would by psychotherapy. There is science showing in regards to medications and psychotherapy both are useful but, really, the whole is greater than the sum of the part. They tend to work better together.
Melanie: Okay. When does it come down to trying other treatments? How do you know that these standard course of treatments together or separately are not working for someone?
Dr. Hamilton: The patients that I see here at UVA are patients that have tried a variety of treatments, both a number of medications in different classes as well as psychotherapy and they either are not responding or they are having an incomplete response that is still leaving their lives not functioning in the way that they want to.
Melanie: So then, what? What’s the first course that you would look at as complimentary medicine?
Dr. Hamilton: Well, I think the first thing that we do is make sure that the person has tried medications that are appropriate to the symptoms that they are experiencing. Not all anti-depressants are created equal and then, not all depressions are the same. Some patients have depressions where anxiety is a huge component of their depression and other patients have depressions where just they feel like they can’t get out of bed and they have a lack of energy. Matching the appropriate anti-depressant medication to the symptoms that a person is experiencing is job number one. Now, if that’s been done and the patient has still failed to respond to a good trial of medications, then we start to look at techniques like TMS which stands for Transcranial Magnetic Stimulation.
Melanie: Tell us what that is.
Dr. Hamilton: We are beginning to understand, primarily through the advances in neuro imaging, the different parts of the brain that are in control of our mood and we know that primarily mood is something that exists very deep in the brain. So, it’s very hard to access. However, there are areas on the outside of the brain, newer parts of the brain, if you will, that are control centers for those deeper parts that we can’t access. TMS allows us to target those areas to improve their functionality and their ability to control the deeper emotional parts of the brain.
Melanie: That’s fascinating. How often does someone have to have a TMS session?
Dr. Hamilton: Well, a group of sessions is every day. One session lasts 37 minutes. It’s pretty brief but it is a commitment because it’s Monday through Friday for 4-6 weeks. Then, we do a taper for three sessions a week for a week, then two, then one. So, it is an investment in time.
Melanie: Does this work in long term doctor? Is it something that they have to keep re-doing? How does that work?
Dr. Hamilton: Well, there’s been a variety of responses. Generally, people don’t need to keep getting sessions. Sometimes, if people begin to experience symptoms of depression again then, we will do an abbreviated course – a few sessions to sort of touch them up and when they begin to respond then we’ll stop. Rarely sometimes people need a complete course again if they’re having another full blow major depressive episode.
Melanie: How do you work with patient’s doctor about other kinds of remedies for depression? Maybe mind/body therapies, cognitive behavioral therapy, exercise where do you include all those?
Dr. Hamilton: Sure. When I’m working with a patient in developing a treatment plan, I think of it as, and the metaphor I often use, is of a chair having four legs. Each leg is important. First leg is medication but I think very often people want a pill that’s going to fix everything. Very rarely is that the case in depression. Medications are an important part of treatment. The second leg of the chair, if you will, is psychotherapy and, as you mentioned, there are a variety of different kinds of therapy. Cognitive behavioral therapy, psychodynamic therapy--that’s the more sort of classic long-term insight-oriented therapy. Short term therapy that’s focused more on developing specific coping skills. The third leg or pillar of treatment plan is the things that we put into our body. That includes diet as well as substances – alcohol, drugs, both illicit and licit--in addition to things like vitamins and nutraceuticals that we know are helpful in treating depression. Finally, and certainly, last but not least is exercise. Exercise is as important as any other aspect of a full treatment plan. Of course, when somebody is in the midst of a full blown depression, it can be cruel to say, “You should start exercising.” Very often, it’s the job of the medications and therapy to get people to the point where they can start having a lifestyle consistent with recovery from depression.
Melanie: Such great information. In just the last few minutes, Dr. Hamilton, why should patients choose UVA for their psychiatric care?
Dr. Hamilton: I think at UVA, we have the advantage of being inside of a large university system and we’re able to bring all of the resources to bear. Rather than being just a TMS Clinic, we are able to really take a look at patients as individuals and decide, what is the appropriate course of treatment for this particular patient? It may be that TMS or some other kind of treatment modality is appropriate. We’re able to really customize and individualize treatment plans based on the individual needs of a patient. We’re more, I think, patient focused than focused on the clinician and what we happen to offer since we have so many different modalities to offer.
Melanie: Thank you so much. Great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAhealth.com. That’s UVAhealth.com. This is Melanie Cole. Thanks so much for listening.
Alternative Treatment for Depression
Melanie Cole (Host): Approximately 1/3 of patients with depression don’t respond to standard treatments. When should you consider alternative treatments for depression? My guest today is Dr. David Hamilton. He’s a board certified psychiatrist whose specialties include TMS therapy for depression at UVA Health Systems. Welcome to the show, Dr. Hamilton. So, what are some of the standard therapies that you prescribe for depression that generally the population would hear about?
Dr. David Hamilton (Guest): I think the mainstay of the treatment of depression is really two-fold. It’s medication on the one hand and there are a variety of medication classes of anti-depressants and other classes of medications that we use in addition to anti-depression medications that have been shown to augment their response. The second thing would by psychotherapy. There is science showing in regards to medications and psychotherapy both are useful but, really, the whole is greater than the sum of the part. They tend to work better together.
Melanie: Okay. When does it come down to trying other treatments? How do you know that these standard course of treatments together or separately are not working for someone?
Dr. Hamilton: The patients that I see here at UVA are patients that have tried a variety of treatments, both a number of medications in different classes as well as psychotherapy and they either are not responding or they are having an incomplete response that is still leaving their lives not functioning in the way that they want to.
Melanie: So then, what? What’s the first course that you would look at as complimentary medicine?
Dr. Hamilton: Well, I think the first thing that we do is make sure that the person has tried medications that are appropriate to the symptoms that they are experiencing. Not all anti-depressants are created equal and then, not all depressions are the same. Some patients have depressions where anxiety is a huge component of their depression and other patients have depressions where just they feel like they can’t get out of bed and they have a lack of energy. Matching the appropriate anti-depressant medication to the symptoms that a person is experiencing is job number one. Now, if that’s been done and the patient has still failed to respond to a good trial of medications, then we start to look at techniques like TMS which stands for Transcranial Magnetic Stimulation.
Melanie: Tell us what that is.
Dr. Hamilton: We are beginning to understand, primarily through the advances in neuro imaging, the different parts of the brain that are in control of our mood and we know that primarily mood is something that exists very deep in the brain. So, it’s very hard to access. However, there are areas on the outside of the brain, newer parts of the brain, if you will, that are control centers for those deeper parts that we can’t access. TMS allows us to target those areas to improve their functionality and their ability to control the deeper emotional parts of the brain.
Melanie: That’s fascinating. How often does someone have to have a TMS session?
Dr. Hamilton: Well, a group of sessions is every day. One session lasts 37 minutes. It’s pretty brief but it is a commitment because it’s Monday through Friday for 4-6 weeks. Then, we do a taper for three sessions a week for a week, then two, then one. So, it is an investment in time.
Melanie: Does this work in long term doctor? Is it something that they have to keep re-doing? How does that work?
Dr. Hamilton: Well, there’s been a variety of responses. Generally, people don’t need to keep getting sessions. Sometimes, if people begin to experience symptoms of depression again then, we will do an abbreviated course – a few sessions to sort of touch them up and when they begin to respond then we’ll stop. Rarely sometimes people need a complete course again if they’re having another full blow major depressive episode.
Melanie: How do you work with patient’s doctor about other kinds of remedies for depression? Maybe mind/body therapies, cognitive behavioral therapy, exercise where do you include all those?
Dr. Hamilton: Sure. When I’m working with a patient in developing a treatment plan, I think of it as, and the metaphor I often use, is of a chair having four legs. Each leg is important. First leg is medication but I think very often people want a pill that’s going to fix everything. Very rarely is that the case in depression. Medications are an important part of treatment. The second leg of the chair, if you will, is psychotherapy and, as you mentioned, there are a variety of different kinds of therapy. Cognitive behavioral therapy, psychodynamic therapy--that’s the more sort of classic long-term insight-oriented therapy. Short term therapy that’s focused more on developing specific coping skills. The third leg or pillar of treatment plan is the things that we put into our body. That includes diet as well as substances – alcohol, drugs, both illicit and licit--in addition to things like vitamins and nutraceuticals that we know are helpful in treating depression. Finally, and certainly, last but not least is exercise. Exercise is as important as any other aspect of a full treatment plan. Of course, when somebody is in the midst of a full blown depression, it can be cruel to say, “You should start exercising.” Very often, it’s the job of the medications and therapy to get people to the point where they can start having a lifestyle consistent with recovery from depression.
Melanie: Such great information. In just the last few minutes, Dr. Hamilton, why should patients choose UVA for their psychiatric care?
Dr. Hamilton: I think at UVA, we have the advantage of being inside of a large university system and we’re able to bring all of the resources to bear. Rather than being just a TMS Clinic, we are able to really take a look at patients as individuals and decide, what is the appropriate course of treatment for this particular patient? It may be that TMS or some other kind of treatment modality is appropriate. We’re able to really customize and individualize treatment plans based on the individual needs of a patient. We’re more, I think, patient focused than focused on the clinician and what we happen to offer since we have so many different modalities to offer.
Melanie: Thank you so much. Great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAhealth.com. That’s UVAhealth.com. This is Melanie Cole. Thanks so much for listening.