New horizons in the treatment of depression

In the treatment of depression, the target is the elimination of depressive symptoms, the acquisition of (regaining) functionality, and the prevention of relapses and recurrences. In the treatment of depression, in certain cases, it may become necessary to implement somatic therapies in addition to psychopharmacological and psychotherapeutic methods.. Of these treatments, the following are the main ones are as follows: electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS) and chronotherapeutic approaches such as sleep deprivation, sleep phase advance and light therapy. ECT is a treatment method whose efficacy in the treatment of many psychiatric disorders has been proven. Its administration is based on the principle of creating generalized convulsions by stimulating brain tissue with electrical current. MST is a new treatment method that uses high doses of rTMS in order to induce seizures. MST is administered under anesthesia. MST seizures have shorter duration compared to ECT. It has been reported that MST causes fewer cognitive side effects. TMS is a technique aiming to generate low-level transient electric current in the cerebral cortex by a very strong magnetic field induced by a stimulating coil. TMS may change regional activities in the cortex by revealing cortical blood şow and cortical metabolic changes. When directly administered, TMS can lead to changes in gene expression patterns. In a study conducted with TMS, it was determined that the c-fos expression led to increases in thalamic paraventricular nucleus in mice. If TMS is administered repetitively and rhythmically, it is called rTMS. VNS is based on the stimulation of the vagus nerve. DBS shows its effect with the current generated with an electrode inserted in a small hole drilled in the skull. tDCS is performed by stimulating cortical neurons via low amplitude 1-3 mA current sent by the electrodes placed on the scalp. If sleep disorders frequently accompany depression, then sleep deprivation and sleep phase advance methods are considered. Once fully implemented, sleep deprivation provides an antidepressant effect. In light therapy, the importance of circadian rhythms is focused in terms of the biochemical, neuroendocrine and behavioral physiology. Externally applied light and light-dark cycles are the most important factors that regulate circadian rhythms. In practice, a broad-spectrum white light is the gold standard. In ideal applications, 10,000 lux of light is applied at least 30 minutes.