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New Treatment-Resistant Depression Clinic

Washington University School of Medicine has opened a clinic for patients with treatment-resistant depression. Directed by Charles Conway, MD, the clinic focuses on patients who haven’t responded to standard depression therapies.

The clinical team also includes Yvette Sheline, MD, and Dragan Svrakic, MD, PhD, Washington University psychiatrists at Barnes-Jewish Hospital. They carefully review the patient’s psychiatric records and oversee patient exams and evaluations.

“Treatment-resistant depression has a devastating impact on peoples’ lives; at times it is completely incapacitating,” Conway says. “We estimate at least 5 percent of those with depression have severe forms that are resistant to treatment.”

When medication hasn’t helped, the clinic team may recommend additional medications to supplement what a patient already is taking, or other treatments such as vagus nerve stimulation (VNS), transcranial magnetic stimulation (rTMS) or electroconvulsive therapy (ECT), treatments that stimulate the brain in various ways to treat depression.

VNS is like a pacemaker, but for the brain. It involves implanting a device under the skin that sends electrical signals along the vagus nerve to the brain. ECT is the “gold standard” for patients who haven’t responded to other therapy, but it causes a minor seizure and requires anesthesia, so some who seek to avoid ECT choose rTMS instead. This involves placing a magnet on the scalp to stimulate a particular area of the brain. The treatment is given five days a week for several weeks.

The clinic also tracks patient responses to treatments to allow the team to learn what works and what doesn’t. Some studies currently under way are attempting to determine in advance—using neuroimaging—which patients might be better candidates for which treatments.

For more information on the trials, call 314-286-1700.
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