September 2016 | Seattle NTC
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September 2016

When Symptoms Return

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By Joshua Bess, M.D.

Patients who have been treated for depression with Transcranial Magnetic Stimulation (TMS) or Electroconvulsive Therapy (ECT) can sometimes go the rest of their lives without needing to undergo additional TMS or ECT treatment. But these patients are the exception, not the rule.

Most patients who have undergone acute treatment with TMS or ECT will experience a return of symptoms at some point. It may be a year after treatment, or it may be longer. Each person is different. But relapse at some point is more likely than not.

Therefore, it’s important for all patients who undergo TMS or ECT to realize going into it that although the treatment is likely to help them significantly, it is probably not a lifelong cure, and they and their care team need to be prepared for the possibility of relapse.

At SeattleNTC, we want to have frank conversations with our patients about the potential for symptoms to return. If we can talk openly about this possibility, we will be better prepared to address symptoms if and when they return. We may even be able to prevent relapse.

Following acute treatment, we have two options. One is to take a “watch and wait” approach, which is not the same as doing nothing. Rather, we continue to communicate with patients about how they are doing and to consult with their general psychiatrist or therapist. If symptoms come back or get worse again, we encourage patients to come and talk to us so that we can decide, together, whether to reinitiate treatment.

A second option is to continue treatment, even before symptoms start to return, as a means of preventing relapse. This is similar to staying on medication even after symptoms subside. In the case of “maintenance” TMS and ECT, treatments are less frequent than during the acute course, but the protocol for each treatment is the same one that helped the patient get better.

We stress with our patients that even if they are feeling better it’s essential to continue seeing members of their care team so that if there are any signs that symptoms may return we can intervene immediately – and, hopefully, well before symptoms become so bad the patient is in crisis.

Remember that depression is somewhat like cancer in that people who have recovered from cancer can be “in remission” for years, but you can never say with 100 percent that the cancer is gone. It’s the same with treating depression. There are people who are in remission for years but usually that is because they continue to undergo active monitoring or treatment.

So to our patients, we say: please don’t ignore any signs of distress that indicate you may be relapsing. The earlier we can intervene with treatment, the sooner you’ll be feeling better again.