Physical therapies

In patients with treatment-resistant major depression, psychiatrists may consider a physical therapy, such as:

• electroconvulsive therapy (ECT) —a response rate of 50 to 80% has been observed
• transcranial magnetic stimulation (TMS) —can be used in mild to moderate major depression for patients who have failed to respond to antidepressants; however, TMS is not as effective as ECT for severe or psychotic major depression.

Direct current stimulation (DCS) is a novel form of neurostimulation using noninvasive brain stimulation by transmitting a weak electrical current into brain tissue via electrodes to the scalp, which modulates neuronal firing. At the time of writing, there is insufficient evidence to recommend DCS for treatment-resistant major depression.