Physical treatments

Electroconvulsive therapy (ECT) is the most effective treatment available for severe depression, with a remission rate of 60%. It is a safe procedure and the major medical risks are related to anaesthesia (mortality 1:80,000). Early use of ECT is associated with shorter and less costly hospital stays and it is reported to enhance health-related quality of life and activities of daily living. Bilateral ECT is more powerful than low-dose unilateral ECT but is associated with more effects on cognitive function. The precise mechanism of action of ECT is not yet known, but in animal models it up-regulates neurotrophic factors and induces hippocampal neurogenesis and synaptogenesis. Recent evidence suggests that repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for moderate depression when compared to placebo treatment alone. Vagus nerve stimulation (VNS) and deep brain stimulation (DBS) remain experimental treatments. Stereotactic neurosurgery for mental illness is practised only in specialized centres for intractable illness, but has a good outcome in selected patients.