Brain Stimulation Therapy

BST encompasses a range of techniques to regulate or improve brain function. These modalities can be applied non-invasively through the scalp or directly to the brain via implanted electrodes. In both cases, the goal is to correct or modify abnormal nerve activity to treat symptoms of neurological and psychiatric disorders.

Electroconvulsive therapy (ECT)

One form of BST is electroconvulsive therapy (ECT), which passes a controlled electrical current through the brain to incite a minor seizure. The treatment typically consists of six to 12 sessions. The surge of electrical activity may reduce symptoms in individuals with severe mental health disorders, such as major depressive disorder,² obsessive-compulsive disorder, or bipolar disorder. Electroconvulsive therapy (ECT) is often recommended for treatment resistant depression. This procedure may have limited side effects and is fairly safe, sending electrical pulses through the brain to target symptoms of mental illnesses. Talk to your doctor about electroconvulsive therapy (ECT) to learn more about its benefits and potential risks. 

Repetitive transcranial magnetic stimulation  (rTMS)

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure and one of the most effective forms of brain stimulation therapies, involving magnetic fields to stimulate nerve cells in the brain. This treatment is typically used for individuals with depression who have not responded well to other treatment options. In repetitive TMS therapy, a coil placed against the scalp creates a magnetic field that stimulates specific brain areas. This type of treatment may effectively alleviate symptoms of depression by improving communication between different regions of the brain. It is typically carried out daily, five times weekly over four to six weeks.  

Vagus nerve stimulation (VNS)

Vagus nerve stimulation (VNS) is another form of treatment for depression that may be considered when other treatments have not been effective. Vagus nerve stimulation (VNS) involves surgically implanting a device under the skin in the chest that connects to the vagus nerve by a wire. The pulse generator device sends regular, mild electrical pulses along the vagus nerve to the brain. Treatment benefits from these electrical pulses may take four to eight months to show, depending on the condition being treated, such as mental illness or movement disorders.  

Deep brain stimulation (DBS)

Another example of BST stimulation therapies is deep brain stimulation (DBS), which involves implanting electrodes within specific brain areas. In this brain-stimulation treatment, these electrodes produce electrical impulses that regulate abnormal neural activity and can influence certain brain cells and chemicals. It may take up to six months to find the most effective settings. This therapy is commonly used for conditions like Parkinson's disease and epilepsy, although it may also be used for obsessive-compulsive disorder (OCD) and depression.

The effectiveness of BST may vary depending on the individual's condition. This type of treatment is only done with guidance from a healthcare professional who can determine the most appropriate treatment plan. In some cases, other treatments, such as medications or psychotherapy, may be recommended in combination with BST. 

Consult a medical doctor before starting, changing, or stopping a medication or medical treatment for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

When preparing for brain stimulation therapy, knowing what to expect during the process may be helpful. Before therapy, clients undergo a thorough evaluation by a healthcare provider to determine whether they are a suitable candidate for the treatment. The assessment may involve a series of tests, including neurological examinations and imaging studies. Follow any specific instructions the medical team provides to ensure the best possible outcome.

Clients may receive anesthesia to minimize or eliminate discomfort depending on the type of therapy used. The procedure may involve inserting electrodes into specific brain regions, which is often guided by precision imaging techniques. The devices used in the treatment are carefully adjusted to provide optimal therapeutic effects. Depending on the type of brain stimulation therapy used, the duration and complexity of the procedure may vary. For example, non-invasive brain stimulation methods, such as transcranial magnetic stimulation, don't involve implantation but use magnets placed on the scalp.

After the treatment, individuals may expect a recovery period that varies depending on the treatment type. Some individuals may experience temporary side effects from brain stimulation treatment, such as headache or fatigue, but these effects may subside within a few days. Following up with the healthcare team and attending scheduled appointments to monitor progress and discuss concerns could be helpful. As the effectiveness of brain stimulation therapy can vary, it may take time to see noticeable improvements. 

BST may be an effective treatment option for individuals struggling with severe mental health and neurological disorders. People who have been diagnosed with conditions like Parkinson's disease, essential tremor, medication-resistant epilepsy, and obsessive-compulsive disorder (OCD) may benefit from this type of therapy, especially when traditional medications are less effective or cause strong side effects.

Brain stimulation therapies may be appropriate for individuals who have exhausted other treatment options or when there is a risk of self-harm. These therapies can serve as an alternative or complementary treatment to existing treatment plans, depending on an individual's particular needs and condition.

BST may be used for the treatment of people with any of the following:

• Severe depression
• Chronic pain
• Dystonia
• Multiple sclerosis (MS)
• Post-traumatic stress disorder (PTSD)³
• Anxiety disorders
• Substance use disorders⁴
• Brain injury

Brain stimulation therapies should only be administered under the guidance of a licensed healthcare provider. Potential candidates for these therapies often have severe or debilitating symptoms. Therefore, monitoring is often necessary to ensure the individual's safety and maximize the potential therapeutic benefits.

Numerous studies and clinical trials have been conducted to evaluate the safety and effectiveness of BST. One comprehensive review analyzed the efficacy, mood effects, and safety of deep brain stimulation (DBS) for people with OCD. The review evaluated data from around 46 different studies and found that DBS treatment significantly reduced OCD symptoms and depressive symptoms. Although there were some side effects and subjects who dropped out of the study, DBS was found to be a promising way to support clients with treatment-resistant OCD.

Another review examined the use of DBS treatment for treatment-resistant depression. The researchers reviewed 17 studies and found that DBS may be effective, with more than half of the participants showing a beneficial response and around a third experiencing complete remission. However, some participants didn’t improve with DBS. Regarding safety, there were side effects in about two-thirds of the patients, including some serious risks, such as thoughts of suicide.

In a recent study, rTMS was found to be a cost-effective and beneficial treatment for major depressive disorder (MDD). The study compared the costs and effectiveness of rTMS and medication therapy for people with MDD who didn’t see improvement after trying one type of medication. The results showed that rTMS was less expensive and more effective than antidepressant medications for all age groups. Based on the findings, the study suggests using rTMS as a treatment option after one unsuccessful attempt with antidepressant medication for adults with MDD.

For those with thoughts of suicide, contact the 988 Suicide & Crisis Lifeline at 988. Please see our Get Help Now page for more resources.

To find an appropriate therapy modality, individuals can consult their primary care physicians, neurologists, or psychiatrists, who can offer referrals to therapists or centers specializing in brain stimulation techniques. As BST is still being studied for various mental health conditions, it may be challenging to find the treatment for certain mental health conditions. A trained professional can help you evaluate and determine whether BST is an appropriate option. When exploring options for brain stimulation therapy, look for experienced practitioners and accredited facilities.

The National Institute of Mental Health (NIMH) conducts studies on various therapies for mental health conditions. Those interested in participating in a trial on BST can contact the NIMH research study team. Studies are often done locally at the NIMH Clinical Center (CC) but may enroll participants nationally. 

As BST may be recommended in combination with therapy or medication, it may be advised to consult a mental health professional. Online platforms like BetterHelp connect individuals to therapists who provide mental health support. While not specific to brain stimulation therapy, platforms like these can be helpful in finding therapists who may specialize in related treatments.