last updated 4/4/2024
Light therapies
First, my favorite (because they’re harmless and cheap): “dawn simulators“. These devices gradually turn on your bedside light. While you’re still asleep, the light reaches through your closed eyelid and tells your brain “it’s daytime, time to get up”. Just the light alone can have an antidepressant effect. So can getting up earlier regularly. And if when you get up, you either connect with people or get some physical activity, that’s more antidepressant effect. More in the links below.
Second, a “light box“. These have strong antidepressant effects, enough to cause a manic shift in people with bipolarity. They have the strongest impact in winter months but many people get benefit even in summer. More about light boxes also in the links below.
Transcranial Magnetic Stimulation (TMS)
TMS stimulants neurons in the front part of your brain using a strong magnetic field. This has a direct antidepressant effect in some people. It has very few risks. Sounds good so far, right?
Some insurance companies pay for this treatment, but they often require lots of other treatments be tried first; e.g. 4 different antidepressants without improvement, and at least one psychotherapy. Otherwise TMS can be very expensive. In most clinics, you have to go in 5 days a week for 30 minutes for as much as 6 weeks. And if you get better, how do you stay well? More TMS? That’s not clear.
And finally: in research trials of people who’ve already had 2 or more antidepressants, the odds of getting better with TMS are not very high. (The odds of getting better with another antidepressant are not very high either. Definitely time to check: what kind of depression do you have?)
Some of the newer ways of using TMS have dramatically shortened the time this treatment requires, but these are not widely available. At this point we can say this much: TMS is a very interesting treatment that can be of benefit to some people. It’s not where anyone would start.
ketamine
Short version of a long story: yes, ketamine works. Amazingly well. For a few days after a treatment. The big question is: then what? That’s not answered yet, as of early 2024.
Ketamine has been around for a long time, for use in general anesthesia. A small dose causes a few hours of feeling really weird, but after that, depression can be much reduced, or gone. Suicidal thinking often completely disappears.
This benefit slowly fades over the next week. The big challenge is making it stick. Some clinics already exist to keep giving you more doses. For how long? That’s not clear yet.
psilocybin
At minimum, learn a lot more about this before you do it. For those who are just wondering “what is this?”: psilocybin causes several hours of… hmm, how to describe this… (haven’t done it myself so how would I really know) … let’s try this … disconnecting from your depressive ruminations and seeing a bigger picture. Getting outside yourself. Like, way outside.
Obviously I don’t know much about this. But I sure had my eyes opened to it after reading Michael Pollen’s book How to Change Your Mind.
I guess the most important thing to say about psilocybin is that after using it carefully, with a prepared guide, some people have had complete remission of their depression that has lasted for many months. Wow. But remember, the research so far has focused on highly selected people who were very ready to try psilocybin, with very good guides. It’s not clear what will happen in less prepared people and less controlled settings.