BACKGROUND: In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. There is renewed interest in refined approaches to brain stimulation, particularly for treatment resistant major depressive disorder (MDD). METHODS: The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on "Neurostimulation Therapies" is one of 5 guidelines articles. RESULTS: Among the four forms of neurostimulation reviewed in this section, electroconvulsive therapy (ECT) has the most extensive evidence, spanning seven decades. Repetitive transcranial magnetic (rTMS) and vagus nerve stimulation (VNS) have been approved to treat depressed adults in both Canada and the United States with a much smaller evidence base. There is also emerging evidence that deep brain stimulation (DBS) is effective for otherwise treatment resistant depression, but this is an investigational approach in 2009. LIMITATIONS: Compared to other modalities for the treatment of MDD, the data based is limited by the relatively small numbers of randomized controlled trials (RCTs) and small sample sizes. CONCLUSIONS: There is most evidence to support ECT as a first-line treatment under specific circumstances and rTMS as a second-line treatment. Evidence to support VNS is less robust and DBS remains an investigational treatment.
And one of the things that often gets lost in discussions of depression is that you know it's ridiculous. You know it's ridiculous while you're experiencing it. You know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower and go out the front door and that it's not a big deal, and yet you are nonetheless in its grip and you are unable to figure out any way around it. And so I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity.
And then the anxiety set in. If you told me that I'd have to be depressed for the next month, I would say, "As long I know it'll be over in November, I can do it." But if you said to me, "You have to have acute anxiety for the next month," I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you're walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months. It's a sensation of being afraid all the time but not even knowing what it is that you're afraid of. And it was at that point that I began to think that it was just too painful to be alive, and that the only reason not to kill oneself was so as not to hurt other people.
目的观察抑郁大鼠电休克治疗后海马内谷氨酸含量以及N-甲基-D天门冬氨酸（NMDA）受体 的表达，探讨电休克治疗抑郁症的谷氨酸能神经机制。方法36只SD大鼠随机分为无抽搐电休克组（电休克组）、抑郁模型对照组（抑郁组）、对照组，每组12 只。前两组采用孤养加慢性不可预见性应激建立抑郁模型，建模后电休克组在丙泊酚麻醉下行无抽搐电休克治疗，隔天1次共2周。检测各组海马谷氨酸含量和海马 CA1区、CA3区NMDA受体2B亚单位（NMDA-NP,2B）的表达。结果①电休克治疗后电休克组大鼠水平移动格数、垂直竖立次数和糖水消耗量都高 于抑郁组（P〈0．01）。②电休克组大鼠海马内谷氨酸含量低于抑郁组（P〈0．01），而抑郁组高于正常组（P〈0．01）。③电休克组大鼠海马CAI 区和CA3区NMDA．NP,2B的表达量高于正常组（P〈0．05），而抑郁组低于正常组（P〈0．01）。结论无抽搐电休克治疗可抑制抑郁症模型大鼠 海马内谷氨酸含量的升高并使NMDA—NR2B的表达量上调，这可能是其抗抑郁机制之一。
But in 1994, three years later, I found myself losing interest in almost everything. I didn't want to do any of the things I had previously wanted to do, and I didn't know why. The opposite of depression is not happiness, but vitality. And it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, "What a lot of people that is to have to call back." Or I would decide I should have lunch, and then I would think, but I'd have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.