Specialties: Schizophrenia, Depression, Bipolar Disorder, Anxiety, Panic Disorder, Autonomic Dysfunction, Sleep Disorders, Trauma, Stress Management, Substance Use Disorder, Alcohol Use Disorder, Behavioral Addiction
More Than Just Feeling Down…
Have you or someone you care about ever experienced this: days go by, yet the world seems to lose its color. Activities once loved no longer bring joy, sleep becomes irregular—either sleepless nights or constant fatigue. Concentration fades, and the body feels inexplicably exhausted. This is not simply “being in a bad mood.” It may be depression quietly affecting both body and mind.
According to the World Health Organization, about 5% of adults worldwide suffer from depression—meaning one in every twenty people is affected. The WHO has listed depression among the top three threats to global health, and by 2030 it is projected to become the leading cause of global socioeconomic burden. Depression alters brain neurotransmission, affects emotions, thinking, and physical sensations. It is a real medical condition that requires professional treatment.
When Medications No Longer Work as Expected
Most patients experience significant improvement with antidepressant medications and psychotherapy. Antidepressants act like switches that help recalibrate imbalanced brain chemistry and restore stability.
However, two major challenges remain.
First, medications may initially work but become difficult to continue due to side effects (such as weight changes, dry mouth, dizziness), fear of stigma or dependence, or premature discontinuation—leading to recurring symptoms.
Second, some patients experience treatment-resistant depression, meaning symptoms remain even after trying at least two adequate antidepressant trials. “Treatment-resistant” does not mean untreatable; it indicates that traditional approaches have reached their limit and new strategies are needed.
A Non-Medication Breakthrough: Repetitive Transcranial Magnetic Stimulation (rTMS)
Depression is not caused by being “too sensitive” or “unable to cope”—it is a condition of the brain. The prefrontal cortex, responsible for regulating mood and motivation, acts like the brain’s command center. When its functioning decreases, emotional regulation becomes impaired, leading to low mood and lack of motivation. While medications help balance neurotransmitters, they may not work for everyone.
rTMS uses safe magnetic pulses to stimulate specific areas of the brain, reactivating under-functioning neural circuits—like waking up a dormant emotional center. Extensive research confirms its effectiveness in treatment-resistant depression, making it a key option beyond medication.
At our institution, we currently provide two rTMS treatment options:
‧ Traditional Repetitive Transcranial Magnetic Stimulation (rTMS)
Procedure: The patient sits comfortably while a coil is placed on the scalp. Rhythmic clicking sounds are heard with mild tapping sensations.
Duration: Each session lasts 20–40 minutes; full treatment takes about 4–6 weeks.
Features: Non-invasive and safe. Mild scalp discomfort or headache may occur temporarily.
‧ Next-Generation rTMS: Deep Transcranial Magnetic Stimulation (Deep TMS)
Compared to traditional rTMS, Deep TMS is equally safe but penetrates deeper and stimulates a broader brain region. Its helmet-shaped coil improves stability and precision.
Advantages:
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Shorter treatment time—usually under 20 minutes per session.
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Faster therapeutic effect.
Both rTMS and Deep TMS are non-invasive, require no anesthesia, and help restore brain function safely.
A Rapid-Acting Option: Esketamine Nasal Spray
For patients suffering from severe depression accompanied by acute suicidal thoughts, waiting 4–6 weeks for oral antidepressants to take effect may be too long. Esketamine nasal spray offers new hope. Unlike traditional medications, it acts directly on key neural circuits, repairing damaged synaptic connections and rapidly improving brain function.
Clinical studies show significant mood improvement within 24 hours of treatment. Esketamine must be administered in a medical facility under professional supervision, twice weekly, with a two-hour observation period after each dose to ensure safety. This fast and safe therapy provides a crucial option for patients in urgent need.
Conclusion: Moving Toward Long-Term Stability
Whether using traditional medications, rTMS, Deep TMS, or Esketamine nasal spray, these treatments aim to help patients emerge from emotional difficulties. However, long-term stability also requires psychological and lifestyle adjustments. Emotional regulation, regular routines, healthy diet, physical activity, and social support are essential foundations for sustained stability.
Treatment-resistant depression does not mean hopelessness—it signals the need for more diverse and precise strategies. From rTMS to Deep TMS to Esketamine, medical advancements now offer multiple treatment pathways. All three options are available at the Department of Psychiatry and Psychosomatic Medicine at Far Eastern Memorial Hospital. If you or someone you know is struggling with depression, we encourage you to consult our medical team for personalized guidance.