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Clinical Services

The following services are offered by the Mood Disorders Service at Dartmouth-Hitchcock Medical Center:

Mood Disorders Consultation Clinic

The Mood Disorders Consultation Clinic provides expert consultation for patients with treatment-resistant depression and other mood disorders. Patients are typically seen for 90 minutes for a full diagnostic evaluation and review of past medical records. The evaluation is typically performed by a psychiatry resident or nurse practitioner together with Dr. Holtzheimer. Referrals for consultation must come from the patient's primary provider of psychiatric services. Once the referral has been made, the patient will receive an information packet. Medical records will also be requested. Once the information packet is returned to the clinic, a consultation visit will be scheduled. Patients can typically be seen within 2-4 weeks from when we receive the completed packet. A written summary of the evaluation is typically completed within one week of the evaluation. In some cases, the patient may be asked to return for a second visit (for example, if more information is needed to provide the best advice possible).

Referrals should be communicated to the Connection Center. Phone: (866) 346-2362. Fax: (603) 676-4080.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is offered at Dartmouth-Hitchcock Medical Center. ECT is one of the oldest and most effective treatments for patients with severe depression. ECT may be effective for other conditions as well. ECT involves using a small amount of electricity to cause a generalized seizure that lasts about 30-60 seconds in most cases. A series of treatments are performed over 3-4 weeks. During the treatment, anesthesia is used to ensure that the patient is completely asleep with all muscles relaxed to minimize any discomfort that might occur. Common side effects include headache, nausea and muscle aches. Memory problems can also occur, though these are usually mild and not permanent. More serious memory problems are uncommon, but can occur. In rare cases, there can also be serious side effects of the anesthesia on heart and lung function. The risks of ECT are discussed in detail with patients before they are asked to consent to the treatment.

Referrals should be communicated to the Connection Center. Phone: (866) 346-2362. Fax: (603) 676-4080.

Transcranial magnetic stimulation (TMS)

TMS is an outpatient procedure that generates a magnetic field that penetrates the scalp resulting in the production of very small electrical currents in the brain. These currents stimulate areas of the brain that may be involved in depression or other mood disorders. This method of stimulating the brain may offer a viable alternative to electroconvulsive therapy (ECT) without the seizures or other risks, including those of general anesthesia. Common side effects of TMS include mild to moderate pain at the stimulation site (this usually goes away over time) and headache. In very rare cases, TMS can cause an unintentional seizure. A careful medical evaluation and the use of established safety guidelines greatly reduces the risk of seizures with TMS. Each TMS treatment takes about an hour, and treatments are given up to 5 days per week over three to six weeks.

Referrals should be communicated to the Connection Center. Phone: (866) 346-2362. Fax: (603) 676-4080.

Deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD)

DBS is approved for the treatment of severe, treatment-resistant obsessive-compulsive disorder under a Humanitarian Device Exemption from the FDA. DBS involves surgically implanting electrodes into a specific part of the brain to provide highly focused electrical stimulation to that brain region. Stimulation is controlled by a computer/battery implanted in the chest wall, and connected to the electrodes by wires that run under the skin. The goal of DBS is to change brain activity for therapeutic benefit in patients with severe, treatment-refractory neuropsychiatric disorders. DBS is currently also approved for the treatment of Parkinson's disease, essential tremor and dystonia.

Referrals should be communicated to the Connection Center. Phone: (866) 346-2362. Fax: (603) 676-4080.

Connection Center Outpatient Referral Form (PDF)

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