People with depression really do suffer…and for those who have what’s called treatment-resistant major depression, psychotherapy and antidepressant medication just don’t help. The good news: Many such patients can be helped by transcranial magnetic stimulation (TMS), a noninvasive drug-free approach that used to be considered way-out-there experimental but is now finding its place in the mainstream.
A new study from Brown University showed very encouraging results, given that it measured the success of TMS in the real world rather than in the rarified atmosphere of a research setting. The researchers followed 307 depression patients who were being treated with TMS at 42 different US-based medical practices. Though other therapies had failed for all of these patients, after receiving TMS, 58% experienced significant relief and 37% saw their depression go into remission.
TMS is not the same as electroconvulsive (“shock”) therapy—TMS uses electricity in a much gentler form. With TMS, electricity is transferred to the brain through an electromagnet to stimulate or “tickle” the prefrontal cortex, the part of the brain that allows us to think, plan, reason, hope and dream. The magnetic field lets the electrical current penetrate the skull and provide a “jump-start” for underactive mood-regulating brain circuitry.
Noah Philip, MD, an assistant professor of psychiatry and human behavior at the Alpert Medical School of Brown University, has been researching treatment-resistant depression for many years, including TMS. He said, “With TMS, we take a magnet that’s roughly the same strength as those used in MRI scanners, though smaller, and we use it to deliver a series of rapid pulses of magnetic energy over parts of the brain that are involved in depression. We don’t yet know exactly how it works, but we think that it changes the activity of individual neurons in the brain and makes them fire properly, alleviating the symptoms of depression.”
Typically, TMS treatments take place in a doctor’s office on an outpatient basis and last about 40 minutes each. Patients visit five days a week for six weeks, after which they usually need only a handful of follow-up visits. No anesthesia or sedation is required. While the patient sits in a reclining chair, a magnetic coil positioned on the left forehead delivers a very rapid series of electromagnetic pulses. Generally the pulses are delivered for four seconds, then there is a rest period of 26 seconds…then that sequence is repeated several dozen times.
Dr. Philip likened the sensation to “having a woodpecker tapping on your forehead”—a sensation that results from the nerves in the face being stimulated—so it’s not exactly pleasant, but it doesn’t really hurt. Some patients experience a twitching sensation of the scalp and/or brief headaches during the treatment, but otherwise there are no significant side effects. This is a distinct advantage over antidepressant medications, which can cause lowered libido, weight gain, headache, fatigue, anxiety and zombielike moods. Importantly, TMS does not cause memory problems the way electroconvulsive therapy does. Patients can resume their normal activities immediately after the end of each session. There are no long-term safety concerns associated with being exposed to the electromagnetic energy, Dr. Philip said.
Who can be helped: TMS may be recommended for people with major depression who have tried one or more types of antidepressant medication without success. TMS is not appropriate for patients with seizure disorders because theoretically, with any stimulation of the brain, there is a risk of triggering a seizure (although Dr. Philip pointed out that in clinical trials involving more than 10,000 TMS treatments, no seizures were reported). TMS also should not be used by people with metal implants in or near their heads, such as aneurysm clips, cochlear implants or stents for hydrocephalus. Dental fillings and other metal orthodontic work do not interfere with TMS. Patients with cardiac pacemakers or implantable cardioverter defibrillators who are interested in TMS must discuss the treatment with their doctors first, Dr. Philip said, because the various devices differ in whether they can tolerate TMS.
Researchers do not yet know how long TMS’s benefits typically last. As with psychotherapy and antidepressant drugs, some patients do relapse after TMS. However, when this occurs, another round of TMS treatment can be used. Dr. Philip said, “For people who respond to a first round of TMS, the odds of responding to a subsequent round are as high as 80%.”
Currently there is one FDA-approved device for TMS on the market, and it is in use at several hundred physician-run centers across the US. The treatment should be provided by a TMS-trained physician. Your doctor or psychiatrist can provide a referral, or you can check the device manufacturer’s Web site at www.NeuroStarTMS.com.
The cost of a six-week course of treatment varies depending on the location and the provider. Because TMS is FDA-approved and is included in the American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Major Depressive Disorder, many major insurance companies are now covering the treatment—so check with your health insurer.
