By Karan Narwal
About 14 million American adults are affected by depression every year. In fact, it is believed that by 2020 depression will be the world’s second leading cause of disability. Medications alone cannot work effectively and in some cases, the side effects can be intolerable for many. Treatment resistant depression is prevalent now more than ever, and so the medical community saw a need for an innovative, non-invasive treatment that can help millions find relief.
Multiple universities conducted research over the last 15 years to determine the efficacy of such a treatment. The results have been overwhelmingly positive. Mark George, MD, a neurologist/psychiatrist at the Medical University of South Carolina and editor of the journal Brain Stimulation, has been exploring the use of TMS for depression since the early 1990s. At that time, he says, most neurologists believed brain stimulation was only successful if it induced a seizure, as in ECT.
But George believed that the gentler electric currents generated by TMS could also be effective if they were delivered repeatedly. Small changes add up, he says. Repeated exercise can strengthen a weak muscle. And in depression, psychotherapy can be an effective treatment over time. “You can exercise brain circuits by retraining how you think,” George says. “We know repeated minor changes to the system can get the system better.”
In the recent years, studies from Harvard and Stanford have shown the significant response that TMS can provide for patients. There is such strong evidence linking the efficacy of TMS that some psychiatrists have opened the idea of TMS being first line treatment for Depression rather than medications. This may take years to enact but regardless, the opportunity for the public to attain an alternative treatment to fight mental health battles is now possible and accepted my most major insurance companies!
How TMS Therapy Works
The concept of TMS applies to the fundamental approach to brain activity. In people suffering with depression, the idea is that brain activity is reduced, more specifically in the left prefrontal cortex. Thanks to Neuronetics, Inc. we use NeuroStar Advanced Therapy TMS which is a state of the art TMS machine that is the most comfortable TMS chair for the patient, and most user friendly for the provider. During treatment, the magnetic coils are placed on a measure location which Doctors and staff map during a mapping procedure. During this process, we are able to find the location of treatment and the specific dosage required for that patient.
Once a patient is mapped, they are allowed to begin treatments. The repetitive pulses generated by the machines coils are delivered in increments of 40 pulses over the course of 20 minutes, delivering 3000 total pulses during one treatment session. Now back to the brain activity in depression. When a person suffers from depression, theoretically there is hypoactivity in the brain, specifically in the left prefontal cortex. These pulses being delivered over time awaken those nerve cells that are under-stimulated and increasing brain activity over time. Think of each pulse as if it were giving you the potential for a positive thought. Patients undergoing TMS treatments can receive anywhere from 100,000-150,000 “positive though potentials” giving patients the opportunity to create neuroplastic change.
These pulses are delivered repetitively during each treatment, utilizing similar energy potential from an MRI, and thus creating an excitatory state of cortical activity in the brain. Essentially, a patient receiving TMS has been given the potential to create more permanent change, learn new things and have the opportunity to create better lifestyle habits too!
The underlying beauty in TMS is not just the efficacy. It is also due to the fact it doesn’t require any anesthesia or sedation. It’s a completely non-invasive procedure with little to no side effects. Very rarely, the most commonly reported side effect is a mild headache within the first 2 treatments which eventually dissipates once your brain sensitizes to these pulses. You remain both awake and alert throughout the 20 minutes it takes to perform the procedure in an outpatient setting. This treatment is prescribed by a psychiatrist, patients must be under supervision at all times during treatment and the commitment requires patients to undergo treatment for 6 to 8 weeks for a total of 36 Treatments.
The FDA and TMS Therapy
The U.S. Food and Drug Association (FDA) gave approved TMS for Major Depressive Disorder in October 2008. They say that while this is a novel treatment, it’s one that’s both safe and effective. Recently the FDA has approved TMS treatment for Obsessive Compulsive Disorder as well as Migraines. The anticipation around the Psychiatry community is that the FDA will eventually approve TMS for Anxiety, PTSD, Insomnia and Bipolar Disorder. This is due to strong evidence linking effective treatment results from studies conducted by various institutions. However, insurance companies only cover TMS for Treatment Resistant Depression.
A Closer Look at the University Medical Center’s Study
In Rush University Medical Center in Chicago, a study by Dr. Philip G. Janicak, takes a look at the durability of this treatment. Three hundred patients who suffer from major depression were randomly assigned to receive TMS therapy during an acute, controlled trial that lasted for 6 weeks. Patients who were responsive to this therapy then also underwent a three-week transition period. Throughout this time these patients were tapered off of the treatment and started on an antidepressant medication or electroconvulsive (ECT) therapy for continued maintenance. This is the typical way of lessening a patient’s chance of relapsing.
In this acute, randomized study there were 142 patients who received active treatment. These patients responded well then went on to enter the three-week transition phase. Only 120 patients completed this phase without any relapse. Of these 120 patients, 90 (81.8%) agreed to have therapists follow them for another 24 weeks. During this time, 10 patients relapsed. Therapists used an intermittent rescue strategy to stop impending relapse in 32 patients (84%). This shows that the therapeutic benefits of this treatment are durable in most patients and it can also be used in combination with antidepressant medication to safely and effectively prevent the patient from relapsing in the future.
This furthermore shows that this therapy is viable for treating patients whose major depression hasn’t responded to the conventional antidepressant medications. However, it is important to follow this therapy up with the standard treatment of antidepressant medication to maintain the therapy’s acute benefit. Doing so has already proven invaluable over a 6-month period for many patients.
Why the TMS Advantage?
At the TMS Advantage, we believe in giving our patients the Advantage when it comes to their mental health. That is why we have cultivated a program that provides the most effective approach to TMS to get the most successful results. Our program is designed to literally take advantage of the neuroplasticity from TMS and use it to instill healthier lifestyle modifications that would in turn benefit the patient in the long run. Our weekly Group TMS meetings for all our TMS patients provides an opportunity to take a psychotherapeutic approach while doing treatment. This only enhances the effects of TMS by using tips and tools from Cognitive Behavioral Therapy and Dialectal Behavioral Therapy.
In addition, we collect data from fitness trackers we provide for all your patients. We want to take full advantage of the chance to optimize the success of TMS and being active only helps. Basically, with increased aerobic activity and being able to monitor sleep we are able to improve lifestyle factors that are can become an unfavorable environment for our patients. TMS is half the battle, and we work with all our patients get the most out of this treatment. If you or loved one has been suffering from treatment resistant depression, and would like to know more about TMS Advanced Therapy, then contact The TMS Advantage. We’ve helped many patients comfortably undergo this treatment and look forward to helping you too!
Picture Credit: Ben White