Transcranial Magnetic Stimulation Offers Hope for Treatment-Resistant Depression

planspace.blogspot.comTranscranial magnetic stimulation (TMS) is a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The procedure was approved by the FDA in 2008.

TMS is the least invasive of neurostimulation procedures. Some of the others:

  • Deep brain stimulation (DBS) involves implanting a medical device known as a “brain pacemaker,” in the chest that sends electrical impulses to specific regions of the brain. Electrodes and electrical leads, which are connected to the pacemaker, are inserted in specific regions of the brain through holes drilled into the skull.
  • Electroconvulsive therapy (ECT) involves applying electrical pulses to the scalp to induce seizures throughout the brain while a person is under general anesthesia. The seizures help relieve depression by promoting the release of serotonin and dopamine.
  • And vagus nerve stimulation (VNS) involves the implantation of a small device in the upper left area of the chest which is connected to the vagus nerve in the left side of the neck. A generator in the device sends timed pulses of electricity to the nerve.

A study published in the “Journal of Clinical Psychiatry” reported that half of patients with treatment-resistant depression who underwent TMS experienced relief of symptoms. Approximately 50 percent of the patients maintained significant reduction of depressive symptoms (an average of 62 percent) through repeated sessions of TMS.

“These findings are certainly exciting and cause for (cautious) optimism,” says Karen Swartz, Director of The Johns Hopkins Mood Disorders Clinic,” in the Fall 2008 issue of the Depression and Anxiety Bulletin.

TMS is designed to treat a variety of psychiatric and neurological disorders such as Parkinson’s disease, stroke, migraines, tinnitus, and obsessive-compulsive disorder. It is usually a 40-minute outpatient procedure that is prescribed by a psychiatrist and performed in a psychiatrist’s office. The treatment is typically administered daily for four to six weeks, and costs $200 to $300 per session. I’m not sure if it’s covered by insurance.

I’m very excited about this procedure because it offers hope for those with treatment-resistant depression.

Published originally on Sanity Break at Everyday Health.

image: planspace.blogspot.com

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24 thoughts on “Transcranial Magnetic Stimulation Offers Hope for Treatment-Resistant Depression

  1. Therese,

    I am in my second week of this treatment. I haven’t noticed any significant results yet, but was told that most patients notice an improvement around the third week. I spent several months researching before I found the right clinic for me. The first thing to note is that the treatments are very expensive. Most places will try to get you to pay the balance up front, which is upwards of 13k for 30 sessions. Remember that everything is negotiable. I pay per session and was able to bring the cost down a bit. Also, this treatment is still painful. I am told that this will get better but at the least I would say it is very uncomfortable. My physician has a Neurostar machine, which is a little different from the one pictured here. It releases a magnetic pulse every 25 seconds for four seconds each. It emits a very loud clicking noise when the machine is active.
    My husband is a physician who works extensively with MRI and is confident that the procedure is safe. The magnetic treatment in one TMS treatment is significantly less than one MRI session. Also, magnetic therapy and imaging have been around for years. The primary complication of TMS is seizure, but it is slight.

    I could go on forever but I am very encouraged. This is definitely a last resort option, at least for me, and should be researched and carefully considered before making a treatment decision. Thanks so much for introducing the subject. It is hard to find good information. I would love to hear from others who have tried TMS

  2. Terese-
    I went through the initial 5 wk treatment 1 year ago. It has changed my life. I am 59 years old and have experienced severe depression since I was a teenager. When I completed the treatment, I realized how depressed I had really been. The sadness, crying spells, ruminations, ultra-sensitivity, exhaustion and fear were gone. I told myself, this is what normal feels like. My relationships have all improved and my energy has increased. In the past, I couldn’t talk to anyone in the morning until I had 2 cups of coffee and even then I had to drag myself out of bed. Now I can actually socialize before I get my morning coffee. My husband of 18 years says that I am much more expressive and free sexually. As an elementary school teacher, I have noticed I’m much more patient with the kids. The crying has stopped. I have had 11 booster treatments during this year, so for me the treatment is not permanent. I am still on Lexapro and Wellbutrin. People ask, if it doesn’t last and you are still on antidepressants why do you continue? I am not rich and insurance does not pay for it in Texas, but it has made such a difference in my life that I will continue the treatment as long as I can. In a few years, hopefully it will be covered by insurance. Neurostar could use me as a spokesperson. If anyone has any questions about the treatment or would like to share your experiences, please email me. cjmurrayhagens@hotmail.com I have not found many personal experience stories online. Joy

    1. Thank you for sharing your story! I am in my 2nd week and scared to death. Do you remember what point in the treatment you began to feel better? I have a similar background and have been prescribed 33 treatments for one hour each, instead of the usual 40 min. I’m praying for relief and thank God that your plan was successful and you continue to thrive!

      1. It took me about 3 weeks to feel better. I went through a stage of crying, then feeling very angry, before I felt better. About every week, I was filling out an IDS form (Inventory of Depressive Symptomatology). I went from a score of 50 (very severe range) before the treatment to a score of 0 (Normal)! After my initial 5-6 wk treatment, I would fill out the IDS at home so I would notice when my symptoms were returning. Then, I would get a booster. Because of the pain, I went from taking Advil to 1/2 of a hydrocodine tablet. That really helped. After a treatment, I feel a little spacey (even on Advil) and I do not go to work. Dr. Crowder says every patient responds differently to treatment. This has been my experience. Let me know how you are doing and if you start feeling better. I remember feeling discouraged the first few weeks. Joy

    2. Joy, I live in Tennessee and have BCBS insurance. Our mental health benefits are managed by Magellan. BCBS denied our claim, but my provider has had success with future reimbursements thru Magellan. It takes a lot of time and patience, but fortunately my doctor is responsible for pursuing. Even if Magellan doesn’t sound familiar, they often manage the mental illness benefits for insurance companies so it may be worth checking into.

      I hope this helps, as I now TMS in insanely expensive, no pun intended:).

    1. I have been on almost every medication and combo imaginable. I broke into years when the psychiatrist (number 1 of 3) td me I should consider ECT when I was expecting yet another med switch. Most recently I’ve been taking lamictal and Zoloft which they want me to continue until I get the okay to taper. I hear this takes several weeks after completing treatment and a lot of patients continue to take them. I am at the end of the 3rd week and feel a little better. The pain is gone too. I’ve been recently diagnosed with type 2 bipolar, which is hard to believe since I feel almost catatonic with depression.

      I am excited about the treatment and hope to share Joy’s success!!

      I would love to continue the discussion either thru this forum or by phone. If you like to message me on FB I’ll give you my cell number.

      Thanks again so much for approaching this topic. I think it’s the most promising treatment yet for depression and bipolar disorders.

    2. i have been on different medications for 20 years. Zoloft did not work for me. Prozac worked for 10 years. Then, it stopped working and I switched to Lexapro 5mg and Wellbutrin 450mg a day. That’s what I am on now. I tried decreasing both of these meds at different times after TMS, but I felt my depression coming back. I know that some people are able to get off their meds after TMS. Unfortunately, I was not able to. I don’t know why. Possibly it’s because I have had depression for 40 years.
      I did read an interesting book recently called “Gut Instinct” by Pallardy that shows the connection between our stomach and the brain. He says the depression/anxiety begins in our stomach. I have had stomach issues for years, so his suggestions made sense to me. Let’s keep the TMS connection going. I know that I will be having booster treatments and I would like to know how long the treatment lasts for others.

      1. Thanks for this, Joy. I asked you because I had read a story that said if several drugs have been unsuccessful then TMS has a lower chance of helping. Since I’ve tried over 30 drugs, I was discouraged by that.

  3. I have seen those reports too. When I asked my doctor, she said that since it’s relatively new technology, most studies were conducted in an educational setting, with multiple chairs in a room with technicians who were probably managing several patients at a time with limited personal interaction. Since TMS should only be considered after meds no longer work, and most responses I have read are positive, her explanation seems to make sense to me.

  4. I will be starting Rtms treatment in the next few weeks. I’m so afraid it won’t work after so many meds failures or marginal response. I haven’t felt real spontaneous joy in a decade despite having a wonderful life. I’ve been suffering from mdd since my 20’s. The episodes used to come, linger for a few months and then completely disappear but each subsequent episode felt worse. At 33 I decided to seek help and began taking Prozac which helped for a few years. After that, it’s really been a rollercoaster and now I feel so dead inside. I really hope this treatment marks the beginning of a new life for me and all of those who suffer from this insidious illness. I will keep you posted.

    1. I am in my 5th week and feel better, but I’m not where I need to be. My doctor changed protocol today. Now she is treating the left and right sides of the prefrontal cortex. Before the stimulation was just on the left side, which is standard protocol. I have 10 treatments left and I’m optimistic, although I was hoping to be further along at this point. Most people feel better around the third week.
      The treatment is safe although very expensive. Some insurance will cover the costs.

      1. I realize I did not answer the question. I haven’t had ECT but my doctor has had several patients in the last year who have tried TMS after ECT with success. I think success rates between the two treatments are similar.

    2. ECT gave my husband increased anxiety, even to the point of major OCD. That just created another cycle of Anxiety/Depression in the long run. I would not encourage ECT to anyone unless they stayed suicidal on a continual bases for an extended period of time.

  5. We have had ECT & TMS. TMS was much more effective, but it’s ongoing as needed. We ran out of $ because we paid out of pocket, and had to drive an exceptionally long distance for the treatment. Consult with your doctor an weigh out the pros an cons in your own personal situation, but I would definitely say go for it if you can. I feel it’s a much better treatment than ECT and trying out tons of meds!

  6. Dear,,

    Hi.. please introduce myself,,My name is Cho Ryeon,,I am Asian,24 years old. I am unemployed. I have been fired from the job I was in twice. I can hardly find any other job bcs of my bad working experience on my cv.
    Since then, I realized that I am a slow learner. I was fired bcs I did mistakes for so many times and didn’t understand the instructions properly.

    Well, I have big problem with learning new thing. I used to be a very hardworker but still there always be some flaws on my work. My supervisor always mad at me like, “I’ve said it so many times!”. They did right thing. I didnt blame my previous supervisors who fired me. All I am blaming is my ability of learning and understanding.

    Because of this,I know my weakness well. This leads me to have a terrible feeling when it comes to talk to someone, I’m always getting nervous and panic when I have to explain something. That’s one of the reason why I got fired. I have bad communication skill. Why, because I am afraid if I’m doing wrong.

    Ever since the last day of my working, I haven’t applied for any job yet. I have traumatic feeling about getting fired. My mom always scold me and asking why I’m not looking for another Job. In fact, I never told this to anyone before include, (especially) my parents. I told them that my contract was terminated because I had to handle another job outside my Job desc. I didn’t tell them the honest reason.

    I can’t even share this to my bestfriends bcs they are the people I am envy with. They are the people I wish I could be. They are now having good position in their company with good salary. I feel so much intimidated when we go out for cinema or just hanging out,, they’re all proudly spending their self-earn money and sharing their working experience. Meanwhile, I am still using my parent’s money,, and the leftover money from my last salary.Things are getting harder for me when they ask what my daily activities are. In fact Im just doing nothing at home.

    I keep telling lies to everyone. I am really afraid to tell the truth and to be judged. Having myself as a slow learner has already become the most hurtful thing I have to face.

    Now I am fighting so much againts my own anxiety and low self esteem. I am so afraid what if I never get a proper job.
    I am really expecting for you to do me a favor about what to do? What am I supposed to do ?
    I am so much thankful for your help..

    Best Regards
    Hwang Cho Ryeon

  7. Hi Hwang, I am sorry to read of your troubles with your job, your low self esteem, and problems learning. I do not know where you live. If you live in the U.S.A., there is help for you. Contact your local Learning Disability Association. They can test you, and your skills to find out what problems you have This can all be done on a no cost to you basis. Also, they can help you find employment that you will be successful with. Please do not stay home and be embarrassed. There is no shame for you. There are good people that will assist you, but you have to reach out to them to get the help you so strongly deserve. I wish you the best.
    Kay

  8. I have struggled with Depression for 41 years. Tried 90, yes 90 meds to no avail and was in therapy for
    25 years with more than a dozen docs. Started TMS last week and have had just 2 treatments and hoping
    for some relief. Not expecting remission at this stage of my life. Feeling absolutely exhausted after the treatments and will say I am concerned. Will keep you posted.

    1. Jeff – how did you go?! *jumping up and down*)
      I’m keen to know as this story sounds like mine. Anyone suffering for such a long time, could relates to how amazing it is to finally find something that works – even if a bit . It’s the fact that relief can be found

  9. I started TMS last week and just had my 4th treatment today. It is very early but I am already noticing positive effects from the therapy. I am quite fatigued post treatment so I just allow time to take a long nap after each session. Because of my unusually high motor threshold on my brain, the TMS machine is cranked up very high, thus more forceful tapping, thus more intense. However, it is absolutely tolerable. I am hopeful as I have been medication resistant , and boy have I tried dozens of medications to no avail! I shall keep you posted!

  10. I started TMS and have had 8 sessions. I am exhausted and feel very annoyed and irritable but continue to have hope. I’ve tried 18 medications in the last four years with no help. I will update on my status in a couple of weeks.
    The pain is bad the first few times but tolerable for the better picture….
    Mine are one hour 5 times a week so it does get annoying going daily but again, worth it if it helps.

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