Transcranial magnetic stimulation (TMS) is a noninvasive treatment option now increasingly available for the two-thirds of all depression patients who experience only partial or no relief from pharmaceutical therapy.
Nearly 300 US medical centers now offer transcranial magnetic stimulation treatment for major depression, and the therapy “is rapidly gaining momentum,” says Loyola University Medical Center neuroscientist Murali Rao, MD.
The treatment, which sends short pulses of magnetic fields to the brain, has helped about two-thirds of his TMS patients so far, Dr. Rao says – either lessening depression significantly or dispelling it completely. (Similarly, a recently published 13-center TMS trial found the treatment helpful for many patients with acute depression, and often as a means of averting impending relapse.)
The therapy was FDA approved in 2009 for patients who have major depression and have failed to improve using at least one antidepressant drug. For example, Dr. Rao explains, before receiving TMS his patient, Nan Miller, had failed nine antidepressants and suffered increasingly severe cycles of depression over seven years.
There were times when she couldn't get out of bed or eat: "I just wanted to die," Ms Miller says. She had even tried electroconvulsive therapy (formerly known as electroshock), and did not want to consider that option any more.
But a few weeks after beginning TMS treatments, she recalls, she was eating lunch when she suddenly realized depression did not consume her any more. "I could almost hear the chains breaking, the darkness lifting and the heaviness dissolving. I feel about 10 years younger and 20 shades lighter."
The FDA has so far approved one TMS system, NeuroStar®, made by Neuronetics. (To watch a patient education video, click here. And to locate healthcare providers familiar with TMS therapy in a zip code near you, click here.)
Together, psychotherapy and antidepressants successfully treat only about one-third of patients who suffer major depression, Dr. Rao explains. So TMS is a noninvasive treatment option now available for the other two-thirds of patients, who experience only partial relief from depression or no relief at all.
What TMS Therapy Involves
The patient reclines in a comfortable padded chair. A magnetic coil, placed next to the left side of the head, sends short pulses of magnetic fields to the surface of the brain. This produces currents that stimulate brain cells. The currents, in turn, affect mood-regulatory circuits deeper in the brain. The resulting changes in the brain appear to be beneficial to patients who suffer depression.
• Each treatment lasts 35 to 40 minutes.
• Patients typically undergo three treatments per week for four-to-six weeks.
• The treatments do not require anesthesia or sedation.
Few if Any Side Effects
Afterward, a patient can immediately resume normal activities, including driving. Studies have found that patients do not experience memory loss or seizures. Side effects include mild headache or tingling in the scalp, which can be treated with Tylenol.
Together, psychotherapy and antidepressants successfully treat only about one-third of patients who suffer major depression. TMS is a noninvasive treatment option now available for the other two-thirds of patients, who experience only partial relief from depression or no relief at all, Dr. Rao says.
TMS Potentially Helpful for Pain, Sleep, Fatigue & More?
A small trial of repetitive TMS for fibromyalgia published in June, 2011 reported reduction of pain but also other symptoms such as fatigue and sleep, “directly correlated with an inhibition of cortical excitation in the brain.” See “Magnetic Stimulation Therapy Aids Fibromyalgia.” Another trial found that TMS significantly improved symptoms in many patients with obsessive compulsive disorder.
Some of the trials now recruiting include a study of repetitive TMS for fibromyalgia pain in Grenoble, France; a trial of TMS to stabilize veteran PTSD patients with suicidal ideation in Maryland and South Carolina; and a trial of TMS for depression in pregnancy at the University of Pennsylvania.
[Note: Recent pilot trials at UCLA of a somewhat similar therapeutic concept – trigeminal nerve stimulation (TNS) – have achieved an average 70% reduction in symptom severity, with 80% achieving remission. This technology involves application of weak electrical current at a spot on the forehead over the trigeminal nerve. The nerve sends signals to key structures deep in the brain.]
Source: Based on Loyola University Health System news release, Feb 2, 2012; Rush University Medical Center news release, Oct 11, 2011; UCLA news release, Sep 2, 2010.