TMS & Other Therapies

Is your child depressed? TMS could be the answer.

June 7, 2019

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Depression in children and adolescents is frequently overlooked or dismissed, but its existence is indisputable—and, as with all cases of depression, treating it is both urgent and potentially life-saving.

However, as commonly seen in adult patients, the prescription of therapy and even medication is not always effective, despite these being the most primary forms of treatment.

Adolescent girl takes pill with water.
Children are most frequently prescribed SSRIs (serotonin reuptake inhibitors) such as Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), Luvox (fluvoxamine), and Lexapro (escitalopram). Common side effects for these drugs include weight gain, nausea, drowsiness, dry mouth, constipation, and dizziness. Image from Harvard Health.

According to Mayo Clinic, up to 40 percent of adolescents with major depressive disorder fail to respond to prescription drugs and psychotherapy: “For these patients, repetitive transcranial magnetic stimulation (rTMS) may be a safe, well-tolerated and effective therapeutic option.”

Transcranial Magnetic Stimulation, or TMS, is a noninvasive, drug-free method of alleviating symptoms of treatment-resistant depression.

You never feel more helpless as a parent than when you’re forced to watch your child suffer while not being able to do anything about it. If your child’s depression isn’t getting better with treatment, continue reading for:

  • A brief introduction to TMS
  • Indications that TMS could be right for your child
  • The science supporting the use of TMS to treat pediatric depression

A Quick Overview of TMS

How it works

TMS uses magnetic pulses to re-energize brain cells affected by depression, which helps to improve mood. Basically, the magnet boosts activity in the brain to combat the debilitating feelings associated with depression, like hopelessness and fatigue.

During the treatment, the TMS coil is placed around the patient’s head in order to emit the magnetic pulses, which are identifiable through a series of clicking noises, similar to those made by an MRI machine.

Aside from the initial consultation, which is usually longer, each session usually lasts up to 20 or 40 minutes, during which the patient is seated while wearing earplugs. In addition to hearing the clicking of the TMS machine, patients will feel a light tapping along their head as the treatment is administered.

Unlike electroconvulsive therapy, TMS does not require sedation and will not impair daily activity or mental clarity. Typically, a patient will receive the treatment 5 days a week for 4 to 6 weeks.

Is it safe?

TMS is FDA-approved with relatively few side effects, unlike most antidepressants. While some patients do feel some discomfort during or immediately following the treatment — typically in the scalp and head — these episodes are short-lived and unlikely to occur after the first week of the therapy.

Due to the magnetic basis of the treatment, patients with metal implants in or near the head (aneurysm clips, stents, deep brain stimulators, metallic ear/eye appliances, shrapnel or bullet fragments, pacemakers, etc.) are not viable for TMS. Braces and dental fillings, however, are permitted.  

In a few isolated cases ( about .001 percent), seizures have been linked to TMS. For this reason, TMS is not recommended to patients with a history of seizure, stroke, or brain tumors.

Young boy lies on floor, uninterested in the toy in front of him.
The symptoms* for depression in kids differ from those found in adults.

TMS could be right for your child if …

  • Your child has been diagnosed with a depressive disorder (major depressive disorder, dysthymic disorder, bipolar I or II, etc.)
  • Traditional treatment methods (antidepressants and therapy) have been ineffective on your child’s depression, or your child’s depression has stopped responding to treatment
  • Your child has experienced adverse side effects to antidepressants
  • A potential side effect of antidepressants in children and adolescents is increased risk of suicidal thoughts. While It’s still not clear what exactly the relationship is between the drugs and this side effect, one theory is that the reduction of the physical symptoms of depression might result in patients fixating more on thoughts of harming themselves. Adolescents most at risk for these symptoms are those with Bipolar disorder and a personal or family history of attempted suicide.
  • According to Carlo Carandang of Canada’s Dalhousie University, “Major depressive disorder in youth is associated with significant mortality by suicide, protracted course of illness, high risk of recurrence, significant non-response to treatment, progression to bipolar disorder within 5 years [6-8], and high frequency of affective illness in  family members. Even with the gold standard treatment with an SSRI and concurrent cognitive behavioral therapy, 30% to 40% will not respond to treatment, thus classified as ‘treatment-resistant.’”
  • Depression is a continuing, worsening, or reoccurring issue for your child, regardless of taking antidepressants  

* Note: Signs and symptoms of pediatric depression include:

  • Irritability or anger
  • Persisting sadness and hopelessness
  • Withdrawal from family, friends, and previously enjoyed activities
  • Changes in appetite or sleep schedule
  • Crying and temper tantrums
  • Difficulty concentrating and focusing
  • Fatigue or low energy
  • Complaints of physical pain, such as stomach aches and headaches
  • Increased sensitivity to rejection or criticism
  • Expressions of worthlessness or guilt
  • Talk of death or suicide

Research on TMS & children

Although TMS is not yet a routine recommendation in response to being diagnosed with depression, mental health professionals have researched it extensively, and scientific studies on its effectiveness date back to the 1980s.

A 2017 study done by the Neuroscience Institute at Georgia State University and the Department of Neurology at University of Colorado-Anschutz Medical Campus, which closely examined PubMed records ranging from 1985 to 2016, came to the following conclusion:

“Available data suggests that risk from [TMS] in children is similar to adults. We recommend that TMS users in this population follow the most recent adult safety guidelines until sufficient data are available for pediatric specific guidelines.”

Unfortunately, much is still unknown about mental illness in adolescents, which means little has been determined in regard to the best way to treat psychiatric conditions such as pediatric depression.

Consequently, most research on TMS features patients over the age of 18. That being said, the findings are both impressive and encouraging.

According to Butler Hospital, 1 out of every 3 patients treated using TMS reports total relief of prior depression symptoms at the end of the six week treatment.

In a study conducted at the University of Calgary, located in Alberta, Canada, medical student Sarah Pradham looked at the effects of TMS on 11 patients ranging from the ages 15 to 21. After being treated with TMS, 7 of the patients tested 62 percent lower on the Hamilton Depression Rating Scale.

Remission could be possible for your child with TMS.

While it remains true that there’s not yet a cure for depression, it’s important to remember that there are treatment options out there that can make living with depression manageable, even in the most stubborn of cases.

The first line of defense is, of course, therapy, followed by medication. However, these are not the only two approaches to depression in the world of modern science.

Transcranial magnetic stimulation is painless with minimal side effects. As it gains traction in the mental health community, more and more insurances are beginning to cover it. Ask your pediatrician or primary health provider about TMS, and give your child a chance at a life of remission.

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