Transcranial Magnetic Stimulation: Alternative Therapy for Chronic Depression
October 12, 2018
Every year, approximately 16.5 million Americans, or 6.7% of US adults, have at least one major depressive episode. While there is a wide range of treatments for depression, including dozens of prescription antidepressants, two-thirds of those suffering from depression do not find relief in the first prescription they try. Many find some symptoms remain even after two months of treatment, and subsequently each new prescription they try is less likely to work than the previous ones.
When antidepressants, or first-line treatments are unsuccessful, some people will seek alternative treatment methods. Electroshock therapy, now know as electroconvulsive therapy (ECT), is a psychiatric treatment created in the 1930s that induces seizures electrically to provide replied from various mental disorders. For many decades, ECT served as the primary method to address treatment-resistant depression, and is still used today. While the process has evolved over time, the main side effects of memory and cognition deficits deter many from trying it. Because of these potential side effects, many people prefer to avoid ECT, leaving them with little relief to their depression. Fortunately there is a new alternative, transcranial magnetic stimulation (TMS), that can assist those who do not respond well to first-line treatments like therapy and medication.
How Transcranial Magnetic Stimulation Works
TMS offers brain stimulation in a non-invasive format by applying powerful magnetic fields to the parts of the brain know correlated with depression. Since the device works completely outside of the body, it doesn’t require anesthesia and patients find it much more tolerable when compared to the side effects of ECT or medication. The most common side effect patients report is headaches during or after treatment, though a rare but serious side effect includes seizures, so patients with a history of epilepsy, serious neurological issues, or head injury should avoid this treatment.
How Effective is TMS?
For individuals who did not find significant relief from other first line treatments like prescription antidepressants, 50-60% experience a meaningful reaction to TMS. Approximately a third of those individuals will go on to experience a full remission, and they no longer suffer from their symptoms. That said, it’s important to note the results are not always permanent. As with many mood disorders, there is a significant recurrence rate. Even so, TMS patients find relief on average for up to a year after treatment ends. At that point many will return for subsequent treatments. For those who do not find relief in TMS, they may find ECT to work better for them and should consider it as an option.
What are TMS Therapy Programs Like?
A TMS treatment plan will require a significant time commitment, requiring five sessions a weeks for several weeks. Sessions typically last 20-50 minutes, depending on the protocol and devices being used. The technician will access the motor cortex to target the ideal placement and intensity for the stimulation. The info gathered during this process helps the technician locate the dorsolateral prefrontal cortex, which is the area of the brain with the most evidence showing its involvement with depression. While there are distinct changes within the brain after only one session, it can often take up to six weeks for noticeable relief in patients.
Additional Uses for TMS
There is currently extensive research using TMS to treat many neurological disorders, physical rehabilitation, and pain management. Bipolar disorder, Pediatric depression, PTSD, OCD, and smoking cessation are just a few of the conditions being testing with TMS in clinical trials. Though TMS is not currently approved for any of these conditions, there is strong promise it may be some day.