Relief for some people sounds like the tapping of a woodpecker and comes from an apparatus that resembles a dental chair.
But what’s unfolding in this exam room at Eastern Virginia Medical School is actually a treatment for depression: magnetic waves being transmitted through the skull of a 33-year-old Virginia Beach woman in hopes of jump-starting mood centers of her brain.
“It’s like a bird tapping on your head,” said the patient, who has suffered depression for more than a decade. “It feels like my whole head is vibrating.”
It’s called Transcranial Magnetic Stimulation, and it’s the first non-invasive brain procedure to be cleared by the Food and Drug Administration for treatment of depression.
If it sounds like electroshock therapy – a treatment still in use for severe depression – that’s because both share a common principle: stimulating the brain.
Research scans have shown that depressed people have low levels of activity in the left frontal region.
That’s where the similarities end. Electroshock therapy, referred to today as electroconvulsive therapy, requires anesthesia and uses an electric shock to create a brain seizure. The controversial treatment has been linked to memory and cognitive losses, and an FDA panel recently recommended it be subjected to more testing for safety and effectiveness.
TMS uses a magnetic field to produce a much smaller electric current that stimulates the brain without a seizure or loss of consciousness; the technology is the same as with an MRI scan.
The outpatient treatment for TMS carries less risk but also is less effective. In clinical trials, patients had an average decrease in depression of 22 percent compared with 9 percent in patients who received a placebo treatment. The company that makes the device, Neuronetics, claims about half of patients experience improvement.
Not exactly a home run, but because the procedure is not invasive and shows few side effects, the FDA cleared it for use in late 2008. Since then, health centers across the country have purchased the machines, sold under the trade name NeuroStar. The company lists about 250 centers that have them in the United States, including six in Virginia.
EVMS purchased one last year, as did Riverside Behavioral Health Center in Williamsburg and Virginia Commonwealth University in Richmond. Private psychiatrists also have started using them, as has Walter Reed Army Medical Center in Washington.
The treatment is aimed at people with moderate depression, for whom a single medication has failed.
“I think it has a real place in the menu of treatment for people with depression, but it’s important to make clear we still have more to learn,” said Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness. “New treatments reveal things over time about how to use them better and problems they might have. So it’s important to be mindful of that.”
The 33-year-old Virginia Beach resident, who finished her six-week treatment two weeks ago, didn’t want her name used because she didn’t want the illness to affect her employment.
The woman experienced depression even as a youngster, but it worsened when she went to college. In her 20s, she tried antidepressants. Some medications didn’t work, others did for a while; still others made her sick.
She tried therapy, but because she hadn’t had anything traumatic happen in her life, she didn’t feel it was helpful.
She was able to summon enough energy to keep a job, but by the time she finished keeping up a facade of normalcy for the day, she was too tired to do anything but sleep.
“I didn’t have a lot to live for,” she said. “It made me sad that I was going to have to live that way the rest of my life.”
Last year, she heard about TMS from a local counselor. When she looked for TMS treatment last spring, Richmond was the nearest place she could find it. By August, though, EVMS had purchased the equipment, so she began treatments in November.
Her insurance denied her claim for the treatment, so she decided to pay $11,000 out of her own pocket:
“It was a big risk as I was going to pay all of this money for something with a 50 percent success rate.”
Dr. Tuesday Burns, an assistant professor in the EVMS department of psychiatry, and Serina Neumann, a psychologist in the same department, assessed the woman, first screening out any other problems, even asking her to go through a sleep study. She had cognitive tests before treatment to gauge her concentration, focus and memory.
Neumann said many people with depression are either untreated or undertreated. A recent study, for instance, tagged 65 percent of depressed working mothers as falling into this category.
Burns said EVMS and other academic centers are collecting data on the effectiveness of TMS, which could help with insurance coverage in the future. For now, the device is used mainly to treat depression and anxiety disorders, but there could be other uses.
The Virginia Beach woman’s treatment included sessions that lasted 37 minutes every weekday. After four seconds of magnetic wave action, there’s a break for 26 seconds.
At first, she questioned whether she could do it for six weeks because it felt so jarring. But she became accustomed to the treatment, and once it was over, she had no side effects.
Within a week, she started noticing a difference.
“I didn’t feel the desire to sleep as much. Sleep was my solace; it’s how I dealt with depression.”
Now she had time on her hands. She could do things that people take for granted, such as going shopping or even watching TV. That in itself was scary as she faced filling the time.
“You get complacent when you think you are always going to be this way. You don’t know what normal is.”
She’s taking up therapy again to help her with that. Cognitive tests given midway through the treatment and after it also have shown improvements in focus, memory and decision-making, all key functions controlled by the area of the brain that was stimulated.
Now she’s wondering just how long it will last. The company’s literature says about six months. Burns said single booster sessions may help keep the effect going longer without a full course of treatment.
As Duckworth said, with new treatments, there’s still a lot to learn, not just about effectiveness and side effects, but about cost-efficiency.
For now, though, the Virginia Beach woman is enjoying more time in the waking world.
“It’s helped me enjoy life and not feel like a robot.”
Elizabeth Simpson, (757) 446-2635, firstname.lastname@example.org