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Friday, April 6, 2012

TMS Therapy: New Technology to Treat Depression

TMS Therapy: New Technology to Treat Depression

By: Melissa Stern
Updated: April 5, 2012
(Springfield, MO) -- A new discovery could mean good news for people who suffer from severe depression.

If your doctor has prescribed a number of antidepressants without results, TMS therapy could be an option.

Dr. H.J. Bains, a local doctor, usesTMS therapy -- a treatment that sends magnetic pulses into the brain -- on some of his patients. He says it's been around in Europe for 20-30 years, but the FDA approved TMS in 2008 in the U.S.

There are close to 350 clinics using it in the country, and Dr. Bains says his clinic is only the second in the state. He says TMS is one of the safest treatments he's seen and produces the fastest results.
"I haven't felt this good since I was a kid," says Lisa Nunn, a patient of Dr. Bains'. She says she has less anxiety and wants to do things besides lay in bed all day. "It's the best thing to happen to me in a long time."

Nunn says she had been on anti-depressants since she was 15, but nothing helped.

"It was quite bad. I slept a good deal of the time. Wasn't able to function well. I was in a pretty bad depression." She says after the first treatment she noticed a difference. "I had much more energy. I had much more stamina. I don't have the mood swings that I was having. I'm just generally a happier person."

Dwayne Dilbeck, her boyfriend, was very worried about her.

"She slept more of the day than she was awake," but he says he's noticed a huge difference. "She's more active. She's awake a lot more -- more alert. She's gotten back to where she's wanting to get back to writing again."

Dr. Bains says when patients first come in, he gives them a score on the depression scale.
"I have patients who come in with very high scores and by the time they finish treatment, their scores are almost close to zero to two or three, which is in the normal range."

He says TMS therapy sends an electrical pulse through the brain, and targets the area of the brain that controls mood.

"The area of the brain -- the prefrontal cortex -- that's the area of the brain which is underactive in people with depression."

The magnetic pulses recharge that area of the brain which helps take patients off their medications -- medications that could have side effects.

"You give medicine and you don't see any benefit for four to six weeks and all side effects from weight gains, sexual side effects, you name it."

But with TMS, Dr. Bains says results can be fast.

"I have seen patients who have shown improvement by the second or third week."

"The first week everything surprised me because she was more active," adds Dilbeck. "She felt like getting out and going shopping. Couldn't keep her out of the stores!"

"It seemed to me that I kind of woke up from a long sleep," adds Nunn.

At Dr. Bains' clinic, Bay Medical Consulting, TMS is $450 each session. He says it requires one treatment every day, five days a week, for six weeks. Each session is approximately 40 minutes long
You can experience mild tenderness on the head, but there are no other side effects. It is not covered by insurance.

It requires no anesthesia or medications, and the patient stays awake throughout the treatment.
Dr. Bains says it's also being used to help migraines, fibromyalgia, pain syndromes, hallucinations, and traumatic brain injuries.

Pregnant women who don't want to take medication can use it.

The American Psychiatric Association says it's good in some cases, but not effective for everyone.

Here is the APA's complete statement about TMS:
APA Practice Guidelines for Treatment of Major Depressive Disorder (MDD). Transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) uses a specifically designed magnetic coil that is placed in contact with the head to generate rapidly alternating magnetic-resonance-imaging-strength magnetic fields and produce electrical stimulation of superficial cortical neurons. Based on the results of a multisite randomized sham-controlled clinical trial of high-frequency TMS over the left dorsolateral prefrontal cortex (268), TMS was cleared by the FDA in 2008 for use in individuals with major depressive disorder who have not had a satisfactory response to at least one antidepressant trial in the current episode of illness. However, another large randomized sham-controlled trial of TMS added to antidepressant pharmacotherapy showed no significant benefit of left dorsolateral prefrontal cortex TMS (269). In comparisons of actual TMS versus sham TMS, most (270-272) but not all (273) recent meta-analyses have found relatively small to moderate benefits of TMS in terms of clinical response. Although the primary studies used in these meta-analyses are highly overlapping and the variability in TMS stimulus parameters and treatment paradigms complicates the interpretation of research findings, these meta-analyses also support the use of high-frequency TMS over the left dorsolateral prefrontal cortex. Lesser degrees of treatment resistance may be associated with a better acute response to TMS (274).

In comparison with ECT, TMS has been found in randomized studies to be either less effective than ECT (275) or comparable in efficacy to ECT (276-278), but in the latter studies TMS was more effective and ECT was less effective than is typically seen in clinical trials. A fewer number of studies have compared cognitive effects of TMS and ECT. One randomized trial found no significant difference between TMS and non-dominant unilateral ECT on performance on neuropsychological tests at 2 and at 4 weeks of treatment (276), although a small open-label trial reported a greater degree of memory difficulties with ECT than with TMS shortly after the treatment course (279).
Across all studies, TMS was well tolerated and was associated with low rates of treatment dropout (270, 280). Transient scalp discomfort and headaches were the most commonly reported side effects (280).

In clinical practice, the need for daily TMS could produce logistical barriers for some patients.

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