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Sunday, August 19, 2012

Treatment may help some with depression

Wayne McCourt receives a TMS treatment for depression. / JOSE F. MORENO/Courier-Post

Treatment may help some with depression

10:56 PM, Aug. 18, 2012

Written by
Christina Mitchell
Courier-Post Staff
One psychiatrist calls TMS therapy a “revolutionary” treatment for depression. Another is more cautious, calling it “welcome.”

Joanne Malia says transcranial magnetic stimulation is a “miracle.”

The 70-year-old Williamstown resident lost three of her four grown children — sons Jimmy, Jeffrey and Joel Malia — in a 2002 speedboat accident. By the time Malia found out about TMS last June, she had been crippled by depression for several years.

“I could not function,” recalls the owner of Malia Auto Body. “I was even told that I drug my feet at work. I wasn’t a help to anyone. I was more of a hindrance.”

About 12 weeks into treatment with Dr. Edward Baruch at TMS Centers of Southern New Jersey in Mount Laurel, “little things” began to change, Malia recalls.

“I would always leave dishes in the sink. And I noticed one day that I did the dishes right away. And I was happy because I like things to be neat. And I was able to talk about the boys … the funny things they did or said.

“Up to that point, I didn’t see anything funny,” she said.

Word is spreading about TMS, which uses MRI-like magnetic pulses of energy to stimulate nerve cells in the right side of the brain that affect mood. Each procedure lasts about 45 minutes and can be done in a doctor’s office. There are no drugs or surgery and side effects are minimal.

Too good to be true? If you’ve lived in the black hole of depression, the answer is no.

“No treatment or toolbox solves the problem of depression completely,” says Dr. John O’Reardon, a primary TMS researcher and chairman of Stratford’s University of Medicine & Dentistry of New Jersey-School of Osteopathic Medicine. But for patients with acute depression, TMS has impressive results, O’Reardon adds.

The Malvern, Pa.-based company Neuronetics was FDA-approved in 2008 to market the treatment under Neurostar TMS Therapy for adults who fail to benefit from antidepressant medication, currently the sole U.S. company licensed to do so.

Baruch invested $70,000 in a TMS machine last May. So far, he says, he has treated about 20 people at a cost of $350 per session. The recommended course of treatment is five times a week for four to six weeks.

“People are starting to wake up to the treatment,” says Baruch (pronounced bar-OOK). “It’s a truly revolutionary treatment for depression that’s not been available before, with extremely limited side effects.”

Baruch says some TMS patients may initially experience mild headaches and scalp irritation from the procedure. Other patients have likened its sensation to a woodpecker tapping on the skull.

While TMS still is largely unknown, it is showing up in medical journals and the media. It got the ultimate endorsement in March from the nation’s favorite TV doctor, cardiac surgeon Mehmet Oz. About 400 centers perform the procedure nationally.

“This is an awakening,” says Baruch, one of a handful of TMS practitioners in South Jersey. “It’s basically introducing an unknown treatment for a community for which this is novel.”

But that community does not encompass everyone with depression. TMS is FDA-approved only for patients who have not responded to medication, or about 30 percent of depression sufferers, explains O’Reardon.

For that group, invasive ECT (electroconvulsive therapy) is often a last resort because it can cause short- and long-term memory loss and requires an electrical current. TMS increases blood flow to a targeted area of the brain with magnetic pulses weaker than the standard MRI.

A study published in 2010 in the journal Brain Stimulation showed long-term relief from TMS, according to the AARP Bulletin. Only 13 percent of those who responded to treatment relapsed after six months, the study showed.

The American Psychiatric Association has included TMS in its practice guidelines. A study funded in 2010 by the National Institutes of Mental Health showed TMS was effective in some patients not responsive to traditional treatments.

“(TMS) is for patients who have not responded to several trials of antidepressant medications in a current episode and where it’s safe for TMS,” explains O’Reardon.

Because it utilizes MRI technology, the treatment is prohibited for anyone with metal implants or a history of epilepsy.

“It’s the first device we have that stimulates the brain, in a doctor’s office, to treat depression, and doesn’t involve medication,” O’Reardon adds.

“It gets a person out of the deep hole.”

But he cautions TMS doesn’t negate the benefits of traditional cognitive (talk) therapy or medications, and some patients may require follow-up sessions after the recommended 25- to 30-session treatment.

Yet for those who endure depression drug side effects — weight gain, sexual dysfunction, lethargy — without benefit, TMS is an enticing prospect. The only downside is cost. A round of TMS treatment can cost anywhere between $6,000 and $11,000, according to Neuronetics, and is currently not reimbursable by Medicare or private insurance in New Jersey.

That could change soon. Medicare now reimburses for TMS in every New England state except Connecticut, according to Neuronetics spokesman Mike Gaynes. Anthem Blue Cross/Blue Shield quietly announced this week it would cover the procedure in 14 states ranging from Connecticut to Georgia.

And at least one pharmaceutical company isn’t adverse to TMS as an ancillary to profitable depression medications.

“Things are changing for sure,” says Suzanne McMonigle of Neuronetics, which recently got $30 million in financing raised in part by Pfizer Pharmaceuticals to expand abroad. Pfizer produces Zoloft, among other antidepressants.

“It’s estimated there are about four million people nationwide who do not respond to medication,” she adds. “That would make pharmaceutical companies start to look outside for other treatment modalities.

“Somebody needs to treat those folks.”

“The great treatments in medicine are the ones that encompass as many aspects of healing as possible,” observes Baruch. “This is truly the best, most revolutionary treatment for psychiatric disorder I have ever seen in my life.

“And I’ve been in mental health for over 35 years.”

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