Nan Miller
Nan Miller, 61, of El Paso, Ill., undergoes a transcranial magnetic stimulator maintenance treatment at Loyola University Chicago Stritch School of Medicine in Maywood. TMS sends short pulses of magnetic fields to the brain for the treatment of major depression. (Chuck Berman, Chicago Tribune / February 16, 2012)
 
By Janice Neumann, Special to the Tribune
April 11, 2012
When the darkness lifted in Nan Miller's mind, she realized the new therapy for her depression was finally working.

Transcranial magnetic therapy, which was approved by the FDA for use with the NeuroStar TMS therapy system in 2008, has been a lifeline to scores of other patients, who could not shake their depression despite multiple rounds of antidepressants, anti-anxiety medications or even electroconvulsive therapy.

In the therapy, a device delivers small electric pulses to nerve cells in the emotional regulation centers of the brain through a wire coil wrapped around the patient's head. The patient sits relaxing in a comfortable chair for the roughly 37-minute treatment, which is repeated for 20-30 sessions over four to six weeks. Side effects include tingling of the scalp and headache.

Miller, 61, had tried about 10 antidepressants over the years and although some helped, she continued to feel terrible. She also tried ECT but did not want to repeat that treatment because it requires sedation, induces seizures and can cause some memory loss. But with thoughts of suicide, she knew she needed help.

After only a few weeks of therapy, she felt better. Her husband has noticed the difference too.
"He was seeing things I didn't notice, that I was laughing, telling jokes — which before I had done in my head, but you just don't have the energy for them to come out of your mouth (when depressed)," said Miller, a retired teacher who lives in El Paso, Ill.

Dr. Murali Rao, who chairs the department of psychiatry and behavioral neurosciences at Loyola University Stritch School of Medicine, has been impressed with the results, noting some depression can be hard to treat. He has treated about 25 patients, including Miller, and found two-thirds improved, with a third of those "totally recovered."

"The problem is because it's a new modality, it's still not available to most people who can use it," said Rao. "Once it becomes available, if we introduce it early in treatment, we'll probably see more response," said Rao, who is recruiting patients for a study on TMS use in individuals suffering from clinical depression and chronic tinnitus, or ringing in the ears.

Not all insurers will cover TMS and a full regimen can cost about $12,000. Only a handful of Chicago institutions and doctors offer TMS, including Northwestern Medical Faculty Foundation and Rush University Medical Center.

Dr. Carl Wahlstrom Jr., a Chicago psychiatrist who began offering TMS in 2009, has seen about 80 percent of the 45 patients he has treated improve. Wahlstrom noted TMS works on the electrical signaling of the brain and medication on chemical signals, so the two "seem to have a combined effect that's more powerful than either treatment alone."

"I've been really pleased with some people who were really ill and tried so many things, including ECT, and came here and got a positive treatment response," said Wahlstrom, who is also an assistant professor of psychiatry at Rush University Medical Center.

Wahlstrom also noted patients tend to tolerate TMS better than other treatments so will continue with a full regimen.

Doreen, one of Wahlstrom's patients, had been hospitalized for depression and anxiety and was considering ECT. But before relocating to Chicago from California, her former psychiatrist suggested TMS instead. She has completed a round of treatment.

"I'm feeling pretty good so far," said Doreen, who asked that her last name not be used. "I was in a pretty bad place."

The handful of patients receiving TMS through Alexian Brothers Behavioral Health Hospital have mostly improved, according to Dr. Greg Teas, psychiatrist and medical director of the hospital. Teas said the treatment could be good for the 10 percent of patients who have trouble tolerating medication or women who are pregnant and prefer to forgo drugs that could potentially harm an unborn child. Teas said more data was needed to determine how much maintenance treatment might be needed to sustain an improved mood.

"It's going to be primarily looked at by consumers as safe and well tolerated treatment, as well as something that offers them hope of improving their condition," said Teas.

While Dr. Lawrence Robbins, a Northbrook-based neurologist, has seen about 30 percent of his 35 patients improve through TMS, he said individuals who had suffered depression for years could be harder to treat. Robbins hopes to eventually use the treatment for migraine patients.

"The brain with depression kindles itself like kindling logs on a fire, so the more you have, the more likely in a year or two years you will be depressed," said Robbins.

"The bottom line is we need better treatments for depression," said Robbins.