Magnets attract attention in fight against depression
By Paul Sisson7:45 p.m.Jan. 4, 2014
Dr. Philip Botkiss demonstrates transcranial magnetic stimulation on Tamara Petersson of La Jolla using a therapy system made by Neuronetics, Inc.
Tamara Petersson just celebrated her second Christmas without depression, a fact that sometimes seems impossible.
“To have a year of being depression-free, it’s a miracle,” she said.
Petersson is one of a growing number of patients turning to a new therapy that can reduce, or even eliminate, severe depression that has resisted traditional medication.
Called Transcranial Magnetic Stimulation, it targets a part of the brain behind the left side of a patient’s forehead called the prefrontal cortex. Studies have shown that depressed patients have less electric activity in this brain region than the average person.
“Those neurons are in hibernation. They’re just not functioning well, and what you’re doing is waking them up,” said Dr. Philip Botkiss, Petersson’s doctor.
Medical literature shows that magnetic stimulation is effective in patients who have seen no results after taking antidepressant medication. The U.S. Food and Drug Administration approved the treatment in 2008 after several double-blind studies showed that 70 to 75 percent of patients showed some improvement after undergoing stimulation, and other studies showed that 30 to 40 percent went into remission, meaning their depression was no longer detectable.
The procedure exposes the prefrontal cortex to a pulsing magnetic field delivered by a transmitter pressed to the left side of the forehead. The pulses induce an electrical current to move across the neurons, causing them to fire as they would in a patient who isn’t depressed.
Treatments last 37 minutes with four-second bursts of 40 pulses followed by 26 seconds of rest. The magnetic field is strong enough to make a staccato clicking sound and usually causes a patient’s face to twitch rapidly.
Petersson said the sensation of receiving the pulses is like a vibration. The sound is more pronounced.
“Some people are saying it feels like a woodpecker,” Petersson said.
Four to six weeks of therapy, administered five days a week, is necessary in order for patients to see results.
Petersson said she had struggled since 1986 with suicidal thoughts, lethargy and a perpetually gloomy mood.
For 7½ years, she said, she tried a different form of brain stimulation called electroconvulsive therapy, which passes an electric current through the brain and produces a seizure. But that technique never truly cleared away the depression. And electroconvulsion is a serious medical procedure requiring sedation and muscle relaxants.
“When you’re finished, you have to go into recovery until the anesthesia wears off. You have to have someone drive you home. It’s very invasive,” she said.
Dr. David Feifel, director of the neuropsychiatry and behavioral medicine program at UC San Diego, said these factors make the noninvasive nature of magnetic stimulation appealing for patients even though electroconvulsive therapy is still the standard of care.
“We have patients who come for treatment during their lunch break and go back to work. You couldn’t do that with ECT,” Feifel said.
Doctors also use another technique called deep brain stimulation to treat depression. That technique involves inserting electrical probes into the brain to deliver shocks to targeted areas. While inserting probes allows doctors to stimulate parts of the brain that cannot be reached with the current crop of magnetic stimulators, Feifel said that is changing.
“New machines that are just coming onto the market are able to go much deeper,” he said, adding that magnetism could soon be used to treat seizures and other brain conditions.
“I believe this is where brain medicine is going to be moving. I think the era of medication has probably reached its high-water mark, and this technology is probably going to become the standard,” Feifel said.
Today the treatment costs between $10,000 and $12,000. Several major health insurance companies, including Blue Cross, Blue Shield and Health Net, have started covering the procedure.
Petersson, 56, said her policy with Health Net covered her treatment in 2012. Before her depression diagnosis, she said she was a San Diego firefighter for 17 years. She said she hopes to go back to school and become a registered nurse.
http://www.utsandiego.com/news/2014/Jan/04/transcranial-magnetic-stimulation/2/?#article-copy
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