Depression is complex and, though it’s usually treatable, it may not always be cured with a pill. When standard treatments such as psychotherapy and medication haven’t worked for major depression, or medication isn’t recommended, doctors have begun turning to repetitive transcranial magnetic stimulation.
Depression is complex — stemming, experts believe, from combinations of biological, psychological and social factors. And, though it’s usually treatable, it may not always be cured with a pill.
When standard treatments such as psychotherapy and medication haven’t worked for major depression, or medication isn’t recommended, doctors have begun turning to repetitive transcranial magnetic stimulation, a non-invasive treatment that stimulates the brain with a pulsed electromagnetic energy.
The treatment isn’t widely available in the United States, but Rosecrance Health Network in Rockford is ready to open Aspen Counseling and Consulting.
“Transcranial magnetic stimulation is on the cutting edge of biological treatment for psychiatric conditions,” said Dr. Raymond Garcia who, along with Dr. Thomas Wright, will be supervising the treatments, which they said produce antidepressant effects with few side effects.
The stimulation, which is done by prescription only, is administered through a device placed against the left side of the patient’s head. The device delivers short electromagnetic pulses over the left front part of the brain known as the prefrontal cortex.
Research has shown that the pulses of magnetic energy generate electric currents in the brain and that the stimulation can energize the prefrontal cortex and result in an improvement in depressive symptoms.
TMS is not recommended as a first treatment option, but Garcia said he thinks up to 10 percent of the current population of depression patients could be helped by it.
“There are patients who, maybe, cannot tolerate medications or they can’t tolerate the side effects,” Garcia said. “There are patients for whom medications may work for a little while, but then they wear off for whatever reason. This would be an alternative for people considering electroshock (electroconvulsive or ECT) therapy, but it’s less invasive.
“There is no pill, which is invasive, and there is no administration of an electric shock, which is what ECT is. In an ECT, you have to be put under general anesthesia. You have to take paralytic drugs, so it’s a very invasive kind of procedure.”
Other reasons patients might not be able to take medications for depression, he said, would be job requirements, pregnancy or recovery from addictions.
Both doctors and their support staff have trained with the equipment for the past six weeks, including experiencing the treatment for themselves.
“I thought it was very important to be able to really tell the patient this is how it feels, rather than guess,” Garcia said. “If they ask, ‘Do you know how it feels?’ I can say ‘Yes.’ ”
Garcia said patients would receive a full medical and psychiatric evaluation, including questioning about any medications they are taking, before receiving the treatment.
“We would want to get a clear picture of who this person is and make sure they are appropriate for this treatment,” he said.
Aspen Counseling and Consulting manager Steve Smith said patients will feel a tapping on their head and there is a rapid clicking of 20 pulses in four seconds and then 30 seconds of quiet before another round of pulses begins. The patient’s “motor threshold” will be determined by finding the minimum amount of energy needed to make a finger or hand twitch. The device is adjusted until the right setting is found.
“The treatment process does take some time,” Smith said. “We’re asking for an every day for 20 to 25 days commitment, but it’s only for 40 minutes each day. There’s no recovery time like with ECT, so they’re in and they’re out.”
The treatment is not yet routinely covered by insurance or Medicare, but some private insurers are starting to cover it on a case-by-case basis. Garcia said studies have shown that the cost effectiveness of TMS is equivalent to or better than electroshock therapy.
Susan Rice, Rosecrance Health Network’s director of communications, said Rosecrance decided to offer TMS because it was looking for a “different program that would work in conjunction with what our specialties already are.
“Since we see so many co-occurring disorders through Rosecrance treatment centers and we have experienced staff, along with Drs. Garcia and Wright, moving into this area was a natural fit for us.”
Staff writer Mike DeDoncker can be reached at 815-987-1382 or firstname.lastname@example.org.
TMS side effects
Common side effects and adverse health problems associated with transcranial magnetic stimulation include, but may not be limited to:
- Scalp discomfort at the site of stimulation
- Tingling, spasms or twitching of facial muscles
- Discomfort from noise during treatment
Uncommon side effects
In rare cases, transcranial magnetic stimulation may also cause more-serious side effects, including:
- Hearing problems
- Long-term effects unknown
Because transcranial magnetic stimulation involves changes in brain function, unknown long-term adverse health effects are possible. Some studies have shown structural changes in the brain after transcranial magnetic stimulation. The significance of these changes isn’t yet known. Also, the long-term effects of exposure to the strong electromagnetic fields involved remain unknown.