Transcranial Magnetic Stimulation for Treatment Resistant Depression

My patients describe, depression makes them feel alone, unable to enjoy the simplest things in life, and walk around feeling “empty” on daily basis. Many of them have tried multiple medications to help manage their depression, but after trying several medications, most of the patients had to stop using them due to side effects and try to go on with their lives waking up each morning feeling as if there is no reason to wake up. They do not look toward their day, as they stop enjoying the things they do.  This condition impacts everyone around them and their families helplessly bear witness to this daily struggle living each day in a very fragile state, filled with emptiness and apathy, deprived of motivation or joy, and at the encouragement of their families many patients seek help of a mental health provider. 

Transcranial Magnetic Stimulation (TMS) 

I have been practicing as a Psychiatrist for more than 10 years now. I have personally seen how depression affects my patients, and their loved ones, especially when their symptoms do not respond to medications or when they stop treatment due to intolerable side effects.  Fortunately, there are alternatives to the traditional interventions, one of which includes Transcranial Magnetic Stimulation (TMS) therapy.  I first learned about TMS during my Psychiatry Residency training and was hopeful that this treatment modality could finally offer hope to patients suffering from depression once approved by the FDA. The well-known options at the time to help patients with treatment resistant depression was ElectroConvulsive Therapy (ECT), but it is associated with significant side effects including cognitive impairment which makes patients very apprehensive about trying this procedure. My goal was to help patients become functional again by returning to work, enjoy all their blessings, by finding a treatment modality for these patients to have their lives back! I have been very fortunate to witness first-hand how most patients who undergo TMS are finally able to achieve remission or significant improvement in their mood, and how in turn their connection with the world around them comes back alive.  I know there are many questions out there from patients who hear about this option but need a better understanding of how TMS treatment works.

How does TMS work?

It is a noninvasive procedure that uses a highly targeted pulsed magnetic field by using a simple magnetic coil applied to the left frontolateral lobe (responsible for mood regulation) to stimulate cortical neurons.

The magnetic field is similar in type and strength to those produced by a magnetic resonance imaging (MRI) machine.  One could say, TMS impulses help wake up sleeping “mood regulating” neurons and make them work better leading to a more natural control of the mood, and diminish or extinguish symptoms of depression. As we activate the brain during sessions there is release of neurotransmitters, as well as increased blood flow and glucose metabolism in the activated regions, which result in improved mood.

How long does the treatment session last and how many treatment sessions do I need?

The treatment sessions usually last around 17-30 minutes for most patients; usually 36 treatment sessions are needed to achieve optimal results.

Am I awake during treatment?

Yes, this is a noninvasive treatment that does not require any sedation at all. You can drive yourself to the appointment and stay awake during the procedure. Many of our patients listen to music, talk to the technician in the room, or search the internet on their phones during treatment. After the treatment is completed, you can drive home immediately as you are fully alert.

Does the treatment itself lead to any discomfort?

Some patients do experience tenderness on their scalp at the site where the magnetic coil is placed, but over a few sessions this goes away, and patient is quite comfortable during the procedure.

How long does it take for the depression to improve?

Everyone is different, but typically patients start reporting improvement in mood approximately three to four weeks after treatment. We do have patients who respond positively to treatment before and after three weeks. Other patients are late responders and mood symptoms significantly improve towards the end of treatment sessions as the neuronal connections in the brain continue to improve. Per the clinical studies available, we tend to see a continued improvement in mood symptoms over a year as the neuronal connections in the brain continue to develop, and the mood area in the brain becomes more active. 

How are the depression remission rates with TMS different from the antidepressant ones?

Per all the clinical studies reviewed, most comprehensive being the STAR-D trial, remission rates after one antidepressant is about 30 % but is decreases with each subsequent trial of medication. The remission rates with TMS by the end of acute treatment (36 sessions) at our clinic are closer to 44 % and continue to improve over the following 12 months with close to 49% of patients achieving remission. More than 68% of the patients who did not reach remission report at least 50% improvement of their symptoms which helps them achieve significant improvement in their quality of life.

Is TMS used to manage other symptoms besides treatment resistant depression?  

Yes, we use TMS for management if anxiety symptoms including obsessive compulsive disorder (OCD), Post traumatic Stress Disorder, smoking cessation, chronic pain, among others. There are other conditions such as movement disorders like Parkinson’s that are currently being investigated with promising results!

Overall, TMS has provided hope to many patients who had lost hope of their mood symptoms ever improving on antidepressants alone. Our experience with this treatment modality has been quite rewarding as there is no better reward to me as a provider to see my patients smiling again, enjoying and looking forward to wake up each day to see what memorable moments it may bring. 

For More Information…

If you are interested in reading more blogs about depression and different treatment modalities, I encourage you to visit https://www.tmsservicesofvancouver.com/blog/