Treatment Resistant Depression

March 8, 2021

Treatment Resistant Depression

 
 
 

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/

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TMS Services of Vancouver
Elia Gonzalez-Rodriguez, M.D.
1498 S.E. Tech Center Place Suite 110
Vancouver, Washington 98683
(360) 831-2276 Fax (360) 326-2606
#Depression #TMS #Transcranial #Addiction #Psychiatrist #Counseling #Therapy #Magnetic #Vancouver #Dr.EliaGonzalez
 
Dr. Gonzalez earned her medical degree via Fifth Pathway Certification from New York Medical College, in Valhalla, NY.

After training at New York Medical College, she completed a Family Medicine Internship at University of Connecticut and afterwards went on to complete Psychiatry Residency at the University of Washington Medical Center in Seattle, WA where she served as Chief Resident at the VA Medical Center in Seattle, WA during her last year in training. She is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology.

Did you miss our previous post?

What is Major Depression?

September 28, 2020

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TEXT ME – 360-226-8735
TMS Services of Vancouver
Elia Gonzalez-Rodriguez, M.D.
1498 S.E. Tech Center Place Suite 110
Vancouver, Washington 98683
(360) 831-2276 Fax (360) 326-2606
#Depression #TMS #Transcranial #Addiction #Psychiatrist #Counseling #Therapy #Magnetic #Vancouver #Dr.EliaGonzalez
 
Dr. Gonzalez earned her medical degree via Fifth Pathway Certification from New York Medical College, in Valhalla, NY.

After training at New York Medical College, she completed a Family Medicine Internship at University of Connecticut and afterwards went on to complete Psychiatry Residency at the University of Washington Medical Center in Seattle, WA where she served as Chief Resident at the VA Medical Center in Seattle, WA during her last year in training. She is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology.

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Is depression a serious disease?

September 28, 2020

Tags:

TEXT ME – 360-226-8735
TMS Services of Vancouver
Elia Gonzalez-Rodriguez, M.D.
1498 S.E. Tech Center Place Suite 110
Vancouver, Washington 98683
(360) 831-2276 Fax (360) 326-2606
#Depression #TMS #Transcranial #Addiction #Psychiatrist #Counseling #Therapy #Magnetic #Vancouver #Dr.EliaGonzalez
 
Dr. Gonzalez earned her medical degree via Fifth Pathway Certification from New York Medical College, in Valhalla, NY.

After training at New York Medical College, she completed a Family Medicine Internship at University of Connecticut and afterwards went on to complete Psychiatry Residency at the University of Washington Medical Center in Seattle, WA where she served as Chief Resident at the VA Medical Center in Seattle, WA during her last year in training. She is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology.

Did you miss our previous post?

What Causes Depression

September 28, 2020

The exact cause of depression is not known, but leading research in Neuroscience points to an imbalance in the brain’s neurotransmitters as the manifestation of depression. Neurotransmitters are chemical messengers that send signals between brain cells. A person’s genetic make-up and life history may also determine a person’s tendency to become depressed.

Tags:

TEXT ME – 360-226-8735
TMS Services of Vancouver
Elia Gonzalez-Rodriguez, M.D.
1498 S.E. Tech Center Place Suite 110
Vancouver, Washington 98683
(360) 831-2276 Fax (360) 326-2606
#Depression #TMS #Transcranial #Addiction #Psychiatrist #Counseling #Therapy #Magnetic #Vancouver #Dr.EliaGonzalez
 
Dr. Gonzalez earned her medical degree via Fifth Pathway Certification from New York Medical College, in Valhalla, NY.

After training at New York Medical College, she completed a Family Medicine Internship at University of Connecticut and afterwards went on to complete Psychiatry Residency at the University of Washington Medical Center in Seattle, WA where she served as Chief Resident at the VA Medical Center in Seattle, WA during her last year in training. She is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology.

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By: TBD

Sourced By: www.healio.com/news/psychiatry/20200923/dasotraline-treatment-safe-efficacious-for-bingeeating-disorder

Published Date: Wed, 23 Sep 2020 19:59:04 Z

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TEXT ME – 360-226-8735
TMS Services of Vancouver
Elia Gonzalez-Rodriguez, M.D.
1498 S.E. Tech Center Place Suite 110
Vancouver, Washington 98683
(360) 831-2276 Fax (360) 326-2606
#Depression #TMS #Transcranial #Addiction #Psychiatrist #Counseling #Therapy #Magnetic #Vancouver #Dr.EliaGonzalez
 
Dr. Gonzalez earned her medical degree via Fifth Pathway Certification from New York Medical College, in Valhalla, NY.

After training at New York Medical College, she completed a Family Medicine Internship at University of Connecticut and afterwards went on to complete Psychiatry Residency at the University of Washington Medical Center in Seattle, WA where she served as Chief Resident at the VA Medical Center in Seattle, WA during her last year in training. She is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology.

Did you miss our previous post?

About NeuroStar® TMS Therapy

September 21, 2020

NeuroStar uses transcranial magnetic stimulation (TMS) to target key areas of the brain that are underactive in people with depression.5 It is not ECT (electroconvulsive therapy).

While the exact cause of depression is not known, the leading scientific theory is that it is caused by an imbalance of the brain’s neurotransmitters, which are chemical messengers that send signals between brain cells.

What is NeuroStar Advanced Therapy (TMS)?

During a NeuroStar treatment session, a magnet similar in strength to that used in a magnetic resonance imaging (MRI) machine is used to stimulate nerve cells in the area of the brain thought to control mood. These magnetic pulses may have a positive effect on the brain’s neurotransmitter levels, making long-term remission possible.

Treatment with NeuroStar Advanced Therapy is easy:

  • Therapy sessions are conducted in your doctor’s office
  • You can return to normal activities right away
  • You are awake during treatment
  • There are no negative effects on memory or sleep
  • It’s covered by most health insurance plans, including Medicare and Tricare

With more than one million treatments performed, this novel treatment approach to achieving remission is bringing new hope to people every day.5

NeuroStar Advanced Therapy (TMS) may not be right for everyone.

What happens during a typical NeuroStar TMS treatment session?

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NeuroStar® TMS Therapy safety and tolerability

September 21, 2020

NeuroStar Advanced Therapy (TMS) is safe and easy to tolerate. Because it is not a depression drug, NeuroStar TMS Therapy does not have the same side effects that are associated with traditional antidepressant medications. More than 3 million treatments have been performed with NeuroStar, further proving its safety and tolerability record.

NeuroStar TMS Therapy is free of systemic side effects associated with specific MDD treatments

NeuroStar TMS Therapy Side Effects
In clinical trials, fewer than 5% of people discontinued treatment due to adverse events. The most common side effect was temporary pain or discomfort at or near the treatment site during therapy that usually resolves within the first week of treatment.

Other side effects (occurring in ≥5% of people and twice the rate of placebo) include eye pain, toothache, muscle twitch, facial pain, and pain of the skin.

There is a rare risk of seizure associated with TMS therapy that occurs in .01% of people. There is no adverse effect on cognition.

People should notify their doctor if they experience worsening depression symptoms, signs, or symptoms of suicidal behavior and/or unusual behavior. Family members and support individuals should also be aware of the need to observe their loved ones and notify their treatment provider if symptoms worsen.

NeuroStar Advanced Therapy (TMS) should not be used with people who have non-removable conductive metal or stimulator implants in or near the head or people who have active or inactive implants such as deep brain stimulators, cochlear implants, and vagus nerve stimulators.

Is NeuroStar right for you?

Did you miss our previous post?

NeuroStar® delivers the right dose to the right location, every time

September 21, 2020

Only NeuroStar Advanced Therapy provides patented precision technology to provide you with the right dose to the right location, every time. If treatment is off by just 1mm, up to 40% of the required dosage can be lost.

NeuroStar delivers more than other TMS systems, so be sure to ask for it by name

Feature/ BenefitNeuroStarBasic TMS

Contact Sensing

Ensures you receive the full, prescribed dose every time

High-Performance Coil

Designed for better, more comfortable fit on your head

3-D Laser Positioning

Helps ensure repeatable and accurate treatment

Proven Efficacy in Multiple Clinical Trials

Backed by 11 studies with over 900 patients and 23 publications

Proven Durability Over 1 Year7

Gives you the best chance for long-term remission

TrakStar™ Cloud

Stores your position and dosage information for fast, accurate treatment, every time

Comfortable & Easy In-Office Experience

Recline in spa-like chair with no helmet or mouth guard required

Find out the truth about TMS

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About Depression

September 21, 2020

Major depression is a serious medical illness that affects approximately 16.1 million Americans.8 Depression can cause ongoing sadness that changes how a person thinks, feels, and acts every day. While medication can help manage symptoms for many people, it is estimated that approximately 4 million patients do not benefit from taking standard antidepressant medication.8

Depression Facts:

  • Women are more likely than men to suffer from depression
  • Depression is a leading cause of disability worldwide
  • Depression has no racial, ethnic, or socioeconomic boundaries
  • Researchers estimate that by the year 2030, depression will be the leading cause of disease burden—impact on length and health of lives—worldwide

What causes depression?

While the exact cause of depression is not known, the leading scientific theory is that it is caused by an imbalance of the brain’s neurotransmitters, which are chemical messengers that send signals between brain cells.

While antidepressant drugs work for many people, some still do not receive adequate treatment.8 For these patients, the effects of depression can still be debilitating. These patients need a proven, safe depression treatment option.

Did you miss our previous post?

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