Transcranial magnetic stimulation (TMS): Hope for stubborn ...

Transcranial magnetic stimulation, or TMS, is a noninvasive form of brain stimulation. TMS devices operate completely outside of the body and ... RecentBlogArticles Numbfromthenews?Understandingwhyandwhattodomayhelp Weightstigma:Asharmfulasobesityitself? Consideringpregnancyandhavelupus?Planahead Somemenwhoseprostatecancerprogressescansafelydelaytreatment Heart-healthyhabitsforchildrenandteenslengthenlives Monkeypox:Anunfamiliarvirusspreadingfast—soundfamiliar? Diabetes:Doesalong-termstudyreinforceorchangeapproachestoprevention? Waranxiety:Howtocope Canwepreventdepressioninolderadultsbytreatinginsomnia? Wanttotryveganism?Here'showtogetstarted / HarvardHealthBlog Transcranialmagneticstimulation(TMS):Hopeforstubborndepression October27,2020 By AdamP.Stern,MD, Contributor DepressionistheleadingcauseofdisabilityintheUnitedStatesamongpeopleages15to44.Whiletherearemanyeffectivetreatmentsfordepression,first-lineapproachessuchasantidepressantsandpsychotherapydonotworkforeveryone.Infact,approximatelytwo-thirdsofpeoplewithdepressiondon’tgetadequaterelieffromthefirstantidepressanttheytry.Aftertwomonthsoftreatment,atleastsomesymptomswillremainfortheseindividuals,andeachsubsequentmedicationtriedisactuallylesslikelytohelpthantheoneprior. Whatcanpeoplewithdepressiondowhentheydonotrespondtofirst-linetreatments?Forseveraldecades,electroconvulsivetherapy(ECTor"shocktherapy")wasthegoldstandardfortreatment-resistantdepression.Infact,ECTisstillconsideredtobethemostpotentandeffectivetreatmentforthiscondition,anditcontinuestobeusedregularlyacrossthecountry.Formanypeoplewithdepression,however,ECTcanbetoodifficulttotolerateduetosideeffectsonmemoryandcognition.Forthoseindividualsandthemanyotherswhohavehadaninadequateresponsetomedicationsandtherapyalone,thereisanewertreatmentoptioncalledtranscranialmagneticstimulation(TMS). Whatistranscranialmagneticstimulation? Transcranialmagneticstimulation,orTMS,isanoninvasiveformofbrainstimulation.TMSdevicesoperatecompletelyoutsideofthebodyandaffectcentralnervoussystemactivitybyapplyingpowerfulmagneticfieldstospecificareasofthebrainthatweknowareinvolvedindepression.TMSdoesn’trequireanesthesiaanditisgenerallyexceptionallywelltoleratedascomparedtothesideeffectsoftenseenwithmedicationsandECT.Themostcommonsideeffectisheadacheduringoraftertreatment.Ararebutserioussideeffectisseizures,andTMSmaynotbeappropriateforpeopleathighrisksuchasthosewithepilepsy,ahistoryofheadinjury,orotherseriousneurologicissues. DoesTMSwork? Approximately50%to60%ofpeoplewithdepressionwhohavetriedandfailedtoreceivebenefitfrommedicationsexperienceaclinicallymeaningfulresponsewithTMS.Aboutone-thirdoftheseindividualsexperienceafullremission,meaningthattheirsymptomsgoawaycompletely.Itisimportanttoacknowledgethattheseresults,whileencouraging,arenotpermanent.Likemostothertreatmentsformooddisorders,thereisahighrecurrencerate.However,mostTMSpatientsfeelbetterformanymonthsaftertreatmentstops,withtheaveragelengthofresponsebeingalittlemorethanayear.Somewillopttocomebackforsubsequentroundsoftreatment.ForindividualswhodonotrespondtoTMS,ECTmaystillbeeffectiveandisoftenworthconsidering. WhatisTMStherapylike? TMStherapyisanintensivetreatmentoptionrequiringsessionsthatoccurfivedaysaweekforseveralweeks.Eachsessionmaylastanywherefrom20to50minutes,dependingonthedeviceandclinicalprotocolbeingused.Whenpatientsarrive,theymaybrieflycheckinwithatechnicianordoctorandthenbeginthestimulationprocess.Thetechnicianwilldeterminetheidealstimulationintensityandanatomicaltargetbytakingadvantageofa"landmark"inthebraincalledthemotorcortex.Byfirsttargetingthispartofthebrain,theteamcandeterminewherebesttolocatethestimulationcoilasitrelatestothatindividual’sbrainandhowintenselyitmust"fire"inordertoachieveadequatestimulation.Calculationsarethenappliedtotranslatethisdatatowardfindingthedorsolateralprefrontalcortex,thebraintargetwiththegreatestevidenceofclinicaleffectivenessandanareaknowntobeinvolvedindepression.Thoughonesessionmaybeenoughtochangethebrain’slevelofexcitability,reliefisn’tusuallynoticeableuntilthethird,fourth,fifth,orevensixthweekoftreatment. CanTMShelpwithotherconditions? TMSisbeingstudiedextensivelyacrossdisordersandevendisciplineswiththehopethatitwillevolveintonewtreatmentsforneurologicaldisorders,painmanagement,andphysicalrehabilitationinadditiontopsychiatry.TherearecurrentlylargeclinicaltrialslookingattheeffectivenessofTMSinconditionssuchaspediatricdepression,bipolardisorder,obsessive-compulsivedisorder,smokingcessation,andpost-traumaticstressdisorder.Whilepromisingavenuesforresearch,TMSfortheseconditionsisnotyetapprovedandwouldbeconsidered"off-label." AbouttheAuthor AdamP.Stern,MD, Contributor AdamP.Stern,MD,isthedirectorofpsychiatryatBethIsraelDeaconessMedicalCenter’sBerenson-AllenCenterforNoninvasiveBrainStimulation,andanassistantprofessorofpsychiatryatHarvardMedicalSchool.Hehaspublishedinjournals … SeeFullBio ViewallpostsbyAdamP.Stern,MD ShareThisPage SharethispagetoFacebook SharethispagetoTwitter SharethispageviaEmail PrintThisPage ClicktoPrint Disclaimer: Asaservicetoourreaders,HarvardHealthPublishingprovidesaccesstoourlibraryofarchivedcontent.Pleasenotethedateoflastrevieworupdateonallarticles. Nocontentonthissite,regardlessofdate,shouldeverbeusedasasubstitutefordirectmedicaladvicefromyourdoctororotherqualifiedclinician. Comments MaryBonnette March5,2018 Manypatientstodaydonottolerateadversesideeffectsofmedications,orsimplypreferamorenaturalwaytomanagedepression.TMSisaviableoption.Otheroptionsthatworkinasimilarwayincludeelectricalstimulation(ES)or(NET)NeuroElectricalTherapyappliedtotheauricle(earreflexpoints-akaauriculotherapy).Thesearebothscience-basedtherapies.Theyworkatthecellularleveltorestorefunctionbystimulatingendogenousdopamineandendorphinactivityinpartsofthebrainthataredeficientandthatregulatemood.Asmentionedabove,therearesituationswherethesetherapiesarecontraindicated,i.e.pregnancy,insulinpumps,painpumps,severedebilitatingmentalillness,pacemakers, (somecardiologisthavetechnicianmonitorduringduringtherapyandfindnodifficulty).Itmaytakeregular(weeklyormonthlysessions)therapyfor6monthstoayeartogetresolution.Itworksquitewellfornicotinedependencyinthosereadyforachange.(Initially,shouldhave3daysinsecessionfornicotinedetoxification).BehavioralcoachingisessentialtoaccompanyES,NETorTMS. Becky March5,2018 HowcanIfindoutaboutparticipationinaclinicaltrialforthistreatmentonbipolardisorder? Pamela March4,2018 LastyearIcontactedmyinsurancecompanyretheirpolicyoncoverageofTMStreatment.Theywerenotawareofthetreatmentandreferredmetoacomplicatedrequestproceduretoapplyforcoverage.IsTMSmainstreamenoughatthistimeforpatientstoinsistoncoverage?Doyouhavedocumentationattheprofessionalpracticelevelthatmaybesubmittedtotheinsurancecompanytoproveitsauthenticityandtohelpmakemycaseforcoverage?Thisisverychallengingforsomeonewhoisdealingwithdepression.Itfeelsveryoverwhelmingtotakeonaninsurancecompany,butIhavebeendealingwithdepressionforthirtyyearswithoutanycombinationofmedicationsbeingeffectiveforlongperiodsoftime.Itislikebeingonaroller-coaster,andI’mtiredoftherideandtheside-effects.Iwouldgreatlyappreciateanyassistanceyoucansuggest.Thankyou. Commentinghasbeenclosedforthispost. 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