Depression is the great disruptor. As one of the most common mental health disorders among Americans, the often debilitating symptoms of major depression can disrupt families, relationships, careers, and friendships. Saddled with unending fatigue, low mood, feelings of hopelessness and despair, those suffering from a major depressive disorder (MDD) place much hope in early efforts to get relief from antidepressants.
As the usual treatment protocol for MDD, antidepressant drug therapy turns out to be ineffective for a large percentage of patients with persistent depression. Drug trial after drug trial may yield no significant reduction in the life-sapping symptoms of MDD, only adding to the misery of the patient.
The Problem with Antidepressants
The most commonly prescribed antidepressant medications are the selective serotonin reuptake inhibitors (SSRI), dispensed under various labels, including Celexa, Paxil, Prozac, Zoloft, Lexapro, and Luvox. At present there are approximately two dozen drugs on the market for treating depression, including SSRIs, serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).
Antidepressant therapy, often combined with talk therapy (psychotherapy), remains the industry standard for depression treatment, even in light of recent studies that show only a slight improvement of symptoms versus a placebo.
A major study, called the STAR*D, revealed that only 30%-50% of participants reached remission using antidepressants, often after several different drugs were introduced over a 12-week study period, but that number only pertained to the participants who did not drop out of the study due to the side effects of the drugs.
Adverse effects from antidepressants can be so difficult to tolerate that patients battling depression may not only receive no significant improvement while on the medications, but compound the suffering with side effects such as weight gain, sleep disturbance, fatigue, excessive yawning, dry mouth, sexual dysfunction, constipation, nausea, and blurred vision.
The majority of these drugs also include warnings for suicidal tendencies that are associated with the medication, especially in patients under 25 years of age. Patients who have unsuccessfully trialed 1-4 antidepressants are then subsequently diagnosed with medication-resistant MDD.
Enter Transcranial Magnetic Stimulation (TMS)
When antidepressant therapy fails to relieve symptoms of MDD it is good to know there is an exciting alternative treatment that is demonstrating promising results: Transcranial magnetic stimulation (TMS).
TMS is a noninvasive brain modulating therapy that harnesses the power of concentrated magnetic fields to reset brain chemistry. The repetitive magnetic pulses are administered to the patient through an electro-magnetic coil that is placed over the scalp, situated over the left prefrontal cortex of the brain. This is the limbic system, or the mood center of the brain.
The mild electrical currents that result then target the brain cells in this region, waking them up from the dormant state that is common in depressed patients. Each TMS therapy session will last approximately 40 minutes, and in most cases TMS treatment plans involve five sessions per week for 4-6 consecutive weeks.
The cumulative effect of the treatments ultimately has the potential to completely reset the brain chemistry, resulting in several positive changes in the patient. These include improved concentration and focus, better sleep quality, more energy, and overall improved mood.
Is TMS Safe?
With any new alternative treatment there is bound to be concern regarding not only efficacy, but also safety. So, just how safe is TMS? In a large meta-data analysis of global clinical studies of TMS over a ten-year+ period the results show TMS therapy to be a safe treatment option for medication-resistant depression. TMS only targets the specific area of the brain involved in emotion regulation, reaching only about 2 centimeters into the brain.
TMS does not require any sedation during the sessions, virtually eliminating many of the risks involved in other types of brain stimulation treatments, such as electro-convulsive therapy (ECT). The TMS sessions are mellow, with the patient simply reclining in a comfortable chair and passing the time watching TV or listening to music.
The patient is completely alert throughout the TMS therapy session, and is able to drive him or herself home or back to work to continue with normal daily activities. There is no down time needed following a TMS therapy session.
Some minor and transient TMS side effects have been reported in patients. Some patients reported experiencing mild to moderate headaches following treatment sessions. As the treatments progressed in the days ahead, the headaches resolved without intervention. In addition, some patients reported irritation on the scalp where the coil had been placed. Again, as treatments continued the scalp irritation resolved spontaneously.
Who is a Candidate for TMS Treatment for Depression?
When considering TMS therapy as an alternative to antidepressants, the treating physician must have first determined that a patient is medication-resistant. This may mean the patient did not respond to several drug trials, or that the patient could not tolerate the side effects of the drugs.
After this designation, it is important to know which items will not qualify a patient for TMS therapy. Because electro-magnetic fields are involved in TMS therapy, patients who are not eligible include patients with these items within 30 cm of the TMS treatment coil:
- Cochlear implants
- Implanted electrodes/stimulators (pacemakers, for example)
- Aneurysm slips or coils
- Bullet fragments
In addition, patients who have wearable or removable devices or objects that can be impacted by the magnetic field should use TMS with caution. Also, patients with implants that are controlled, or not controlled, by physiological signals that are within 30 cm of the TMS treatment coil should also use the therapy with caution.
Marissa Katrin Maldonado has been working in the behavioral healthcare industry for over 13 years. She is the founder of The Treatment Specialist, a national online resource and helpline for those seeking treatment for addiction and mental health conditions.
Dedicated to guiding individuals to the help they seek, Marissa believes that with the right support and guidance, those struggling will have the opportunity to turn their lives around and enjoy a healthy and happy life. She is a proud mother and wife and enjoys long distance running, traveling, and music.