Transcranial Magnetic Stimulation for Depresion
Transcranial Magnetic Stimulation For Treatment Resistant Depression
Transcranial Magnetic Stimulation (TMS) is a treatment that was cleared by the FDA in 2009 for treatment resistant depression. TMS involves the use of magnetic energy to create very short pulses that stimulate nerve cells within the brain. Once the nerve cells are activated they transmit information to other nerves within the brain.
How TMS Works
TMS is targeting the pre frontal cortex and looking to activate areas within the limbic system which is believed to control mood. The treatment is non-invasive meaning that the treatment coil is place outside the brain. The coil is placed on the patients scalp and energy is sent through the skull and into the cortex 2-3cm without being distorted. This treatment is aimed directly at the source meaning maximum results are possible.
There are a few side effects. Most people report scalp discomfort or headaches during the first week of treatment. To deal with this an individual could take something like Tylenol prior to treatment. Scalp discomfort is reduced by using a lidocaine cream 15-20 minutes before treatment has begun. Another possible side effect is a seizure. This is very rare and has happen in less the 1% of all treatments. In most cases a clinician should be able to notice the signs of a seizure prior to it occurring.
The treatment requires a commitment from potential patients. Generally a patient receives treatment 5 days a week for 6 weeks. After the initial 30 treatments a taper over three weeks occurs, it goes 3.2.1. After the end of an initial course a 1/3 of people will never need treatment again, another 1/3 will need a booster treatment or two and the final 1/3 will need another complete series.
TMS has very good clinical results so far. Nationally 60-65 percent of all people treated hit responder status which is a 50% reduction in depressive symptom burden. 30% of all individuals treated obtain remission. Remission is when a person is free of depressive symptoms. Some clinics and hospitals receive higher rates of return. Butler Hospital in Rhode Island 70-75% responder rate and a 40% remission rate. Recently on the Dr. Oz show the West Coast Institute for TMS reported a 80% response rate. What should be noted is that these rates are much better then most medications.
Who is TMS for?
TMS is not for everyone. Before undergoing a trial of TMS an individual should have at least tried a couple of medications ideally in two or more classes. TMS is recommended for individuals with major depressive disorder. Please talk to your doctor and a TMS clinic prior to starting treatment.
TMS is just started to be covered by insurance nationwide. While it is still only covered by a minority of providers steps are being taken to change this. Medicare has started to cover TMS if the patient hits certain criteria. Many college insurance for students Cover TMS. Some major private insurers like Blue Cross and Blue Shield cover the treatment in certain states. Many cases go through and appeals process in which insurance denial of coverage can be overturned.
Some good websites for information regarding TMS are attached below