Defeating Depression

Leading-edge magnetic pulse therapy offers new relief.

Not everyone who flees the frigid north and travels to Florida during the winter months is looking to escape the snow and cold. Some are literally trying to stay a step ahead of a bout with what is known as winter depression.

Photo by Fred Bellet.

Dr. Barnett (standing) administers TMS
treatments in a specially designed chair.

Those short days of cloudy, gray skies and long, cold nights can bring on a case of the blues in even the most chipper of folks, which is one reason why depression is considered the most common mental illness throughout the world.
Globally, more than 350 million people suffered from some sort of depression last year, according to the World Health Organization. In the United States alone, it’s estimated that 16 million people experience at least one episode of major depression each year.
The effects, of course, can range from mild melancholy to debilitating, and for many of those who struggle with major depression, the standard treatments such as antidepressant medications and talk therapy simply don’t work.
For those who have sought relief from depression but not found it through standard practices, there is new hope, and it can be found in the offices of Debra Barnett, MD, at Associates for Behavioral Medicine in New Tampa.

The TMS Era

Dr. Barnett recently became one of an ever-growing number of mental health professionals who have begun offering treatment for major depression through the use of transcranial magnetic stimulation, or TMS.
Approved by the Food and Drug Administration in 2008, TMS therapy is for people suffering from depression who have not achieved satisfactory improvement from prior antidepressant therapy. That group accounts for nearly 50 percent of all patients receiving therapy, Dr. Barnett stresses.
“There are a lot of people out there who have tried medications and probably talk therapy as well and yet they’re still not getting an adequate response; they’re still considerably depressed,” Dr. Barnett explains.
“It could be that they can’t tolerate the medicine or something of that nature, but for whatever reason, they’re not responding to standard therapy, and as a result, they’re just pushing through life or limping through life.
“They’re never really happy, but in their minds they feel better than they used to, so they’re not looking for any additional treatment or for anything different because they’re afraid to go back to the way they were.
“And one thing we know for sure is that with depression, the longer you have it, the harder it is to treat it. For those people, the ones who have yet to find that optimal treatment, TMS therapy offers new hope, and for some, it could even be lifesaving.”

Simple, Safe Procedure

Developed after more than 20 years of research, TMS therapy has already proved to be effective. In more than one trial in which the patients underwent treatment five days a week for six weeks, half the patients said their depression symptoms improved significantly through its use, while a third said they were no longer experiencing any depression symptoms.
It is also precise; the treatments stimulate only the part of the brain believed to be involved in mood regulation.
Finally, it is considered safe and easy on the body. The most common side effect is some mild to moderate scalp discomfort stemming from the treatment applications, which are delivered through magnetic pulses.
These magnetic pulses are similar to those used in MRI stimulation, and are delivered through a paddle-shaped device with a magnetic coil that is placed on the prefrontal cortex while the patient rests in a comfortable chair similar to a dentist’s chair.
“I’ve had people pass by the room where we do the TMS therapy and ask me, Are you doing dentistry here now?” Dr. Barnett reveals. “The chair tends to throw them a bit. But that’s fine because it gives me a chance to tell them about the TMS therapy.”
Dr. Barnett does not currently recommend TMS as an initial treatment for depression, in part because most insurance companies will not cover the cost of the treatment until standard treatments have been tried.
“The number of standard treatments really depends on the insurance company,” she relates. “Everybody has written up their criteria, whether it’s four medication trials plus augmentation, which is where we add things to the anti-depressant.
“Some of them may even require an addition to the medication and/or a trial of standard psychotherapy, standard meaning an approved trial of cognitive or interpersonal behavior. Most people have tried more than a couple of medications before trying TMS.
“So in my initial consultation, I’ll look at whether we need to try some other medications. Then I’ll have a discussion with people about what the other options are, and at that point, we decide whether one of those options is TMS.”

Different from ECT

Dr. Barnett has found that the only trepidation some patients express about TMS therapy lies in their fear that it is similar to electroconvulsive therapy, or ECT. Dr. Barnett assures the two therapies are quite different.
“For starters, we do the TMS therapy right here in our office,” Dr. Barnett reports. “You’re not going to get ECT in a doctor’s office. And with TMS therapy, we’re applying magnetic fields. We’re not applying an electric stimulus to the brain as you do in ECT.
“Another difference is that with TMS therapy, you do not get anesthesia. The patient is awake through the entire process, which lasts between twenty and forty minutes per treatment. With ECT, you get anesthesia, and you are actually out for a while.
“Nor are we inducing a seizure. In fact, with TMS, we avoid inducing a seizure. That’s not the idea behind the treatment. The idea with ECT is that for it to be effective, you actually have to induce an electrical seizure in the brain.
“And finally, with TMS, at the end of each session, you get out of the chair, you walk out of the office and you drive home. After ECT, you are wheeled out on your bed and back to a recovery room because they still have to allow you to wake up from the anesthesia.”
Dr. Barnett stresses that ECT remains an important and valuable modality for a lot of patients. She believes, however, that TMS offers several advantages that have the ability to make it a very successful treatment. And not just for depression.
“It’s still not approved for these yet, but there have been some small studies and some anecdotal reports about other problems that are being treated through TMS such as anxiety, obsessive compulsive disorder, even chronic pain and addiction,” she says.
The use of TMS for anything other than help with depression may be years down the road. For now, though, this leading-edge treatment is filling a need as a valuable tool for those who have sought help for depression but failed to find it.
“There are a lot of people who have been brave enough to seek treatment from somebody for their depression, maybe even a primary care physician, but they’re still not where they want to be in life,” Dr. Barnett says. “With this, they can do better. They really can do better.”

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