THERE’S another weapon in the war against major depression: transcranial magnetic stimulation, or TMS, which the FDA recently approved to treat patients who have failed to respond to antidepressant medications.
This is big news for psychiatry, because hard-to-treat patients have had limited treatment options.
Electroconvulsive therapy (ECT) was one option. Considered more effective than TMS, it’s also much more invasive. The treatment requires anesthesia and causes a brain seizure, as well as other potential side effects.
Another option was implanting electrodes inside the brain to stimulate underactive nerve pathways related to depression. But that requires neurosurgery – definitely not something to be taken lightly.
So what’s TMS, exactly? It involves applying a powerful magnetic coil to the scalp over the area of the brain that typically shows decreased activity in depressed patients. The magnetic field passes through the skull and induces an electrical current in underactive brain cells beneath it, stimulating them to be more active. Out of the patients who received TMS treatments for six weeks, more than half showed lasting improvement – even though prior attempts to treat them with antidepressants, psychotherapy or both had failed.
So far, the side effects from TMS are very limited. Some patients experience a temporary, dull headache; a little fatigue or confusion can follow treatment, but that goes away quickly. Rarely – one time in a thousand – patients have experienced a seizure.
That’s the upside. On the downside, TMS isn’t as convenient as medication or psychotherapy – or both combined. It requires daily sessions for weeks, isn’t yet widely available in psychiatrist’s offices and isn’t covered by insurance. That means patients may have to travel to an academic medical center to receive the treatment, which can cost thousands of dollars.
The positive data on TMS have been questioned by some scientists. They argue that the study that led to FDA approval might have included a “placebo effect,” despite attempts to avoid it. That’s because the TMS machine makes noises and can cause mild muscular contractions that may have been recognized by patients in the research trial. Patients weren’t supposed to know if they were getting the real treatment when they reported whether it was working for them.
Still, TMS is incredibly promising, particularly given its early stage of development. Refinements in equipment and technique are sure to come. That means major depression, already one of the most treatable psychiatric illnesses, is under siege from yet another front.
Keith Ablow, MD, is a psychiatrist, Fox News Channel contributor and founder of livingthetruth.com. Contact him at [email protected].