Depression is a complex and mysterious mental health disorder that affects over 16 million U.S. adults each year. While in some cases the advent of a depressive episode may be linked to distressing life events, such as the death of a loved one, divorce, loss of a job, or a serious medical diagnosis, it is just as likely that depression will envelop one with no rhyme or reason. One day you just don’t feel like yourself, but can’t seem to point to any concrete reason for feeling so lethargic and sad. To date, science has yet to pinpoint the cause of depression, although certain factors have been identified that can be involved in developing the disorder.
One of the most daunting challenges a doctor will face is treating a patient with major depression. Even with dozens of antidepressants available for this purpose, in about half of depression patients they simply do not alleviate the symptoms in a meaningful way. This is a source of great dismay and frustration for the patient, who is likely dealing with crippling depression symptoms with no cure in sight. Not only were the antidepressants ineffective for these individuals, but the side effects of the drugs can be highly unpleasant as well.
In 2008 transcranial magnetic stimulation (TMS) was FDA-cleared as a treatment option for individuals who were unable to find relief of these crippling depression symptoms with antidepressants. This novel approach to treating drug-resistant depression provides a safe and non-invasive alternative treatment method using electro-magnetic energy to make adjustments in brain chemistry. There is a slew of clinical data available repeatedly demonstrating how in clinical trial after clinical trial, TMS has led to high response and remission rates for these patients who were not helped with the drugs.
What Are the Symptoms of Depression?
The symptoms of depression usually appear as a cluster of behaviors and physical symptoms that endure for more than two weeks. When the symptoms persist that long it is appropriate to see a doctor to first rule out any medical issue that could be causing the symptoms. The signs and symptoms of depression include:
- Low mood, persistent sadness, feelings of hopelessness and despair
- Irritability, agitation, restlessness
- Mood swings
- Withdrawing from friends, social events, and activities once enjoyed
- Sleep changes, such as insomnia or hypersomnia
- Eating changes, resulting in sudden weight gain or loss
- Problems with concentrating or making decisions
- Thoughts of death or suicide
What Causes Depression?
Although it is still a mystery as to what might cause the brain chemistry or neural connection changes that might be at the root of depression, there are some factors that have been identified that may also cause depression. These factors include:
- Genetics. Some families have a strong genetic predisposition to depression. When a first-degree family member struggles with depression it increases the odds of other close family members also developing depression.
- Personality. Some people have a type of personality or temperament that is more prone to depressive features.
- Substance abuse. Drug or alcohol addiction may bring about depression as the consequences from the addiction begin to multiply and cause difficulties in family, work, and relationships. However, depression can also lead to substance abuse as a means of self-medication.
- Medical conditions. Certain medical conditions can cause depression symptoms, including diabetes, Parkinson’s disease, Alzheimer’s disease, heart disease.
Treatment for Crippling Depression Symptoms
The first-line treatment protocol for someone exhibiting the symptoms of major depressive disorder remains a combination of psychotherapy and antidepressant drug therapy. Antidepressants are available in several different forms, including SSRIs, SNRIs, tricyclic antidepressants, and MAOIs. A doctor will initially select the drug he or she believes will have the most positive effect on the symptoms. The drug will be trialed by the patient for 4-6 weeks, and at the end of the trial period it will be determined if the drug is a good fit. This is because side effects can make these drugs very hard to tolerate, so adjustments can be made to the dosing, or a new drug can be trialed.
Psychotherapy is a mainstay in the treatment of depression as well. During sessions with a clinical psychologist or a psychiatrist, the individual will examine issues that may be contributing to the depression, and the therapist can help guide the patient toward new methods of perceiving these issues and managing the associated emotions.
Antidepressants Side Effects
Although antidepressants remain the cornerstone of depression treatment, there is a 50%-70% chance that the drugs will not effectively reduce the symptoms of depression. In addition to the questionable efficacy of antidepressant drug therapy, the accompanying side effects also pose a challenge to patients. Each type of antidepressant carries a list of adverse effects, but many of them are common to most antidepressants. These include:
- Weight gain
- Sexual dysfunction
- Blurred vision
- Dry mouth
- Sleep disturbance
TMS Therapy for Drug-Resistant Depression
If the antidepressant treatment regimen is not successful in alleviating the symptoms to a noticeable degree, then the individual is considered drug resistant. For these individuals, TMS offers a promising alternative treatment for depression. TMS works by stimulating the area of the brain related to the mood regulation functions, as well as other executive brain functions.
A typical TMS session is conducted in a doctor’s office by a doctor and/or technician specifically trained in TMS therapy. There is no need for sedation, as the therapy is well tolerated by patients, and there is no incision or surgical procedure involved. The patient is seated comfortably and wide awake throughout the 40-minute session. Most TMS treatment plans call for 5 sessions weekly for 4-6 weeks for optimal results.
A coil is place over the scalp and positioned to deliver the magnetic pulses to the limbic region in the left prefrontal cortex of the brain. The magnetic field induces electrical currents that then stimulate the lazy neurotransmitters so commonly seen in depression patients. Over the period of treatment, patients begin to notice improvements in mood, sleep quality, concentration, and energy.
What Types of Depression Does TMS Treat?
TMS therapy treats all forms of depression, including:
- Major depressive disorder (MDD)
- Postpartum depression
- Seasonal affective disorder (SAD)
- Premenstrual dysphoric depression
TMS can help reduce the symptoms associated with the various forms of depression when antidepressants failed to do so. In addition to depression, TMS can reduce symptoms of co-occurring anxiety disorders, such as generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
Clinical Studies of TMS Therapy for Depression
TMS has been studied extensively. A large number of clinical trials have been conducted globally, demonstrating the safely and efficacy of TMS therapy for treatment of drug-resistant depression. Ongoing investigational trials continue to be conducted, and many are in process currently. Some meta-analysis studies have been compiled and reviewed collectively to assess the clinical data, such as:
- A meta-analysis published in JAMA Psychiatry included 81 randomized trials and concluded that the TMS treatment versus sham treatment were more effective regarding response rates.
- A large meta-analysis published in Neuropsychiatric Disease and Treatment concluded that TMS is a promising treatment with a safety and tolerability profile that makes it an attractive option for drug-resistant depression patients.
- A meta-analysis of more than 100 published clinical trials of TMS for treatment of MDD produced a consensus that daily TMS treatments show substantial evidence of efficacy and safety for patients who are drug-resistant or intolerant.
- A meta-analysis of TMS published in the Shanghai Archives of Psychiatry looked at 9,798 articles and 29 studies, concluding that TMS was safe, and a viable treatment option for refractive depression.
Is TMS Therapy Safe?
TMS therapy is a noninvasive technique that requires no surgery, no implanted devices, no general anesthesia, and no recovery period necessary. Because there is no anesthesia involved, the usual health risks associated with sedation are eliminated. Patients receive the TMS treatments in an office setting while fully alert, and can return to work immediately following the session.
Some patients have reported transient side effects that later resolved spontaneously. These include scalp tenderness or irritation where the magnetic pulses were delivered, mild to moderate headache, some facial tingling or muscle twitches, and lightheadedness. The doctor can adjust the level of TMS stimulation to help reduce these symptoms. Generally, TMS therapy is tolerated well by patients.
Who is Not a Candidate for TMS Therapy?
Some individuals will not qualify for TMS therapy for safety reasons. These are individuals with non-removable metal implanted in or near the head. Examples of these would include:
- Metal device or object implanted in or near the head, such as a pacemaker
- Aneurysm clips or coils
- Deep brain stimulators or vagus nerve stimulators
- Metal implants in the eyes or ears, such as cochlear implants for hearing
- Electrodes to monitor brain activity
- Stents in the brain or neck
- Facial tattoos with metallic ink
- Shrapnel or bullet fragments in or near the head
Individuals with a history of seizures or family history of epilepsy would also disqualify them from receiving TMS therapy.
Anew Era TMS is a Leader in TMS Therapy Orange County
Anew Era TMS is an industry leader in providing expert TMS therapy for individuals suffering from crippling depression symptoms. At Anew Era TMS, the team of doctors and TMS technicians is dedicated to helping individuals to overcome the symptoms of depression and reclaim their quality of life. For more information, or to learn if you are a candidate for this exciting treatment option, please reach out to Anew Era TMS today at