Tue September 24, 2013 12:03 pm
By Jared Brumbaugh
This week, we speak with an East Carolina University psychiatrist about a new, non-invasive treatment being used for people living with depression.
Depression… it’s difficult to treat. An estimated one in 10 adults in the United States suffers from depression, according to the Center for Disease Control and Prevention.
“It’s a very common disorder and a very serious disorder that has significant disabling features associated with it.”
There are several ways to treat depression, including medications and psychotherapy. But psychiatrists at the Brody School of Medicine at East Carolina University are working with a new non-invasive, non-drug treatment for depression. It’s called repetitive transcranial magnetic stimulation, or rTMS. The Brody School of Medicine is the only hospital in eastern North Carolina to offer the service. Associate Professor in the Psychiatric Medicine Department Dr. Thomas Penders says the treatment differs from electrical shock therapy, which also has anti-depressant effects.
“With TMS, we don’t produce a seizure but we do what we do is those repetitive, brief pulses of magnetic waves that are passed through the brain and because of the electro-magnetic effect, it affects the nerve cells or the neurons by producing electrical currents within them. And when we stimulate certain parts of the brain that are associated with depression, we get a therapeutic effect as a result of that neurostimulation.”
rTMS was approved by the Food and Drug administration in 2008. When a patient receives the treatment, an electromagnet is placed over the frontal area of their scalp. Next, the physician and technician determine the amount of magnetic impulse needed to produce a movement in the thumb.
“We have the patient put their thumb up in the air and when we see it moving, more than half the time, that’s what we call the motor threshold. That gives us an indication of the power we need to use with our magnetic impulses. So we move the magnet forward about 5 cm, which is about two inches, and that is the area that approximates the area that is used to treat depression. At that point, the pulsatile stimulations, the rapid pulsatile stimulations of about eight per second begin in that there’s a train of those that continue for about 37 minutes.”
Dr. Penders describes the sensation similar to a tapping on the skull. This outpatient treatment is only available by prescription and is administered daily for 4-6 weeks. So far, no major side effects have been reported. But in rare instances, the treatment has caused seizures.
“The numbers are like one in 10,000 to one in 30,000 cases will develop a seizure and the cases so far have been amongst people who already have a predilection to having seizures.”
Still, research shows the rTMS therapy is safe and effective for the treatment of major depressive disorder in adults. According to a 2008 study in the Journal of Clinical Psychiatry, over 10,000 active TMS treatments have been performed with no reported systemic side effects commonly associated with antidepressant medications. Dr. Penders says rTMS is just another tool psychiatrist can use to help people suffering from major depression.
“The current approved FDA indication for use of rTMS is in patients who have major depression and have failed one single trial of an anti-depressant. So, anti-depressants are likely to help about 70 percent of people who present with depression, but that might be after multiple trials. Anti-depressants do have side effects and many people have difficulty tolerating those side effects. “
The Brody School of Medicine received their NeroStar TMS Therapy system about a month ago, and, so far, it hasn’t been used. I asked Dr. Penders about the possibility of the machine being used to treat military service members that experience post-traumatic stress.
“Many veterans return with in addition to PTSD, major depression. And if they reach this category of having major depression with one failure of an anti-depressant, they certainly would be candidates for use of this, we would advocate for that.”
Dr. Penders says the use of rTMS therapy for the treatment of post-traumatic stress is still in the experimental stages. A study conducted in 2009 found that performing TMS to treat PTSD symptoms resulted in a significant improvement in mood and a significant reduction of anxiety. Also, researchers noted the improvements in PTSD symptoms were long lasting. To learn more about rTMS treatment at East Carolina University, go to our website, publicradioeast.org. I’m Jared Brumbaugh.
For more information on the rTMS treatment, go to: http://www.ecu.edu/cs-dhs/dhs/newsStory.cfm?ID=2826