Part three of three in our series on depression and the holidays.
Though the holidays can be a joyous time of year, they also come with seasonal stressors that can bring on the blues or trigger depressive episodes in those prone to the disease. In the last two posts, we discussed holiday stressors, as well as antidepressant medication, which is the first line of therapy for those suffering from major depression. There is also a subset of patients who do not respond adequately to antidepressants. For those who don't find relief from medication, there are now excellent non-pharmaceutical alternatives available, including Transcranial Magnetic Stimulation (TMS), a highly effective treatment with minimal side effects.
Over the last 25 years, not only have we reduced the stigma associated with mental illnesses, treatments for depression have significantly improved. Scientists have developed more targeted antidepressant medications and advanced the field of brain stimulation therapy, inventing or improving treatments that activate the brain with electricity, magnets, or implants.
Newer classes of antidepressants with reduced side effects, including SSRIs and SNRIs, have made a huge difference in the lives of millions of people with major depression. Unfortunately, antidepressants don’t work for up to one third of patients, even after they modify their doses or try multiple medications. These patients can suffer with symptoms for months; waiting for relief that does not come, which can be an incredibly painful and frustrating experience.
Fortunately, we now have advanced second-line therapies, including TMS. TMS is a non-invasive outpatient procedure that uses electromagnetic energy to stimulate nerve cells in the prefrontal cortex, which regulates mood. Approved by the FDA in 2008 to treat severe depression, TMS is increasingly recommended due to its high success rate; clinical studies have shown that it relieves symptoms in about 60% of patients, making it twice as effective as antidepressants. TMS patients also typically experience far fewer side effects than those on antidepressants. Incredibly, some even report permanent cessation of symptoms.
TMS is performed in a doctor’s office and does not require anesthesia or sedation. Before beginning treatment, the patient is asked to remove all magnetic-sensitive items. The patient is then seated in a reclining chair, much like in a dentist’s office. The physician places an insulated coil next to the patient’s scalp and administers a few magnetic pulses to gauge their “motor threshold,” or the minimum dose required to make their thumb twitch. The dose is adjusted to the client’s sensitivity and treatment begins.
Magnetic pulses are then delivered to the left prefrontal cortex. Patients feel a light tapping sensation on the scalp that can be adjusted if deemed uncomfortable. During the procedure, the TMS machine makes a distinct clicking noise, and headphones or earplugs may be used to diminish the sound.
Though most patients report no discomfort during the treatment, some experience mild side effects such as headaches or lightheadedness, which generally improve shortly after the session and diminish over time. The entire session takes approximately 45 minutes and patients can resume regular activity immediately afterward.
The course of treatment usually involves five sessions per week over four to six weeks. Some patients notice temporary improvements as early as the first or second week as existing neural circuits are stimulated. Repeated treatments over several weeks gradually encourage new circuits to form, making depression relief self-sustaining for many patients.
If you feel that your antidepressants aren’t working or that you may benefit from TMS therapy, talk with your physician about your options or contact TMS Health Solutions. In the meantime, make sure you don’t stop taking any medication without consulting your doctor, as you may experience withdrawal as well as a return of symptoms. Should you opt for TMS, be sure to shop around and find a provider makes you feel comfortable and answers all your questions and concerns.
From all of us at TMS Health Solutions, we wish you a happy new year and the very best of health.