TMS for when drugs don’t work

Most people suffering from depression are likely to be offered Antidepressants as a first treatment when they visit their doctor for help. Although this isn’t ideal, sometimes it is the only option available as lengthy waiting lists along with a lack of resources means that other types of therapies such as cognitive therapy might not be immediately available.

Although antidepressants are effective for many, one of the main problems with them is that any relief they do offer, comes with the price of suffering some unpleasant side effects, including nausea, dizziness, sleep disturbances, headaches, loss of libido, agitation, and erectile dysfunction in men.  Another problem is that in some people, antidepressants will have no effect on the symptoms of depression whatsoever. No one really understands why this is the case and it isn’t possible to predict which people will benefit and which won’t.

Now, a new study has highlighted an innovative therapy that is fast gaining recognition as a possible maintenance treatment for major depression in people who either couldn’t tolerate antidepressants or found that the antidepressant drugs didn’t work.

Magnetic pulses

Transcranial magnetic stimulation or TMS as it is known is a treatment involving magnets placed on the head to send magnetic pulses to the parts of the brain responsible for regulating mood.

Neurostar Inc is the company that has come up with Neurostar TMS machine which apparently carries very few, if any, side effects. The most common is a mild headache after treatment.

Pilot Study

In a pilot study carried out by Neurostar, the researchers treated half of the patients with TMS for a period of six weeks and the other half were observed monthly. After the six week period they found that 61.2 percent of those treated with TMS had experienced a remission of depression symptoms and after three months the figure was 62.5 percent compared to 43.8 percent of those who didn’t receive TMS therapy.

“This pilot study supports the notion that maintenance TMS may be useful in the prevention of recurrence of major depression and is an important step in learning what the optimum treatment parameters will be” said Dr. Scott Aaronson, director of Clinical Research Programs and associate medical director at Sheppard Pratt, in a statement.

“This preliminary information will help define an approach to TMS as a maintenance therapy as we extend our understanding of the long-term usefulness of TMS in the treatment of people with this debilitating illness.”

Neurostar Inc revealed the results of their study at the 167th American Psychiatric Association Annual Meeting in New York. According to the company, the treatment is safe.

Unlike ECT (Electroconvulsive therapy) patients do not require sedating prior to treatment. TMS can be carried out in the doctor’s surgery and is typically given daily for a period of four to six weeks.

Effective for more than 50 percent

The results of another study released in May 2014, showed that after one year, more than 50 percent of patients suffering from major depression and treated with Neurostar TMS either had no symptoms of depression or very mild symptoms. After the same period of time the figure is only 38 percent for antidepressants.

Dr Amit Anand from the Center for Behavioural Health at Cleveland Clinic thinks that TMS could be a useful addition to the treatments already available at the Clinic.

“It’s a way to treat depression directly, with few side effects” said Anand, who was not involved in the Neurostar study.

“Other research has shown only a small percentage of people respond to it, but I think if even a quarter of those people respond, it’s a benefit.”

 Expensive

One disadvantage, however, is that TMS is more expensive than drugs, costing between 7,000 and 10,000 dollars. However, if you consider that the treatment isn’t likely to be ongoing in the same way that medication is, then the cost is more viable. Some insurance companies in the US are starting to fund TMS treatment.

TMS in the UK

In the UK and indeed in Europe, TMS is available in very few places. The National Institute for Health and Clinical Excellence (NICE) says that doctors can only offer this treatment in the UK on the NHS as part of a research study.

Conflicting results

Not much is currently known about the way it works and indeed there have been conflicting results as to whether it works as well as some reports have indicated. In one analysis of 11 studies involving 197 people, there was an improvement after two weeks but not after that.  In another analysis of 33 studies involving 877 patients there was no real difference between TMS and a placebo. In yet another study comparing TMS with ECT, 10 out of 20 people having TMS responded to the treatment with 2 of them cured compared to 6 out of 15 having ECT where 3 were cured.

Anything that helps alleviate the symptoms of depression is welcome and TMS could well find its place as a further option, especially where previous treatment has failed.

 

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