Saturday, May 1, 2021

Transcranial Magnetic Stimulation: Experience?

 It sounds like ECT meets Scientology but without the negative effects.  A friend suffers from severe depression and none of the antidepressants are helping her.  Published reviews:

The introduction of transcranial magnetic stimulation (TMS) and vagal nerve stimulation (VNS) have rekindled interest in the use of brain stimulation methods for the treatment of psychiatric disorders. TMS enables the clinician to focally stimulate specific areas of the brain noninvasively and painlessly. The efficacy of TMS in the treatment of depression has been extensively studied. TMS has also been shown to have some beneficial effects in the treatment of posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).

TMS was introduced in 1985 by Anthony Baker at the University of Sheffield in England. It was designed to be a neurodiagnostic tool used to produce an evoked potential in muscle tissue by activating neurons in the motor cortex. TMS is based on two basic principles in physics: Ampere's law and Faraday's principle of electromagnetic induction....

George, et al., studied the efficacies of rTMS in patients with depression in a double-blind crossover design. Twelve patients were given either active rTMS or sham treatment. The study suggested that daily left prefrontal repetitive transcranial magnetic stimulation has antidepressant activity.

Klein, et al., in a double-blind, placebo-controlled study assessed the efficacy of slow repetitive TMS (rTMS) in patients with major depression. Seventy patients with major depression were randomly assigned to receive active rTMS or sham rTMS in a double-blind design. It was shown that patients who received active rTMS had a significantly greater improvement in depression scores compared with those who received sham treatment and provided evidence for the short-term efficacy of slow rTMS in patients with recurrent major depression.

Berman, et al., in a randomized, double-blind, clinical trial, studied the efficacy of rTMS in treatment resistant major depression. Depressed subjects, who had failed to respond to a median of four treatment trials, were assigned in a randomized, double-blind manner to receive either active or sham rTMS. Adjusted mean decreases in HDRS scores were 14.0 (±3.7) and 0.2 (±4.1) points for the active and control groups, respectively (p<0.05). A two-week course of active rTMS resulted in statistically significant but clinically modest reductions of depressive symptoms, as compared to sham rTMS.

Toro, et al., studied the efficacy of rTMS in drug-resistant depression. In this randomized, double-blind study, 40 patients received either active rTMS or sham rTMS to the left prefrontal cortex. The authors of this study concluded that real, but not sham, HF-rTMS was associated with a significant decrease in the Hamilton Depression Rating Scale and that left prefrontal high frequency-rTMS was effectively associated with antidepressant treatment. But the size effect was small.

Th cost is pretty high; enough so that because insurance companies now cover it, I suspect that it does not qualify as experimental or quackery. 

1 comment:

  1. Clayton,
    I have seen depression listed as one of the medical problems that HBOT (hyperbaric oxygen therapy) has been found to have a positive effect. Not covered by insurance at this time, it is considered an "off label" therapy. There are several clinics in NV that have this equipment.