New help for depression
A device that delivers magnetic pulses to the brain could help ease depression — even in people who haven’t been helped by medication.
Research is ongoing into whether transcranial magnetic stimulation, or TMS, can help people with autism, schizophrenia and a host of other conditions involving the brain.
For now, the U.S. Food and Drug Administration has approved TMS for use in adults with depression who haven’t been helped by medication.
Dr. Chad T. Brown, a pediatric and adult psychiatrist, began offering the treatment this year at his Medford practice, Path to Awareness. He estimates about 50 to 60 percent of patients who’ve tried TMI at his office have seen improvements in their depression symptoms.
“For the people who get better, it’s pretty dramatic,” Brown says.
Many patients have suffered from debilitating depression for years, he notes.
Following TMS treatment, one patient picked up an instrument after not playing for nine years, Brown says. Another was able to go to work after being too depressed to even apply for a job. A patient who had been having suicidal thoughts for years no longer feels suicidal, Brown says.
“One person described it being as if a fog was lifting,” he says.
The results so far in Medford mirror studies that found 53 percent of patients with medication-resistant depression who were treated with TMS reported no or mild depression following six weeks of treatment, according to results announced in 2014 at an American Psychiatric Association meeting.
The TMS patients achieved better results than depressed patients who tried a different medication after failing to improve from past medication. Among patients trying new medication, 38 percent saw improvements, according to study results.
Brown says TMS doesn’t work for everyone.
“For some people, when it doesn’t work it can be really disappointing for them — and that’s tough to see. It’s tough to work with that person and see them not get better,” he says.
Those aided by TMS often need help adjusting to a more active life, he notes.
“Anxiety can go up. When you’re depressed, anxiety can be low if you’re not doing anything,” Brown says.
When depression lifts, patients and those around them often develop higher expectations about what the patient should be capable of doing.
“They’re trying to do things they haven’t done in years. That can provoke anxiety. It’s important to work with a therapist. Things will come up,” Brown says.
The treatment is time-intensive, but research shows it can provide long-lasting improvements.
Patients come to the Medford practice five times per week for sessions that last 20 to 50 minutes. The treatment goes on for six to eight weeks.
A TMS technician attaches the device to the side of a person’s head. Patients feel a tapping sensation and hear a clicking noise. Side effects can include a headache and tenderness on the scalp.
As for the science of TMS, the pulses target the dorsal lateral prefrontal cortex on the left side of the brain when used for depression. The pulsating magnetic fields create electric currents in the brain’s nerve cells.
“The more often a neural circuit is fired, the stronger it gets. By activating that side of the brain, we’re strengthening the connections that are important in mood regulation,” Brown says.
The pulses are thought to increase blood flow and encourage the growth of connections between brain cells. TMS can also cause the release of the neurotransmitters dopamine, serotonin and norepinephrine — chemicals that help send signals between cells, according to researchers.
Dopamine helps control the brain’s reward and pleasure centers, while serotonin influences brain cells related to mood, sleep, memory, learning and other functions. Low levels of norepinephrine are linked to conditions that include depression and attention deficit hyperactivity disorder, according to scientists.
Although the FDA has approved TMS only for medication-resistant depression, the treatment has been approved in Europe for bipolar disorder, post traumatic stress disorder, chronic pain, obsessive compulsive disorder and adult ADHD, according to transcranialmagneticstimulation.com.
The website offers information about TMS and American medical providers who offer the treatment.
According to the website, depression affects approximately 1 in 10 Americans and is a leading cause of disability. Depression can last for months or years, with serious depression usually caused by a chemical imbalance in the brain.
Depending on the speed at which magnetic pulses are delivered to the brain, TMS can either increase or decrease activity in targeted areas.
Researchers have reported mixed results for using TMS to treat schizophrenia, a severe, chronic mental illness that can cause hallucinations, delusions and other symptoms. Medication doesn’t work for everyone with the disease, and can trigger side effects such as apathy, weight gain and shaking that cause people to stop taking their prescriptions.
TMS appears to be most promising in treating auditory hallucinations, in which people with schizophrenia hear sounds — including voices — that aren’t there, according to the journal Innovations in Clinical Neuroscience.
Imaging studies suggest the voices arise from parts of the brain involved in perceiving spoken speech. Researchers theorize low-speed magnetic pulses could reduce activity in brain areas that appear to be generating the voices.
In one study, 53 percent of schizophrenic patients had their voice hallucinations reduced by at least half. The improvement lasted from one week to over a year, with about half of patients seeing significant improvement for at least three months following the trial, according to Yale-New Haven Psychiatric Hospital researchers.
The researchers noted voice hallucinations can be very distressing to patients, interrupting their ability to work, study, sleep and interact with others. Negative, commanding voices can lead to suicide in extreme cases.
Research on TMS treatment for autism is still in its infancy.
Small-scale clinical studies suggest the treatment could reduce repetitive behaviors and improve social skills, among other benefits. But more research and larger studies are needed, according to neuroscientist and autism researcher Lindsay Oberman.
TMS successfully reduced symptoms of tinnitus in more than half of patients with the auditory and neurological condition. People with tinnitus hear a persistent ringing, buzzing, hissing or humming noise when there is no external sound source, according to Oregon Health & Science University and Veterans Affairs Portland Medical Center researchers who reported their results in 2015.
Tinnitus affects nearly 45 million Americans, including veterans with combat-related hearing damage. Tinnitus is the most prevalent service-connected disability in the VA system, according to OHSU.
When people have hearing loss in their ears and can no longer hear sounds at certain frequencies, the brain may produce an experience of sound to make up for the loss of external stimuli in those frequencies. The brain essentially fills in the missing sounds, according to the American Tinnitus Association.
While tinnitus is usually associated with hearing loss, symptoms can be triggered by about 200 health issues, including congestion from colds and autoimmune disorders, the association notes.
Although the FDA has approved TMS only for medication-resistant depression for now, Brown says people with other conditions could eventually be helped by the innovative treatment.
“There are ongoing studies. Not everything will pan out, but it’s promising,” he says.