FDA-approved transcranial magnetic stimulation used for major depressive disorder

Todd Walker stares straight ahead as Ruth Rogers uses a red-light marker to align the arm of the NeuroStar machine on the Vancouver man’s head.

A warning tone sounds. Walker takes a deep breath. He flinches as the magnetic coil of the machine taps his forehead.

He always flinches with the first contact.

The taps continue — 10 pulses per second for four seconds, followed by an 11-second pause — for 18 minutes. After that first tap, though, Walker is able to ignore the repetitive pulses. Usually, he listens to AC/DC. Sometimes, he falls asleep.

But on this day, the 46-year-old talks about how the tapping — a form of treatment called transcranial magnetic stimulation — has changed his life.

“I was really close to the very end of my rope,” Walker said. “I was in a bad spot.”

After several weeks of treatment, however, things turned around.

“I’m feeling really good,” Walker said, “better than I have in a long time.”

Walker has struggled with depression off and on for his entire life. The last five years, however, things got progressively worse. He tried a multitude of medications to treat his depression and lessen his anxiety. They all seemed to make him feel worse.

Desperate for another option, Walker and his wife researched electroconvulsive therapy. But, Walker decided, that was too extreme of a process.

Then he heard about transcranial magnetic stimulation, a noninvasive technique that uses magnetic fields to stimulate nerve cells in the brain. Transcranial magnetic stimulation, or TMS, is a Food and Drug Administration-approved treatment for major depressive disorder. The method is used at major medical institutions, such as Johns Hopkins University and the Mayo Clinic.

“There’s a certain segment of the population with depression that just doesn’t get help from medication,” said Rogers, a psychiatric nurse practitioner. Those people may find relief with TMS, she said.

Rogers and her business partner brought the technique to Vancouver this summer when they opened their clinic, Serenity TMS, in downtown Vancouver.

After years of treating patients’ depression with medications — with varying levels of success — Rogers was growing frustrated.

“You start having this feeling of desperation like the patients,” she said.

Rogers had heard about TMS and saw demonstrations at various professional conferences she had attended over the years. But it wasn’t until after a particularly tough day of arguing with insurance companies about patient medications that she really started thinking about alternative options.

The next day, a representative for the TMS therapy machine NeuroStar showed up in her office.

After months of jumping through hoops to secure loans and approval to use the device, Rogers opened Serenity TMS on June 8. Three months in, a handful of patients had undergone, or were in the process of undergoing six weeks of daily treatment. Several more were awaiting insurance approval for treatment, and the number of calls inquiring about TMS was growing.

“It’s just exciting that something is available here,” Rogers said.

The treatment is pretty straightforward.

The patient is seated and the machine is positioned so the treatment coil is over the left prefrontal cortex — the area of the brain that affects mood, Rogers said. The treatment coil is essentially an MRI-strength magnet that stimulates the neurons in that area of the brain.

Each patient’s pulse strength and coil positioning is determined at the first appointment. The patient is awake and alert during the treatment.

Sometimes the tapping can cause a little jaw shaking or eye twitching, both of which are normal. The treatment can be annoying, but it isn’t painful, Rogers said.

“It feels like a woodpecker pecking on your skull,” she said.

For patient Todd Walker, the daily annoyance has paid off.

Walker was administered clinical questionnaires to rate his depression and anxiety during his first visit. He scored “severe” for both. Three weeks later, he was down to “mild” depression and anxiety. Four weeks after that, as he was nearing the end of his treatment, he scored “minimal” for both.

Walker, his wife and his friends have noticed the change, too, he said. His mood has improved, and he’s found joy in doing things he used to enjoy but had lost interest in, such as riding his motorcycle and tinkering on an old Jeep.

“Life is still kind of hard,” he said. “But things are easier.”