Depression is common. More than 14 million American adults suffer from depression. Only a fraction of individuals suffering from depression seek treatment. Of those who do, greater than 30% fail to achieve satisfactory improvement. Not all patients improve when treated with medications or psychotherapy. Up to 25% of people suffering from depression will not respond to multiple trials of medication due to a lack of efficacy or difficulty tolerating medication. Likewise, many people struggle to respond to the best efforts of psychotherapy, either due to a lack of response or a lack of time and/or financial resources that are necessary for psychotherapy interventions. Alternate treatment modalities are critical to addressing the ongoing needs of patients who suffer from the debilitating effects of depression.

Understanding the Benefits of Transcranial Magnetic Stimulation

Depression has been linked to an abnormal function of nerve cells in a specific part of the brain. Highly focused magnetic field pulses used in Transcranial Magnetic Stimulation (TMS) therapy gently stimulate these nerve cells. Evidence shows that TMS is effective in the treatment of moderate to severe depression in patients with a history of treatment resistance. New data emerging from recent studies suggests that in most patients, the clinical benefits of TMS were maintained through 12 months.

How Transcranial Magnetic Stimulation Works

TMS is a non-invasive, localized treatment conducted using a device that delivers rapidly pulsating and localized magnetic fields that activate a subset of nerve cells in the front part of the brain. While treatment is administered, patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the system generates highly concentrated magnetic field pulses.  Transcranial Magnetic Stimulation  is delivered in a series of 37-minute outpatient treatments, typically administered daily, (5 days per week) for 4 to 6 weeks.

Pros of TMS Therapy

  • Does not require anesthesia, non-invasive, well tolerated.
  • An outpatient service and patient continues normal daily routines.
  • Current data demonstrates efficacy in patients who have struggled

with medication.

  • May be good alternative for patients who responded to ECT in past.
  • No significant memory impairment.
  • FDA Approved in 2008 for the treatment of depression.

Cons of TMS Therapy

  • Facial twitching during the treatment.
  • Skin redness at site of coil placement.
  • Anxiety before and during treatment.
  • Mild discomfort (usually dissipates by end of first treatment).
  • Headache.
  • Process for insurance coverage can be cumbersome.
  • Time required 30 treatments over 6 weeks.

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

 

Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry
The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms
of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality
of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

 Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

 

One of the leading forms of mental illness today is severe depression.  An estimated 15 million Americans suffer from this disorder, which creates ongoing symptoms of sadness, hopelessness, sleep and appetite disturbance, and even despair.

For many individuals, psychotherapy combined with antidepressant medication can be a literal lifesaver.  However, some people who suffer from severe depression do not respond to conventional treatment approaches.  Recent advances in alternative treatments have led to a new method of managing depression: the use of transcranial magnetic stimulation (TMS).

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation treatment is conducted using a device called the NeuroStar® TMS Therapy System.

While treatment is administered, patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the NeuroStar® TMS Therapy System generates highly concentrated magnetic field pulses that turn on and off rapidly.

In clinical trials, patients reported relief from the emotional effects of depression and experienced improvement in anxiety, changes in appetite, body aches and lack of energy – all physical symptoms of depression.

The Nature of Transcranial Magnetic Stimulation Treatment

Transcranial Magnetic Stimulation is based upon the principle that direct electrical stimulation of nerve cells in the brain can affect mood and behavior. Many mental disorders may stem from abnormal behavior of particular regions of the brain or the over- or under-stimulation of nerve cells.

The transcranial magnetic stimulation procedure involves the use of magnetic fields to stimulate nerve cells in the brain.  While sitting in a specially designed treatment chair, a patient has a large electromagnetic coil placed against the scalp.  A magnetic field can then be produced by passing a current through the coil, as a machine generates the precise amount of current necessary. When the coil is activated, its current travels through the skull into the brain, stimulating the prefrontal cortex, a region associated with mood control.

A series of several treatments is usually conducted to achieve maximum effectiveness.

Transcranial Magnetic Stimulation Benefits and Concerns (more…)