Category: TMS

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By Kelly M. Heitkamp, LISW-S

 

As someone who sits on both sides of the therapy couch – borrowing that perfect phrase from my colleague Dr. Laurie Bruce’s enlightening podcast “From Both Sides of the Couch” I’ve developed a unique perspective on depression treatment. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care.

The Tried and True (But Sometimes Not Enough)

Cognitive Behavioral Therapy (CBT) remains one of the most effective approaches for treating depression. This structured therapy helps identify and change thought patterns that contribute to depressive symptoms. Along with other evidence-based approaches like Interpersonal Therapy and Mindfulness-based techniques.

Then there’s medication – those SSRIs and SNRIs that many people have complicated relationships with. Many find life-changing relief, while others struggle with side effects or minimal benefits. When therapy and standard medications work, they really work. But let’s be honest – for about a third of people with depression, these approaches aren’t enough, which is why I’m so excited about what’s emerging.

New Kids on the Treatment Block

Ketamine therapy has gained significant attention. Many patients report experiencing relief within hours rather than the weeks or months typical medications require. The treatment seems to work by creating new neural pathways, helping the brain “reset” established patterns associated with depression.

Right here in our region, the Lindner Center of Hope offers innovative ketamine treatment options. Patients undergo thorough evaluations before treatment helping you and your provider decide if the treatment is right for you. When you are receiving treatment the Center’s medical team carefully monitors each session.

Another exciting treatment offered at the LCOH is Transcranial Magnetic Stimulation (TMS). This non-invasive procedure uses magnetic fields to stimulate nerve cells in the brain and has shown promising results for those who haven’t responded to traditional treatments.

Tech Meets Therapy

The digital mental health space is also exploding. As someone who was initially skeptical about app-based therapy (can an app really replace human connection?), I’ve been surprised by the research showing legitimate benefits from some digital interventions. These tools can be particularly helpful for people who live in areas with therapist shortages or who cannot afford traditional therapy.

Evidence-based apps can serve as supplements to therapy – kind of like “homework” between sessions. They are not replacements for human connection, but they can be valuable additions to your treatment.

What This Means for You (or Someone You Care About)

If you’re struggling with depression, or supporting someone who is, know that the treatment landscape is more promising than ever. The stigma is slowly lifting, and our understanding of what works is expanding rapidly.

What I’ve learned both personally and professionally is that depression treatment isn’t one-size-fits-all. Sometimes it takes trying different approaches or combinations before finding what works. And that’s okay.

The most important thing is to keep going. Whether it’s traditional therapy, medication, newer treatments like ketamine, or some combination that ultimately helps – there are more pathways to healing than ever before.

And as someone who’s been on both sides of this journey, I can tell you that finding your way through is absolutely worth it – even when the path isn’t straightforward.

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Transcranial Magnetic Stimulation (TMS) is an innovative treatment for depression. Depression is common and affects 1 in 10 adults. 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

Evidence shows that TMS is effective in the treatment of moderate to severe depression in patients with a history of treatment resistance. 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 stimulates these nerve cells. New data emerging from recent studies suggests that in most patients, the clinical benefits of TMS therapy are 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. Technological advancements in equipment has led to decreased treatment durations.

Pros and Cons of TMS Therapy

Some advantages and disadvantages of TMS include:

  • It 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 Electroconvulsive Therapy (ECT) in the 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

TMS at Lindner Center of HOPE

The Lindner Center of HOPE is a nationally recognized Leader in TMS Therapy. Our expert reputation is a result of years of clinical research and experience in mental illness and collaboration with academic centers such as Johns Hopkins and the Mayo Clinic through the National Network of Depression Centers. For patients, this means the best of the best – the best clinical minds, the best data and the best technology are being applied to achieve successful outcomes.

There is HOPE. For more information on TMS Therapy, call (513) 536-4674 or click here.

 

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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/

Return to blog >

 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/

 

Return to blog >

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…)