Some health providers now treat depression with magnets instead of pharmaceuticals
When patients do not respond to drug or talk therapy treatments for depression, a clinic in Corte Madera is among those using another method — magnetic fields.
Jacqueline Perlmutter, an addiction specialist at the Mind Therapy Clinic in Corte Madera, said transcranial magnetic stimulation (TMS) uses magnetics instead of electricity to stimulate small regions of the brain that are underactive, stimulating neurotransmitters like serotonin, which can affect mood, social behavior, appetite, sleep, and more.
TMS is an outpatient procedure. The patient wears a magnetic stimulation device on their head, and the device is monitored by a computer that uses precisely targeted magnetic pulses — similar to those used in MRI — to target predetermined areas of the brain, based on measurements gathered from brain imaging.
Patients are awake and alert during treatments which last about a half hour, and can resume normal activities afterwards.
They typically receive one treatment each day, five days a week for two to six weeks.
Americans spend billions of dollars each year on antidepressants, but it is estimated that they work for only 60 to 70 percent of people who take them, according to the National Institutes of Health.
According to the World Health Organization, 16 million Americans report having a major depressive episode.
The number of people with depression has also increased 18 percent since 2005.
TMS was first developed in 1985 and was approved by the FDA in 2008. Though not completely mainstream, the treatment is covered by most insurances and is used by the Mayo Clinic, the Johns Hopkins Brain Stimulation Program, and several clinics throughout the North Bay including Brainefit, in Davis.
Brainefit is run by Medical Director Guohua Xia, a psychiatrist, researcher and associate professor at University of California, Davis. He was in on the ground floor to use TMS for research since 1988 and became a principal investigator for several international clinical trials later on to study the efficacy and safety of TMS for the treatment of brain disorders.
He was so impressed with the initial results and the potentials of the treatment, he tried to make a machine himself but 'I was a young physician, not an engineer, and there was not enough funding...' he said.
TMS is also a safe alternative to electroconvulsive therapy (ECT), said Xia (pronounced 'Hsia'). ECT, formerly known as electroshock therapy and often referred to as shock therapy, electronically induces seizures in patients who are unresponsive to other therapies, to provide relief from severe mental disorders including treatment-resistant depression.
Side effects of ECT, however, can include memory loss and brain damage according to a widely publicized report from the University of Aberdeen, Royal Cornhill Hospital in the United Kingdom.
Unlike ECT, in which electrical stimulation is more generalized, TMS can be targeted to a specific region in the brain.
Side effects of TMS may include headache or scalp discomfort and in rare cases seizures. Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may feel a buzzing, Perlmutter said.
Because the treatment is relatively new, long-term side effects are unknown.
While Xia has been a leading proponent of TMS since the beginning, he said there is margin for error.
Each patient is initially given treatment to the same area of the brain, but there are many variables depending on each patient. If one area of the brain doesn't respond, another area could be tried.
'Treatment doctors and technicians must be trained to have the skill to get the right location, angle, intensity of pulse, and other parameters,' he said
Prices for this kind of treatment vary by provider, but TMS is typically in the range of $400-500 per session for a total cost of about $15,000. The cost has been going down in the last several years. ECT by comparison is around $2,500 per session, $25,000 for 10 sessions, plus the cost of one-week hospital stay in some cases.
Most insurance carriers usually authorize TMS after a client has tried four antidepressants, two augmentation strategies and psychotherapy during the current episode of depression. TMS is FDA-approved for treatment-resistant depression, but insurance carriers currently do not pay for the treatment of other disorders.
More funding is needed to answer the questions raised in using this technology, Xia said, however, researchers and doctors in the U.S. are also exploring whether the treatment could also be used for a variety of other conditions including schizophrenia, epilepsy, Parkinson's disease and chronic pain.
In clinical trials using TMS on bipolar patients, some of the cognitive functions tested, like memory, have been shown to improve, Xia said.
In Europe, TMS is approved to treat addictions, Alzheimer's disease, bipolar disorder, Parkinson's disease, postraumatic stress disorder (PTSD) and more.
Cynthia Sweeney covers health care, hospitality, residential real estate, education, employment and business insurance. Reach her at Cynthia.Sweeney@busjrnl.com or call 707-521-4259.