Transcranial Magnetic Stimulation (TMS) for Depression
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for major depressive disorder and. It works by using magnetic fields to stimulate nerve cells in the brain.
TMS is typically used when other treatments for depression, such as medication or therapy, have not worked.
How TMS works
TMS works by delivering electromagnetic energy painlessly via an electromagnetic coil placed against your scalp.
The magnetic pulses stimulate nerve cells in the area of the brain involved in depression and mood.
TMS is believed to work because it activates areas of the brain with less activity when one is depressed. Why it works isn’t completely known, but it seems to ease depression and improve mood in a majority of patients.
Several factors influence the effect of TMS on the brain:
The design of the coil
Location of the stimulus
Single pulses vs. repeated pulses
Intensity of stimulation
Frequency of stimulation
Who is eligible for TMS?
To be eligible for TMS, patients must have:
Treatment-resistant major depressive disorder
At least one failed medication at or above the minimum dose
Moderate or severe depression
There is no age limit to receive TMS.
What to expect during treatment
TMS is typically performed in a doctor’s office. You will be seated in a comfortable chair for the duration of the treatment.
Before anything happens, you will be encouraged to enter a relaxed state of mind by listening to alpha wave music and/or focusing on an object, such as a painting. This helps your brain become more receptive to treatment.
Once you are relaxed, a magnet is used to locate your prefrontal cortex, which is where depression “lives” in the brain.
Your doctor will determine the amount of magnetic energy needed by placing the magnet on your scalp.
Once the right dose has been identified, the magnet then delivers pulses at this intensity for a total of 30 minutes. You will be awake and alert for the entire treatment.
You can return to your normal daily activities after your treatment. Between treatments, most patients can typically work and drive.
Risks of TMS
TMS is a non-invasive treatment. It does not require surgery or implantation of electrodes. Although it is considered safe, there are some potential side effects:
Scalp discomfort at the site of stimulation
Tingling, spasms or twitching of facial muscles
To reduce these symptoms, your doctor can reduce the level of stimulation or recommend taking an over-the-counter pain medication before the procedure.
After each treatment
If TMS works for you, symptoms of depression may improve or go away completely.
Most patients experience relief after a few weeks of treatment.
After a TMS treatment series, medication and psychotherapy may be recommended as ongoing treatment.
Treatment after depression recurrence
Sixty percent of patients with severe depression will respond to TMS. Of people treated with TMS for severe depression, 60% will remain depression-free after one year.
If your depression improves with TMS and later recurs, the treatment can be repeated.
Transcranial Magnetic Stimulation (TMS) for OCD
The FDA has recently cleared TMS treatment for OCD. The treatment utilizes a different coil, but the procedure is largely the same.
Psychiatric Second Opinion
Patients have a decreased likelihood of response to medications with each failed treatment. Furthermore, the rate of medication discontinuation increase with each subsequent medication trial. I am specialized in addressing the needs of the patients that have failed many other first-line treatments. Sometimes it is needed to combine medications, use FDA approved interventions, and at times when nothing else has helped, use interventions with only empirical evidence in the literature to address the most difficult symptomatology in order to achieve a decrease in the suffering of the people with treatment-resistant mental illnesses.
QEEG Dementia Diagnostics & Esketamine Clinic
Esketamine is a derivate of Ketamine, approved for the treatment of treatment-resistant depression. It can be prescribed, but the administration of the medication is done only in clinics. We are certified to deliver this treatment.
Dementia is characterized by cortical synaptic dysfunction contributing to deficits in sensory and cognitive processing. However, other illnesses, such as depression, can present the same clinical picture. With the clinical tools available now the diagnosis of dementia, especially at the beginning of the illness, is nonspecific. Event-related potentials (ERPs) are part of the electroencephalogram generated by sensory and cognitive processing of external stimuli. As such, ERP’s provide a real-time physiological measure of fundamental cognitive process, i.e. a cognitive biomarker. Additionally, ERPs can evaluate the pro-cognitive efficacy of therapeutics irrespective of the mechanism of action. As an absolute measure of cognitive function, ERPs provide subject stratification from a single test.
The recording will be done using a Neuronetrix device with ten leads, FDA approved for diagnosis of dementia. The electrodes will be placed on the scalp of the patients. The earpiece will produce auditory signals at variable intervals and the patient will be instructed to press a button upon hearing that signal. Quantitative EEG uses computerized digital signal analysis to enhance the analysis of standard EEG. This approach uses techniques such as Fourier analysis and wavelet analysis to quantitatively investigate frequency-based information in the EEG. Certain frequency-based information has been shown to be a reliable measure of brain function. One such measure, Peak Alpha, is the specific frequency within the Alpha band (8-12Hz) where the highest relative amplitude occurs. A higher frequency Peak Alpha is related to faster cognitive processing. Event-Related Potential (ERP) is a subset of the EEG and which is specifically the brain’s responses to a sequence of external stimuli (auditory in this case). The data is analyzed through a program installed on my computer and the report is generated in minutes.
The focus of my clinical activities and of my patient-oriented research has always been on understanding the interplay between psychiatric illnesses and medical conditions and on developing innovative ways of addressing the whole spectrum of psychosomatic needs in patients with complex presentations. As a psychiatrist, I have a broad background in diagnosing and treating mental illness. I use pharmacological and nonpharmacological approaches that target the symptoms one is experiencing and also being very careful with medication interactions with other medications taken for other medical illnesses. The most common example is with people taking various medications for cancer, as many of the medications used in psychiatry affects the metabolism and efficacity of those treatments