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Transcranial Magnetic Stimulation (TMS) for Depression, Anxiety, and OCD 

 

Transcranial Magnetic Stimulation (TMS) 

 

Transcranial magnetic stimulation (TMS) is a non-invasive treatment for Major Depressive Disorder, Anxiety, and Obsessive-Compulsive Disorder. It works by using magnetic fields to stimulate nerve cells in the brain. 

 

TMS is typically used when other treatments, such as medication or therapy, have not worked or were not tolerated. 

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 executive functioning, depression, and mood. 

TMS works by activating areas of the brain which display lower levels of activity in patients with depression, anxiety, and OCD

 

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: 

Moderate to Severe Major Depressive Disorder, Anxiety, or Obsessive-Compulsive Disorder

At least one failed medication at or above the minimum dose

A failed course of talk therapy

There is no age limit to receive TMS. 

What to Expect from TMS

For most patients, response to TMS follows a predictable pathway of results.

Within your first few sessions, thinking begins to grow clearer and the "brain fog" starts to subside

 

Around session 5, sleep patterns become more regular and many patients report feeling more well-rested

During the second week of treatment, you will start to have more energy and improvement will be visible to those around you

Starting somewhere between the 10th and 15th sessions, you will start to notice that you are feeling better and the symptoms affecting your life are starting to subside, an improvement which will grow and consolidate over the remaining duration of treatment.

In a real world retrospective study using CGI-S and a sample size of 615, patients with depression experienced 83% Response and 62% Remission. This data comes from the world’s largest depression outcomes registry from NeuroStar, with evaluable data on over 6621 patients since being initiated in 2016.

Logistics of TMS

TMS is typically performed in a doctor’s office. You will be seated in a comfortable chair for the duration of the 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. 

Before starting the treatment, 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. 

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: 

Headache

Scalp discomfort at the site of stimulation

Tingling, spasms or twitching of facial muscles

Lightheadedness

If any of these symptoms occur during your first session, you will be recommended an over-the-counter pain medication to take before the procedure for the next few sessions in order to prevent further occurrences. 

Like antidepressant medications, TMS carries a slight risk of producing euphoria, which may result in hypomania or mania; as well, seizures may occur in roughly 1 in 30,000 patients during the procedure.

 

After TMS treatment 

If TMS works for you, symptoms of depression may improve or go away completely. 

After a TMS treatment series, medication and psychotherapy may be recommended as ongoing treatment. 

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. 

Read More: 

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.

Quantitative EEG Dementia Diagnostics 

 

Quantitative EEG

Memory problems can originate from many disorders, such as depression. It is often difficult to distinguish dementia from other disorders which have similar symptoms. However, this device is able to read brain activity and diagnose dementia without the battery of psychological tests usually needed for that purpose. 

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.

Medication Management

 

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