Deep TMS battles medication-resistant depression

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Did you know a staggering 50% of patients treated for depression are resistant to traditional medication?

A noninvasive, drug-free option called deep transcranial magnetic stimulation, or TMS, is helping give some patients their lives back, and new research indicates that for some patients, individualized treatment plans may soon make this an even more effective option.

Kristi miller has struggled with anxiety and depression since she was 13.

"I would have this intense feeling in my chest like it was so tight and I couldn't breathe," she recalled.

The busy teacher has tried more than 30 antidepressant medications, but over time, they would stop working.

"Zoloft, Wellbutrin, Cymbalta, Lexapro, Effexor," she listed.

Dr. Sandeep Vaishnavi says newer options like deep TMS can be very effective.

"What this technology is doing is that it's stimulating the brain using these magnetic pulses," Vaishnavi said.

He says that causes the networks in the brain to change over time.

"We want to make that cognitive control network, the prefrontal cortex, we want it to be more efficient so it can modulate the emotional brain," Vaishnavi said.

The patient is fitted with Brainsway's deep TMS helmet that sends magnetic pulses to the brain.

The patient undergoes a 20-minute session where they feel a light tapping on the side of their head.

Results have been dramatic: A recent study found that only 11% went into remission with medication alone.

"But with TMS and medications, it was 60%," Vaishnavi said.

Miller says she felt a difference after the very first session.

"It was like all the colors in the sky were just brighter," she remembered.

The patient generally undergoes a series of 36 sessions in combination with medication and/or therapy.

Doctors say there's a very small risk of seizures, but it's less than one in 30,000 sessions. In fact, the American Psychiatric Association guidelines suggest TMS after one medication failure.

Deep TMS has also been approved by the Food and Drug Administration to treat obsessive compulsive disorder. Most insurance companies cover the full 36 sessions.

REPORT: MB #4687

BACKGROUND: Depression affects more than 264 million people worldwide. It is different from usual mood fluctuations and short emotional responses in every day life. It causes work, school and family life to suffer greatly. At its worst, depression can lead to suicide. Although there are effective treatments for mental disorders, between 76% and 85% of people in low and middle-income countries receive no treatment for their disorder. Some barriers to effective care include a lack of resources, lack of trained health-care providers and social stigma associated with mental disorders. Another barrier is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants. (Source:

FACTORS CONTRIBUTING TO DEPRESSION: Faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems can be many possible causes of depression. It's believed that several of these forces interact to bring on depression. Chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Many chemicals are involved, working both inside and outside nerve cells. Researchers have learned much about the biology of depression and have identified genes that make individuals more vulnerable to low moods and influence how an individual responds to drug therapy. These discoveries should lead to better, more individualized treatment in the future. (Source:

ADDITIONAL BREAKTHROUGH TREATMENT: Ketamine does not target neurotransmitters like serotonin, norepinephrine or dopamine like traditional antidepressants. Researchers believe that ketamine stimulates a broad set of receptors in the brain, which in turn facilitates a process called synaptic neuroplasticity. Neuroplasticity allows the brain to grow and change and is directly linked to the improvement of depressive symptoms. Cristina Cusin, MD, Massachusetts General Hospital found that between 60 to 70% of patients with treatment-resistant depression responded positively to treatment. Carlos Zarate, MD, Chief of Experimental Therapeutics at the National Institute of Mental Health, calls IV-ketamine treatment a "paradigm shift" for the field of psychiatry. Its fast effect has the potential to help those with the most severe forms of treatmentresistant depression and is also known to help eliminate suicidal thoughts. (Source: