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Category: Depression

How Deep TMS Can Treat Depression

Is Transcranial Magnetic Stimulation Safe?

Transcranial magnetic stimulation (TMS) is a treatment for depression that has been revolutionizing the field of clinical psychiatry.

The U.S. FDA approved TMS for the treatment of depression in 2008, with great success following. It is especially helpful for those who do not respond to antidepressants and people who wish to avoid the side effects frequently caused by medications. TMS treatments occur on weekdays and usually include six weeks of non-invasive, in-office treatments that take less than an hour each day, five days each week for approximately 30 treatments. These treatments are associated with few minor side effects, making dTMS a very safe option.

Dr. Handoo offers Deep TMS (dTMS) for patients at Interpersonal Psychiatry.

About dTMS

Transcranial magnetic stimulation is a non-invasive method of stimulating neuromuscular tissue using strong, time-varying magnetic fields to induce electrical currents. These can stimulate the cortex, spinal roots, and peripheral nerves. Instead of using invasive electrical currents like in electroconvulsive therapy (ECT), the magnetic pulses from TMS are similar in strength to those emitted during a typical MRI. The pulses are directed toward the brain’s prefrontal cortex to change the magnetic field and stimulate neurons within the mood center, known as the limbic system. This mitigates depression in the near term, with multiple sessions promoting long-lasting relief.

There are a few different ways TMS can be delivered. One distinction refers to the frequency of magnetic stimulation or pulses, while the other refers primarily to the penetrative ability. The frequencies are either single-pulse, paired-pulse, or repetitive (which is commonly seen as rTMS). However, the depth of stimulation is the most important factor to consider when choosing your treatment. 

While rTMS can directly stimulate brain areas roughly one centimeter below the skull, dTMS has the ability to stimulate brain regions up to 4 centimeters beyond the skull. Herein lies its power. While both therapies target the dorsolateral prefrontal cortex (DLPFC), dTMS has proven especially effective in stimulating the DLPFC and providing relief from depressive symptoms. Research has demonstrated that this brain region plays an important role in mood regulation. Specifically, the DLPFC is considered a central component of negative thoughts and beliefs that are characteristic of depression.

Deep TMS achieves this with a novel electrical coil applied to the scalp. According to Brainsway, developer of dTMS: “Standard rTMS uses a figure-8 coil, while deep TMS uses a patented H-coil held inside a padded helmet. While the magnetic pulses activated by standard rTMS only reach a depth of 0.7cm, deep TMS’s technology manages to reach a significant sub-threshold of 1.25” (3.2cm). This is shown in a Brain Stimulation study from 2014. Deep TMS also utilizes a significantly wider field of stimulation compared to that of standard rTMS.”

Benefits of dTMS

  • Effective for treatment-resistant depression — those not helped by antidepressants often see quick improvement
  • No drug side effects — no reported nausea, weight gain, dry mouth, or decreased sex drive
  • Long-lasting – many patients find their depressive symptoms have subsided after about six weeks of treatment, with some requiring ongoing sessions
  • Non-invasive — no anesthesia, electrodes, or electrical current used
  • Simple, in-office — administered by a technician, and the patient can drive home afterward

What Does a dTMS Session Look Like?

TMS treatment is performed in a doctor’s office while the patient is fully awake and seated in a comfortable chair. Because the magnetic pulses make a sound similar to that of a woodpecker, earplugs are provided. The TMS device is then placed in the proper position on the head, and the magnetic pulses are delivered. The process takes 19 minutes per deep TMS session.

Dr. Handoo administers deep TMS (Transcranial magnetic stimulation for patients in Suite 329 at Interpersonal Psychiatry.

It is relatively simple:

  • The patient takes a seat
  • The device is placed on the head
  • Pulses are delivered for a short time
  • Patient returns to daily activities

Final Thoughts

For those with treatment-resistant depression or those hoping to avoid the side effects and uncertainty of antidepressants, which can take up to four weeks to show any signs of effectiveness if they work at all, dTMS is an innovative and well-tested solution. The process is safe and effective and requires little of the participant. If you are ready to take back control of your life, dTMS may be the right treatment for you. 

Dr. Handoo can walk you through everything you need to know to make a well-informed decision and find relief from these symptoms in a safe and welcoming environment.

Ketamine Treatments

Ketamine is something that is well-known to many. In some cases, ketamine has gotten a bad reputation. Just like any other medication, some people choose to misuse them, however, this shouldn’t outweigh the good that they can do over the bad. 

When it comes to examining ketamine, there has been a recent breakthrough that suggests that Ketamine Treatments and help with treatment-resistant depression. This is a much-welcomed breakthrough that according to Dr Thomas Insel, the former director of the National Institutes of Mental Health is “perhaps the most important breakthrough in antidepressant treatment in decades,”.

There have been numerous clinical trials that have shown that Ketamine can help significantly with patients who suffer from suicidal thoughts and severe depressive symptoms where another medical treatment has failed. Ketamine treatments have now been used extensively all across the United States for over the past 15 years to help with depression. 

There are currently 2 different ways to administer ketamine–IV ketamine treatments, and intranasal ketamine (Spravato), which was FDA approved in 2019.

There have been studies to show that Ketamine produces a sustained and rapid reduction in severe depression symptoms and is usually given as a single intravenous infusion over a 40 minute period. It has been shown that it helps by blocking NMDA receptors for glutamate, a different mechanism from most modern antidepressants that work on other target areas. 

When going through treatment the majority of patients recover within 30 minutes then head home, driven by a family member or friend. You can’t drive on the day of treatment. On average patients have 6 infusions, and many notice a dramatic difference after just 2-3 treatments. 

Depression is one of the most common mental illnesses

Major depression is one of the most common mental illnesses facing people worldwide and for those who don’t like to take medications, it can be a battle to find something that alleviates symptoms. Sometimes people who take medications regularly as well as therapy, still find that their symptoms persist. When quality of life is diminished, it is time to make a stand. 

There are however, some modern and alternative methods of treatment that can offer hope today and one of those is TMS otherwise known as Transcranial Magnetic Stimulation. This is an innovative approach that has been pioneered over the past few years and it is becoming a benefit form of treatment for depression. It works as a therapeutic approach to depression that uses magnetic devices to stimulate nerves in regions of the brain. It is often used when the other forms of treatment have failed. 

TMS sends a series of magnetic pulses to a patient’s brain, repeatedly over the space of a thirty minute session. It does not require anesthesia, it rarely reports any type of side effects, and the results can be felt immediately. However, most patients require a few months worth of treatment before they begin to feel a real change in their mindset. Although this treatment is only in its infancy, there is growing evidence that suggests that TMS can be beneficial and useful among a plethora of conditions, including bipolar and PTSD. It’s important for anyone suffering with long term mental health problems, to consider all options for a healthier future.