TMS Offers Different Hope Than Past Depression Treatments
Daniel Finney has struggled with depression for nearly two decades. In that time, his doctors prescribed the two stalwarts in the depression treatment stable: talk therapy and prescription drugs. When he went through a major depressive episode earlier this year, however, his doctor suggested transcranial magnetic stimulation.
"The type of treatment that I am using was approved in 2013 so it's very new and I was kind of afraid it was hokum. If not hokum, it'd be the kind of thing that would have minimal effects. It wouldn't hurt, but it wouldn't help, and it'd just be an expense to insurance and myself," says Finney.
After a month of doing it five times a week, he found a better disposition than he'd had in ages.
"Now I feel fairly strong. I feel on the verge of, if not--I would never use the word 'cured' because that's not how this disorder works. But I feel on the verge of remission."
The promise of TMS lies in its uniqueness, says Dr. Jimmy Potash, head of psychiatry at the University of Iowa Hospitals and Clinics. While there are nearly 25 prescription drugs for depression on the market currently, most of them work in just a handful of ways.
"Part of the problem is that those drugs all seem to operate in fairly similar ways, that is, we think all of them mostly operate through influencing those two neurotransmitters I mentioned earlier--seratonin and norepinephrine," says Potash.
Most of those drugs were created in the 70s and 80s. New developments have been largely regulated to what Potash calls 'me-too' drugs, pills that work in similar ways to previous treatments.
"What we have not had, unfortunately, until very recently, are treatments that seem to work through entirely different avenues, entirely different mechanisms. Part of the reason we're so excited about some of these new treatments like transcranial magnetic stimulation is they seem to be doing something very different than these old drugs."
TMS works by sending magnetic pulses through the skull, targeted at the limbic system, which plays a large hand in controlling mood. This is similar to electroconvulsive therapy, or ECT, in that it focuses on the electrical, instead of the chemical, processes of the brain.
"TMS is, in some ways, a relative of ECT, in that it's trying to do something similar. It's trying to change the electrical patterns in the brain as a way of treating depression. [...] It's much less invasive. ECT is sort of like getting minor surgery. It's a big deal to administer it."
While ECT is one of the most effective treatments for depression, the fact that it necessitates anesthesia creates a major barrier for its use.
"TMS is much more low-key in that you're wide awake, you don't have to be put to sleep. You sort of lie back and something gets put on the side of your head, almost like holding a blow dryer to someone's head and you get this magnetic wave sent into your brain. You don't even necessarily know anything's happening."
On this edition of Talk of Iowa, Charity Nebbe talks with Dr. Potash and Finney about recent developments in depression science.