Antidepressants didn’t help you? Consider thinking outside the prescription pillbox. Consider TMS therapy.
When slogging through the dark funk of depression, it seems that each day—from sunrise to sunset—presents you with a seemingly endless number of challenges. Like getting out of bed in the morning … or at all. Like focusing on your job and trying with all your might to be productive. Like simply conversing with your children. Even the most basic daily activities have become giant hurdles erected by the depression.
If you are like most people who do eventually seek out the help of a doctor, you will be placed on a treatment protocol that relies heavily on the two clinical bulwarks: antidepressant drug therapy and psychotherapy. For decades, this combination has been the routine go-to treatment for helping folks to manage major depressive disorder (MDD). Unfortunately, only about half these patients experience significant relief from the depression symptoms that dog them.
So what does it mean when antidepressants don’t help your depression? This diagnosis is called treatment-resistant major depressive disorder, or TR-MDD, meaning the individual was either unresponsive to the drug or could not tolerate the side effects and had to suspend treatment. For someone suffering from the effects of depression, this situation is both frustrating and disheartening.
Transcranial magnetic stimulation (TMS) offers an alternative, drug-free approach to treating depression. TMS is a safe and effective treatment method that is offering thousands renewed hope to overcome the debilitating depression symptoms and rediscover a better quality of life.
About Major Depressive Disorder
The process of diagnosing MDD begins with identifying the symptoms that have persisted daily for at least a two-week period. The DSM-5 lists specific criteria to assist in the diagnosis of clinical depression, with the threshold being five or more of these symptoms being present. The criteria include:
- Depressed mood most of the day, including tearfulness and feelings of sadness, emptiness, and hopelessness
- Markedly diminished interest in activities that once were pleasurable
- Significant weight loss or weight gain
- Sleeping more than usual or insomnia
- Appearing to others to be agitated or moving slower than usual
- Irritability and angry outbursts
- Feelings of worthlessness or inappropriate guilt
- Trouble with concentration and decision-making
- Obsessive thoughts of death, suicide ideation or attempts
An MDD diagnosis includes other considerations as well, such as whether the symptoms have caused statistically significant distress in social, academic, work or other areas of functioning. The higher the impairment in functioning, the more severe the depression is considered.
What Causes Depression?
Identifying the exact cause of this complex mental health disorder has stumped medical researchers for centuries. Outside of life-altering events, such as loss of a loved one, loss of a job, trauma, such as physical or sexual abuse, divorce, or diagnosis of a major health condition, depression can find its basis in physiology and biology. These factors include hormone levels, family history of depression, personality traits or temperament, and brain chemistry.
When brain chemistry is suspected as the major contributing factor, the first line of treatment is antidepressant drug therapy, prescribed with psychotherapy. Antidepressants, however, have been found to only help about half of the patients with MDD, as was determined in the STAR*D study. Many patients do not experience relief from the depression symptoms and may find the side effects from the drugs intolerable.
Limitations of Antidepressants
Antidepressants are in the class of drugs known as serotonin selective reuptake inhibitors (SSRIs), and have been the gold standard treatment for major depression for three decades now. In many cases, a compound problem is experienced by patients who trial antidepressants. Not only are 50% of patients unable to find relief from symptoms—possibly up to 70% after trialing several different medications—but a wide array of highly unpleasant symptoms are associated with the drugs.
Depression is difficult enough, and being disappointed in the lack of treatment response can lead to a deep sense of despair. In addition, the long list of side effects from the drugs can make antidepressant treatment unbearable. These symptoms may include:
- Weight gain
- Dry mouth
- Nausea and diarrhea
- Blurred vision
- Sexual dysfunction and loss of interest in sex
- Chronic constipation
TMS Therapy for Depression
In 2008 the FDA cleared TMS to treat TR-MDD for patients who had not found relief in the traditional medications and psychotherapy treatments. TMS is a safe, noninvasive therapeutic solution that offers new hope to these patients. TMS does not involve surgery or anesthesia and can be administered in a doctor’s office while the patient is awake.
TMS therapy uses electromagnetic energy to target the region of the brain that is responsible for mood regulation, decision-making, and impulse control, within the left prefrontal cortex. The magnetic pulses, which are about the same strength as an MRI, are delivered through a coil placed over the scalp and into the brain, where they induce an electrical current. This current stimulates the neurotransmitters that have been functioning at a diminished capacity, resulting in a rebalancing of the brain chemistry, such as dopamine, serotonin, and norepinephrine, which regulate mood. This results in relieving the symptoms related to depression over the course of treatment.
Effectiveness of TMS Treatment for Depression
For TR-MDD patients promising clinical results for TMS offer newfound hope. Trial results over the past decade have continued to demonstrate the effectiveness of TMS treatment for depression, providing statistically significant improvements in symptoms. A meta-analysis of several TMS clinical trials highlights several examples:
- One multicenter clinical trial spanned 16 weeks and enrolled 230 subjects with TR-MDD. The study took place in 22 medical centers located in the U.S., Europe, Canada, and Israel and sought to evaluate the efficacy and safety of TMS in its subjects. This double-blind placebo-controlled study demonstrated a significant reduction in the MDD symptoms, with a 32.6% remission rate and a 38.4% response rate.
- Another study followed 307 patients with TR-MDD. The study revealed that 264 of these patients (62%) achieved significant improvement in their symptoms, with 41% reporting complete remission. Following the patients for one year (with some patients using concurrent medication and some receiving maintenance TMS sessions as needed), 68% of the study participants had achieved symptomatic relief, and 45% attained complete remission.
- Another study out of Rush University Medical Center in Chicago, Illinois involved 301 patients who suffered from MDD who were randomly assigned to receive either TMS or a sham therapy over a six-week period. The results confirmed a positive treatment result for a majority of the patients, with a low relapse rate.
How Safe is TMS?
A multitude of clinical studies have proven that TMS is safe and well tolerated with few, if any, side effects. Without the need for anesthesia, the associated risks are absent. The few side effects that have been reported tend to be transient and dissipate as the TMS sessions continue over the 4-6 weeks. These adverse effects include:
- Mild to moderate headache. Headaches are the most common of the side effects reported from TMS.
- Discomfort over scalp region. Some patients report scalp irritation where the coil was placed during the procedure. Most describe this side effect as mild to moderate in intensity.
- Lightheadedness. Sometimes lightheadedness accompanies the dizziness and mild headache. As is with the other side effects, lightheadedness resolves shortly following the TMS therapy session.
- Tingling sensation. A few patients have reported a tingling sensation in the head during the therapy session. Tingling is mild and subsides following the TMS session.
- Dizziness. Feelings of dizziness have been reported following a TMS session. In most cases, the dizziness dissipates soon after the session.
If a patient does experience side effects due to a TMS session, they tend to be more noticeable during the first two weeks of treatment, and then start to subside. It is rare for side effects to linger throughout the extent of the treatment period. Because the benefits of TMS therapy outweigh the minimal adverse effects, few patients will suspend treatment due to these discomforts.
Other Alternative Therapies that Help With Depression
TMS therapy is just one alternative therapy for treating depression. When antidepressants do not offer relief, in addition to TMS there are other therapies that can be effective in relieving depression symptoms. Other alternative depression treatments include:
- Exercise. Physical activity has a powerful effect on mood by the release of certain brain hormones called endorphins, as well as producing dopamine, norepinephrine, and serotonin.
- Nutrition. Certain foods boost levels of serotonin, a mood-enhancing brain chemical. These include fish high in omega-3 fatty acids, lean proteins, healthy fats such as nuts and seeds.
- Sunlight. Exposure to sunlight increases vitamin D levels, which in turn boost mood. For regions that have little sunlight, a therapeutic light box can help improve depression symptoms.
- Supplements. A nutritionist can suggest certain mood-enhancing supplements once any potential drug interactions (with other medications) are eliminated. These supplements include St. John’s Wort, vitamin B, SAMe, L-Theanine, 5-HTP, and Omega-3.
- Limiting caffeine, which reduces serotonin levels, and alcohol, which is a depressant
- Holistic activities. Certain holistic therapeutic activities can promote overall relaxation and centeredness, which can positively impact mood. These include yoga, mindfulness, prayer or meditation, journaling, guided imagery, acupuncture, aromatherapy, and massage therapy.
TMS Therapy Near Me Online Locator Resources
TMS Therapy Near Me offers useful information about the effectiveness of TMS treatment for depression, and is a handy tool for locating expert TMS therapy providers. Why not explore the possibility that TMS therapy offers for treating your TR-MDD? Use our portal to reach out to the team for a referral in your area.