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Monday, July 2, 2018

TRANSCRANIAL MAGNETIC STIMULATION

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New procedure for the treatment of depression

Depression has long been a condition discussed within the mental health field, and more recently it has been the subject of headlines as the public grapples with understanding the sometimes devastating effects this illness can have in its most severe form. Within the conversation, one of the most important facts about depression is this: It is treatable. Practitioners, physicians, therapists and research will echo many of the same sentiments: that medication, psychotherapy or a combination of both can be effective for many people. There are those remaining, however, who don’t always respond to these traditional forms of intervention and treatment. This was a defining reason for Dr. Jason Broussard, D.O., a boardcertified psychiatrist with Willis-Knighton Health System, to explore transcranial magnetic stimulation (TMS) as an option to help those suffering.

“The field of psychiatry is lagging behind other medical fields when it comes to new treatments and the use of modern technology,” said Broussard. “There really hasn’t been anything new in the treatment of mental illness for the past 30 years or so before TMS arrived. The standard treatment for depression, which is antidepressant medications plus psychotherapy, work well for some people. But there are so many patients out there that fail these treatments and are left to suffer needlessly.”

“A few years ago, I had a young female patient that came to me with a severe episode of depression,” Broussard continued. “I had to hospitalize her twice, and I treated her aggressively with medications and she saw her therapist regularly. Despite everything we tried, I was only able to get very minimal results, not even enough for her to be able to function at work. Her family lived in a major city in another part of the country and became concerned enough that they brought her home to seek a second opinion, which I was supportive of. The psychiatrist there did not make a single medication change and only did one thing differently: He treated her with TMS. She came back to me in full remission and remains in full remission to this day. That motivated me to bring this treatment to our area so that our patients suffering from depression have TMS as an option.”

TMS is a noninvasive procedure in which magnetic fields stimulate nerve cells in the brain to improve symptoms of depression. Broussard explains that by using pulsing magnetic fields that penetrate into the brain, treatment providers can stimulate the brain cells to begin firing electrical signals.

“In depression, we target an area of the brain that is often inactive in depression, which is in the left frontal region,” he said. “By repeatedly stimulating activity in these brain cells, we hope to get these cells to become more active on their own, thus alleviating the symptoms of depression.”

Broussard shared that in 2006, the results from a government-funded trial looking at antidepressant therapy, titled the STAR-D trial, found that there is a population of people with depression who have a diminishing chance of successful treatment with medication.

“While I always recommend therapy as part of patient’s treatment, as with medications it isn’t going to work for everyone,” he said. “For that treatmentresistant population, we need something else. I think this is where TMS comes in as an excellent option. Each of these treatment modalities target the disease in a different way, and often a combination of all three can be very effective.”

At the initial day of treatment, Broussard explains that a coil is placed over an area of the brain called the primary motor cortex (an area of the brain involved with voluntary muscle movement), and a motor thresholds determination is performed. A magnetic pulse is sent in order to determine how strong of a pulse is required to make the patient’s muscles move.

“This [part of the procedure] helps us determine how strong of a pulse we will need later to treat their depression,” he said. “After we have determined how strong of a magnetic pulse is needed for treatment and where the treatment area for that individual patient is, we begin their first treatment. Treatment consists of a series of rapid pulses for four seconds then a rest period. This is done over and over again until the patient has received 3,000 pulses to the treatment area. Treatments are repeated five days a week, for a total of 20-30 treatments, or four to six weeks. One treatment lasts just under 40 minutes.”

Broussard explained that many of the patients that are seeking TMS tend to be experiencing more severe symptoms and have not had any relief from other treatments. His hope, he continued, is that TMS will become more commonly used in the field of psychiatry, and patients will consider this option earlier in their treatment so that it gives them a better chance to respond positively and reduce the amount of time they are suffering from their illness.

“So far, I have been very pleased with the results,” he said. “I have been performing TMS for just over a year, and the vast majority of patients that I have treated have gone into full remission from their depression.”

There is a clearly defined space for TMS in the conversation around how to treat depression and the need for more public awareness around the procedure. Within that public awareness, however, is the overarching need to normalize the topic of mental illness, depression and effective treatment.

“TMS has been proven in multiple research studies to be safe and effective in treating depression in patients that have not done well with medication treatments,” said Broussard. “One of the barriers to this treatment, in my opinion, is that most people have never heard of it. Also, we have always had to fight the stigma of mental illness which keeps people from seeking treatment. I think because of this stigma, people are less likely to undergo a treatment that consists of a procedure as opposed to just taking a pill. My hope is that we can continue to reduce the stigma of mental illness and educate the public that TMS is an excellent option to help them get back what depression has taken away from them.”

– Katie Ho

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