Brain Stimulation for Depression: What You Need to Know About Transcranial Magnetic Stimulation
Randy Pardell, MD, DFAPA
Q: What is Transcranial Magnetic Stimulation?
A: In Transcranial Magnetic Stimulation (TMS), we use MRI-strength magnetic fields to stimulate areas of the brain that are under-functioning in psychiatric disorders, waking them up to improve brain function. For example, our typical TMS protocol stimulates the left frontal lobe — which is the part of the brain involved in planning and other higher cognitive tasks. For those with depression, the frontal lobe underperforms, so we use TMS to stimulate the left side of the brain, thus normalizing frontal lobe performance and improving the cognitive and emotional symptoms of depression. On the other hand, for a patient suffering from anxiety, we can use TMS to encourage inhibitory activity in the right side of the brain, which has a calming impact on areas of the brain that modulate anxiety.
Q: What specifically happens to the brain, following TMS treatment?
A: TMS uses a time-varying magnetic field that gently stimulates the brain electrically. This causes the stimulated nerve cells to fire and subsequently release neurotransmitters and neurotrophic (nerve growth) factors. TMS stimulates the brain’s networks, with circuit-to-circuit effects — going deep into the limbic system and brainstem. Recent studies have shown that TMS causes the brain to grow connections between nerve cells and can increase the brain’s gray matter. In other words, TMS affects both the brain’s structure and function.
Q: What is TMS like, as a patient?
A: TMS is a daily procedure that occurs 5 days a week for 5-6 weeks of treatment. The typical treatment time is approximately 30 minutes. During the treatment session, our technician will place the magnetic coil gently against the patient’s front part of the scalp. Then the TMS Therapy System will deliver rapid series of “pulses” of the magnetic field — usually in 4 second intervals with 10 pulses delivered per second, with a rest interval in between.
The pulses will feel like tapping on the scalp. Most patients find the sensation “different.” Some find it uncomfortable in the first few treatments, but, eventually, TMS is easily accommodated to. We are experienced in making TMS Therapy comfortable, safe and effective. During treatment, our patients relax in our European spa chair. Our private suite offers a serene environment to listen to music, audiobook, watch a movie or your favorite show on TV while undergoing TMS therapy.
Q: How long-lasting are the effects of TMS?
A: The effects are long-lasting: In a recent prospective study of depressed patients successfully treated with TMS who were followed for one year, 85% were still doing well at one-year post treatment. (With a similar treatment group who responded to antidepressant medication, they had a continued response rate at one year closer to 30%.) If patients who received TMS began to fall back into depression, almost all returned to wellness with another, shorter course of TMS treatment.
Q: How effective is TMS compared to other forms of treatment?
A: TMS is a highly effective procedure and is an FDA cleared treatment for depression with minimal side effect burden. Currently, over 270 million people in the US now have TMS as a treatment option under their insurance policies. In a study of our own patients, 72% of our depressed patients responded favorably to TMS, and 57% became completely well. But perhaps the most powerful testimony is that our patients who have struggled with depression for much of their lives now have hope. The despair of failed medication trials is replaced with the alleviation of suffering and an improved quality of life.
Dr. Pardell is the Founder and Medical Director of Riverview Psychiatric Medicine PC and the TMS Center of the Hudson Valley. Recognized by patients and colleagues alike for his groundbreaking work, he was selected as a Castle Connolly/US News and World Report Top Doctor. Additionally, a sought-after lecturer on innovative mental health treatments, Dr. Pardell is an Assistant Professor of Clinical Medicine at Eastern Virginia Medical School. Dr. Pardell obtained his undergraduate degree from the University of Pennsylvania—receiving Magna Cum Laude honors and election to Phi Beta Kappa. He then received his Medical Degree, with honors, from New York University School of Medicine. Dr. Pardell completed his Residency in Psychiatry at St. Luke’s-Roosevelt Hospital, where he served as Chief Resident.
Riverview Psychiatric Medicine, PC
370 Violet Avenue
Poughkeepsie, New York 12601
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