Transcranial Magnetic Stimulation Is A Mild And Effective Treatment For Depression
If medications havent adequately treated your depression symptoms, and you are considering ECT, its important to know that there are other options. Transcranial magnetic stimulation is an increasingly popular noninvasive treatment for individuals suffering from severe and treatment-resistant depression.
TMS does not involve anesthesia or seizure induction, and it comes without many of the severe side effects of electro shock therapy. With TMS, there are no electrodes and no convulsions, and you are free to drive yourself home after treatment.
TMS was approved by the US Food and Drug Administration in 2008. While electric shock therapy uses direct currents of electricity to induce seizures, TMS uses a magnetic field to stimulate a region of the brain known as the dorsolateral prefrontal cortex. This region of the brain controls mood regulation and cognitive memory, and is involved in our daily decision-making processes.
A typical TMS session lasts about 20 minutes. For optimal results, most treatment plans require four or five weekly treatments for up to six weeks. Between these individual treatment sessions, patients will note their progress and symptoms , to help their doctors determine if the regimen requires adjustment.
Cost Of Electroconvulsive Therapy
Because ECT is a medical procedure that requires the time, space, and resources of several medical professionals, the treatment is expensive, especially when compared to medication or therapy services. One ECT treatment can cost as much as $1,000, while a year of antidepressant medication costs just a few hundred dollars.7
Even though ECT may seem expensive, there are two important considerations:4,7
- Many insurance companies will pay for all or some of ECT treatment.
- ECT is cost effective when balanced against the cost of being severely depressed with missing work and needing intensive treatment.
A New Method Raises Old Questions
- Brain implant automatically monitors and stimulates neural circuits to treat depression
I just laughed out loud, Sarah said describing the first time doctors stimulated electrodes implanted in her brain. That was the first time I spontaneously laughed and smiled in five years.
Major depressive disorder is a serious, life-risking condition that can be difficult to treat. Sarah had suffered severe depression for years, which was not alleviated by any treatment, including shock therapy. My daily life had become so restricted and impoverished by depression that I felt tortured. Each day I forced myself to resist the suicidal impulses that overtook me several times an hour.
Neurosurgeon Edward Chang and psychiatrist Katherine Scangos and colleagues at UC San Francisco implanted recording electrodes in Sarahs brain in an effort to identify faulty neural circuits that were causing her depression and then attempt to treat it by restoring normal electrical activity in those circuits by stimulating electrodes.
Sarah underwent brain surgery so that her doctors could implant electrodes in ten different places in her brain. Over the next ten days, they monitored electrical activity at these spots and attempted to correlate the neuronal firing patterns with Sarahs self-reported feelings of depression. They noticed that neural oscillations in the gamma band peaked in the amygdala region of her brain at times when her depression symptoms worsened.
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How Is Ect Performed
Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia. Electrodes are placed on the patient’s scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain.
Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time.
ECT is usually given up to three times a week for a total of two to four weeks.
Debunked 4 Myths About Electroconvulsive Therapy For Depression
Electroconvulsive therapy is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression. ECT also can be used to treat other psychiatric issues, such as psychosis and catatonia .
ECT is approved by the U.S. Food and Drug Administration and has been shown to be highly effective, giving some patients full reversal of severe depression symptoms. Overall, ECT is approximately 80 percent effective when a patient is a good candidate. By comparison, about 50 percent of patients respond to antidepressant medication.
ECT is primarily reserved for patients who do not respond to other types of therapy, but in some patients with severe symptoms, failure of other therapies is not a requirement.
Electroconvulsive therapy is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression, and can also be used to treat other psychiatric issues, such as psychosis and catatonia .
While ECT can be incredibly effective, the internet is rampant with misinformation about the therapy. People liken ECT to the outdated treatment in the movie One Flew Over the Cuckoos Nest. But thats simply not the case. Lets discuss ECT and debunk four myths about this advanced therapy.
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What Is Ect And Why Is It Used
ECT is an effective treatment for some types of severe mental illness. It is usually considered when other treatment options, such as psychotherapy or medication, have not been successful or when someone is very unwell and needs urgent treatment.
ECT is given as a course of treatments, typically twice a week for 38 weeks. If you have ECT, it will take place under general anaesthetic. This means that you will be asleep while it happens.
While you are asleep, your brain will be stimulated with short electric pulses. This causes a fit which lasts for less than two minutes. As well as an anaesthetic, you will be given a muscle relaxant which reduces how much your body moves during the fit.
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Mri And Mrs Acquisition And Preprocessing
All the MR studies were performed in a Philips Achieva 3.0 Tesla magnet scanner , equipped with an eight-channel phased-array head coil provided by the manufacturer to obtain three-dimensional anatomical images and proton MR spectroscopy.
Three-dimensional anatomical images
High-resolution anatomical images were obtained using a sagittal T1-weighted three-dimensional fast spoiled gradient sequence. A total of 160 slices were acquired with repetition time=8.1ms echo time=3.7ms flip angle=8°, field of view=240 × 240mm matrix size 256 × 256 pixels, in-plane resolution=0.94 × 0.94mm2 slice thickness=1mm.
Structural MRI data were processed on a Microsoft Windows platform using technical computing software and Statistical Parametric Mapping . First, the images were visually inspected by experienced members of the research team for the presence of any artifacts preventing further analyses. Subsequent image preprocessing was performed at the individual level, and consisted of an initial rigid-body within-subject co-registration to the first scan of the series to ensure good starting estimates.
1H MR spectroscopy
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What Is Transcranial Magnetic Stimulation
While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness. The current is caused by the magnetic field created by an electromagnetic coil that delivers the pulses through the forehead.
Approved by the FDA in 2008 for treatment-resistant depression, TMS works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis. Patients undergoing TMS must be treated four or five times a week for four to six weeks.
Research has shown that TMS produces few side effects and is both safe and effective for medication-resistant depression. However, its effectiveness as currently performed appears to be less than that of ECT.
Stigma As A Barrier To Care
Despite that track record, ECT has been shrouded in stigma, particularly in popular culture through movies such as One Flew Over the Cuckoos Nest, a 1975 film that portrayed a punitive, painful treatment of a patient transferred to a hospital from a prison farm.
Todays treatment is a far cry from the film version. Its usually done on an outpatient basis. Patients receive general anesthesia and a muscle relaxant that puts them to sleep for five minutes and relaxes the body so there is little, if any, movement. Electrodes are placed on the scalp, usually on the right temple and on the top of the head, and low-intensity electrical pulses are administered to trigger a grand mal seizure. Treatments generally are given two or three times a week until the symptoms are in remission.
Seiner noted that todays treatment reflects a lot better understanding of how much stimulus is needed and the best places in the brain to induce a seizure to minimize side effects. The patients are completely asleep, so there is little to no movement when the seizure is induced. We also have better monitoring to make it safer. We have better medications to make it more comfortable. And now its done more often on an outpatient basis, and patients tend to tolerate it pretty well.
Fiction number one is that its painful, stated Seiner. The only mildly painful part for people is when we put a tiny IV in. And occasionally, most often after the first treatment, people have a mild headache.
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Can Tms Help With Other Conditions
TMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatry. There are currently large clinical trials looking at the effectiveness of TMS in conditions such as pediatric depression, bipolar disorder, obsessive-compulsive disorder, smoking cessation, and post-traumatic stress disorder. While promising avenues for research, TMS for these conditions is not yet approved and would be considered “off-label.”
About the Author
Adam P. Stern, MD, Contributor
Can Depression Return If You Stop Treatment
Even when treatment such as ECT, TMS, vagus nerve stimulation, or other alternative therapies is successful, depression can return. Psychotherapy and/or maintenance antidepressant medication can help prevent depression from coming back. Psychotherapy does this by correcting the beliefs, perceptions, and behaviors that contribute to your depression. If you do experience recurring symptoms, don’t hesitate to seek help again.
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Does Depression Look The Same In Everyone
Depression can affect people differently, depending on their age.
Children with depression may be anxious, cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
Older children and teens with depression may get into trouble at school, sulk, be easily frustrated feel restless, or have low self-esteem. They also may have other disorders, such as anxiety and eating disorders, attention-deficit hyperactivity disorder, or substance use disorder. Older children and teens are more likely to experience excessive sleepiness and increased appetite . In adolescence, females begin to experience depression more often than males, likely due to the biological, life cycle, and hormonal factors unique to women.
Younger adults with depression are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, and substance use disorders.
Middle-aged adults with depression may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning awakening. They also may more frequently report having gastrointestinal symptoms such as diarrhea or constipation.
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Is Tms The Same As Shock Therapy
No. Shock therapy induces a seizure which has to be induced under anesthetic and with muscle relaxants memory loss and confusion are common side effects. Patients must be monitored post treatment. TMS used magnets to stimulate the brain there are no drugs involved. Patients may experience a headache or scalp discomfort but are otherwise able to directly resume normal activities.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Recovery TMS website is solely at your own risk.
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What Are The Disadvantages Risks Or Possible Complications Of This Procedure
Though it is extremely effective, ECT does have some disadvantages.
- Theres a risk of memory loss. Most people who undergo ECT have temporary memory loss and confusion. Most people’s confusion clears up quickly, and memory loss usually goes away entirely within a few months. However, some people do have permanent memory problems. Using the right-unilateral electrode placement and shortening the electrical current duration can reduce the risk of this happening.
- Its a medically intensive procedure. Each ECT procedure requires multiple providers with advanced training to be present. That means this treatment is often not available in smaller healthcare facilities and communities.
- This procedure might only have short-term effects. Some people who receive ECT need follow-up treatments. These maintenance procedures may need to happen for weeks or months. Usually, these follow-up treatments can happen once a week or even once every several months. The use of medication along with ECT can help with this.
Electric Shock Treatment Has Serious Potential Side Effects
Typically, electroshock therapy is a last-ditch effort used when all other treatment options have failed to offer symptom relief to those suffering from severe depression, bipolar disorder, schizophrenia, or other serious and debilitating mental illnesses. The current modified procedure for administering electric shock therapy is certainly more humane than earlier variations, however, the treatment still comes with a rather extensive list of long-term and short-term side effects. When faced with these possible side effects, patients are often forced to make hard choices about whether or not electroshock therapy is worth the risk.
Side effects associated with ECT are rare but typically include prolonged seizure, stroke, cardiovascular complications, blood pressure changes, dental damage, physical trauma, and, in some cases, even death.
Cardiovascular complications are rare, but when they occur are a common cause of ECT-related death. Other cardiovascular complications can also occur as a result of electric shock treatment.
Furthermore, a typical ECT regimen will typically involve up to three treatments each week, for multiple weeks. Therefore, memory loss can accumulate quickly, covering vast swaths of time over a short period. Although it is common for individuals to regain these memories in the following days and weeks, even temporary confusion and amnesia can be frustrating and unsettling for many patients.
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What Does Ect Look Like
ECT is a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. When undergoing ECT, patients are asleep and their muscles are completely relaxed. Depending on condition severity, patients often go in for sessions weekly, biweekly, or monthly, and end treatment when in remission.
Shock Therapy: Process Preparation Outcomes And More
Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Shock therapy, known medically as electroconvulsive therapy , is a treatment for major depressive disorder , bipolar disorder, and other psychiatric conditions. ECT is generally offered when other treatments are ineffective or there is a need for rapid response.
ECT has a stigma attached to it from the early days of shock therapy, but the ECT that is available today is very different from what it was like when first administered in 1938.
When ECT was first used, patients would be awake for the procedure and endure a full-body seizure created by an electrical current. In the decades since, scientists and researchers have used the knowledge they have gained about the brain to create a more therapeutic and less traumatic method for treating depression.
Here is an overview of how shock therapy is used today, including what to expect from an ECT session.
Verywell / Danie Drankwalter
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Magnetic Seizure Therapy: A New Treatment For Depression
UT Southwestern is the only clinical trial site in the country using a new form of brain stimulation to treat major depression. Preliminary findings indicate that magnetic seizure therapy can ease depression without the cognitive side effects associated with electroconvulsive therapy.
MST is similar to ECT but uses magnets in place of electrical currents to stimulate the brain. We know that bilateral ECT is superior to MST and unilateral ECT . Preliminary data suggests that right-unilateral ECT and MST are comparable, but MST carries fewer memory-loss symptoms. We are excited about this trial because we hope to, in the future, offer magnetic therapy as an alternative for patients who are concerned about cognitive side effects of ECT.
Another therapy for treatment-resistive depression is repetitive transcranial magnetic stimulation , which does not carry some of the side effects of ECT. While rTMS is not as effective as ECT, there is exciting research in progress that could lead to rTMS becoming a more effective option for patients in the future.
Additionally, the drug ketamine was approved by the FDA in as a therapy for treatment-resistant depression. Ketamine is still being studied for other major depressive disorders clinical studies are currently being conducted at UT Southwestern.
How Electroconvulsive Therapy Works
With ECT, an electrical stimulation is delivered to the brain and causes a seizure. For reasons that doctors don’t completely understand, this seizure helps relieve the symptoms of depression. ECT does not cause any structural damage to the brain.
The procedure itself typically requires a stay in the hospital, although more and more it is being performed on an outpatient basis. During the procedure, you will be put to sleep under general anesthesia. You won’t feel anything. Your doctor will also give you a muscle relaxant. Electrodes will be applied to your scalp and deliver an electric current. This electrical stimulation causes a brief seizure. The seizure is controlled with medications so your body doesn’t move. You will wake up a few minutes later without any memory of the treatment.
The number of required sessions varies. Many people have six to 12 sessions administered 2-3 times per week over a period of several weeks. After initial treatment, you might require further ECT treatments in addition to depression medicine and therapy to prevent your depression from returning.
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