For Those with Depression, TMS Technology Offers New Hope during the Holidays

SACRAMENTO, CA -- By Dr. Richard Bermudes, Sacramento TMS, www.sacramentotms.com.

As meaningful as the approaching holiday season can be, this time of year doesn't necessarily bring comfort and joy to all. The additional stress, planning and often loneliness associated with holiday gatherings and traditions can be especially difficult on people suffering with depression.

The National Alliance on Mental Illness (NAMI) estimates that depression affects 15 million American adults each year, an estimated 5 to 8 percent of the adult population. In the greater Sacramento region, that translates to approximately 90,000 families that will suffer the consequences of the debilitating disease in just this year alone.

Despite the obvious personal impacts to those afflicted, depression carries national economic implications as well. As the leading cause of disability in the United States, depression costs taxpayers tens of billions of dollars each year in lowered productivity and workplace absenteeism.

As a local psychiatrist, I've spent the last 13 years trying to provide relief to patients suffering from symptoms of depression. I've witnessed the devastation the disease can have not only on my patients, but on their loved ones and work associates. It's truly heartbreaking to see the marriages irreparably damaged, jobs lost, children alienated and friendships severed as untreated patients hit rock bottom.

Like many other psychiatrists, my practice treats depression with both traditional antidepressant medication and cognitive behavioral therapy, an effective combination of evidence-based therapies that has led to good results in the majority of patients. And in severe cases, electroconvulsive therapy (ECT) has been found to be quite effective.

Yet, research shows about half the patients seen for depression simply don't respond to these common therapies, or suffer intolerable side affects such as weight gain and sexual problems from medications, or substantial memory loss from ECT. For these patients, I truly feel there's been a serious gap in the treatment options we can offer. Until now.

Transcranial Magnetic Stimulation (TMS) is a cutting edge technology approved by U.S. Federal Drug Administration (FDA) in October 2008 for the treatment of Major Depression. In my own practice, I started providing TMS treatment in March 2010 to several of my patients who weren't finding relief with traditional therapies. I'm here to report many of these patients have experienced amazing, life changing results.

TMS technology consists of a specialized chair, similar to what you find in dentist offices, with an attached magnetic coil that generates a focused magnetic field, about the size of a quarter, onto the patient's scalp. The magnetic field strength, about what a patient would receive in getting an MRI of the brain, is administered in a series of rapid pulses to induce a weak current in the part of the brain responsible for depression.

TMS is an outpatient procedure that is both non-invasive and non-systemic (nothing is ingested or injected). It is administered without anesthesia in the privacy of an office setting. Unlike antidepressants, the therapy has relatively few side effects, the most common including headaches and mild discomfort at the site where magnetic coil touches the scalp. Each treatment takes approximately 40 minutes and the full course of TMS therapy usually consists of five treatments each week over a 4-6 week period.

In Northern California, there are currently clinical TMS treatment facilities in Sacramento, Berkeley, the East Bay and Fresno. There also is a research-based trial being conducted at the University of California, Davis, under the direction of Dr. Guohua Xia, M.D., Ph.D.

As a scientist, I was initially impressed with the clinical trials that showed the effectiveness of TMS. But it's the way my real-world patients have responded that, for me, is significant enough I felt the need to share those results.

One of my patients, a 30 year-old woman named Betsy*, had suffered from depression since her mid 20's. Her depressive symptoms had gotten so severe she was forced to quit her job and had not left her home in over a year. During years of therapy, she had tried four different antidepressant medications -- two had increased her anxiety, and the other two were totally ineffective. She finally resorted to electroconvulsive therapy, which helped her depression, yet caused memory impairment so she discontinued therapy altogether.

In March 2010, Betsy started TMS treatment. After a full course of TMS therapy over a period of 4 weeks, she is experiencing full remission of her depression symptoms for the first time in her adult life. No longer gripped with fatigue, she plans to return to work and to a normal life.

Another one of my patients, a 40 year-old woman named Shelly* had a life-long history of depression. In the spring of 2009, she noticed the symptoms becoming more severe, despite increased medication. She stopped golfing, couldn't get to the store and was having difficulty simply following her normal day to day routine. Like many of those suffering from depression, she completely withdrew from her family and was emotionally out of control. Her psychiatrist recommended a series of electroconvulsive therapy treatments, which she discontinued after suffering memory impairment.

Shelly started TMS in April 2010 and after 30 treatments, her symptoms improved by 50 percent, which is regarded as "significant" improvement in the medical field. She now functions independently throughout the day and has returned to normal activities such as grocery shopping and meeting with friends.

While not all patients may respond to TMS treatment as these two did, the results are undeniably promising. The only downside of TMS therapy I see at this point is the cost to the patient out of pocket -- treatment is generally between $8,000 and $12,000. Many patients report the cost of depression is far greater. Although the treatment is FDA approved and was recently verified in an industry independent National Institutes of Health sponsored study, many insurance companies still consider TMS to be "experimental." However, some companies have already written TMS into their plans. And when insurance coverage is petitioned on a case-by-case basis, 75% of cases that have gone to external appeal have ultimately been covered.

Earlier this year the American Medical Association granted TMS permanent CPT codes. Because of this, we can expect TMS written into most insurance policies in the next few years. It's encouraging to note that despite limited insurance coverage, there are now over 300 TMS centers nationwide helping patients and the number of centers continues to grow.

I recognize it may not be typical, or even appropriate, for a medical professional to publicly sing the praises of new treatment. But after seeing a remarkable difference in patients who had suffered immeasurably, I feel TMS could be the most exciting advancement in the treatment of depression we'll likely see in our lifetime. For patients who feel that devastating hopelessness on a daily basis, this new technology may just provide the glimmer of hope they need to envision a healthy future.

*names changed to protect patient privacy


About Dr. Richard Bermudes
Dr. Richard Bermudes is an associate physician at Mindful Health Solutions and Sacramento TMS. He is a member of The Academy of Cognitive Therapy, the Association for Behavioral and Cognitive Therapies, and The American Psychiatric Association. He has authored articles on cognitive therapy techniques, the metabolic syndrome, medication associated obesity, and is the principle editor of a book published by the American Psychiatric Publishing, Inc. titled A Clinical Guide for Managing Metabolic Abnormalities in the Psychiatrically Ill: What Psychiatrists Need to Know (2007)