By Meg Walker, Vitals contributor
Anne* has dealt with depression for much of her life. As a young woman, she was hospitalized a few times for depressive episodes, and once she took an overdose of medication.
Anne remembers that fortunately she was able to call an ambulance and get the help she needed.
“It showed me how serious depression is,” she said, recalling the episode.
Over the years, Anne, in her 60s, has learned how to manage her depression with medication and therapy. But in the last few years, she could tell something was still not right.
“I knew I was depressed, but I didn’t want to try a new round of medication,’’ she said, describing how she became scatterbrained, irritable and fatigued. “Adding another medication would have been an ordeal.”
This spring, after talking with her psychiatrist, Anne decided to try a treatment for depression that she had heard about called Transcranial Magnetic Stimulation (TMS).
What is Transcranial Magnetic Stimulation?
TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. It was approved by the FDA in 2008, and it is typically used when other depression treatments haven’t been effective.
“I’m glad I tried it. It didn’t involve me having to take another drug,” said Anne, who had the treatment in early 2022. “Now I can really enjoy things and be happy. The monkey is off my back.”
The psychiatry department at the Palo Alto Medical Foundation’s San Carlos Center has offered the treatment since 2020 under the leadership of Dr. Noah DeGaetano, a Palo Alto Foundation Medical Group clinician specializing in adult psychiatry. Palo Alto Medical Foundation is part of the not-for-profit Sutter Health integrated network of care. A $150,000 grant from PAMF Philanthropy’s Grants and Disbursement program made it possible to purchase a TMS machine using donor gifts.
About 50 patients have been treated with TMS in PAMF’s San Carlos offices. TMS is also offered at Sutter Center for Psychiatry in Sacramento through the interventional psychiatry department.
Depression is one of the leading causes of disability worldwide, according to the World Health Organization. In addition to affecting the quality of a person’s life, depression can put people at a higher risk for other serious health conditions such as heart disease and diabetes.
“For patients suffering from severe depression, sometimes for years or decades, TMS is an important option to consider,” says Dr. DeGaetano. “For someone who has been depressed for years and has tried all sorts of ways to improve, and then the patient tries this, and the symptoms the patient has experienced for so long, are gone or mild — that is a powerful experience. Patients can start thinking about how to restructure their lives and how to stay well.”
Depression is not a condition that can be cured but it can be managed, though finding the right treatments and therapies can be tricky.
While some patients are effectively treated with anti-depressant medication, psychotherapy, or a combination of these, up to 30 percent of patients don’t respond to these treatments, according to studies of large patient populations.
How TMS Works
During a TMS session, an electromagnetic coil is placed on the patient’s scalp. The electromagnetic coil delivers a magnetic pulse that stimulates nerve cells in the pre-frontal cortex, a region of the brain involved in mood control and depression. The electrical pulses are thought to activate regions of the brain that may have decreased activity in depression.
TMS has several characteristics that benefit patients, Dr. DeGaetano says.
The treatment can be done safely in the office, and a patient can resume normal activities after the treatment. Side effects are few, and studies show that it reduces or relieves symptoms of depression for at least 50 percent of those who undergo TMS.
Dr. DeGaetano says that in the patients he has treated with TMS he has found similar results to large studies that show over half of all patients who receive TMS have a clinical response, meaning they have a significant decrease in depression symptoms. Of the people who have a positive response to TMS, over half improve so much that their symptoms of depression are in remission.
How long the treatment lasts varies from person to person. If a person responds positively to TMS once they are very likely to benefit if they need and have a second treatment, Dr. DeGaetano said.
For a patient, a TMS session lasts 20 to 30 minutes and patients have daily sessions for six weeks. Then the treatment tapers off over three weeks and they may just have the treatment a couple times a week.
Patients say the process is painless and comfortable, though it may take a bit of getting used to.
“It was like a tiny woodpecker pecking on one side of your head and then it takes a break and starts up again,” said Sara*, a patient describing the TMS procedure that she finished in March. “After a few days I got used to it, and it was actually pretty nice. Dr. DeGaetano’s staff would chat with me and play music for me.”
Like other patients, Sara, who is in her 20s, wanted to try TMS because she felt her therapy as well as medications were not stopping the symptoms of depression that she had been having for years.
She often had nightmares about bad experiences, and when things went wrong Sara felt like she wanted to physically punish herself, she said. She found interacting with groups of people could be difficult and performing tasks in school or at work was often challenging.
Sara said she learned coping skills from her therapy, but she had a hard time applying them.
“I wanted to do these skills but there was a brick wall that I just couldn’t get past,” she said.
“I was feeling like I was a lost cause and I wanted to find something that offered hope for people when medications just don’t work,” she said.
Despite her problems with depression, Sara graduated from college and is currently working toward a master’s degree.
Now that she has finished the treatment, Sara says, “I’m definitely happier and I feel a lot better about life. When there is stressful stuff, I can handle it better. The brick wall is beginning to tumble. It takes some effort to climb over it, but it’s now possible.”
*Patients’ names in this article have been changed to protect privacy.
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