What is Magnetic Stimulation Therapy For Depression?
Magnetic Stimulation Therapy or Repetitive Transcranial Magnetic Stimulation (rTMS) is a newer, state-of-the-art, non-invasive, safe and effective treatment for depression, anxiety, bipolar disorder, obsessive-compulsive disorder and other psychiatric disorders. It uses a magnetic field externally on the scalp to stimulate nerve cells in the brain. It was approved by the US-FDA in 2008 for the treatment of resistant depression. It became available in India over five years ago.
How is rTMS administered and how does it work?
An electromagnetic coil is placed against the scalp at a predetermined site. The rTMS device then delivers focused, MRI-strength magnetic pulses to specific areas of the brain. Repeated sessions of rTMS progressively change brain activity, improving depression in some patients.
rTMS is non-invasive and painless and does not require anaesthesia. Individuals can work normally immediately after treatment. No sedation is required, patients are awake and alert during rTMS treatment and can even drive themselves home, or resume work immediately following treatment.
How many sessions of rTMS are needed?
It varies depending on the disorder but in general, daily administration of rTMS for four to six weeks is required. Each treatment session typically lasts between 20 and 30 minutes.
What are the side-effects of rTMS?
rTMS is a very safe treatment. Side-effects are rare if the right protocol is followed. Few patients may experience some discomfort on the scalp for sometime or headaches. These can be treated with analgesics such as paracetamol. A very rare side-effect (less than 1 in 1000 patients) is seizures. A careful pre-treatment assessment and strictly following the right treatment protocol can minimize the risk of seizures.
What are the contraindications for receiving rTMS therapy?
Metal objects in the head and neck region, cardiac pacemakers and implanted medication pumps, orthopedic implants, increased intracranial pressure and serious heart disease. Prior history of seizures, family history of epilepsy and individuals taking medication that might increase the risk of seizures.
Who can benefit from rTMS?
Individuals with the following conditions can benefit significantly from rTMS treatment:
- Major depressive disorder (US-FDA Approved in 2008)
- Bipolar disorder
- Anxiety Disorders: including Post-Traumatic Stress Disorder (PTSD) & Obsessive Compulsive Disorder (OCD)
- Schizophrenia (certain symptoms)
- Eating disorders - Anorexia Nervosa and Bulimia
- Chronic pain
- Parkinson's disease
- Multiple Sclerosis
- Migraine headaches
- Attention Deficit Hyperactivity Disorder
Is a repeat course of rTMS necessary once individuals are better?
Maintenance treatment is usually required for chronic illnesses such as major depression and obsessive compulsive disorder. This can most often be achieved using medication, once the individual is better. Some individuals, however, can benefit from a repeat course of rTMS 6-12 months post-initial treatment; this is usually done after a re-evaluation and discussion of maintenance treatment options.
What are the benefits of rTMS over conventional treatments?
Research studies have shown that the therapeutic effect of rTMS in depression matches the effect produced by antidepressant medication. However, rTMS has a relatively rapid onset of action and the beneficial effects are usually noticeable in the second week of treatment, sometimes earlier. rTMS is especially useful among individuals who do not show a good response to antidepressant medication, who experience significant side-effects from medication, or in whom a rapid response is desirable. rTMS also has very few side-effects. The possibility of achieving remission is greater with the combination of rTMS and antidepressant medication than with conventional medication alone.
How does rTMS compare with ECT?
Electro-convulsive therapy (ECT) requires the administration of anaesthesia and the induction of a seizure. Its efficacy is well documented in the literature. However, the electrical stimulus to the brain is scattered (and not focused on precisely on the targeted brain regions), producing undesirable side effects, such as memory loss. Repetitive Transcranial Magnetic Stimulation (rTMS) does not involve anaesthesia, electric shock or seizure induction. In rTMS treatment, the electromagnetic stimulus is focused on targeted brain areas, avoiding undesirable side-effects such as memory loss, as shown by research.