ó A machine that sends magnetic pulses into a patientís
brain has become the new frontier of depression treatment,
promising to ease symptoms for those who have found little
relief from medication or talk therapy.
treatment, known as transcranial magnetic stimulation, or TMS,
is part of a wave of technologies that attempt to jolt the
brain back to health. It caught on quickly after the Food and
Drug Administration approved its use six years ago, and more
than 25 Chicago-area hospitals and psychiatrists now use TMS
some have questioned the technologyís effectiveness, more
insurance companies are starting to cover it, helping with a
price tag that can reach $10,000 for six weeks of treatment.
this does is raises (your mood) up to normal," a
55-year-old woman from the western suburbs said after
finishing a treatment session at Linden Oaks at Edward in
Naperville. "You can operate."
brain therapies have been around for decades, the best known
being electroconvulsive therapy, a technique that uses an
electric current to cause a seizure. It was portrayed as a
mind-erasing menace in the movie "One Flew Over the
Cuckooís Nest," though psychiatrists say the procedure
is safe today.
methods use implanted devices to send electrical pulses to the
vagus nerve ó a transmission line that carries messages to
the brainís mood center ó or to the brain itself. Some
studies have found that these techniques help to elevate the
moods of people with severe depression.
George, a South Carolina psychiatrist who edits the medical
journal Brain Stimulation, said TMS produces similar effects
without the need for surgery.
patient sits in a chair that resembles something from a
dentistís office as a device containing the magnetic coil is
placed on his head. When itís activated, George said,
magnetic pulses penetrate the skull and stimulate nerve cells
ó the Linden Oaks patient described the sensation as
"having a woodpecker sitting on your head" ó
provoking a therapeutic response.
acknowledged that the technology doesnít work for everyone.
Early studies, which relied on subjects who had been taken off
their medications, found that only about 15 percent saw their
depressive symptoms go away.
later research that allowed subjects to stay on their meds,
which George called a more true-to-life test, found that 40
percent had complete relief from their symptoms, while 60
percent got at least somewhat better.
not as effective as electroconvulsive therapy, which has full
remission rates of around 60 percent, but George said that
treatment requires patients to be anesthetized and is known to
cause memory and cognitive problems in some.
contrast, requires no sedation, and its biggest complication
appears to be discomfort where the magnets are placed on the
a highly effective treatment and has only trivial side
effects," said Dr. Jesse Viner, medical director at north
suburban Evanstonís Yellowbrick psychiatric health care
center. "Thereís no persistent adverse effect. You can
have a little bit of a headache or facial pain, but that
quickly subsides, and in our experience, by the time people
have their third or fourth treatment, theyíre OK."
effectiveness of TMS came into question in 2007 when the FDA
was considering its use as a depression treatment. The
Washington-based advocacy group Public Citizen, which often
tangles with the agency over what it considers lax standards
for medical devices, claimed the study the FDA relied on was
at first showed that TMS was not significantly superior to a
"sham treatment" that didnít subject patients to
the magnetic pulses, the group said: Better results from TMS
were evident only when some subjects were removed from the
trial, and even then the difference was small.
more, the group said, patients receiving TMS knew they were
getting something because unlike the sham treatment, the
pulses produced a painful sensation.
the small differences we were seeing, that could have been
explained by the placebo effect," said Dr. Michael Carome,
director of Public Citizenís health research group.
David Brock of Neuronetics, the Pennsylvania-based company
that sought FDA approval for its TMS machines, pointed to a
rebuttal by the studyís authors that defended their
methodology and cited the improvement made by patients who
received the treatment. Subsequent research, Brock said, has
further demonstrated the effectiveness of the technology.
decided to allow TMS as a depression treatment, and many
Medicare contractors have since covered the service. Though
private insurance companies remain split, with companies such
as Blue Cross and Blue Shield of Illinois paying for TMS and
others declining to do so, more than 100 million people now
have coverage for the treatment, Brock said
encouraged more health care providers to invest in the
machines, which doctors said cost $75,000 to $90,000. But Dr.
Rad Gharavi, a suburban Oak Park psychiatrist who has offered
the service for four years, said insurance problems remain.
begins only after a patient has failed to get better after
trying antidepressants. Gharavi said that can force patients
to endure the side effects of medications for months.
means we are essentially delaying treatment," he said.
"TMS can literally take away all the symptoms in six
more complicated than that for the Linden Oaks patient, who
has dealt with depression since she was a teenager. She first
received the treatment four years ago but comes for follow-up
treatments every three months or so when she "can feel
the beast creeping up," she said.
apparently very individualized," she said. "Thereís
been a bit of fine-tuning in terms of knowing when to come
back for a booster."
Philip Janicak, a psychiatrist who has researched and
performed TMS and is now helping Linden Oaks set up its
program, said a recent study to which he contributed found
that, generally speaking, the effects of the treatment last
for a year.
now firmly established as a depression treatment, Janicak said
research is turning to other possible uses, from migraines to
Parkinsonís disease to post-traumatic stress disorder.
see us really at the opening of this era," he said.
"Thereís a lot of things we can do with this technology
to help people, and weíre just starting to touch the surface
of it with depression."