— Depression lifted from Nick O’Madden’s life like a set
of foggy glasses being wiped clean.
this summer, O’Madden, 31, felt he was living in a
distracted haze, sprinkled with nighttime panic attacks. Now,
after undergoing an emerging high-tech treatment involving
magnetic currents, he said he’s literally seeing the world
in a new light.
are brighter," said O’Madden, a mental health therapist
who lives in Elk Grove, Calif. "Last night, I was looking
at the moon, and it just looked clearer and brighter and more
beautiful ... It’s almost kind of scary to see that at
first, it’s so new to me."
described the changes from a reclined medical chair at TMS
Health Solutions, a treatment center in Sacramento’s Campus
Commons area that specializes in transcranial magnetic
stimulation. With a metal coil positioned near his forehead,
he spoke between bouts of jackhammer-esque pulsing that
erupted every 15 seconds during the 50-minute session.
"train pulses," as technicians call the strings of
sound, are actually the back-and-forth flexing of the metal
coil as the device sends out a 2-tesla-strong magnetic
current. The coil creates a magnetic field that reaches 2 to 3
centimeters into brain matter to stimulate the dorsal-lateral
prefrontal cortex, the poker chip-sized area responsible for
regulating mood, memory and decision-making.
estimated 7 percent of American adults suffer from clinical
depression, which can cause lethargy, indifference, moodiness
and other symptoms that interfere with day-to-day functioning.
Researchers have found that the prefrontal cortex is often
underactive in people diagnosed with the illness.
technology uses electric currents to excite cell activity in
that part of the brain, theoretically helping neurons better
communicate with one another and increasing blood flow to the
tissue, which promotes healthy brain function. The federal
Food and Drug Administration has approved the treatment, but
for limited use given that it is relatively new. Physicians
can administer it only to patients who haven’t responded to
at least one prescription medication for depression.
of the treatment refer to it as revolutionary; there hasn’t
been a major development in procedure-based depression
treatment since the advent of electroconvulsive therapy.
Unlike that treatment, which applies electricity directly to
the skull to invoke a brain seizure, the magnetic TMS
procedure has not shown negative impact on memory or
other new treatments that focus on physical stimulation of
specific parts of the brain, signal a departure from
traditional methods of treating mental illness, such as talk
therapy and prescription drugs. As advances in medical
technology allow researchers to better understand how the
human brain functions, approaches to treatment are following
a growing recognition, both with scientists and patients, that
depression is a brain problem — a problem with chemicals in
our circuitry," said Dr. Paul Croarkin, a psychiatrist
with the Mayo Clinic. "The fact that we’re soon going
to have more and more offerings in that regard is a positive
many emerging medical treatments, practitioners and insurers
hesitate to embrace new procedures without a solid track
record. Though the FDA approved the nation’s first TMS
device in 2008, major health insurance companies have only
begun covering the treatment in the past few years.
Richard Bermudes is principal owner and medical director of
TMS Health Solutions and president of the nationwide Clinical
TMS Society. By his estimate, about 700 TMS devices are in use
in the United States.
treatment has been the focus of about 30 randomized clinical
trials in the United States, and in most of those, a
statistically significant portion of patients were determined
to have benefited. But some researchers caution that the
improvements could be the result of a placebo effect, and have
called for longer-term studies.
study published in the Journal of Clinical Psychiatry showed
that half of the patients involved in that trial responded to
the treatment within six weeks, and 25 percent went into
remission. Still, guidelines from the Agency for Healthcare
Research and Quality and the Department of Health and Human
Services state that evidence is "insufficient to evaluate
the ability of (repetitive) TMS to maintain response or
upside, the therapy has not been shown to cause whole-body
side effects, such as weight gain or fatigue, as an oral
medication might, said Dr. Guohua Xia, a clinical associate
professor at University of California-Davis and medical
director of Brainefit, a mental health institute offering a
form of TMS services. That means it can be especially helpful
for pregnant women and elderly people who may experience
problems with standard depression drugs.
Health is the only hospital system in Sacramento to offer the
treatment. Dr. Theodore Goodman, director of interventional
psychiatry for Sutter Health, said TMS has resulted in
improvement for about 60 percent of patients during the two
years it has been offered at the Sutter Center for Psychiatry.
expressed frustration at insurance companies not covering the
treatment long term. TMS is currently approved only as a
treatment for acute clinical depression, meaning patients are
in the throes of symptoms.
50 percent of patients will relapse over a year’s
time," he said. "The way you avoid that is
maintenance treatment, but insurance won’t pay for that. It’s
a horribly unenlightened viewpoint."
NeuroStar, the model used at Bermudes’ clinic, was the first
TMS device approved on the market, other brands go even
further into brain matter and have been used to target other
conditions, including migraines.
Health Solutions, the recommended treatment plan is four to
six weeks of daily TMS sessions, at a cost of $5,000 to
$7,000. Since opening clinics in El Dorado Hills, Calif., in
2007 and Sacramento in 2010, Bermudes said, he has used the
technology to treat hundreds of patients and currently sees
about 20 TMS patients a day.
he recently changed the clinic’s name — from Mindful
Health Solutions — specifically to highlight the treatment.
not a lot of access to this modality currently in the
community," he said. "A lot of our patients have
been depressed for years before coming to TMS. If we can get
people into TMS earlier, our remission and response rates may
said that, for him, improvement came after three weeks of
treatment, though technicians say results can take longer.
Before his physician suggested TMS, O’Madden said, he was
having trouble sleeping and focusing, and struggled to control
anxiety and obsessive thought patterns.
he’s now feeling more focused and active, with a renewed
passion for boxing. He recently started a blog to document his
want people to become more aware of (TMS), and I also want
mental health to be less stigmatized," he said. "I
want people to see me as a person: I’m a father and a
husband, but I suffer from a mental health disorder, and I’m
seeking help ... and other people can do the same thing."