The rates of depression in the U.S. have tripled over the last year, with over 25 percent of adults expressing symptoms of depression. While depression was always a leading cause of mental illness and disability, it has become a worsening problem during the COVID-19 pandemic. An increasing number of people are suffering from the symptoms of sadness, loss of interest in pleasurable activities, and impairments in sleep, appetite, energy, and concentration.
At its worst, depression can lead to feelings of hopelessness and suicidal thoughts. Although psychotherapy and antidepressant medications work well for many, there remains a sizable subset of individuals who do not respond well to these treatments and continue to suffer from distressing symptoms of depression. Treatment-resistant depression (TRD) is defined as someone who has not responded to at least two antidepressant medications. Up to one-third of patients with depression may meet this criterion. This growing subset of patients may cycle through many trials of antidepressant medications without finding relief.
For these patients, the answer may not be a pill but instead a powerful magnet. Transcranial magnetic stimulation or TMS is not a new treatment. TMS was first cleared by the FDA in 2008 for treatment-resistant depression and can provide relief when traditional treatments have failed. It later gained indications for migraine (2013), OCD (2018), and smoking cessation (2020). But despite over 13 years as an available treatment, most patients and many doctors are not aware that it exists as a treatment option. Unfortunately, this means TMS is being under-utilized by patients despite widespread coverage by commercial insurance as well as Medicare and VA benefits.
TMS works by applying magnetic pulses to a specified area of the brain called the left dorsolateral prefrontal cortex (DLPFC). This area of the brain is hypoactive or slowed in individuals with depression. The magnetic pulses work to activate the area and stimulate normal brain activity, improving overall brain function and normalizing the production of important neurotransmitters like serotonin. This allows the brain to heal naturally without the need for medications that artificially boost levels of neurochemicals.
TMS holds many advantages over other treatments, including both efficacy and safety. For patients that have not responded to medications, response rates with at least a 50 percent improvement of depressive symptoms are superior to an additional medication trial and approach 70 percent. TMS also has very few side effects, with scalp tenderness and headaches being the most common.
There are no known long-term side effects of TMS, unlike medications that can cause weight gain, gastrointestinal symptoms such as nausea, diarrhea, and sexual side effects.
Individuals who have failed at least two antidepressant medications and a course of psychotherapy are good candidates for TMS if they are still dealing with moderate to severe depressive symptoms. Since most psychiatrists do not perform TMS, it is often necessary to contact a local TMS treatment center to see a psychiatrist specializing in this treatment. This non-invasive, FDA-approved treatment may be the answer for those suffering from treatment-resistant depression.
Heather Luing is a psychiatrist.
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