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Magnetic brain stimulation helps treat depression

Edward Fruitman No Comments

Atlanta Business Chronicle by Urvaksh Karkaria, Staff Writer

Date: Friday, October 26, 2012, 9:41am EDT – Last Modified: Friday, October 26, 2012, 10:30am EDT
Magnetic stimulation helps to treat depression
ACBJ file photo

While powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression, those receiving the treatment did not report effects on sleep or arousal commonly seen with antidepressant medications,Georgia Health Sciences University researchers say.

Staff Writer- Atlanta Business Chronicle
While powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression, those receiving the treatment did not report effects on sleep or arousal commonly seen with antidepressant medications, Georgia Health Sciences University researchers say.

The finding resulted from a secondary analysis of a study of 301 patients at 23 sites comparing the anti-depressive effects of the Neuronetics Transcranial Magnetic Stimulation (TMS) Therapy System to placebo treatment in patients resistant to antidepressant medications.

TMS sessions were given for 40 minutes, five days a week for six weeks. Initial findings were the primary evidence in the Food and Drug Administration’s approval of TMS for depression. The secondary review reaffirmed TMS’s effectiveness in depression but revealed no differences in rates of insomnia or sleepiness among those who got actual and placebo therapy. Patients in the treatment group were also no more likely to request medication for insomnia or anxiety.

Sleep problems are a common side effect of major antidepressants: some drugs sedate patients while others stimulate them and increase insomnia. Insomnia occurs in 50-90 percent of patients with major depressive disorder. Other depressed patients complain they sleep too much. The good news is that TMS does not contribute to insomnia or oversleeping.

TMS targets the prefrontal cortex of the brain, involved in mood regulation as well as other higher-order functions like planning, evaluating and decision-making. In this procedure, patients sit in a recliner and receive brief pulses of a MRI strength magnet held against the front of the head. The magnetic energy of TMS causes the brain cells closest to the surface of the brain to increase their activity which in turn influences the activity of the brain as a whole.

Major Depressive Disorder affects about 14.8 million, or about 6.7 percent of American adults in a given year, according to the National Institute of Mental Health. It’s the leading cause of disability in ages 15 to 44.

Urvaksh Karkaria covers Technology and Health Care

Brain therapy offers hope for treatment-resistant depression.

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Transcranial Magnetic Stimulation offers hope for treatment-resistant depression.

By Cindy Sutter Camera Staff Writer
Posted:   10/23/2012 09:55:26 AM MDT

TMS in Media by Trifecta Health NYCShe was driving to Boulder after spending the summer at her family’s place in the mountains. What should have been a busy and exciting time, returning to town for her young son to start school instead put the 50-year-old woman on the precipice of disaster — literally.

“I was looking for a place to drive off a cliff,” she says. “I cried all the way home.”

What saved her that day in her severe depression was that one of the family’s two dogs was in the car with her and she didn’t want the dog to die.

What she hopes will save her in the long run is a treatment called Transcranial Magnetic Stimulation, an FDA-approved therapy for treatment-resistant clinical depression in which doctors use a mild electric pulse to stimulate the brain. The therapy, unlike electroconvulsive therapy, once known as electroshock therapy, uses a mild current no stronger than the type used for MRI testing. Unlike ECT, which causes a seizure and requires hospitalization and anesthesia, TMS is done in a doctor’s office in a series 20 to 30 treatments, each lasting about 40 minutes and administered five days a week. The treatment also does not cause cognitive deficits such as memory loss.

Dr. Richard Suddath, who with his partner Dr. Earle Shugerman, owns Boulder Center for TMS in Boulder says they have found TMS effective for many of the roughly 40 patients they’ve treated, since they purchased the TMS machine about a year and a half ago.

“I think it is dramatic,” Suddath says of the results they have seen in some patients. “We have gradually become more confident in its ability to treat some patients who have treatment-resistant depression.”

The Food and Drug Administration approved TMS for patients who have failed in one or more course of treatments with antidepressants, which generally means at least two months of treatment at the therapeutic dose without improvement, Suddath says. In his practice, however, the number of drugs that failed to have an effect is often much higher.

“In most patients, we have seen more than 10 different medications (used) and they’ve been treated for more than a decade,” he says. “Some have even had ECT in the past.”

Thus, the results they have seen with the treatment have been very encouraging, he says.

“We have tended to divide it into thirds,” Suddath says. “A third have had a fairly dramatic improvement. Several have said it’s the best they’ve felt in five or 10 years. “Another third feel 50 percent better with significant improvement.”

Of the final third, about half have had some improvement and the rest experienced minimal benefits.

More than 30 studies back up the efficacy of the treatment for some patients who have not responded to antidepressants. A study reported in Science Daily and published online in June 2012 in Depression and Anxiety, looked at 307 patients in 42 clinics across the United States and found a 58 percent positive response to the therapy and a 37 percent remission rate.

A course of treatment typically costs $8,000 to $12,000. Currently, however, many insurance companies do not cover the procedure, although an increasing number do, Suddath says.

Back from the cliff

The 50-year-old Boulder woman who considered taking her life experienced a striking improvement after years of battling depression.

“My suicidal thoughts were gone after the first 48 hours,” says the woman who asked that her name not be used because of the lingering stigma of mental illness.

Her depression began after the birth of her son in her mid-40s, although the seeds of it were likely sown years before. She grew up in a physically abusive family, which she describes as “full of uncertainty,” and when she was in her 30s she had a serious cycling accident in which she lost consciousness. She believes that her fitness activities — running and cycling — may have helped control or mask her depression, but that when she curtailed activity to take care of her new baby, the depression came crashing down.

“All of a sudden I didn’t know what to do. You don’t recognize you’re depressed,” she says.

But her husband noticed her extreme mood swings and inability to concentrate, which were at levels way beyond those typical for a post-partum woman. She began also to feel anxious. Simply taking her child out of the house was overwhelming.

“It’s a matter of I have to get in the shower. I have to figure out what I’m going to wear. I have to pack up the baby’s bag. I have to get the baby in the car. I have to take the baby out of the car,” she says.

She went for cognitive therapy and was prescribed medication and saw some improvement. During that period, the family moved a couple of times.

“It seemed like every time we moved and lost that stability, I would go a layer deeper,” she says.

She was hospitalized for two months in 2009.

“I had to leave my little son,” she says. “It was the most horrific experience I’ve ever had. You’re locked up. Even though it’s voluntary, you’re locked into a facility.”

Doctors tried several medications without any or only temporary benefits. The family lived for awhile on the East Coast, where she had a constant migraine that would not go away. She felt hopeful coming back to Colorado.

“I thought I would pull myself out of it,” she says.

But the depression continued and led her to that desperate drive and finally to the therapy that she hopes will keep her depression in remission.

The treatments are generally done on the left side of the brain with the pulse reaching about 3 centimeters below the brain’s cortex to activate parts of the brain thought to be inactive in patients with depression. She has also received “off label” treatments on the right side of the brain, which she says help with anxiety. She is now on a maintenance dose of treatments about once a month.

She hopes insurance companies will eventually cover the treatment.

“This treatment works,” she says. “It’s not experimental. Insurance companies need to help. Otherwise people are going to take their own life. Marriages are going to break up. Children are going to lose parents. Parents are going to lose children. I want people to know there is an answer.”

‘Feeling very hopeful’

For a 39-year-old Denver woman, her first experience with depression came in her teens — with a year and a half of difficulty functioning and frequent crying. At the time, she and her parents chalked it up to teenage blues, an idea reinforced when the depression lifted before her senior year.

A shorter episode hit her in college. Then, when she was about 25, the depression returned.

“I went to see a therapist for the first time,” she says. “I was in therapy for about a year and made some major life changes, going back to school and moving.”

In grad school she again became depressed, but attributed it to the misery of writing her thesis.

In her early 30s, she experienced one of her worst episodes.

“I kept going to work, but I had to keep my office door closed, because I was crying all the time,” she says. “I sought therapy again. It was the first time anyone said to me, ‘I think you need to see a doctor.'”

She did, and was prescribed antidepressants. Her mood improved. She decided to make more lifestyle changes, taking a job in Colorado with its sunshine and wealth of outdoor activities.

However, as it turned out, she had bipolar disorder with severe depression and mild mania. The antidepressant made the mania worse, leading her to become extremely angry and irritable, alternating with severe depression, crying and suicidal thoughts.

She was hospitalized.

“It took a little while to sink in,” she says. “It made me understand the seriousness of what I was dealing with. I wasn’t able to take one pill and pretend that everything was OK. It was going to require an investment of time to find the right treatment and keep myself well.”

After nine months, she found another medication that seemed to work, but it began to fail, and she fell back to her pattern of suicidal thoughts and crying. Her mother came and stayed with her for two months to help keep her safe.

She tried to work, starting back several times, but not being able to do it.

“Each time, I realized I wasn’t stable enough. That was really hard for me. I get a lot of self worth out of being productive,” she says.

She began to get better and started volunteering and found another job in 2009.

At the end of 2011, her father died of pancreatic cancer, and she began to unravel again under the strain and the grief.

She began researching TMS and began treatment, while also taking a mood stabilizer.

Although many patients are not bothered by the treatments, which feel like tapping, she says they are somewhat painful.

“It feels like a little woodpecker sitting on your ear and tapping into your brain,” she says. “I was able to tolerate it. The discomfort stops as soon as the treatment stops.”

She really began to feel it was worth it about three weeks into treatment.

“The first point was everybody started to say to me that they thought I seemed better,” she says. “I was so afraid to hope that I might actually be feeling better. (Then) I noticed I wasn’t having suicidal thoughts anymore. I wanted to be around people.”

She completed her last treatment a couple of weeks ago.

“I’m feeling very hopeful that the improvements are going to last,” she says. “I can start to make plans. (I can) go back to work and not worry about having to disappear again, start to be social again and get out there to meet new people.”

Innovative science to treat depression

Edward Fruitman No Comments

By NICK WILLIAMS — nwilliams@bradenton.com

Published: October 16, 2012

Lakewood Ranch psychiatrist Mark Sylvester is standing on the front line of depression treatment.

As a psychiatrist for Comprehensive MedPsych Systems Inc., a private Sarasota-based behavioral medicine group, Sylvester and his colleagues are using an innovative system that is slowly gaining nationwide recognition.

In 2008, the U.S. Food and Drug Administration approved the use of NeuroStar Transcranial Magnetic Stimulation, a non-drug treatment solution that uses magnetic field pulses, similar to those used during MRI examinations, to increase activity in parts of the brain that control emotional regulation. The system was manufactured by Pennsylvania-based Neuronetics.

In July, Comprehensive MedPsych opened a branch

in Lakewood Ranch. The office features a NeuroStar machine. Sylvester studied medicine at the University of Florida and used the NeuroStar during his residency training. The machine is also being used at some of the top psychiatric hospitals in the country, such as Johns Hopkins and the Mayo Clinic.

The system is available by prescription only and can only be administered by a psychiatrist.

“The number one benefit is there is virtually no side effect,” Sylvester said.

Sometimes there is discomfort from the tapping sensation the magnetic pulse delivers to the scalp. There is a 0.1 percent risk of seizure.

According to the Centers for Disease Control, one out of every 10 Americans reports symptoms of depression and in Florida, between 9.2 and 10.3 percent of adults meet the criteria for depression.

Sylvester said clinical trials have shown NeuroStar improved depression in 55 percent of patients who were not responding to medication. Within his client base, Sylvester had seen improvement up to 70 percent.

Christine Uttaro, 52, of Venice, has used antidepressant medications for 20 years and was not seeing improvements. Within eight weeks of therapy with Comprehensive MedPsych, she witnessed a life-changing turnaround.

“It’s allowed me to celebrate life,” she said. “It keeps me out of the hospital and keeps me functioning.”

Read more here: http://www.bradenton.com/2012/10/16/4240267/lakewood-ranch-psychiatrist-uses.html#storylink=cpy


Neuronetics, Inc., Honored with Prestigious Industry Award for the NeuroStar TMS Therapy® System at Phoenix 2012 Conference

Edward Fruitman No Comments

Published: Tuesday, Oct. 16, 2012 – 10:03 am

NeuroneticsPHILADELPHIA, Oct. 16, 2012 — /PRNewswire/ — Neuronetics, Inc., a privately-held medical device company committed to the development of innovative, non-invasive therapies to treat psychiatric conditions, announced today that its NeuroStar TMS Therapy® System has been awarded the prestigious Phoenix 2012 Most Promising New Product Award at the 19th annual Phoenix Conference.  Phoenix, the Medical Device and Diagnostic Conference for Chief Executive Officers, presents awards each year to exceptional individuals and companies representing the medical device and diagnostic industry.

The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy System is a non-invasive, non-drug therapeutic device that delivers magnetic resonance imaging (MRI)-strength, pulsed magnetic fields to stimulate nerve cells in the part of the brain thought to control mood.  The NeuroStar TMS Therapy® System is the first and only TMS system cleared by the US FDA for major depressive disorder (MDD).  It has been proven to be safe and effective for patients with MDD who have not benefitted from antidepressant medication.  The goal of NeuroStar TMS Therapy is remission from depression without the side effects typical of antidepressant medications.

“On behalf of the entire team at Neuronetics, I am honored to receive the Phoenix 2012 Most Promising New Product Award for NeuroStar TMS, a breakthrough in depression treatment, and appreciative that the industry has recognized its value to patients and physicians,” said Bruce Shook, President and CEO, Neuronetics, Inc.  “We are privileged to offer a proven treatment to the millions of people suffering with major depressive disorder and contribute toward their wellness.”

About Depression

Depression is a serious illness that affects about 20 million Americans annually.  People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiousness, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems.  It is estimated that about four million patients do not benefit from standard treatments for depression, even after repeated treatment attempts.

About NeuroStar TMS Therapy®

Neuronetics’ NeuroStar TMS Therapy System was cleared by the FDA in October 2008 for the treatment of Major Depressive Disorder (MDD).  NeuroStar TMS Therapy is indicated for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation.  It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly-focused MRI-strength magnetic field pulses. The treatment is available by prescription and typically administered daily for 4-6 weeks.  For full safety and prescribing information, visit www.NeuroStar.com.

About Neuronetics, Inc.

Neuronetics, Inc., is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses.  Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation.  Neuronetics was created as a spin-out of The Innovation Factory, a medical device incubator in Duluth, GA.

NeuroStar®, NeuroStar TMS Therapy® and TMS Therapy® are registered trademarks of Neuronetics, Inc.

SOURCE Neuronetics, Inc.

Read more here: http://www.sacbee.com/2012/10/16/4915963/neuronetics-inc-honored-with-prestigious.html#storylink=cpy


Patients Tell How Magnetic Therapy Lifted Their Depression

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ScienceDaily (Oct. 15, 2012)

News about TMS— Three patients who have suffered periodic major depression throughout their adult lives told an audience attending a Loyola Grand Rounds presentation how their lives have been transformed by a new magnetic therapy.

The treatment, called transcranial magnetic stimulation (TMS), sends short pulses of magnetic fields to the brain.

“I feel better now than I have in a very long time,” said patient Jannel Jump. “I’m living a life now, rather than hiding from it.”

Another patient said TMS brought him out of a depression so severe he couldn’t get out of bed.

And a third patient said TMS “has helped me to have a glass-is-half-full outlook. I’m in a much better spot today.”

The Food and Drug Administration approved TMS in 2009 for patients who have major depression and have tried and failed at least one antidepressant. The FDA has approved one TMS system, NeuroStar®, made by Neuronetics, said Dr. Murali Rao, MD, DFAPA, FAPM, Chairman of the Department of Psychiatry and Behavioral Neurosciences at Loyola University Chicago Stritch School of Medicine.

The patient reclines in a comfortable padded chair. A magnetic coil, placed next to the left side of the head, sends short pulses of magnetic fields to the surface of the brain. This produces currents that stimulate brain cells. The currents, in turn, affect mood-regulatory circuits deeper in the brain. The resulting changes in the brain appear to be beneficial to patients who suffer depression.

Each treatment lasts 35 to 40 minutes. Patients typically undergo three to five treatments per week for four to six weeks.

The treatments do not require anesthesia or sedation. Afterward, a patient can immediately resume normal activities, including driving. Studies have found that patients do not experience memory loss or seizures. Side effects may include mild headache or tingling in the scalp, mostly during stimulation.

Together, psychotherapy and antidepressants result in complete remission in about one-third of patients who suffer major depression. TMS is a noninvasive treatment option for the other two-thirds of patients, who experience only partial relief from depression or no relief at all, Rao said. He noted that TMS is recommended by the American Psychiatric Association’s 2010 Treatment Guidelines.

Rao said treatment reports from 41 TMS treatment centers show that about 33 percent of TMS patients who previously had been treatment-resistant reported their depression had significantly lessened or gone away completely. This success rate is about twice as high as the success rate of patients who have tried three or more antidepressants. Loyola recently began recruiting for a study on whether TMS can benefit patients who suffer from both depression and debilitating tinnitus (ringing in the ears).

TMS Breakthrough: New Hope for Treating Severe Depression With Few Side Effects

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Tuesday, 02 October 2012 09:50By Robert WilburTruthout | News Analysis

A new treatment for major depression – and possibly other maladies, including pain and post-traumatic stress disorder – seems as effective as the alternatives, with lower cost and fewer side effects. Psychiatrists say TMS is showing much promise in preliminary studies.

Until four years ago, psychiatrists had only two options for treating major depression: drugs and electroconvulsive therapy (ETC), formerly known as electroshock.

Antidepressant drugs can take as long as four to six weeks to kick in, and they have many side effects: cardiac toxicity, urinary retention, impotence, loss of libido, blurred vision, dry mouth, somnolence, overstimulation and assorted other complications that vary from drug to drug.

Surprisingly, ECT, which passes an electric current through the brain, is considered to be safer than drugs for patients with many physical illnesses, but it also has a steep downside of its own: A course of ECT can wipe out crucial memories like Ajax scouring out a sink.

Most psychiatry textbooks write that a first trial of an antidepressant is effective only 60 percent of the time. ECT is generally said to be effective 70 percent to 80 percent of the time.

In 2008, the US Food and Drug Administration approved a new device for treating major depression: Transcranial Magnetic Stimulation, or TMS. TMS has its roots in the research of Michael Faraday, the giant of 19th century physics. He could scarcely have dreamed that his law of induction would one day be used to treat mental illness.

Faraday’s Law is simple: It states that an oscillating magnetic coil – that is, a coil moving back and forth – generates an electric field. Now if a magnetic coil sets up an electric field inside the brain, the electric field will stimulate the neurons to release brain chemicals called neurotransmitters, of which the three most familiar are serotonin, dopamine, and noradrenaline (although there are dozens more under varying degrees of investigation).

Serotonin is a sedating neurotransmitter; dopamine is energizing; noradrenaline resides somewhere in between. The increased availability of one or more of these neurotransmitters is believed to lift the depression.

The instrument that was approved by the FDA is called “NeuroStar.” It is manufactured by Neuronetics for “major depression that does not respond to a trial of an antidepressant drug.”

This is very generous labeling by the FDA, and in reality the labeling doesn’t amount to much, because once a drug or medical device has been approved for marketing, it can be used by the physician for any indication he sees fit.

Already NeuroStar is being used to treat chronic anxiety, bipolar depression (the depressive swing of manic-depressive illness) and chronic pain. I’ve also been told the military has bought several TMS instruments for treating post-traumatic stress disorder.

As for “major depression,” it is an entity that has paraded through the psychiatric literature under a variety of names, among them: “unipolar depression” (to signify that it is not the depressed phase of manic-depressive – bipolar – disorder), “and “endogenous depression (which is intended to signify that it is a biologically, and probably a genetically driven, disorder).”

The condition is marked by mental symptoms such as low mood and morbid or outright suicidal thoughts, as well as physical symptoms like sleep disturbance, loss of appetite and anxiety.

According to Sue McMonigle, vice president for marketing at Neuronetics, there are currently 424 facilities in the US, ranging from hospitals to private offices that use the device. So far, McMonigle said, about 9,000 people have undergone treatment with TMS.

Small-scale studies indicate it is effective about 70 percent or more of the time – in the same range as ECT, but definitive studies are needed to nail this figure down.

The potential for TMS is enormous. According to the Centers for Disease Control, one American adult in ten suffers from depression, by which the CDC means major depression or the milder condition, dysthymia.

This number does not include manic-depressive (bipolar) patients in the depressed phase. Nor does it factor in all the other psychiatric and neurological disorders for which TMS is already being used.

Truthout spoke with two practitioners of TMS – Dr. Alan Manevitz, clinical associate professor of psychiatry at Weill Cornell Medical School, and Dr. James Halper, MD, clinical associate professor of psychiatry at New York University School of Medicine, who set up the first TMS facility in New York City.

The doctors said that, second to depression, the best-established indication for TMS is pain. They called TMS a “new pathway of treatment” without the problems of antidepressant drugs or ECT.

So exactly what is NeuroStar? Manevitz and Halper invited me to visit their private clinic on New York’s chic Sutton Place, where their clinical coordinator, Yoko Kanamori, demonstrated the workings of the Neurostar for me.

The treatment room looks like a dentist’s office, with a comfortable recliner and the magnet mounted in an armature, rather like the dentist’s drill, that is connected up to a box that allows the operator to adjust the number of magnetic oscillations per second and, applying Faraday’s Law of Induction, the strength of the electrical field inside the brain.

The magnetic field is weak – it would take 30 treatments with the NeuroStar to equal the degree of magnetic exposure of a single scan with a magnetic resonance imager (MRI), Kanamori told me.

The business end is the magnetic coil under a padded headpiece that covers the prefrontal cortex, a region of the brain associated with depressive mood and morbid, sometimes suicidal, thoughts. The prefrontal cortex sends and receives bundles of nerve fibers to and from a region of the brain, the limbic system, that is responsible for what are called the somatic or “vegetative” symptoms of depression like disordered sleep, loss of appetite, anxiety and other symptoms not ordinarily amenable to will power (which is one good reason why it is stupid and cruel to tell someone suffering from depression to “snap out of it”).

Kanamori switched on the NeuroStar and held the back of my hand against the cushion. I felt a mildly annoying rat-tat-tat of the magnet oscillating back and forth, then a longish respite, followed by another burst of magnetic activity. Not surprisingly, headache is a rather frequent complaint from TMS, but it can be easily treated with Tylenol or aspirin. Otherwise, TMS is largely free of side effects.

The definitive study on the indications and side effects of TMS was conducted last year by a “blue ribbon” panel of experts chosen by French medical societies. After reviewing the literature on TMS, the authors concluded that the only significant side effect was the rare occurrence of seizures, and these occurred as a rule when the practitioner departed from the instructions for using the instrument, or rarely when the patient was taking an antidepressant that lowers the seizure threshold.

In TMS, the patient is fully awake, sitting comfortably in the recliner, and reading or watching a video. There are five sessions a week, and each session lasts for one hour. A complete course of treatment lasts four to six weeks. Since this is about the same as the time it usually takes for antidepressant medication to go to work, what’s the advantage of TMS?

First, far fewer side effects. Secondly, some studies show that it works when drugs fail. When the magnet is lifted off the patient’s head, out she walks.

The same cannot be said of ECT. Practitioners vary in their methods, but ECT is usually given every couple of days for a total of seven to 10 treatments. The patient is wheeled into the ECT suite on a gurney, where a minimum team of a psychiatrist, an anesthesiologist, and an ECT nurse await him.

The anesthesiologist promptly administers a short-acting anesthetic such as brevital. Next comes succinylcholine, an agent that paralyzes all the skeletal muscles of the body – including the muscles involved in breathing. An ECT nurse at once begins to “bag” the patient, that is, force oxygen into his lungs or else he would soon die.

With the patient all “prepped,” the psychiatrist positions electrodes on the temples (or on just one side, if he opts for the unilateral procedure) and hits the “on” button, which sends a jolt of 225-450 volts of electricity through the brain.

Were it not for the muscle-paralytic effects of succinylcholine, the patient would experience violent convulsions that often shattered bones in the past. As it is practiced today, just about all there is to see that suggests a convulsion is a brief bending of the feet.

The ECT nurse continues to bag the patient until he starts breathing on his own; then he is wheeled into the recovery room where he is observed by a nurse until the anesthetic progressively wears off, and he emerges from his experience disoriented and confused.

Today, ECT is almost always administered to hospitalized patients, but there are “buzz shops” to be found that give ECT on an out-patient basis. Usually it takes the patient a couple of hours before she’s steady enough to leave, but the patient is usually warned not to drive herself home.

It will probably have occurred to the reader that TMS and ECT have a common denominator: Both set up an electric field within the brain, although TMS delivers the electricity gradually and moderately over a period of weeks, while ECT serves it up in seven to ten flashes of current.

In fact, one of many theories of ECT efficacy is that the electric field releases a torrent of neurotransmitters.

An important consideration in treating depression, and all the more important when the depression is severe, is a feature called the durability – the length of time from the termination of treatment to the return of depressive symptoms.

For antidepressant drugs, the durability is six months to relapse. Skilled psycho-pharmacologists usually maintain their seriously ill patients on medication for two years, then taper the dose very gradually and kick it right back up again at the first hint of a relapse.

Some depressed patients require lifelong medication. I have been using the word “antidepressant” in the singular, but in fact the art of psychopharmacology is often to use drug combinations skillfully.

The most popular and effective adjunct is to add lithium to an antidepressant. This combination is so effective that results are often seen in a matter of days. Another safe and effective adjunct is thyroxine (T3), and the addition of lithium and thyroxine is more effective that either adjunct alone.

Many other drug combinations are used, such as two different categories of antidepressants – for example, a tricyclic like Elavil, and a monoamine oxidase inhibitor like Phenelzine – or the addition of a stimulant, like Ritalin, to an antidepressant.

In recent years, the addition of “second-generation antipsychotics” – Abilify, Seroquel, Zyprexa and other agents that are more than just antipsychotics; they possess antidepressant and anxiolytic properties in their own right – are gaining in popularity as adjuncts.

This far from exhausts the cornucopia of adjuncts that are used in modern psychopharmacology.

Clinical experience over a period of decades has found that ECT has a durability of six months. Most psychiatrists find it prudent to discontinue antidepressant medications before embarking on a course of ECT; once the patient has completed seven to ten treatments, the psychiatrist starts a regimen of antidepressant medication to prolong the durability of the recovery; some psychiatrists, rather than administering medication, give periodic “booster” doses of ECT. Similarly, two or three booster treatments of TMS will usually effect a remission in patients who have experienced a course of TMS and, after a variable period of time, show signs of a depressive relapse.

One advantage of TSM over ECT is that the patient can safely take antidepressants during TSM therapy, a consideration that strengthens its durability.

Memory loss and, sometimes, confusion are the major side effects of ECT – and they can be major, according to Dr. Maria A. Sullivan, a psychiatrist and psychologist at New York State Psychiatric Institute, who uses ECT so infrequently that she couldn’t recall when she last employed it. Her view is that ECT should only be administered to the most severely ill patients – those with catatonia and severe, life-threatening depression that does not respond to aggressive pharmacotherapy and psychotherapy.

Other psychiatrists intervene earlier. Thus, Dr. Gabriella Centurion – a psychiatrist in private practice who is a TMS provider – calls ECT the “gold standard” for treating severe depression. Virtually since its introduction, ECT has stirred controversy between therapeutic “doves” and “hawks.” An ongoing study at Columbia University, which compares TMS to ECT and which is large enough to overcome the objections to the small, existing pilot studies, may provide definitive information.

So long as they are interpreted cautiously, the existing pilot studies show that TMS and ECT are comparable. If confirmed, these data will have a major impact on the way that we treat severe depression.

What about the bottom line? Fees vary for the treatment. According to Manevitz and Halper, the usual cost for TMS runs from $10,000-$11,000. ECT costs generally run higher, because the treatment requires a three-person team: a course of 12 ECTs comes to about $24,000, according to the Carrier Clinic in New Jersey.

Pills may be the most expensive of all, though, especially if someone has to take a combination of drugs for two years. According to Mark Bausinger, a vice president at Neuronetics, the insurance industry is slow to pick up the tab for TMS, but one by one they are coming on board as they come to appreciate the cost-effectiveness of TMS. This is often the case with new medical instrumentation.

Inexplicably, but not surprisingly, Medicare is divided on the issue. The New England district picks up the tab for a course of treatment. Other districts won’t pay a cent. Still others remunerate at such a miserly rate that few psychiatrists are willing to learn how to use TSM and invest in the apparatus.

The failure of Medicare to pay for TMS is yet one more burden on the elderly, who have an even higher prevalence of depression than younger people. With their multiple illnesses and failing memories, our senior citizens are often poor candidates for medication or ECT, but as Kanamori told me, old people tolerate TMS well.

Neuronetics has a special program for TMS patients that helps them to fill out insurance forms to receive remuneration from insurance carriers. Manevitz and Halper reported that, at least in their practice, 75 percent of patients receive some reimbursement from their insurance carriers after taking their case to appeal – but the remuneration often is not adequate, and depressed people may have a hard time coping with the complex appeals procedures of public and private carriers. It will be interesting to see how much – if anything – the Affordable Care Act allows for TMS.

At this point, Manevitz and Halper told me in our three-way phone conversation, major depression and chronic pain are two indications for which TMS therapy is well-supported by the evidence from clinical trials and psychiatric practice.

It is being looked at closely for other indications; some will hold up under the weight of rigorous clinical trials and others will turn out to be disappointing. But right now, hopes are high in the psychiatric community.

Botox Fights Depression

Edward Fruitman No Comments

The wrinkle treatment prevents facial muscles from registering negative emotions

By Tori Rodriguez

botox for depression at trifecta health nycA common complaint about wrinkle-masking Botox is that recipients have difficulty displaying emotions on their faces. That side effect might be a good thing, however, for people with treatment-resistant depression.

In the first randomized, controlled study on the effect of botulinum toxin—known commercially as Botox—on depression, researchers investigated whether it might aid patients with major depressive disorder who had not responded to antidepressant medications. Participants in the treatment group were given a single dose (consisting of five injections) of botulinum toxin in the area of the face between and just above the eyebrows, whereas the control group was given placebo injections. Depressive symptoms in the treatment group decreased 47 percent after six weeks, an improvement that remained through the 16-week study period. The placebo group had a 9 percent reduction in symptoms. The findings appeared in May in the Journal of Psychiatric Research.

Study author M. Axel Wollmer, a psychiatrist at the University of Basel in Switzerland, believes the treatment “interrupts feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotions.” Past studies have shown that Botox impairs people’s ability to identify others’ feelings, and the new finding adds more evidence: the muscles of the face are instrumental for identifying and experiencing emotions, not just communicating them.

Please see the great Botox Deal in NYC by Wall Street Botox Cosmetic Center.

Magnetic fields used to boost depressed teens

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By Jamie Komarnicki, Calgary Herald September 27, 2012

CALGARY — Calgary researchers are studying a new way of helping teenagers cope with depression by using magnetic fields to give a “booster shot” to the part of the brain used to make decisions.

Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique used extensively to treat adults, will now be used on youth as part of a project at the Alberta Children’s Hospital Research Institute for Child and Maternal Health.

The Calgary hospital is equipped with the only brain stimulation lab of its kind with the ability to perform the treatment on teenagers, said principal investigator Dr. Frank MacMaster, who is working with pediatric neurologist Dr. Adam Kirton on the pilot study.

The project, funded by community donations, is geared toward teenagers with depression who haven’t responded well to standard treatments, including medication and psychotherapy, MacMaster said.

The researchers will use transcranial magnetic stimulation to excite the frontal lobe — “the boss of the brain” — to help regulate their emotions, MacMaster said.

It will give a “booster to that part of the brain to try to help it do its job better so these kids can fight the symptoms.”

The goal of medication and cognitive behavioural therapy is to change the brain so the patients feel better, and TMS is no different, MacMaster said. It could provide a new treatment option for the approximately 50 per cent of young people with depression whose symptoms aren’t helped by the current therapies, he added.

The researchers are looking for 50 patients between 12 and 21 years old, who have treatment-resistant depression, to participate in the study.

Read more: http://www.calgaryherald.com/health/Magnetic+fields+used+boost+depressed+teens/7299000/story.html#ixzz2AKifQH9C

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Edward Fruitman No Comments

London : United Kingdom | Sep 24, 2012 at 10:58 AM PDT

Hand held magnetic device relieves throbbing and associated migraine symptoms

Migraine headaches are one of the most common problems seen in emergency rooms and physician offices. These pounding, throbbing headaches affect about 36 million Americans with the pain lasting from a few hours to a few days.

View slideshow: Alternative options for migraine headaches

There now may be hope for the millions that endure these headaches as headache specialists around the United Kingdom reveal encouraging results from a new treatment in the form of a hand-held device that transmits brief magnetic pulses to the back of the head reducing 73% of pain within three months. This new therapy called neurostimulation comes from a device by eNeura Therapeutics a California based company.

This new device costs about £500 or 245 U.S. dollars, is portable and about the size of a radio. This device is placed on the back of the head and with a push of a button sends a brief magnetic pulse to the brain.

The results from a trial of sixty participants had revealed promising results with 53% reporting a reduction in headaches in a few days.

One British participant Andy Bloor said “The key for me was using the device quickly, as soon as the migraine started. When I did, it stopped the migraine in its tracks. The plus of the device is it reduces my reliance on strong drugs.”

The results from the trial were presented at the European Headache and Migraine Trust International Congress in London.

Dr. Fayyaz Ahmed, MB, BS, MD, FRCP, Neurologist Hull & East Yorkshire Hospitals NHS Trust Hull and East Yorkshire Hospitals NHS Trust and chairs the British Association for the Study of Headaches, stated according to the Daily Mail “We think neurostimulation is the future in treating headache disorders, particularly if it is non-invasive. “

“A significant proportion of migraine sufferers either do not respond or are unable to tolerate available oral treatments.”

“Now TMS will provide them with an alternative to deal with their disabling migraines and be able to continue with their activities of daily living.”

The findings of the trial were published online March 2010 in The Lancet Neurology.

The trial had noted that this device is used in the aura phase and may reduce or eliminate the need for medications and no serious side effects have been associated to the device.

Ohio State University researchers conducted a randomized, placebo-controlled, double-blind study using transcranial magnetic stimulation (TMS) device.

Their trial included 52 patients, who have migraine with aura from two headache centers. Among the patients 296 had been treated with TMS and 19 with a placebo device that did not transmit a pulse.

At the first sign of a migraine patients had been instructed to report to the clinic. Depending on what group they were in they had received treatment.

All patients record their responses during the 24 hour period before and after treatment.

The results revealed 69% of the TMS group no longer had painful migraine or only mildly painful for two hours after treatment. Also, reported by the TMS group; 84% had no noise sensitivity, 64% no light sensitivity and 88% no nausea.

The device was recently approved in Europe and will be available there this summer. There is no word on when the FDA will act upon the application for approval in the United States, and the device cannot be prescribed or sold in the U.S. until it’s approved by the FDA, according to Migraine.com.

Information on Migraines can be found online at the American Migraine Foundation.

TMS Used to Boost Depressed Teens

Edward Fruitman No Comments

CALGARY — Calgary researchers are studying a new way of helping teenagers cope with depression by using magnetic fields to give a “booster shot” to the part of the brain used to make decisions.

Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique used extensively to treat adults, will now be used on youth as part of a project at the Alberta Children’s Hospital Research Institute for Child and Maternal Health.

The Calgary hospital is equipped with the only brain stimulation lab of its kind with the ability to perform the treatment on teenagers, said principal investigator Dr. Frank MacMaster, who is working with pediatric neurologist Dr. Adam Kirton on the pilot study.

The project, funded by community donations, is geared toward teenagers with depression who haven’t responded well to standard treatments, including medication and psychotherapy, MacMaster said.

The researchers will use transcranial magnetic stimulation to excite the frontal lobe — “the boss of the brain” — to help regulate their emotions, MacMaster said.

It will give a “booster to that part of the brain to try to help it do its job better so these kids can fight the symptoms.”

The goal of medication and cognitive behavioural therapy is to change the brain so the patients feel better, and TMS is no different, MacMaster said. It could provide a new treatment option for the approximately 50 per cent of young people with depression whose symptoms aren’t helped by the current therapies, he added.

The researchers are looking for 50 patients between 12 and 21 years old, who have treatment-resistant depression, to participate in the study.


Edward Fruitman No Comments

September 21, 2012|By Nicole Brochu, Staff Writer

So many Americans are medicated for depression — more than one in 10 of us — that antidepressants have become the second most-prescribed drug.

But here’s the real downer: They only work for about 30 percent of those who take them, studies suggest.

Now, a new, non-invasive procedure performed in a doctor’s office without anesthesia or major reported side effects is helping a growing number of South Floridians find the peace and functionality no other treatment could deliver.

Cleared in 2008 by the Food and Drug Administration to treat depressed adults who failed to get results from at least one antidepressant, Transcranial Magnetic Stimulation uses highly focused magnetic impulses to stimulate key neurons in the brain during daily, 40-minute treatments in a high-tech chair over six weeks or so.

The technology has proven so groundbreaking — in treating depression and other brain disorders — that Palm Beach psychiatrist Dr. Aron Tendler likens it to the advent of stents in treating arterial diseases.

“This new technology is changing the way we treat diseases of the brain,” Tendler said. “It’s the start, not the finish.”

Palm Beach landscape business owner Brett Armstrong says the therapy has “changed my life.”

After developing bipolar disorder from head trauma suffered in a 2003 motorcycle wreck, Armstrong said he tried multiple medications before sticking with one, Seroquel, that helped ease the manic symptoms of his disorder. But he was taking such a high dose, 600 to 800 milligrams a day, that the “blanket” of lethargy it threw over his day had an indelible impact on his business.

That’s when the folks at Tendler’s office suggested TMS. “Since TMS, I feel better. It’s almost like I beat it,” Armstrong said. “I’ve got a normal life now.”

Dr. Darryl Appleton, a Delray Beach psychiatrist, said society doesn’t realize how prevalent depression is in America today, or how many people struggle on medication, either because of side effects or because they produce few results.

“Our average patient has had 18 previous medication trials, and a lot of them have been hospitalized, too. So when they come in here, they’re looking for a piece of hope,” Appleton said.

He called TMS revolutionary in offering his patients an effective option to antidepressants or more extreme treatments like electric shock therapy, which remains controversial. Many TMS patients see a difference after just a few sessions.

Using a small magnetic coil applied to the head, at the left prefrontal cortex, TMS sends 80 pulses of electrical currents a minute to target the area of the brain that controls mood. The currents stimulate cells that are thought to release neurotransmitters like serotonin, norepinephrine and dopamine — mood-regulating chemicals that are out of balance for many suffering depression.

A 2010 study published in the journal Brain Stimulation showed TMS produced lasting relief in patients with major depression, and only 13 percent of those studied relapsed after six months.

Other research suggests TMS can be effective in treating brain conditions like Parkinson’s disease, post-traumatic stress disorder, fibromyalgia, strokes, even drug cravings for addicts.

But because it’s still considered relatively new, it doesn’t come cheap. The cutting-edge machinery and computerized chair cost about $75,000, according to Neuronetics, the machine’s creators.

And because it’s not yet covered by insurance or Medicare in Florida, patients fork out $400 per session. Since a full course of treatment takes 20 to 30 daily sessions, that could prove pricey.

But the cost is worth it for West Palm Beach retiree Rebecca Summers, who has suffered from chronic depression for years and has long since found antidepressants ineffectiveBefore TMS, she said, “I had absolutely no interest in doing anything.”

She noticed an immediate difference after just a few sessions. After 10 treatments, her depression score went from 39 to 22, and after 20 sessions, it fell to 14. A score of under eight is considered normal, Appleton said.

“It’s unbelievable,” Summers said. “It’s important for people to know what this can do for them.”

Though the literature lists a rare risk of seizures for some people, Appleton said his patients typically complain of mild, temporary side effects like a tapping feeling at the scalp during treatment and tiredness after.

Unless the insurance industry embraces the therapy more fully, though, it will remain an option only for patients who have already tried psychotherapy and medications first.

“There’s no shortage of need,” Tendler said. “Once insurers are more willing [to cover it], we’ll be seeing that we’ll be able to help a tremendous amount of people.”

Is magnetic therapy effective for tinnitus?

Edward Fruitman No Comments

September 18, 2012

 Loyola University Medical Center is studying whether a new form of non-invasive magnetic therapy can help people who suffer debilitating tinnitus (ringing in the ears).

The therapy, transcranial magnetic stimulation (TMS), sends short pulses of magnetic fields to the brain. TMS has been approved since 2009 for patients who have major depression and have failed at least one antidepressant. The Loyola study will include patients who suffer from both depression and tinnitus. Recent studies have found that about 12 percent of people with chronic tinnitus also suffer depression and anxiety—a rate three times higher than that of the general population. Tinnitus is the perception of sound in one or both ears when there is no external source. It can include ringing, hissing, roaring, whistling, chirping or clicking. About 50 million Americans have at least some tinnitus; 16 million seek medical attention and about 2 million are seriously debilitated, according to the American Tinnitus Association. There is no cure. The perception of phantom sounds can be more pronounced in people who are depressed. Moreover, antidepressant medications can cause tinnitus occasionally, said Dr. Murali Rao, principal investigator of Loyola’s TMS tinnitus study. Several earlier studies have found that TMS can benefit tinnitus patients. Loyola’s study is the first to examine patients who suffer from both tinnitus and depression. “The combination of these two conditions can be extremely debilitating,” Rao said. During TMS treatment, the patient reclines in a comfortable padded chair. A magnetic coil, placed next to the left side of the head, sends short pulses of magnetic fields to the surface of the brain. This produces currents that stimulate brain cells. The currents, in turn, affect mood-regulatory circuits deeper in the brain. The resulting changes in the brain appear to be beneficial to patients who suffer depression. Each treatment lasts 35 to 40 minutes. The study will enroll 10 to 15 patients. Each patient will receive five treatments a week for four to six weeks, for a total of 20 to 30 treatments. Each patient will be evaluated by a physician three times during the treatment course, or more frequently if the doctor deems necessary. The treatments do not require anesthesia or sedation. Afterward, a patient can immediately resume normal activities, including driving. Studies have found that patients do not experience memory loss or seizures. Side effects include mild headache or tingling in the scalp, which can be treated with Tylenol. Rao is chair of the Department of Psychiatry and Behavioral Neurosciences of Loyola University Chicago Stritch School of Medicine. His co-investigator in the study is Sam Marzo, MD, medical director of Loyola’s Balance and Hearing Center. Other investigators are Matthew Niedzwiecki, MD, a psychiatry resident; and James Sinacore, PhD, a statistician. Provided by Loyola University Health System

Read more at: http://medicalxpress.com/news/2012-09-magnetic-therapy-effective-tinnitus.html#jCp

TMS Possible Treatment for Hoarding/OCD

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Time.com) — Why do some people find it impossible to get rid of old newspapers and junk mail, and end up hoarding them instead?

New research suggests that hoarders have unique patterns of brain activity when faced with making decisions about their possessions, compared with healthy people. And despite the fact that hoarding has traditionally been seen as a symptom or subtype of obsessive compulsive disorder (OCD), brain activity in those who cannot de-clutter is also distinct from that of people with typical OCD, the study shows.

“Many things are unique and distinct about hoarding,” says Dr. Eric Hollander, director of the autism and obsessive compulsive spectrum disorder program at Montefiore/Albert Einstein School of Medicine in New York, who was not associated with the new research.

He notes that the new study adds to the evidence that hoarding should be recognized as a specific syndrome that falls not under the standard definition of OCD — only about 18% of people with hoarding symptoms meet the full criteria for OCD as it is currently defined — but within a spectrum of related conditions.

“[This] is a very interesting and important study,” he says.

Indeed, a separate diagnosis of hoarding disorder has been proposed for inclusion in the upcoming revision of psychiatry’s diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Time.com: Real-world hoarders and obsessive-compulsives

For the new research, published in the Archives of General Psychiatry, David Tolin of the Institute of Living in Hartford, Connecticut, recruited 107 people for brain scans using functional magnetic resonance imaging (fMRI). Forty-three people had hoarding disorder, 31 people had OCD and 33 participants were normal controls.

The participants were asked to bring a sample of their own junk mail or newspapers to the lab and were assured that researchers wouldn’t throw out anything they wanted to keep. The participants were also told that while they were having their brain activity imaged, they would be asked to decide whether to keep or shred these papers.

Inside the scanner, the participants were shown images of either their own stuff — preceded by a slide identifying it as “Yours” — or images of junk mail and newspapers from the lab, labeled “Ours.” For each item, they had to decide whether or not to submit it to the shredder.

Not surprisingly, people with hoarding disorder chose to keep more of their own items than did those with OCD or those without a diagnosis. When they were faced with tossing or keeping their own items, the hoarders’ brain responses also differed from that of the other participants: they showed excessive activation in the anterior cingulate cortex, a brain region involved with decision-making, particularly in situations involving conflicting information or uncertainty.

Activity was also elevated in the insula, a region that monitors one’s emotional and physical state (it’s also involved in disgust, shame and other strong negative emotions). Together, these regions help assign relative levels of importance or significance to objects.
“Hoarders have great difficulty making decisions, especially around the value of their possessions,” says Michael Jenike, an OCD expert and professor of psychiatry at Harvard, who was not associated with the research. “This study is very interesting as it demonstrates that brain regions associated with monitoring for errors under conditions of uncertainty are activated when hoarding patients are deciding whether or not to throw out personal items.”

In other words, hoarders assign too much value to their possessions, making it difficult or impossible to decide to get rid of them.

Consequently, the study found that people with hoarding disorder took much longer to make decisions about discarding their possessions and felt more sadness and anxiety about these choices than did the other participants.

“One of the characteristics of hoarding is that people feel this sense of discomfort if they feel like they may be giving away something that they could use in future,” says Hollander, explaining that patients often become greatly distressed or even angry if they are pushed to give up apparently useless or excess possessions.

Interestingly, however, when people with hoarding disorder made similar decisions about discarding junk mail that didn’t belong to them, they again showed unusual levels of activity in the anterior cingulate cortex and insula — but in this case, their brain activity was much lower than normal.

The paper’s authors note that the reduced activity is a “pattern reminiscent of that seen in patients with autism,” who are often disengaged from others and who, like hoarders, have rigid routines as well as obsessive behavior.

The authors suggest that this lack of brain activity could be linked with the “diminished motivation and poor insight frequently observed” in patients who hoard; that is, it may be what allows them to live amidst overwhelming clutter and piles of junk, but fail to clear it out or even be bothered by it.
Meanwhile, the hyperactivity in these regions may make them overly anxious about and attached to their own possessions, rendering them too overwhelmed to decide to change.

Hollander compares it to a “check engine” light that keeps flashing on the dash for no reason. A healthy person might be able to disregard the alarm as irrelevant, but the hoarder becomes obsessively focused on it.

“One problem with hoarding, and with OCD, is that when that alarm goes off, it becomes more and more important and the brain pays more and more attention to these signals.” says Hollander. “The [person’s] specific concern becomes more and more salient and other routines and activities become less salient, and that’s what’s associated with functional consequences. Their lives get smaller and smaller.”

So, it’s not that hoarders are slobs or obsessive collectors. Rather, it’s that they have problems making the kinds of decisions about their stuff that others would consider reasonable.
Hollander notes also that the new findings could have important implications for the treatment of hoarding. A new type of transcranial magnetic stimulation (TMS), for example — a therapy that uses non-invasive electrical stimulation of the brain to treat depression — may work for people with hoarding disorder.

Stop Depression with TMS at Trifecta Health Medical Center

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Thu, Mar 1, 2012, http://newyork.nearsay.com
TMS Terapy new yorkDepression is all too common in our society and for many suffering from this mind crippling and misunderstood disease, seeking medical care can be a confusing, difficult task. At Trifecta Health Medical Center treatments for depression are offered with great care and expertise, and as an innovative and highly attentive medical center, Trifecta offers the latest treatments for depression.

Several causes result in depression, from overwhelming personal difficulties, loss of a loved one and genetic history, to inflicted abuse, substance abuse and more, depression is a very real, complex disease that can be carried in many forms. As one one the latest treatments for depression the medical staff at Trifecta have adopted Transcranial Magnetic Stimulation (TMS) as a highly effective treatment. Medical Pioneer, Dr. Edward Fruitman, first to bring the healing power of TMS Therapy to Manhattan’s Financial District of New York, treats his patients who suffer from depression, after other methods had failed.

TMS, approved by the U.S. FDA in October of 2008, is a magnetically stimulated treatment for adults suffering from depression. With over ten years of clinical study, TMS has been proven to provide a more effective treatment option than typical anti-depressants. TMS targets the prefrontal cortex in the brain, or the region of the brain responsible for regulating mood and emotions. The treatment coil sends magnetic pulses to stimulate the cortex, triggering a release of neurotransmitters through the brain. This positively affects mood and adjusts any chemical imbalance to relieve depression symptoms.

Not only is TMS safe and effective, but gentle and painless for the patient. Don’t continue living in a depressed world. Trust the expert staff at Trifecta Health Medical Center for a diagnosis and a treatment that is right for you.

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TMS: Pregnancy & Depression

Edward Fruitman No Comments

Foxnews.com (Jan 16, 2012)- A recent research paper published in the British Medical Journal reported that taking serotonin reuptake antidepressants (SSRIs) like Fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) during the second half of a woman’s pregnancy could mare than double the risk that babies will develop persistant pulmonary hypertension of the newborn (PPHN).

This finding supports a warning issued by the FDA during 2006 that alerted women that those taking SSRIs wer six times more likely to deliver babies with PPHN.

PPHN is high blood pressure in the arteries of the lungs. It causes the right ventricle of the heart- which must pump blood through the lungs to pick up oxygen- to work harder, too hard. This can ultimately cause weakening of the heart and heart failure.

Pulmonary hypertension affects about 1 in 1,000 newborns, but more than double that number of newborns of mothers taking antidepressants in the second half of their pregnancies seem to be affected. And an increased risk-though lower- appears to be present in those babies born to mothers who take antidepressants in the first half of their pregnancies.

Antidepressants of one kind or another have been implicated in- but not proven to be absolutely responsible for- increasing the risk of low birth weight, premaurity, and low blood sugar.

So, women should stop antidepressants when they learn they are pregnant, right? Not exactly. There are reasons to stop and theire are reasons to continue.

So, my advice is this:

1) If you are a woman considering pregnancy, try to stop or not to start antidepressants- as long as your symptoms are relatively mild. If you require treatment for depression, try psychotherapy or  Transcranial Magnetic Stimulation (TMS), which treats depression with magnetic pulses delivered to the head and which has no known contraindications in pregnancy. But, if you have serious symptoms of depression, use SSRIs, with the advice and under the care of your physician.

2) If you find out you are pregnant while you are already taking anti-depressants, talk to your doctor about very slowly stopping them, but only if you can do so safely, without severe symptoms of depression returning.

3) Never stop antidepressants all of a sudden. This can cause serious symptoms that affect you and your unborn child.

4) Do not stop antidepressants during pregnancy if you have been suicidal while depressed in the past and antidepressants have been necessary to ward off thoughts of harming yourself.

As a final note, while many obstetricians and many primary care doctors are comfortable treating depression, I believe it is best to be seen by a psychiatrist if you are taking antidepressants and want to have a baby.

TMS Success at Trifecta Health Medical Center

Edward Fruitman No Comments

tms therapy new yorkNEW YORK, NY, December 14, 2011 /24-7PressRelease/ — Transcranial Magnetic Stimulation (TMS) is an out-patient, non-invasive procedure to treat Major Depression Disorder as well as other diseases like ADD/ ADHD, Parkinson’s and Dementia. TMS emits electromagnetic pulses into an individually focalized area of the brain believed to control mood. By completing the 4-6 week TMS treatment course, patients should experience a significant decrease of symptoms or complete remission.

TMS is being offered by Doctor Edward Fruitman, MD, a nationally recognized expert in psychopharmacology as well as a Board Certified Psychiatrist at Trifecta Health Medical Center in Manhattan’s Financial District of NYC. With Dr. Fruitman’s comprehensive approach and medication management, his practices have had a nearly 100% success rate among patients who have completed TMS treatment, significantly above the national average.

TMS Therapy has become a popular treatment option for people suffering with Major Depression among mental health practices across the country because it is non-invasive and has essentially no side-effects. As a result, TMS has become increasingly mentioned within the media. Below are two video clips offering further details on the benefits of TMS as well as first-hand accounts of successful treatments. If you are an individual who has had little to no success in controlling your condition with medication do not hesitate to call Trifecta Health Medical Center to discuss the possibilities of TMS with one of our TMS Specialists or to schedule a consultation with Dr. Fruitman. Our serene environment along with Dr. Fruitman’s innovative approach to treatment ensures a positive experience for all of our patients.

Video Clips:

What are the Benefits of TMS Therapy

Treating Depression Without Drugs


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New TMS Research Offers Anorexia Relief

Edward Fruitman No Comments

EuroNews (Nov. 21, 2011)- Katherine Damazer was at school doing exams when she became anorexic. Previously on holiday with her family in Tibet she caught a virus, became very ill and lost a lot of weight.

At first she enjoyed being thin, then dieting took over her life.

“I used to feel faint all the time and every morning I woke up and blacked out for a while every time I got out of bed, and I used to be freezing, constantly freezing and shivering and having funny heart palpitations and having this constant feeling like your stomach was eating itself. You’re just so hungry and it kind of becomes enjoyable and satisfying because you know you’re doing a really good job at having an eating disorder,” she laughs.

But it is no laughing matter. Anorexia nervosa is a complex condition.

A London-based team is investigating whether repetitive transcranial magnetic stimulation could help sufferers. They are targeting the part of the brain that is implicated in the experience of craving.

“We found that one session of Trans Cranial Magnetic Stimulation as we deliver it may reduce cravings in people with bulimia nervosa, food cravings. In people with anorexia nervosa we found that reduces their sense of fullness and fatness when they’re exposed to foods and it also reduces their anxiety,” says Consultant Psychiatrist at King’s College, London, Frederique Van den Eynde.

Professor of Eating Disorders Ulrike Schmidt says anorexia takes an enormous toll on the body.

“They have, typically, after a period of time, lots of physical disabilities, the bones crumble, osteoporosis develops, people have problems with all their internal organs,” she says.

Around a million people in the UK suffer from eating disorders and experts do not really know what causes them. Up to 20 per cent of sufferers will die from their illness, so any new potential therapy has to be good news for patients and their families.

TMS May Help Decrease Cigarette Cravings

Edward Fruitman No Comments

THURSDAY, Nov. 3 (HealthDay News) — In smokers, stimulating the brain in certain ways can manipulate their cravings for cigarettes, researchers have found.

The finding could lead to new treatments to help people kick the habit, according to the authors of the study published in the Oct. 15 issue of Biological Psychiatry.

Using brain imaging technology, researchers from Duke University Medical Center identified several regions of the cerebral cortex and the limbic system, which is involved in emotion, that are activated during cravings. Based on these studies, they used noninvasive magnetic stimulation of these areas of the brain in an attempt to manipulate these cravings.

“We directly stimulated a frontal brain region using magnetic fields and showed that it exaggerated smokers’ craving for cigarettes when they viewed smoking-related cues. By gaining a better understanding of how the brain influences craving responses, strategies for blocking these responses can be devised and ultimately, more effective smoking cessation treatments may be developed,” explained one of the study authors, Dr. Jed Rose, in a journal news release.

Although low-frequency stimulation did not reduce smokers’ cravings, high-frequency stimulation did have this effect when participants were viewing nonsmoking cues, the researchers found. They also noted that high-frequency stimulation reduced the ability of cigarettes to satisfy smokers’ cravings, an effect that helps keep them addicted.

More research is needed to explore how this could lead to new treatments to help smokers quit, the authors pointed out.

“This elegant study implicates the superior frontal gyrus in controlling the activity of the craving circuit,” Dr. John Krystal, editor of Biological Psychiatry, said in the news release. “Additional research will be needed to determine the potential value of repetitive [transcranial magnetic stimulation] as a treatment for smoking.”

TMS Treatment-Migraines

Edward Fruitman No Comments

A 2010 study suggests that TMS is effective treatment for migraines with aura. The randomized, double blind study included individuals 18-68 years old that had aura followed by a severe headache. The patients were treated with either a hand-held portable TMS machine or a placebo device, and were instructed to treat a maximum of one attack per month for 3 months during the aura stage of the attack. Researchers found that participants using the TMS device found complete freedom from pain after 2 hours and was pain free for up to 48 hours. Researchers believe that TMS is a promising treatment method for migraine patients.

Original Article:

Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Richard B Lipton MD, David W Dodick MD, et al. The Lancet Neurology – 1 April 2010 Vol. 9, Issue 4, Pages 373-380. 

TMS Treatment for PTSD

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Jun. 2, 2011-UTD News Center

The Center for BrainHealth at The University of Texas at Dallas has been awarded a $3 million grant from the Department of Defense to further test a cutting-edge treatment for post-traumatic stress disorder (PTSD).

Up to 8 percent of the population will have PTSD at some point in life, according to the Department of Veterans Affairs. Up to 20 percent of veterans returning from the wars in Iraq and Afghanistan are diagnosed with PTSD.

With the funding, 50 patients will be treated with a combination of repetitive Transcranial Magnetic Stimulation (rTMS) and Cognitive Processing Therapy (CPT), a behavioral therapy treatment designed to give individuals suffering from PTSD a new way to handle distressing thoughts.

The study being conducted at the Center for BrainHealth will combine rTMS, a magnetic coil that alternates polarity resulting in the right frontal lobe of the brain to temporarily reduce the fear response to a tolerable level, and CPT, a method of psychological training that will teach patients how to lessen the emotional response associated with PTSD. The blinded study will measure subjects’ EEG (brain wave) tests and functional MRIs (fMRI) before and after to determine positive treatment response.

“We are very hopeful that the combination of these two treatments will positively affect one of the most debilitating symptoms of PTSD,” saidDr. John Hart, medical science director at the Center for BrainHealth and lead researcher of the study. “If this clinical trial proves successful, thousands of veterans returning from war will have an even greater chance of transitioning smoothly back into civilian life.”

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