Transcranial Magnetic Stimulation offers hope for treatment-resistant depression.
She 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.”