An effective, non-invasive alternative “gave me my life back,” says local man
By Steve Dorfman
Brett Armstrong has no memory of the event that forever changed his life — a 2003 motorcycle crash that left him in a month-long coma.
He does, however, recall all too well the debilitating after-effects that the traumatic brain injury wrought on his mental and emotional well-being.
“My body healed pretty quickly, but my mind wasn’t right,” says Armstrong, 45, owner of a Palm Beach Gardens landscape-design business. “I couldn’t handle any kind of stress. I would go for days without sleeping. I’d be depressed. I couldn’t function.”
Diagnosed post-accident with bipolar disorder, Armstrong was prescribed a litany of antidepressant and mood-stabilizing drugs.
None produced the desired effect — but they did create plenty of unwanted side effects: “I felt like I was wearing a ‘mental cloak.’ I couldn’t think straight,” Armstrong explains.
In 2009, at the suggestion of friends, he went to a different psychiatry office — Advanced Mental Health Care (AMHC) in Royal Palm Beach. It’s one of just three practices in Palm Beach County (BrainStim in Delray Beach and Chrysalis TMS Institute in Boca Raton are the others) that offer a relatively new, non-invasive, alternative form of treatment for depression: transcranial magnetic stimulation (TMS).
The effects of the TMS were rapid — and dramatic — Armstrong says: “It was like a miracle. TMS therapy gave me my life back.”
FDA-cleared in 2008
The medical exploration of TMS efficacy dates back to 1985. One specific device — the NeuroStar by Neuronetics — was cleared by the U.S. Food and Drug Administration in 2008 for the treatment of major depressive disorders in patients who had failed to derive satisfactory results from antidepressant medication(s).
According to AMHC psychiatrist Dr. Aron Tendler, whose practice was the first in Palm Beach County (and just the seventh facility in the entire U.S.) to acquire a NeuroStar, the machine works by “directly stimulating neurons that are unstimulated when a person is depressed.”
It does so via specifically targeted, repetitive (though painless) magnetic pulses. The patient is awake the entire time.
This is in stark contrast to electroconvulsive therapy (ECT — the modern-day version of “shock therapy”), which requires sedation and is fraught with serious potential side effects (including memory loss).
In addition, unlike with antidepressant drugs, the TMS pulses make no distinction between different chemical neurotransmitters in the brain (serotonin, dopamine, norepinephrine). They simply “wake up” dormant neurons and/or regulate unbalanced brain chemicals in the region that controls mood.
The advantage, explains Tendler, is that the patient’s metabolism — that is, how his or her body processes drugs — is bypassed.
This was especially important in Armstrong’s case. “I’ve always been hypersensitive to even the least amount of medication,” he explains. “I’m sure that’s why the antidepressants and mood stabilizers were so ineffective for me.”
Commitment and cost
According to Advanced Mental Health Care psychologist Kristie DeBlasio, Ph.D., a typical TMS treatment lasts four to six weeks, and totals 20 to 30 individual sessions.
Patients undergo the treatment daily. “It usually lasts about 40 minutes,” DeBlasio explains.
Reported side effects are exceedingly rare, mild, and tend to dissipate quickly. “The worst thing patients usually say about it is that the ‘tap, tap, tap’ of the pulse gets annoying,” notes DeBlasio.
Anecdotal stories, as well as preliminary research, suggest that transcranial magnetic stimulation also can be effective in treating a host of other neurological issues, including Parkinson’s disease, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), to name just a few.
However, doctors who use it to treat these conditions, or another condition other than severe depressive disorder, are doing so “off-label.”
How quickly patients begin feeling mood elevation varies. Tendler notes, however, that 80 percent of the several hundred patients he has treated with transcranial magnetic stimulation experience marked improvement: “This modality is not experimental — it’s clinically proven.”
Armstrong, for one, certainly doesn’t need convincing: “I can still remember the first treatment. I walked in feeling one way, and left feeling another.”
These days, Armstrong undergoes periodic “maintenance sessions” when he’s feeling particularly stressed. He says, “I always leave feeling better than when I came in.”
The primary obstacle to making the treatment more widespread, says DeBlasio, is cost. “Because insurance companies still think of the treatment as ‘new,’ most resist covering it.”
Thus, patients are forced to pay out of pocket. Earlier this year, The Sun-Sentinel reported $400 as the typical price per TMS session. Do the math, and that means a full course of TMS treatment for depression could run from $8,000 to $12,000.
But for Armstrong, the cost has been well worth it: “People with depression need to know about TMS, because it could change their lives.”
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