Using magnets to fight depression

Steve aspires to be the next great novelist. He's in the process of closing a very long chapter in his life: 20 years of severe depression. Steve tried psychiatry sessions and medications, but continued his fall into despair and darkness.

"For all practical purposes, I was asleep 18 to 20 hours a day," said Steve.

For the past few months, Steve's been getting /*transcranial magnetic stimulation*/, or TMS. It was recently cleared by the /*Food and Drug Administration*/ for treating depression.

A machine delivers a series of quick pulses to a section of the scalp about the size of a quarter. Researchers say the stimulation reactivates parts of the brain that regulate mood.

"The beauty of it is we can do it noninvasively in the doctor's office without needing sedation, with the patient able to resume normal activities immediately," said Dr. John O'Reardon, associate professor of psychiatry, /*University of Pennsylvania*/.

In a study of more than 300 people with major depression, those who had TMS were twice as likely to go into remission or have a good response compared to those who didn't have the magnetic pulses. Doctors say possible side effects can include headaches and a low risk of seizures. Steve noticed a change in his mood after two weeks.

"I came back, and I came back I think far more suddenly than I left," said Steve.

Now he's looking forward to writing the next chapter in his life.

Five percent of patients in the TMS study stopped treatment because of side effects. That's still three times better than the discontinuation rate of standard medications.


BACKGROUND: Major depression is a medical illness and, according to the National Alliance on Mental Illness, it affects 15 million American adults each year. Unlike typical episodes of sadness, loss or passing moodiness, major depression is persistent and can significantly interfere with an individual's thoughts, behavior, mood, activity and physical health. Physically, depression can cause an individual to suffer from aches and pains, weight loss, constipation and chronic loss of energy. Among all medical illnesses, major depression is the leading cause of disability in the United States. Depression occurs twice as often in women as in men. Why women are more prone to the illness isn't known. More than half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. Without treatment, the frequency of depressive illness as well as the severity of symptoms tends to get worse over time. Left untreated, depression can lead to suicide. Major depression (also known as clinical depression or unipolar depression) is only one type of a family of depressive disorders. Other disorders include dysthymia (chronic, less severe depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression).

TRADITIONAL TREATMENTS: Several treatment options are available for major depression. The three most widely used treatments are medications, psychotherapy and electroconvulsive therapy (ECT). Anti- depressants are a group of drugs approved by the FDA for the medical treatment of depression. They work by interacting with naturally occurring biochemicals in the brain to change a person's mood. Other drugs that are not approved by the FDA for the treatment of depression, yet still have a positive effect on mood, are sometimes prescribed. This practice, called off-label use, is legal and fairly common. Psychotherapy is another key depression treatment and is often used along with medication. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy. In ECT, electrical currents are passed through the brain to trigger a seizure. Although many people are leery of ECT and its side effects, it typically offers fast, effective relief of depression symptoms. ECT is usually used for people who don't get better with medications and for those at high risk of suicide.

STIMULATING THE BRAIN: Transcranial magnetic stimulation (TMS) is an experimental treatment that uses a magnetic field to stimulate a small area of the brain. Unlike ECT, TMS does not cause the patient to have a seizure and is thought to be less invasive. During TMS a coil of wire incased in plastic is held to the patient's scalp. The coil produces a magnetic field that induces electrical currents to excite neurons in specifically targeted malfunctioning circuits of the brain. The stimulation is thought to restore these malfunctioning circuits and ultimately alleviate symptoms of depression. TMS sessions last 20 to 30 minutes and can be done multiple times per week. A patient remains fully awake during treatment and no recovery time is needed. Researchers say it takes about 10 to 20 sessions to see good results. Although there is a very small risk of seizure, the most common side effect of TMS is a mild headache. In October 2008, TMS was cleared by the FDA for the treatment of depression in people who failed to respond to antidepressants.



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