Transcranial Magnetic Stimulation . . . A New Hope For Treatment Resistant Depression

A former patient wrote this to check in with me . . .

As a former patient of your practice, what are your thoughts on treatment resistant depression?  Anything new or in the pipe line?   At present I am doing well with Pristiq ,lithium, and Depakote. I am also involved in a sleep study with a blind trial of rozerem with a Doctor at a local hospital. Best of luck to you. You should start writing a book by now.

First off, it always warms my heart to hear from former patients!  Thanks for taking the time to view my blog and to ask a very good question (great segue!!).

Managing treatment resistant depression (TRD) is one of the more challenging tasks for us in the mental health world.  But as challenging as it is for me . . . it is far more difficult for the patient who is living it . . . and their family.  It is near impossible to change how you feel when you feel as bad as you do with TRD.  The people around you feel so dis-empowered and, in many cases, progressively more angry, at your “lack of trying” or your “lack of caring”.  It is true that when you are at your worst, you feel like you don’t care and you may not try . . . but that is because of how impossible a task it seems.  When you are in the depths of your depression, you might as well be asked to pick up a truck.  Can’t do it.  Can’t smile . . . can’t laugh . . . can’t get out of bed.

Very scary for those around you who care about you.  They can feel hopeless and helpless.  Confused and angry.  And hurt.

So what is there to offer these days.

First off, how about just good basic treatment.  Even that can be in short supply at times!  It is vitally important that people get good basic treatment.  This would include solid trials with medicine (enough medicine for long enough) AT THE SAME TIME as you are getting good therapy.  Good basic treatment would also include combination treatments with complementary antidepressants, neuroleptics (Abilify is the most common agent here), lithium or thyroid hormone.  With everyone’s physiology being different, it is impossible to predict what is going to work for a particular person.  Sometimes things just click in and life is good again.  Sometimes, it is unsuccessful trial after unsuccessful trial.  Frustrating.  And potentially deadly.  Under treated depression is a potentially lethal disease that must not be minimized.  Any

In the past, repeated medication failures would indicate a need to consider ECT . . . Electro-convulsive Treatment . . . shock treatment.  The mention of this invariably scares the tar out of anyone who hears that it might be the only way out of severe depression.  Visions of Jack Nicholson getting shock treatment in One Flew Over The Cuckoo’s Nest are hard to get out of your head.  The stories of memory loss and cognitive impairment (a very real risk with ECT) has to make one consider if muddling along feeling like crap would be better than plugging in to ECT.  I have personally been an advocate of ECT for severe treatment resistant depression, and have told my wife that I wanted it if I was ever in a position of being severely depressed to the point of incompetence.  But now there is a new option.

Transcranial Magnetic Stimulation (TMS) has been in use in Europe, South America and Canada for years.  It has been shown, when done carefully, to improve about half of the patients who have failed previous medication trials and bring a third of the patients to remission.  REMISSION.  Wow.  That means ALL BETTER.  And, it has virtually no side effects.  No memory issues.  No cognitive issues.  Just better.

It doesn’t get better than that.

Not everyone benefits from it, but the treatment is specifically for patients who have failed all conventional trials.  It is expensive still, because insurances are slow to pay for new treatments.  The company who has gained approval of their machine (Neuronetics) has a great patient advocacy program that tries to get approval through the insurance company and, if that fails and the patient has the treatments, tries to get reimbursement.  They have been successful in a handful of cases.  That is a start.  There are also financing plans in place to help people get the treatment while they wait for the insurance companies to get on board.

So, as an FYI to my wife . . . if I ever get severely depressed and am not coming out of it . . . I’ll take TMS, please!

–Dan Hartman, MD

PS     I’m working on the book!

3 comments to Transcranial Magnetic Stimulation . . . A New Hope For Treatment Resistant Depression

  • Larry wrote in the following comment that I thought belonged here:

    I HAVE BEEN TRYING FOR SO LONG TO GET HELP, BUT REGARDLESS OF WHERE I CALL, NOONE IS UNDERSTANDING OR LISTENS TO WHAT MY PROBLEM IS. FOR YEARS I HAVE HAD SEVERE TREATMENT RESISTANT CLINICAL DEPRESSION. AFTER THE DEATH OF MY BELOVED PARENTS, IT’S BECOME TO MUCH TO BEAR. I HAVE HARDLY ANY FAMILY, AND THE 2 COUSINS I THOUGHT LOVED ME SCOFF AT THIS ILLNESS. MY HUSBAND AND I HAVE BEEN SEPARATED FOR YEARS, I HAVE NO ONE. IF I WEREN’T AFRAID THAT BY KILLING MYSELF I WOULD NOT BE ALLOWED TO REUNITE WITH MY PARENTS IN HEAVEN, I WOULD TRY TO DO IT BECAUSE I HAVE NO LIFE… ONLY A SAD, SCARY, JOYLESS EXISTENCE. I WISH GOD WOULD BRING ME HOME RIGHT NOW.

  • Luigi

    i am the person who wrote the above email, and my name is not Larry…. it is Luigi . . .

    i am still trying to get help, and still having no success at all because i don’t know where else to turn. after searching hours every day for months and months, i might finally locate the number of a doctor who has, supposedly, had experience with this type of depression. but then the assistant or whoever answers the phone appears totally bored with my concern, and no one ever calls me back. if i’m lucky enough to get an email response from, once again, some type of assistant, the most i’m able to get is; you can try to make an appt with the doctor. i would be happy to do so. however before i pack up and make plane reservations., id like to make sure the doctor has something to offer me. i don’t mean that he is to assure me he can cure me… i just want to know that there is something to try; a possibility that something MAY help; the possibility that he will be able to at least suggest a treatment that MAY work. I will pay for those few mins. of his time prior to my traveling there. i just don’t want to use emotional energy that i don’t have to travel there and have him tell me: i really don;t know of any other treatment for you to try at this time. my money is gone, my energy gone, but the most important is that my small bit of hope is also gone!
    another reason i want to make sure there will be some kind of treatment for me to try is because i am now scared to make a trip to somewhere i’ve never been. i used to travel all over, studied in mexico and didn’t know a soul before arriving there, went to europe, etc. i was never afraid, nor did fear even come up in my thoughts. because of this depression, i am scared; although i would travel anywhere to get the right kind of help. it seems though that i’m disappointed at every turn. i think i’m going to die here without ever getting any real help. i’m not afraid to die, but i think it’s so sad to have the thougjt going through my mind 24/7: i guess i’m not good enough to warrant getting any help. i’ve tried so hard. why doesn’t God hear me? without a family, i’m no one. and i miss my mama and my daddy so such it hurts. if they were here, i would have help. but nobody else cares. what kind of life is this. i’m so sad, but i’m so angry too. no one should ever have to suffer like this… it’s constant and it’s so terrible.

  • Luigi–

    Come on . . . quit the nonsense . . .

    It is up to you to make the decision and to follow through on the steps needed to make your life better. You can sit and complain . . . or sit and blame . . . but ultimately your situation is just like mine and everyone else in the universe . . .

    Your life is what you make it.

    It doesn’t have anything to do with your parents (alive or dead) or with your peers, or with your siblings, or your children or with Obama or Stalin or Glen Beck or Dr. Phil or Oprah . . .

    It is all about you.

    What are YOU going to do about your life and your circumstance???

    What do YOU need to heal . . . to be whole . . . to move forward???

    It is up to you to make the calls and to make the effort to connect with someone or some organization that may (MAYBY . . . or MAYBE NOT) meet your needs and help you feel better.

    Sitting by yourself in your own universe is not going to help. Doesn’t help me . . . won’t help you.

    Gotta reach . . . out . . . and . . get . . . some . . help . . . some . . . human . . . touch . . . some . . . perspective . . .

    Your choice.