Mental Health in the News: August 11, 2022

By Dr. David Woo - August 11, 2022

Welcome to Madison Avenue TMS & Psychiatry’s Mental health in the News weekly update. Below are some current news events relating to mental health and mental health treatments.

TMS Is a Safe and Effective Alternative to Depression Medication

The Department of Psychology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, employs the use of brain stimulation techniques, such as transcranial magnetic stimulation (TMS), for the treatment and management of neurological, ENT (ear, nose, and throat), and mental health conditions since 2016.

TMS is a safe, non-invasive, outpatient therapy that uses electromagnetic pulses to stimulate areas of the brain, and is proven to reduce symptoms of various medical and mental health conditions.

Assistant Professor of Psychiatry, Dr. Shalini Naik, says the department has treated more than 300 patients for depression, obsessive-compulsive disorder, substance use disorders, schizophrenia, post-stroke depression, migraine, and tinnitus.

TMS technology was originally developed in 1985. Pascual-Leone first used TMS to treat major depressive disorder (MDD) in 1996. TMS works by delivering magnetic pulses through the scalp that travel into the brain, regulating brain activity and neural connectivity.

Today, TMS is well-known as an effective treatment for reducing symptoms of depression and is FDA-approved as a safe and effective treatment for depression. 

Depression is associated with reduced activity of the left prefrontal cortex, an important area in the front of the brain thought to moderate response to emotional stimuli. TMS works by regulating activity in the prefrontal cortex to relieve depression symptoms. To treat depression, TMS is typically delivered at 10-20 pulses per second in 30-45 minute sessions daily for four weeks. 

While it has proven to be highly effective, TMS treatment is still relatively less common due to the availability of devices and trained technicians. For this reason, TMS is often reserved for treatment-resistant patients, or those who have not found relief from depression symptoms with other treatments, like medication and psychotherapy.

Side effects of TMS are few, and include occasional discomfort of the scalp and, rarely, seizures in patients with previous episodes. Careful standards are upheld so as to limit the occurrence of side effects. Patients and doctors carefully consider risks and benefits before TMS treatment.

To read the original news article, click here.

Can TMS Treat Depression Symptoms in Patients with Multiple Sclerosis?

Preliminary research data suggests that transcranial magnetic stimulation (TMS) may be effective at treating symptoms of depression in patients with multiple sclerosis (MS). In early June, these findings were presented at the Consortium of Multiple Sclerosis Centers’ (CMSC) 2022 annual meeting in National Harbor, Maryland.

Twenty people with MS participated in a quantitative study that aimed to assess the efficacy of TMS for relieving depression symptoms. The 20 patient participants ranged in age from 33 to 68 years old, 70% female and 30% male. Thirteen participants had relapsing-remitting MS (RRMS), four had primary progressive multiple sclerosis (PPMS), and three had secondary progressive multiple sclerosis (SPMS).

Using the Expanded Disability Status Scale (EDSS), a questionnaire used to quantify disability in individuals with MS, patient scores ranged from 0 to 6.5, with the average score being 4.6±1.9.  

Subjects had been diagnosed with MS for between one and 24 years with an average of 10.0±7.2 years. Patients were also scored on the Beck Depression Inventory, a self-reporting questionnaire used to measure the severity of depressive symptoms. At the beginning of the study, six patients (30%) presented with depression. 

All participants received one TMS treatment session daily for 10 days in a row. After the 10 TMS treatments, 13 out of 20 patients (65%), including five out of six subjects with depression (83.3%), reported a reduction of symptoms on the Beck Depression Inventory. Researchers concluded that TMS showed potential for treating MS patients for depression, which is a frequent mental health condition of people diagnosed with MS.

To read the original news article, click here.

Observing the Effects of TMS on Depression Using fMRI

About 40% of patients with depression are considered to be treatment-resistant (they don’t see relief from depression symptoms with prescription medication or therapy). Transcranial magnetic stimulation (TMS) is a medication-free, non-invasive treatment that is proven to help patients with treatment-resistant depression find relief from symptoms. 

During TMS therapy, magnetic pulses are delivered from an electromagnetic coil to the brain through the patient’s scalp, at a frequency of 1 Hertz. These magnetic pulses regulate targeted brain areas, like the DLPFC (dorsolateral prefrontal cortex), to reduce symptoms of depression. 

While TMS is proven to be effective to treat depression, many aspects of how it influences the brain are still unknown. The results of a recent clinical trial published in 2022  in the American Journal of Psychiatry show that TMS results in extensive improvements in brain function in patients with treatment-resistant depression.

During the study, researchers used functional magnetic resonance imaging (fMRI) to directly observe the effects of TMS on the brains of patients diagnosed with treatment-resistant depression. Essentially, fMRI technology takes detailed images of the brain using a magnetic field and radio waves, allowing researchers to map out the changes in real-time.

The study results suggested that:

• The ability of the individual patient’s brain to change (called plasticity) may determine the efficacy of TMS
• The effects of TMS extend farther throughout the brain than just the treated area into regions responsible for the regulation of emotional response to memory and motor control

Comparing fMRI images from the beginning and end of the four-week treatment, researchers correlated changes in brain activity to positive changes in depression symptoms. The team hopes that observations of this kind may help practitioners predict how responsive individual patients may be to TMS treatment.

The same research team is now observing whether TMS could improve memory in Alzheimer’s patients and other neuropsychiatric conditions. They’ll soon explore the use of fMRI to help determine the ideal location of the brain to target, unique to each patient, to get the best results from TMS treatment for depression.
To read the original news article, click here.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.