Mental Health in the News: September 8, 2022

By Dr. David Woo - September 8, 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.

How TMS Therapy Can Help Relieve Depression Symptoms When Other Treatments Fail

Major depressive disorder (MDD) is a serious mental health condition characterized by extreme sadness that impacts the daily life of those affected for two weeks or more.

Though several antidepressant medications can treat major depression, researchers and psychiatrists know that antidepressants don’t work for everyone. Up to 30% of adults with MDD experience treatment-resistant depression or TRD. People with TRD don’t experience enough relief (or any) from depression symptoms with antidepressants and talk therapy, even after trying at least two different antidepressants from different classes.

TRD can be frustrating for patients who hope to see immediate relief from depression symptoms with medication. The prevalence of TRD highlights the complexity of depression and the lack of information that exists about its causes. Some scientists believe that depression is caused by low levels of certain chemicals (called neurotransmitters) in the brain, primarily serotonin and norepinephrine. Others cite inflammation as the underlying cause of depression.

Emerging information suggests that TRD may be due to low levels of two genes that play a role in forming brain circuits. If this is true, it could explain why antidepressants — which raise levels of serotonin and norepinephrine — don’t work for everyone.

Now, an innovative treatment provides renewed hope for better mental health. Transcranial magnetic stimulation (TMS) helps many people with TRD experience the symptom relief antidepressants have failed to provide.

TMS uses brief pulses of magnetic energy to stimulate the particular area of the brain associated with depression. Mental health providers can focus these pulses on different areas of the brain, based on the person’s specific symptoms. This allows for a more personalized approach to treatment.

The NeuroStar® TMS system delivers targeted magnetic pulses in short bursts over the course of several minutes. Patients typically receive TMS therapy every day for several weeks.

Many people who get TMS therapy experience noticeable relief from depression symptoms for six months or even one year after treatment.

Another groundbreaking therapy that gives hope to people with severe TRD is esketamine. Derived from ketamine — an anesthetic drug that’s been used to treat depression for years — esketamine comes in the form of a nasal spray.

Esketamine is FDA-approved for people with TRD, but it must be used in conjunction with an antidepressant.

To read the original news article, click here.

Making Deep TMS Therapy More Accessible Could Have a Major Public Health Impact

Millions of Americans experienced an increase in depression and anxiety symptoms as the COVID-19 pandemic limited access to vital mental health resources. Difficulty accessing mental health care could lead to a potentially life-threatening situation for the 10% to 30% of people with major depression who don’t respond to antidepressant medications.

Deep transcranial magnetic stimulation (dTMS) is a medication-free treatment that’s helping people with depression find the relief they haven’t been able to feel with antidepressants. Deep TMS therapy is a safe, non-invasive procedure that uses magnetic pulses to stimulate neurons (brain cells) in regions of the brain associated with mood.

Although Deep TMS therapy was approved by the FDA for treatment-resistant depression (TRD) in 2013 and obsessive-compulsive disorder (OCD) in 2018, experts say they haven’t been able to make a big public health impact with it yet. 

Incidences of depression, suicide, and drug overdoses continue to skyrocket, despite this safe and effective treatment being available. Unfortunately, many mental health care providers remain unaware of how life-changing TMS therapy can be; for some patients, it can be more effective than antidepressants.

Roadblocks to Accessibility of Deep TMS

Several major insurance companies cover TMS therapy, but patients don’t usually qualify for coverage unless they meet the diagnostic criteria for TRD and have tried at least four different antidepressants from two different classes, without achieving symptom control.

This means millions of people who are either undiagnosed or unable to tolerate the side effects of antidepressant medications may face out-of-pocket costs of TMS therapy. In the state of New York, Medicare covers up to 80% of the cost of TMS for patients with depression.

Can Deep TMS Help Those with Mental health Conditions Other Than Depression?

Deep TMS is FDA-approved for depression, anxious depression and OCD (obsessive-compulsive disorder), and is being studied as a possible treatment for anxiety, PTSD, and other mental health conditions.

To read the original news article, click here.

Can Brain Stimulation Help People Who Stutter?

Approximately 70 million people—about 1% of adults worldwide—are thought to stutter. Stuttering can cause social distress and stigma, and can generally impair a person’s quality of life. However, its exact causes remain unknown.

Currently, speech therapy is the only available treatment for stuttering. While speech therapy can improve fluency and reduce the side effects of stuttering, such as involuntary muscle movements, it shows limited success in adults. Additionally, speech therapy doesn’t address the underlying cause of the condition. Scientists know that people who stutter show reduced activity in a region of the brain involved in language processing and speech, called the left inferior frontal cortex.

Recent studies suggest that noninvasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) therapy, may succeed where other treatments have failed. TMS uses magnetic pulses to stimulate neurons in specific brain regions. The goal is to remodel circuits of interconnected brain cells (neurons). This approach has already shown positive results in treating depression.

In 2019, brain researcher Guillermo Mejias, Ph.D., published a short paper reporting the positive effects of treating himself with TMS. Dr. Mejias has had a stutter since childhood, but his paper reported a noticeable improvement in his speech, including a 30% reduction in blocks and repetitions, that lasted a few weeks. Additionally, he noted that the speech improvements increased his confidence.

Other researchers have investigated brain stimulation as a treatment for stuttering with a similar technique called transcranial direct current stimulation (tDCS). Unlike TMS, tDCS uses large electrodes to pass an electrical current from one side of the brain to the other.

While TMS allows for greater control over the targeted treatment area than tDCS, both treatments show promising results for reducing the symptoms of stuttering. Future studies may investigate another technique, called transcranial alternating current stimulation, which mimics the brain’s natural electrical rhythms.

These findings make brain stimulation researchers optimistic about using techniques like TMS and tDCS to treat the root cause of stuttering.

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.