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TMS for Depression during Pregnancy and Postpartum

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By Suzanne Kerns, M.D.

Women who suffer from depression during pregnancy or in the postpartum period might not seek treatment if they assume medication is the only treatment option available to them. Although concerns about taking medication while pregnant or breastfeeding are understandable, untreated depression can also be very dangerous.

Women who want to avoid or limit the use of antidepressants may consider Transcranial Magnetic Stimulation (TMS) as a safe and effective treatment option. Approved by the FDA in 2008 for treating depression, TMS works by delivering electromagnetic pulses to specific areas of the brain that regulate mood.

A standard treatment course is five sessions a week for four-to-six weeks. Each session lasts about one hour. Patients remain awake and alert during the treatment, and there are minimal side effects.

Several research findings have shown that TMS is a safe and viable treatment for women who are pregnant or postpartum.

  • A University of Pennsylvania study of TMS and pregnancy found that among 10 pregnant women treated with TMS, 70 percent responded well within just 20 sessions, with no adverse effects on pregnancy or fetal outcomes. The only side effect was a mild headache in four of the patients.[1]
  • Another study that focused on TMS during postpartum found that eight of the nine women who were treated with TMS experienced complete remission of their depression.[2]

In addition to being safe and effective for patients, TMS has not been shown to have adverse effects on a fetus or nursing child. A recently published study looking at 26 children ages one to five years old, whose mothers had received TMS treatment during pregnancy, found there were no differences between the children born to women who had TMS during pregnancy and children born to women who did not undergo TMS.[3]

TMS’s safety and effectiveness make it an ideal option for women with a history of non-response to standard antidepressant medications that are deemed safe in pregnancy or for women who don’t want to take medication during pregnancy or while breastfeeding. Unlike antidepressant medication, TMS does not enter the bloodstream, and therefore does not have any known or foreseeable effects on a fetus or nursing child.

[1] Kim, DR, Epperson, N, Paré, E, Gonzalez, JM, Parry, S, Thase, ME, Cristancho, P, Sammel, MD, O’Reardon, JP. (2011) An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. Journal of Women’s Health 20(2): 255-261.

[2] Garcia, KS, Flynn, P, Pierce, KJ, Candle, M. (2010) Repetitive transcranial magnetic stimulation treats postpartum depression. Journal of Brain Stimulation 3(1): 36-41.

[3] Eryılmaz, G, Sayar, GH, Özten, E, Gül, IG, Yorbik, O, Işiten, N, Bağci, E. (2015) Follow-Up Study of Children Whose Mothers Were Treated With Transcranial Magnetic Stimulation During Pregnancy: Preliminary Results. Journal of Neuromodulation 18(4): 255-60.

 

TMS versus ECT

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By Joshua Bess, M.D.

The first line of treatment for patients suffering from anxiety and depression is typically antidepressant medication and psychotherapy. If these treatments have not been as effective as hoped, it may be time to consider brain stimulation therapy.

There are two kinds of brain stimulation technologies that are FDA-approved for depression. One is Transcranial Magnetic Stimulation (TMS) and the other is Electroconvulsive Therapy (ECT). TMS and ECT are safe and effective treatment options for adults who have tried medication and psychotherapy for anxiety or depression without seeing good results.

Both TMS and ECT work by stimulating specific areas of the brain that regulate mood. In most cases, it makes sense to try TMS first because TMS can improve brain function without cognitive side effects and does not require anesthesia.

TMS involves placing an insulated coil over the scalp to deliver electromagnetic pulses to specific areas of the brain that impact depression. Patients remain awake throughout the treatment, which is non-invasive. The most common side effects are slight discomfort at the site where the coil sits on the scalp during treatment and a mild headache afterward. Patients can resume their usual daily activities, including driving, immediately after a treatment.

Studies have shown that TMS is highly effective for treating medication-resistant depression, with response rates between 40 and 60 percent and remission rates between 35 and 40 percent. While some patients see results in just two weeks, an average treatment course is four to six weeks.

TMS is almost always the first choice for brain stimulation treatment. If a patient is suffering from severe depression and is perhaps even suicidal, ECT may be an appropriate treatment option. ECT is also considered when a patient does not respond to TMS. ECT involves passing electrical pulses through a person’s brain to produce intense brain activity during a brief period of time.

Between 80 and 90 percent of our patients who undergo ECT treatment see improvement. We typically see positive clinical response and substantial reduction in suicidal thoughts among our patients within one to three weeks.

Most of our patients tolerate ECT remarkably well. Immediate side effects can include nausea, headache, jaw pain, muscle ache and muscle soreness, as well as confusion. Patients may also experience memory loss, although memory problems from ECT usually resolve within a couple of months after completing treatment.

Both TMS and ECT can be used in combination with medication and psychotherapy. Many patients have better results when brain stimulation is used to augment existing therapies.

SeattleNTC is the only medical group in the Seattle area that offers both TMS and ECT. We work closely with patients and their referring providers to determine the most appropriate course of treatment.

Brainsway Deep TMS

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We have added a new TMS device at our Cherry Hill Office:  Brainsway Deep TMS.  Deep TMS (dTMS) is a new technology that produces significantly deeper cortical stimulation.  Brainsway Deep TMS is approved by the FDA for Major Depressive Disorder.  The FDA indication is based on a 16-week double-blind, placebo-controlled multi-center study, which enrolled over 200 subjects, showing a profound decline in the Hamilton Depression Rating Scale (HDRS-21), a significant remission rate of 32.6% and an even higher response rate in treatment resistant patients.  Brainsway Deep TMS is currently being studied in over 60 clinical trials at leading institutions worldwide.  Approved clinical indications in Europe include Bipolar Disorder, PTSD, Schizophrenia (negative symptoms), Autism, Alzheimer’s disease, Parkinson’s disease, chronic pain and smoking cessation.