A Non-Medication Treatment Effective for Severe Depression, OCD, and BipolarDepression

As a psychiatrist in practice for the past 7 years I have many times been frustrated at the lack of effectiveness of medications to treat severe depression, OCD, and bipolar depression. An avid reader of professional journals I came across an article about a new method of treating severe depression, this was basically a mini table top MRI machine which was due to come on the market in a few years. Intrigued I waited for news of its arrival hoping it would be a device for in office treatment of individuals who were not getting response from medications or therapy but it never seemed to come into practical use. Then I got a phone call from a psychiatrist who was excited about a new technology he had been using in his office, Brainsway deepTMS (different from the tabletop MRI device but still based on the use of magnetic fields). He wanted to partner with having one in my office. He reported that after 20 years in practice he now once again had renewed excitement for his job as he saw people respond and improve with this treatment where medications had failed. So I looked into this technology and as a result of the effectiveness reported in the research decided to get a Brainsway deep TMS for my office.

I started a new practice in Fort Collins, CO in September 2019. It was slow going initially getting on insurance panels but now we are paneled with BCBS, Cigna, Aetna, Tricare, and Medicare for TMS treatments. We are pleased with the results we are seeing in patient improvement in patients who are severely depressed who until now have not been able to get relief from their depressive symptoms. Studies show that with each subsequent medication trial the effectiveness drops dramatically. In one large study the first medication tried was shown to have effectiveness in 27.5% of patients, the second has effectiveness in 21.2%, the third medication tried 16.2%, and the fourth saw a dramatic drop in effectiveness to only 6.9% of people trying a fourth medication. So, this is the main reason a non-medication option was needed and pursued. TMS has very minimal side effects especially compared to ECT which is the other non-medication option for individuals with severe depression. Unlike ECT (Electro Convulsive Therapy), there are no cognitive deficits or memory loss associated with TMS. You can drive yourself to and from the appointments as no anesthesia is required and you will be able to resume your normal routine immediately after a 20 minutes treatment. If you are considering ECT but not wanting to risk the side effects, TMS effectiveness is comparable (75% improvement compared to 80% with ECT). In fact a patient who is scheduled for ECT with insurance pre-approval may likely be able to switch their treatment to TMS with insurance prior authorization intact for bipolar depression which is not usually necessarily covered by insurance otherwise. TMS is considerably less costly than ECT so it is easy to see why insurances would want to allow that option in addition to the lower side effects profile and comparable effectiveness of TMS. Another TMS company has recently received fast track approval for its FDA application for TMS treatment of bipolar depression.

OCD (Obsessive Compulsive Disorder) is a newer application of TMS, Brainsway deep TMS has a special coil design the H7 helmet that was FDA approved for treating OCD in 2019 and was specifically designed for targeting the brain areas involved in OCD. OCD is typically very resistant to treatment, which can be very debilitating and affects 2-3% of the general population. Since FDA approval, some insurance companies are providing coverage for this non-medication treatment option for OCD. At the end of the 6 weeks of treatment in the studies that were submitted for FDA approval, 54% of patients treated with deepTMS had a 20% reduction in OCD symptoms and 38% had a greater than 30% reduction in OCD symptoms.

The mechanism of action of magnetic fields in treatment of brain disorders has been studied since 1985 and is well understood. The extremely low current generated in brain areas being treated with deepTMS cause activation of these underactive brain areas in severe depression, OCD, and bipolar depression. This gentle brain stimulation retrains these areas of the brain to be more active in ways that help individuals function in their daily lives and find more enjoyment in life. The most common side effect is a mild headache which is usually only present during treatment and fades with each subsequent treatment. IF you know someone suffering with these debilitating mental illnesses who are not improving with medication and therapy interventions help them get relief by making them aware of this life changing treatment.

An overview of the main study investigating deepTMS for OCD treatment<<

About the author : Dr. Rose George MD

Dr. George completed her fellowship at The University of Utah and is double boarded in Child and Adolescent Psychiatry and Adult Psychiatry. She has served as Medical Director for two residential treatment centers and enjoys running her own private practice. She prides herself in the conservative use of medications and a collaborative, caring approach, seeking to provide each patient with the greatest level of well-being.

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