TMS THERAPY
FDA-cleared, non-medication depression treatment
Does TMS Work Long Term?
Mary El Grammer
For those who have struggled to find relief from depression symptoms, transcranial magnetic stimulation (TMS) therapy is an appealing option. FDA-cleared for major depressive disorder (MDD), obsessive-compulsive disorder, and smoking cessation, TMS is a non-invasive treatment with minimal side effects and a high response rate in patients with treatment-resistant depression.
"Before TMS therapy, I was moody, mercurial, sad, and crying most of the day," says Emily, a Greenbrook TMS patient. "I felt relief from my overbearing, all-consuming depression after my first 20-minute session."
So, does TMS work? With most patients, like Emily, yes. TMS therapy is changing the lives of people with depression symptoms every day. With many patients seeing results immediately or within a few treatments, the question remains: does TMS work long term, and will patients need to return after some time? That answer is a bit more complicated.
What the Research Shows
Looking at three major TMS studies may be helpful in understanding how we measure success, in both the short and long term.
One of the original studies of TMS, which examined TMS's efficacy and safety in the acute treatment of MDD, was conducted with randomized, double-blinded, sham-controlled trials. In other words, study subjects didn't know if they were getting a real or a fake TMS treatment. All study participants discontinued their antidepressants before beginning the trial, and the technicians administering TMS were told to be emotionally neutral, making the trial sterile and, subsequently, not terribly impressive. Researchers concluded TMS was effective in treating MDD with minimal side effects, and the FDA gave its approval—but many participants who were given the placebo, or fake treatment, were left without any improvement.
Neuronetics, a company that makes one of the TMS chairs that Greenbrook TMS uses, saw an opportunity for a continuation study. They invited participants from the first study to participate in an open-label phase where participants knew they were receiving a real TMS treatment. Study participants were treated with TMS in a real-world setting, not a sterile, emotionless one. Many patients find the very process of TMS therapy to be therapeutic, setting aside time for themselves each day to be greeted by friendly people who are interested in their well-being. Plus, patients were allowed to go back on their antidepressants, suggesting that TMS may provide even better outcomes when used in conjunction with other things that work.
A similar, second continuation study was conducted two years later that followed participants for a year. By this time, results were looking good: After six weeks of TMS therapy, patients had a 62.3% response rate to TMS, and 41.2% of patients experienced remission. A year later, 62.5% of the patients who responded were still better, and 45.1% of those patients in remission were still in remission. Furthermore, 84.2% of patients who benefited from TMS during their first course of treatment but did not achieve remission were found to benefit from TMS during a second course of treatment.
So,
does TMS work long term? For many, the answer is yes. And for others who experience symptoms at some point after receiving TMS therapy, another round of TMS will successfully set them back on track.
Staying Well After TMS
More research is needed to understand how to get the full range of benefits from TMS therapy, but based on studies about depression, as well as doctors' and patients' experiences, other therapeutic modalities can encourage and prolong the positive effects of TMS therapy.
1. Antidepressants
Even if antidepressants didn't work for you before TMS, a singular antidepressant can hold your state constant afterward, reducing your risk of depression symptoms returning. Staying on an antidepressant for a year after your course of TMS can be a safe, precautionary way to support your positive response to TMS.
"TMS and medications work best together," says Dr. Don DuBose, Greenbrook TMS's South Carolina Medical Director. "The goal is getting you better, so whatever we need to do to get you there, that's what we do."
2. Talk Therapy
Talk therapy is exceedingly useful in sustaining wellness, even if therapy didn’t seem to help before TMS. Cognitive behavioral therapy (CBT) is one particularly well-supported type of therapy. CBT helps you avoid the pitfalls of cognitive loops that can lead to a circular decline in mood.
3. Lifestyle Changes
If you responded to TMS therapy, then maintaining a normal sleep-wake cycle, getting adequate nutrition, and exercising regularly can aid in keeping you well. Overdoing any of these, particularly exercise, is not the goal; the medical benefits of exercise can happen at modest levels. If your doctor clears you to exercise, you do not need to engage in an extreme regimen. A walk around the block, gardening, or walking your pets all have tremendous health benefits and can help sustain the benefits of TMS.
What to Do If Depression Comes Back
You can do everything right and your symptoms may still return—that's simply the way depression is. It's important to remember that having depression is not your fault. Still, the more you stay well, the more the wellness pathways in your brain will be strengthened to keep you feeling well.
If you do find that your depressive symptoms are returning after TMS therapy, get back into treatment quickly. Don't let those depression symptoms fester for more than a couple of weeks before you reach out to a TMS center. The
Care Team at Greenbrook TMS is ready to hear your concerns and work out a plan to get you feeling better, faster
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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