TMS THERAPY
FDA-cleared, non-medication depression treatment
History of TMS Therapy: How Long Has TMS Been Around?
Laurence Lippsett
As a condition with a variety of symptoms and causes, depression affects different people in different ways. This also means that health care providers can offer a variety of treatments, to differing degrees of success. Most people have heard about traditional talk therapies, antidepressant medications, or recommended changes in diet, exercise, and other lifestyle habits. But there's another treatment that isn't as well-known: transcranial magnetic stimulation, or TMS. You might be surprised to learn just how much research has gone into TMS over the years. So, what is TMS therapy exactly, and how long has TMS been around?
The Connection: Electricity and the Brain
Physicians have long been intrigued by the effects of electricity on the brain. As far back as 46 A.D., Scribonius Largus, the court physician to the Roman emperor Claudius, compiled a book of medical treatments known as Compositiones. It included a recommendation for applying live electric torpedo fish onto patients' scalps to cure headaches. A thousand years later, the physician Ibn-Sidah prescribed using live electric catfish to treat epilepsy.
In the mid-20th century, scientists began applying electrodes to the brain in electroconvulsive therapy (ECT). While ECT is still
used successfully, it requires patients to go under general anesthesia and is reserved for those with severe mental illnesses who have not responded to other therapies. It is understood that nerve cells operate by
generating electric signals that trigger muscles, for example, or activate chemicals in the brain. To investigate how these processes work and better develop treatments, researchers sought safer ways to introduce electricity to the body.
How Long Has TMS Been Around
In 1985, Anthony Barker and his colleagues were the first to use a magnetic stimulator to activate the brain. This development took advantage of a basic discovery made by physicist Michael Faraday made back in 1831. Barker's device, placed on a patient's head, generated a magnetic pulse that passed painlessly through the scalp and induced an electric current in the underlying brain tissue. Within a few years, scientists engineered improvements to allow TMS devices to deliver repeated magnetic pulses.
Although the new TMS device was originally meant to be a research tool, Hans Martin Kolbinger and his colleagues published a pilot study in 1995 showing evidence that TMS helped patients with major depressive disorder (MDD). The next year, leading TMS researchers convened to set detailed guidelines on how TMS should be used safely and ethically in laboratory research and clinical settings. With these guidelines in place, scientists expanded tests using TMS, initially involving patients with depression who did not find relief from existing treatments.
In 2007, results were published of a major clinical trial that conducted TMS treatments on 301 patients with MDD who had not benefited from other therapies. It found that TMS was safe and could alleviate symptoms of MDD. By then, more than a decade of studies had shown that TMS therapy produced few and minor side effects. In 2008, the U.S. Food and Drug Administration cleared TMS therapy as an accepted depression treatment.
Breaking New Ground with TMS
Since 2008, numerous studies have demonstrated that TMS therapy can provide relief for those whose depression symptoms haven't improved after medications and/or talk therapy. Further, TMS has often provided more relief when used in conjunction with other therapies.
Antidepressant medications, for example, have been shown to help relieve symptoms in 40% to 60% of patients. Some people don't like to take antidepressants, even if they are effective, because they sometimes come with side effects such as insomnia, weight gain, headaches, blurred vision, rashes, high blood pressure, and gastrointestinal and sexual problems. TMS is a non-drug, non-invasive therapy with a long history of producing few side effects. Patients sit in a comfortable chair with a TMS device near their scalp. The magnetic pulses are not painful, but rather feel like a gentle tapping, as they stimulate areas of the brain that are known to regulate moods.
When it comes to just how exactly TMS works, scientists have many theories. TMS may increase electrical activity and/or blood flow to brain regions that may be slowed down because these were lacking. Magnetic fields from TMS may help growing brain cells align into more efficient circuits to convey brain signals. Or, TMS could help trigger the release of chemicals that speed brain signaling.
Because these mechanisms logically could also aid in other brain conditions, researchers have explored using TMS to treat other conditions. In 2018, the
FDA approved TMS as a treatment for
obsessive-compulsive disorder. What's more, TMS is also being tested and used to help patients with Parkinson's disease, migraines,
strokes,
head traumas, and
multiple sclerosis. Talk with your doctor to see if
TMS therapy might be a beneficial option for you.
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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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