Depressions and TMS

Depression can have life-changing impacts on those it affects, as well as their loved ones. Fortunately, there are various treatment methods for depression, including TMS Therapy, a non-invasive procedure that stimulates nerve cells in the brain to reduce symptoms of depression. ¹

What Is Depression?

Depression is a mental illness that affects more than 264 million individuals worldwide. It is usually longer-lasting and more intense than short-lived mood fluctuations resulting from everyday obstacles. Depression can become a severe health condition and affect a person’s daily functioning related to work, school, and family. In the most severe cases, depression can lead to suicide, which is the second leading cause of death for individuals aged 15 to 29. ²

Facts About Depression

• One in every 15 adults are affected by depression in any given year ³
• One in every six individuals will experience depression within their lifetime ³
• Depression usually first occurs for someone in their late teens to mid-twenties ³
• One in every three women will have a major depressive episode at some point in their life ³
• Individuals with first degree relatives who have depression are approximately 40% more likely to experience depression themselves ³

Symptoms

People who are diagnosed with depression experience at least some of the following symptoms most of the day, almost every day, for at least two weeks: ⁴

• A persistent sad or anxious mood
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest in once enjoyable hobbies or activities
• Decrease in energy
• Talking or moving slower than usual
• Restlessness
• Difficulty with concentration, memory, or decision making
• Challenges with sleep
• Changes in appetite or weight
• Suicidal thoughts or attempts
• Physical pain including aches, headaches, or cramps
• Digestive issues without a clear physical cause

Some individuals who experience depression may exhibit only a few of these symptoms, while others may experience most of them. Symptoms of depression manifest differently for each individual. The length, severity, and frequency of symptoms are unique to each individual. Someone who is diagnosed with major depression will experience several persistent symptoms and an overall low mood. ⁴

Causes

Depression may occur due to a significant life event or physical illness, but it can also onset spontaneously. The following factors can contribute to depression: ⁵

• Trauma. Trauma that occurs at a young age can create long-term changes in how someone’s brain responds to fear and stress, leading to depression.
• Genetics. Many mood disorders, like depression, can be genetically inherited.
• Life challenges. Changes in relationships, marital status, financial difficulties, and undesirable living situations can influence depression.
• Brain changes. Changes in the pituitary gland and the hypothalamus’ response to hormonal stimulation can affect the development of depression.
• Medical conditions. Individuals with a history of sleep disturbances, medical illness, chronic pain, anxiety, and attention-deficit hyperactivity disorder are more likely to develop depression than someone without any of these conditions.
• Drug and alcohol abuse. In 2018, 21% of adults with a substance use disorder also experienced a major depressive episode.

Treatment Options

There are various treatment options for individuals who experience depression, each with benefits and disadvantages. Treatment options include different types of psychotherapy, antidepressant medication, and procedures such as electroconvulsive therapy and transcranial magnetic stimulation.

Psychotherapy 

Psychotherapy is a form of therapy, often referred to as “talk therapy,” that I used to treat mental health issues by talking with a mental health professional. Psychotherapy involves learning about one’s mental health challenges, moods, feelings, thoughts, and behaviors. Individuals who engage in psychotherapy also learn how to utilize health coping mechanisms for dealing with mental health issues. ⁶

Some popular types of psychotherapy include, but are not limited to:

Advantages

There are several advantages to the psychotherapy treatment method. Some of these advantages include: ¹¹

• Gaining a better self-understanding
• Developing healthy coping mechanisms
• Adopting more positive thinking patterns
• Mood improvement
• Ability to communicate more effectively
• Better emotional regulation

Disadvantages

In addition to advantages, psychotherapy also has several disadvantages. Some of these disadvantages include: ¹¹

• It can take a long time to become effective and may never work for some individuals
• Therapists are unable to respond and help in acute crises
• Most insurance policies do not cover many mental health professionals

Antidepressant Medication

Antidepressant medication is used to help relieve some depressive symptoms and can be used on its own or in addition to any number of psychotherapy methods. This type of medication works to correct any chemical imbalances in neurotransmitters within the brain responsible for challenges with mood and behavior.  ¹²

Advantages

Some of the advantages of antidepressant medication include: ¹³

• Improved mood
• Improved appetite
• Increased focused
• Improved sleeping patterns
• Decreased anxious symptoms
• Decreased depressive symptoms

Disadvantages

All medications produce some combination of side effects. Some antidepressants cause only minor and manageable side effects, while others may produce more severe side effects. The most commonly prescribed antidepressant medication, SSRIs, may have the following side effects: ¹³

• Improved mood
• Improved appetite
• Increased focused
• Improved sleeping patterns
• Decreased anxious symptoms
• Decreased depressive symptoms

Antidepressants can also take 6 to 8 weeks before they begin relieving symptoms. Recent research also suggests that antidepressants may be of no benefit for children and adolescents who struggle with depression. ¹³

Procedures

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a type of procedure that works by delivering electrical stimulation to the brain to induce a seizure. This seizure has been shown to relieve symptoms of depression and does not cause any structural damage to the brain. ¹⁴

This procedure usually requires a hospital stay but is increasingly performed on an outpatient basis. ECT usually requires general anesthesia. During the process, electrodes are applied to the scalp and deliver an electric current, causing the seizure. The seizure is controlled by medications that ensure the body does not move ¹⁴

Advantages

ECT has been shown to work for many people who do not respond to other traditional modes of therapy, including psychotherapy and antidepressants. One study found that 71% of those who received electroconvulsive therapy responded positively to treatment, and 28% of those who received antidepressants responded positively. ¹⁴

Disadvantages

ECT requires 6 to 12 sessions that occur 2 to 3 times a week. While ECT may only take two weeks to work, it can take up to 6 weeks total. Further treatments may be necessary as well. There are also some side effects of ETC, including short-term memory loss, long-term memory loss, and a brief rise in heart rate and blood pressure during the procedure.¹⁴

Additionally, 50% of those who receive ECT relapse within several months of treatment, if they do not use additional treatment afterward. Additional treatment may include medicines prescribed to prevent relapse. A doctor often recommends antidepressants to maintain the results of ECT and to avoid relapse. ¹⁴

TMS Therapy 

Transcranial Magnetic Stimulation (TMS) Therapy is a procedure that stimulates nerve cells in the brain to improve symptoms of depression. The procedure is non-invasive and stimulates the nerve cells by delivering painless repetitive magnetic pulses to the brain.  ¹¹

During a TMS Therapy session, an electromagnetic coil is placed above the scalp and delivers magnetic pulses that stimulate nerve cells associated with mood control and depression. This technique impacts the brain’s functioning, which results in a decrease in depressive symptoms and an increase in improved mood.  ¹¹

Dr. Randy Pardell established the ClearWave Mental Health to provide innovative psychiatric treatment to Hudson Valley residents. He believes that TMS plays an essential role in addressing both the physiological and psychological effects of depression on an individual and is the president of the Clinical TMS Society. ¹⁵

Advantages

TMS Therapy is FDA cleared and is considered safe and well-tolerated. Unlike other procedures, TMS does not cause seizures or require any anesthesia or surgery. ¹ Additionally, individuals who receive TMS therapy are four times more likely to achieve remission of depressive symptoms. Within a year of TMS therapy, only 1 in 3 patients needs to go back for maintenance sessions. ¹⁵

Disadvantages

Common side effects of TMS include:

• A headache
• Discomfort on the scalp at the stimulation site.
• Tingling or twitching of facial muscles.
• Lightheadedness.

These side effects are usually mild or moderate and diminish shortly after a session. They become less and less intense with each additional session. Additionally, stimulation levels can be altered to reduce side effects, or individuals may take pain medication before a session. ¹

Sources

1. https://adaa.org/finding-help/transcranial-magnetic-stimulation
2. https://www.who.int/news-room/fact-sheets/detail/depression
3. https://www.health.harvard.edu/mind-and-mood/what-causes-depression
4. https://www.nimh.nih.gov/health/topics/depression/
5. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression
6. https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616
7. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899418/
9. https://www.racgp.org.au/afp/2012/september/problem-solving-therapy/
10. https://www.webmd.com/depression/guide/interpersonal-therapy-for-depression#:~:text=Interpersonal%20therapy%2C%20or%20IPT%2C%20is,moderate%20forms%20of%20clinical%20depression.
11. https://www.apsense.com/archive/advantages-and-disadvantages-of-psychotherapy.html
12. https://www.medicalnewstoday.com/articles/248320
13. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/
14. https://www.webmd.com/depression/electroconvulsive-therapy
15. https://clearwavementalhealth.com/how-tms-works/

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