Posted on January 17, 2023

The FDA approved transcranial magnetic stimulation more than a decade ago for treatment-resistant depression but Dr. John Luerh said it's still relatively unknown.

MINNETONKA, Minnesota — "It's kind of like the best new treatment for depression that nobody knows about," said Dr. John Luehr, a psychiatrist at Sonder Behavioral Health and Wellness in Minnetonka.

Dr. Luehr is referring to transcranial magnetic stimulation (TMS), a type of treatment typically used when other approaches have not been effective.

The Food and Drug Administration approved TMS for treating Major Depressive Disorder (MDD) in 2008.

"It's interesting because TMS has been around for over a decade. Yet they've done a survey and they found out that less than 10% of people in the United States know about it and that includes physicians and providers," Dr. Luehr said. "Unfortunately, insurance companies were not in favor of it for a long time but as the data became more robust, now virtually every insurance and Medicare and Medicaid all pay for it  So it's become far more available but people still haven't heard about it."

Treatment includes a coil that is placed against the head while magnetic pulses stimulate nerve cells in the region of the brain known to affect mood.

"Recently, Stanford has come up with some really good explanations and even images that when you're depressed, your inner brain sends negative messages to the cortex and the cortex listens to all those negative messages. So with the treatment of TMS, the cortex gets re-energized and gets back in charge and starts to block out those negative messages and you can actually see that on studies," Dr. Luehr said.

Those who may be good candidates for TMS have an MDD diagnosis and have tried four different antidepressants and talk therapy without great results.

"It's been kind of exciting because you have people who have been depressed for decades and they come and they're starting to feel better for the first time in their life," Dr. Luehr said. "I think of one lady who said, 'It's like I have the phone here and the charger is here and they're just not connected.' And as we went through TMS, she said, 'It's connected.'"

Dr. Luehr said through studies and what they have personally seen, about half of TMS patients experience a 50% reduction in depression symptoms, with one-third of them experiencing complete remission.

"It really is quite remarkable and we don't want to oversell it because it is 50%, but that 50% is actually better than any antidepressant does on its own," he said.But Dr. Luehr stressed that while someone is getting TMS, they should continue with their medications and talk therapy.

"There's a lot of folks that say, 'I want to do TMS so I can get off my meds.' And we need to be clear that's not the current recommendation. We certainly have people that have gotten better; they've been able to simplify their medication regiment if they're causing side effects and things like that but that's not the goal of TMS," Dr. Luehr said.

The magnetic pulses may feel uncomfortable but it's noninvasive and does not require anesthesia. Dr. Luehr described it like a mouse with a jackhammer or a woodpecker on your head.

"It's magnetic and not direct electrical current, and that's what makes it so much more tolerable," Dr. Luehr said.

According to Mayo Clinic, common side effects include scalp discomfort at the site of stimulation; headaches; lightheadedness; and tingling, spasms or twitching of facial muscles.

Mayo Clinic said, "Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions."

Some people will receive TMS and respond well to it, only to see depression symptoms return six months to a year later.

"Then we know that repeating the TMS is a good maneuver and insurance is glad to pay for that. For those folks that haven't gotten really any benefit from the TMS, we have to think about other alternatives."

A typical treatment is 36 sessions. Insurance will usually pay for one treatment per day but coverage is very individualized to each person's benefits.

Sonder is now conducting a pilot study to examine an accelerated treatment protocol for TMS.

"People are coming here for 5-7 weeks to get their daily treatments which last less than 20 minutes. We have wondered... what if we could condense those 36 treatments and do them all in one week? So instead of people having a 5-7 commitment, they'd have one week. They'd be here most of the day getting those treatments," Dr. Luehr said.

Sonder is currently recruiting participants for the study who will receive TMS free of cost. They have already completed sessions with two people. Those interested to see if they would be a good candidate.

Source