Approximately 2/3rds of adults with depression do not respond with the first antidepressant medication they try and each subsequent medication trial is less likely to help than the first.
There are several other options for such individuals who do not respond to initial treatments. Some of these include combination of antidepressant medications or addition of a non-traditional antidepressant medications or nasal Es-Ketamine. Other options includes electroconvulsive therapy (ECT or shock therapy). However, ECT is invasive and requires the individual to be under anesthesia while receiving treatment.
A non-invasive option for individuals who do not respond to medications alone include transcranial magnetic stimulation (TMS).
Transcranial Magnetic Stimulation (TMS)
TMS, is an FDA approved non-invasive procedure to treat depression. TMS is commonly used on patients suffering from severe depression or anxiety, that has not responded to other treatment methods such as medication or psychotherapy. Two major varieties of TMS are approved by FDA for treatment of depression. These include the superficial "figure 8 coil" and the deep-TMS (BrainsWay). We use deep-TMS in our clinic.
dTMS (deep TMS) Procedure
During the deep-TMS, an electromagnetic coil (helmet shaped ) is placed on your head, targeting an area of the brain that is involved in mood regulation. Then, quick electromagnetic pulses are emitted through the coil off and on for approximately 20 minute duration. The electromagnetic pulses stimulate nerve cells in the targeted area. This procedure rarely causes any discomfort except for the feeling of light taps on the head as the pulses are administered. dTMS is usually performed in a series of several treatments per week, for four to six weeks.
Risks of the dTMS Procedure
dTMS is a non-invasive treatment with minimal local side effects which may include:
- Spasms or twitching of facial muscles
- Scalp discomfort where magnets were placed
These side effects are usually mild and subside within a week or two after treatment. In extremely rare cases, seizures may occur after a TMS procedure.