Research | You’ve tried medication, you’ve tried talk therapy, and nothing seems to bring you out of the hole of chronic depression.
Now imagine reclining comfortably in a chair—and even chatting a bit— while a doctor stimulates your brain with pulses of magnetic energy. After 30 to 45 minutes you get up and walk away, a step closer to recovery.
Dr. John O’Reardon is hopeful that in a couple of years this therapy may become a reality for more people with treatment-resistant depression.
The assistant professor of psychiatry and director of Penn’s Treatment Resistant Depression Clinic is taking part in a 16-center nationwide study to test the efficacy of Transcranial Magnetic Stimulation as a depression treatment. “Probably the most exciting thing about TMS is that it’s a noninvasive outpatient procedure where you target some part of the brain and you only treat that area,” O’Reardon says. “If you take a drug, of course the drug goes to every cell in the body through the bloodstream. As the years have gone by, people have said, ‘These are good medications, but they also can produce side effects, such as sexual dysfunction.’”
TMS—which O’Reardon has used on 80 patients since 1998—works by delivering pulses of magnetic energy to the left or right prefrontal cortex of the brain, which is involved with regulating mood. (Though this study focuses only on the left prefrontal cortex, the frequency and target of the pulses are typically adjusted according to an individual’s needs. Neuroimaging studies of those at risk for depression typically show underactivity on the left and hyperactivity on the right.)
The patient doesn’t need to be sedated for the procedure, which uses a magnetic coil on the scalp to send a painless, five-second pulse to the appropriate part of the brain at 30-second intervals.
“It doesn’t interfere with their thinking,” O’Reardon says. “They will be having a conversation with me at the same time as I’m stimulating their brain. It’s kind of cool.” The device itself resembles a newfangled hair-styling appliance, and indeed he jokes that TMS therapy is like a visit to the salon: “You rest in a chair, someone messes with your hair, and you feel better.”
TMS is already available in several countries, including Canada, Australia, and Israel. If it wins approval here, O’Reardon wouldn’t be surprised to see it in the offices of primary-care physicians as well as psychiatrists. Because the magnetic field involved in TMS reaches only a few centimeters wide and deep, it doesn’t require the same precautions or special facilities that Magnetic Resonance Imaging does. “It can’t suck the keys out of your pocket.”
Once a patient is treated, the goal is to keep that person from falling back into depression again, O’Reardon says. Each episode of depression increases the odds of it recurring for that person. To maintain the effects of TMS, his patients have typically returned to him for maintenance sessions a couple or more times a month.
In this study patients are treated with five 45-minute sessions a week for up to six weeks, with an optional six-month follow-up.
“On the one hand it’s more labor-intensive than medication because people like to pop a pill and prefer not to do therapy,” O’Reardon notes. “On the other hand the side-effect burden with TMS is very low.” As someone who treats many “tough” depression cases, he says, “I’m always looking for new options.”
O’Reardon is embarking on another study to see if TMS can be used on the right prefrontal cortex to improve attention and concentration in teenagers with attention deficit hyperactivity disorder. (Neuroimaging studies of children with ADHD typically show low activity in that part of the brain.)
Because the device can be used on different parts of the scalp, he adds, it may potentially treat other disorders, including manic-depression and the auditory hallucinations that often accompany schizophrenia.—S.F.
