TMS Therapy

In this episode, Wendy discusses TMS Therapy and what her research reveals.




Involuntary Hold, Wendy's novel about the psych ward, is now available on Amazon and Audible.


 

International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life
Ep 3/S2-TMS Therapy

Good evening and welcome to “Bipolar for Life.” I’m your host, Wendy Foard, and I’ve managed to live with bipolar disorder for 44 years now. It hasn’t always been pretty, but I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

 Let me say up front that I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly mental illness through shared information and experiences.  

As we discuss issues, please remember that I am speaking from my own experience; your bipolar experiences may be entirely different. Yet, I suspect highly that we have more in common than not. 

 Recently, my psychiatrist suggested that we might try TMS Therapy. I had never heard of it, so I hesitated. I told him that I would do some research and get back to him. Tonight, I’d like to share what I’ve found, in case your doctor suggests this treatment for you.

 Transcranial Magnetic Stimulation, or TMS therapy, was first developed in 1985, and now sees widespread use for a variety of mental health and brain-related conditions. 

 TMS is a noninvasive form of brain stimulation in which a changing magnetic field is used to create an electrical current aimed at a specific area of the brain through electromagnetic induction. Magnetic pulses induce small electric currents that change the firing patterns of neurons, altering dysfunctional brain patterns associated with depression. In simple terms, TMS stimulates specific areas of the brain to provide relief and break the cycle of depression. 

 It can also help with OCD (obsessive-compulsive disorder), anxiety, and PTSD (Post-traumatic stress disorder). The procedure may also improve motor dysfunction, benefiting those with Parkinson’s disease, multiple sclerosis, or stroke rehabilitation. 

 Yet, TMS is mainly used for the treatment of depression. It was approved by the U.S. Food and Drug Administration (FDA) for depression in 2008. 

If you want to treat your depression, but are worried about the side-effects of antidepressant drugs, TMS therapy is a viable alternative. TMS can help restore mental health to normal with little or no side-effects. 

 Depression is a treatable condition. But for some people, the standard treatments, such as psychiatric drugs and therapy, aren’t effective. 

 To fully understand the success rate of TMS, it is vital to learn about the success rate of medications. In a study funded by the National Institute of Mental Health (or the N.I.M.H.), scientists discovered that the medications commonly prescribed for depression, including SSRI’s (serotonin reuptake inhibitors) have a success rate of about 27.5%. When SSRI’s fail to yield results, as often happens with people who have treatment-resistant depression, the success rate of medications goes down. 

 I also found that the National Institutes of Health estimates depression medications work for 60% to 70% of the people who take them. Therefore, the percentage of people with treatment-resistant depression is about 30%, which correlates with the study by the N.I.M.H. 

By the time the patient gets the fourth medication, the effectiveness rate of the next drug is lower than 7%. 

 It takes one to two months to make sure an antidepressant is working, and patients may end up spending four to eight months on medication trials when remission chances are small. Increased use of medications also means a higher risk of dealing with unwanted side-effects such as nausea, weight gain, headaches, sexual dysfunction, and gastrointestinal issues. 

 Multiple clinical trials have shown that TMS can alleviate treatment-resistant depression successfully and that the outcomes are long-lasting. A 6-week treatment period is necessary to achieve these TMS success rates. Maintenance sessions may also be necessary sometimes. Some people may have depressive symptoms again in the future, and TMS may be required a second time. 

Based on the data available from most TMS providers, the success rate stands between 70% and 80%, meaning that most people who undergo the treatment experience relief afterwards. Approximately 50% of patients go into full remission, meaning they become completely asymptomatic after one treatment course. 

 TMS takes multiple treatments—typically, 3 to 5 per week, spread out over several weeks. For FDA approved protocols for depression, a typical TMS course happens every weekday over 6 weeks for a total of 30 treatments. 

 In most cases, people feel better after 10 to 15 treatment sessions, which equals to 2 to 3 weeks of treatment. Some people will experience improvement in just 1 to 2 weeks. Results vary person to person. Patients typically experience relief for 6 to 9 months after their last treatment session. Some individuals may feel the benefits for years, while others return for additional treatments after a few months of well-being.

 TMS is sometimes used to treat migraines and to help people stop smoking after all other treatments have failed. It can also offer an alternative to electroconvulsive therapy, if ECT isn’t an option or isn’t effective.

 The therapy is done by a TMS technician or TMS physician. It’s an outpatient procedure, so it may be done in a medical clinic. If it’s done in a hospital, you won’t need to stay overnight. Before the procedure, you’ll need to remove items that are sensitive to magnets, like jewelry.

 Here’s what will happen during a TMS treatment session:

 1)          Your technician will have you wear earplugs to minimize the clicking sounds of the magnetic impulses, which are much like an MRI test. They’ll have you sit in a comfortable chair. You won’t need any anesthesia for you’ll be awake the whole time.

 2)          If it’s your first session, the technician will measure your head to determine where to place the magnetic coil. They’ll also take other measurements to personalize the setting on the TMS machine.

 3)          Your technician will place the coil above the front area of your brain. Next, they’ll start the treatment.

 4)          You’ll hear a clicking sound as the magnetic impulses are released. You’ll also feel a tapping or knocking sensation beneath the magnetic coil.

 5)          The treatment can last 30 to 60 minutes. You can drive yourself home after the procedure and resume normal activities.

 You’ll need to repeat the procedure 5 days a week for about 4 to 6 weeks. The exact length of your treatment depends on your response and specific condition. 

 Recent research suggests that there are a few factors that may influence whether a patient will respond to TMS treatment or not. 

 AGE: TMS has demonstrated to be more effective in patients under the age of 60

 TREATMENT-RESISTANT LEVEL: TMS seems to have a more favorable effect on patients who are resistant to antidepressant medications, especially if they’ve tried more than one type of medication.

 USING ANTIDEPRESSANTS: Those taking antidepressants while undergoing TMS therapy may have a better success rate. The reason is that both treatments can work synergistically, or in tandem.

 Once a treatment session is over, you can return to your normal routine or schedule for the day. If you have lingering side-effects, such as twitching or unusual sensations in your head or face, your provider may ask you to wait a few minutes before leaving. Most of the symptoms that follow a treatment session are mild and last only a few minutes. 

 The most likely complications after a session include:

·     Headaches

·     Pain usually in your scalp or neck

·     Dizziness or lightheadedness

·     Tingling in the muscles of your face or scalp

·     Temporary tinnitus or ringing in your ears

·     Unusually high sensitivity to sound

 You should see your health care provider for all recommended visits. Missing sessions makes this treatment less effective. You should also contact your provider if you notice any side-effects that are moderate or severe, or that linger and don’t go away.

 Experts have performed dozens of research studies on TMS. None of those studies has linked TMS to harmful changes in the brain. There are very isolated cases where people have reported significant side-effects. However, such cases are extraordinarily rare, and there are only a handful of cases where experts concluded that TMS was probably, or definitely, the cause.

 A 2018 review reported that up to 50% of people continued to respond to TMS 12 months after their initial treatment, but more research is necessary to understand how effective it is as a long-term treatment method.

 It is NOT safe for a person to receive TMS therapy if they have any of the following implants in their head:

·     Facial tattoos with magnetic ink

·     Metallic eye or ear implants

·     Bullet or shrapnel fragments

·     Aneurism clips or coils

·     Deep brain stimulators

·     Electrodes, or

·     Stents

 However, braces or fillings do not stop a person from being a candidate for TMS therapy.

 People with risk factors for seizures should also avoid TMS as seizures are a possible side-effect. These risk factors include:

·     Epilepsy

·     A history of seizures

·     Excessive alcohol consumption

·     History of severe head trauma

·     Brain tumors

·     Stroke

·     Eating disorders, or

·     Cocaine and ecstasy use

 About one-third to one-half of people become symptom-free following TMS treatment. Others may experience an improvement in mood and then find that antidepressant medication, talk therapy, and lifestyle changes (such as diet & exercise) provide additional relief. The therapeutic effects from TMS tend to last longer for people who do follow appropriate medication and lifestyle choices that help to maintain an improved mood. Also, some individuals may benefit from a form of “maintenance” TMS for relapse prevention.

 The FDA have granted a “breakthrough device designation” for bipolar depression, but has not cleared it for bipolar disorder. 

Nearly all insurance companies cover TMS for depression, but they may not for other uses such as OCD or smoking cessation. Please contact your insurance provider for more information. 

 Although scientists do not fully understand how TMS treatment works, some suggest that it increases synaptic plasticity and enhances functional connectivity. Which basically means that it enhances the firing of your synapsis, increasing brain activity.

 There is some controversy around TMS therapy, with some people arguing that the long-term benefits have not been proven. However, the majority of research suggests that the benefits of TMS therapy do last for several months after treatment ends, and there are no long-term side-effects associated with it.

 TMS therapy is being studied extensively and across disorders, and even disciplines, with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation, in addition to psychiatry. 

 I have to say, after all my research, I’m now more inclined to talk about doing this therapy than I was. The side-effects are short and sweet, unlike those of the medications I’m currently on, and this is indeed an important addition to the psychiatrist’s arsenal. 

 I want to thank you for being with me tonight, and I hope that’s answered some of the questions you may have about TMS. It has for me. It sounds like the hardest part of this therapy is finding the time to schedule it in your busy day!

 If you, or a loved one, find yourselves in a dark and horrible place, please don’t hesitate to get help! Just dial 9-8-8 to connect to the Suicide and Crisis Lifeline. There are people there ready to help 24/7 and they even speak Spanish! If you prefer, you can text H-O-M-E to 741741 and chat via text. There are people who want to help and who can help… just make that call. You’ll be glad you did! 

 Now, if you live outside the United States, locate the number for the suicide hotline in your area. Almost every country has a suicide prevention line waiting to help. Please, don’t wait, call today!

 As always, be safe in all your travels and I’ll see you next time on “Bipolar for Life”.