Posted by Pfinstegg on July 27, 2005, at 16:21:31
In reply to Re: I tried it, posted by denise1966 on July 27, 2005, at 14:15:43
I noticed that my name, and this topic, has come up once again, and I wanted to let you know what I have learned about it recently. The FDA is expected to approved rTMS in the summer of 2006. I have to agree with you that an 80% improvement rate, as claimed in Vancouver, is far too high an estimate; Dr. Hutto cites 40% (he deals with an extremely ill group of patients, many of whom have had multiple hospitalizations and courses of ECT). All the other studies which I have read range around 35-60% improvement, with around 45-50% being the average. (Improvement means an improvement of 50% or more on one of the depression rating scales).
rTMS is a physiologically good treatment, in that it temporarily reverses some of the physical abnormalities present in major depression. It brings HPA axis overactivity down to normal, increases blood flow to the left cerebral hemisphere, normalizes serotonin and dopamine levels, and increases BDNF and new cell growth in the hippocampus. This is real- at least in animal models of depression in rats and tree shrews studied at the German Primate Center. There was no evidence of neuronal damage, or any increase in inflammatory markers, in the studies done there. At Harvard, cognitive function before and after rTMS was studied intensively; there were no adverse effects, and memory acquisition actually improved for several hours after each treatment.
There are some limitations. The effects don't last very long (two weeks to several months), it's very painful (I need Tylenol #3 to tolerate it), and, if you don't protect your ears carefully, you could get some hearing loss. Also, until it's approved and begins to be covered by insurance, it's awfully expensive!
I think it's a wonderful treatment for about half of us who have TRD. I still take a tricyclic, and Cytomel, but they work really well combined with the rTMS, although they're not very effective by themselves.
Recently, I went to see my pdoc in my home town, armed with a sheaf of reprints about rTMS from Medscape. Even before reading them, he said, "I've just been waiting for a patient to show an interest! I really want to do it." (He does medications and a lot of ECT at present). He then asked ME (!) where he should get trained to do it. I suggested Dr. Mark George at the University of South Carolina, as he has been among the first to take an interest in rTMS, and has published the most about it. Also, Dr. Hutto trained with him, and he is very skilled at it. It turned out that Dr. George is now giving week-long courses for physicians in rTMS several times a year! My pdoc is there now. Because this is an electromagnetic treatment which only goes one or two centimeters into the brain, I think it's very important that the doctor who is giving it knows exactly where and how to place the magnetic coil, and also knows what intensities and frequencies are the most effective. As it gradually becomes a more available treatment, I think it would be important for anyone interested to make sure their doctor is trained by Dr. George, rather than by someone from the Neonetics company, who manufacture the rTMS machines. (they may do a good job of training, but I do know from personal experience that Dr. George is really excellent.)
poster:Pfinstegg
thread:533960
URL: http://www.dr-bob.org/babble/20050723/msgs/534338.html