An Effective Treatment for Depression Without Drugs or Psychotherapy
Depression is a treatable condition, but standard approaches aren’t always effective, resulting in some sufferers feeling hopeless
Transcranial magnetic stimulation (TMS) may be used when typical treatments such as medications and psychotherapy don’t work or when a patient desires a more natural approach to treat their depression—the results can be life-changing.
The Cost of Depression
The National Institutes of Health estimates that 21 million adults in the United States had at least one major depressive episode from 2019 to 2020—representing 8.4 percent of all adults.
According to the Centers for Disease Control and Prevention’s Household Pulse Survey, about 28 percent of adults experienced symptoms of anxiety and depression during the first two weeks of February 2023.
The financial cost associated with major depression is staggering, with an estimated economic burden of $326 billion in 2020.
The amount of suffering is great, especially considering that 30 percent of patients treated for depression experience treatment-resistant depression, meaning that the depression does not respond to two or more combinations of medication.
TMS for Treatment-Resistant Depression
There is hope for those who have treatment-resistant depression or who may simply decide they do not want to take antidepressants—they can use TMS.
TMS is a noninvasive procedure that uses magnetic fields to stimulate neurons in the brain to improve symptoms of depression.
The most common and standard type of TMS treatment involves repetitive magnetic pulse and is called repetitive TMS or rTMS. An electromagnetic coil is placed on the scalp close to the forehead. A painless magnetic pulse is administered via the electromagnet.
Neurons help relay information by using electrical impulses and chemical signals to communicate information between different areas of the brain and the nervous system. The treatment works by stimulating neurons and increasing activity in parts of the brain that are less active than they should be.
The use of TMS dates back to 1985. TMS devices were developed and originally used in the field of psychiatry as a secondary option for patients with major depressive disorder who would typically have received electroconvulsive (shock) therapy, Dr. Kevin Murphy, a radiation oncologist, told The Epoch Times.
A number of studies have shown that TMS can be a promising treatment for resistant depression. It improves symptom severity and is considered generally safe.
A review of TMS research shows that approximately 30 percent of people will reach the treatment goal of remission from depression following treatment.
Another study published in The Journal of Clinical Psychiatry used TMS to treat patients with major depressive disorder, who were previously unresponsive to antidepressant medication. The researcher found that TMS had a “clinically meaningful durability of acute benefit over 12 months of follow-up.”
TMS has the potential to impact the emotional and cognitive state of patients, and may significantly reduce suicidal ideation in depressive patients.
Personalized TMS Versus Standard TMS
Murphy, a radiation oncologist who specializes in the treatment of brain and spinal cord tumors in children, explained that in the process of treating the tumors, adjacent tissue is also harmed. Treatments like radiation, surgery, and chemotherapy, can induce trauma, resulting in reduced brainwave frequency, and “does it at irregular intervals.”
Murphy says this creates a “brain arrhythmia” which can lead to any number of symptoms, including depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder (OCD), sleep disorders, addiction, attention deficit disorder, attention deficit hyperactive disorder, autism, and more.
Murphy has used TMS to help fix patients’ brain arrhythmias and to get the neurons all firing together.
In 2013, Murphy had the desire to further personalize the dose given during standard rTMS. He partnered with many other physicians and providers across the nation and coined this new method “personalized repetitive transcranial magnetic stimulation” (PrTMS).
PrTMS has some distinct advantages over standard rTMS—namely that PrTMS utilizes a quantitative electroencephalogram (EEG) and an electrocardiogram to measure a patient’s brain wave frequencies, heart rate, and brain-heart coherence to evaluate which areas of the brain are not functioning properly so that the treatment can be tailored to each patient’s individual needs.
PrTMS looks at the brain frequencies in 19 different locations. During stimulation, the patient sits in what looks like a reclined dental chair. A magnetic paddle is placed on the scalp over one of five to six different targeted brain areas.
Standard rTMS does not utilize EEG information to plan or implement the treatment; only one region of the brain is treated.
Murphy says standard rTMS also uses one set pulse frequency of 10 hertz. A magnetic field is delivered to the brain over a period of six seconds—referred to as a treatment “train,” with a rest interval of about one minute, for a total of approximately 40 minutes.
PrTMS provides a personalized treatment train between six and 15 seconds, followed by 10 to 60 seconds of rest before the next train—delivered over the course of 20 to 30 minutes.
Both treatments are given daily, five days a week, for about six weeks, depending on different situations.
What is particularly unique about PrTMS is that a much lower magnetic field intensity, or amplitude is used. According to Murphy, this lower amplitude is more tolerable for patients, reduces the risk of potential side effects, and allows treatment of brain regions otherwise not accessible by way of standard rTMS.
Approved Treatments
Frank Plut, who runs NeuroHealth Center in Hackettstown, New Jersey, heard about PrTMS years ago. Their son with autism was nonverbal, a toe-walker, flapped his arms when excited, and did not respond to his name. They had tried occupational, physical, and speech therapy to help their son without results, Plus told The Epoch Times.
Plut and his wife flew to California so that their son could receive PrTMS treatment. After three weeks of treatment, Plut’s son was talking, and when treatment was completed after four weeks, he was no longer toe walking or flapping his arms when stimulated.
After such dramatic results, Plut decided to bring PrTMS treatment to his hometown to help other children with autism, as well as adults and children suffering from depression and other diagnoses.
About eight different TMS devices have been approved by the Food and Drug Administration (FDA) for use in the treatment of depression and OCD using standard rTMS protocol. Standard TMS is also FDA-approved for the treatment of migraines, however, the treatment does not require repetitive pulses (rTMS).
Additional clinical trials on the effects of PrTMS are planned, including one for autism.
All insurance companies have their own specific criteria for covering standard rTMS—approval is usually contingent upon a demonstrated lack of improvement in depression or OCD symptoms after the use of one or more different drugs and psychotherapy. Insurance may or may not pay for PrTMS as it is an off-label treatment.
Standard rTMS has about a 40 percent response rate, according to a 2022 study, while Plut says PrTMS has response rates “pretty close to 90 percent,” based on his clinical experience.
Plut says that when repeated EEGs no longer indicate that a patient is depressed, patients can begin weaning off medications with the help of their prescriber if they choose to do so.
Although the technology is showing promise in the treatment of many different illnesses, PrTMS is not for everyone.
Contraindications and Side Effects
Murphy says that those with metal in their head in the form of bullets, shrapnel, metal shunts, or other metal devices or implants are not candidates for the treatment. Those that have titanium or non-ferrous implants, however, can receive the treatment.
Additionally, those with a known history of mania or bipolar disorder are not candidates since the treatment has the possibility of inducing mania, said Murphy.
Psychotic patients also do not currently qualify for the treatment; however, this group of patients is being studied to determine if they might benefit from the treatment, according to Murphy.
Side effects are mild and can include lightheadedness and temporary headache.
Feeling Better Without Medication
Plut knows first-hand how much PrTMS can help those suffering from depression and autism, as he recently received treatment after suffering from his own depression for decades. He tried multiple different medications without complete relief of depressive symptoms before trying PrTMS himself.
After an EEG confirmed he was depressed, Plut received four weeks of PrTMS.
He now says he feels great, is sleeping much better, and is in the process of weaning off his medication.
“It felt like there was a black cloud that weighs like 1000 pounds that is following me around and on my shoulders. That’s gone for me now,” said Plut.
“According to the EEG, I’m recovered—I don’t have depression anymore.”
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