Treatment of Depression with rTMS

Introduction

Depression is a common and serious mental illness that affects millions of people worldwide. It is characterized by persistent feelings of sadness and loss of interest in daily activities, along with a range of physical and emotional symptoms such as changes in appetite and sleep, fatigue, and difficulty concentrating. While there are many effective treatments for depression, some people do not respond to traditional therapies such as medication and psychotherapy. In recent years, there has been growing interest in the use of repetitive transcranial magnetic stimulation (rTMS) as a potential alternative or adjunct treatment for depression.

What is rTMS?

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that uses a magnetic field to stimulate specific areas of the brain. It involves placing a coil over the scalp that emits rapid pulses of magnetic energy, which can create electrical currents in targeted brain regions. rTMS has been used to treat a variety of neurological and psychiatric disorders, including depression, anxiety, and chronic pain.

How does rTMS work for depression?

The exact mechanisms of action of rTMS are still not fully understood, but it is thought to work by modulating the activity of brain circuits involved in mood regulation. In depression, there is often a dysfunction in the prefrontal cortex, a region of the brain that is involved in decision-making, attention, and emotion regulation. rTMS can stimulate this area of the brain, leading to changes in the activity of the neural circuits that are involved in regulating mood.

What are the different types of rTMS?

There are two main types of rTMS: high-frequency (HF) and low-frequency (LF). HF-rTMS involves delivering rapid pulses of magnetic energy at a frequency of 5-20 Hz, while LF-rTMS delivers pulses at a frequency of 1 Hz or less. HF-rTMS is typically used to stimulate brain regions that are underactive in depression, while LF-rTMS is used to inhibit regions that are overactive.

What does rTMS treatment involve?

rTMS treatment for depression usually involves multiple sessions over several weeks. During each session, the patient sits in a comfortable chair while a clinician places a magnetic coil on their scalp. The patient may feel a tapping or knocking sensation on their head during the treatment, but it is not painful. The sessions typically last between 20 and 40 minutes, and patients can return to their normal activities immediately after the treatment. The number of sessions required varies depending on the severity of the depression and the individual response to treatment.

What are the potential benefits of rTMS?

Several studies have shown that rTMS can be an effective treatment for depression, particularly for people who have not responded to traditional therapies such as medication and psychotherapy. In one randomized controlled trial of HF-rTMS, 60% of patients with treatment-resistant depression showed a significant reduction in symptoms after six weeks of treatment, compared to 14% of patients in the placebo group. Another study found that LF-rTMS was as effective as antidepressant medication in reducing symptoms of depression. Additionally, rTMS has minimal side effects, and those that do occur are usually mild and short-lived.

What are the potential risks of rTMS?

While rTMS is generally considered safe, there are some potential risks and side effects. The most common side effects are mild to moderate headaches and scalp discomfort, which usually resolve within a few hours after treatment. Other possible side effects include dizziness, nausea, and tingling or twitching sensations in the face or scalp. Rarely, rTMS can cause seizures, particularly in people with a history of seizure disorders. However, the risk of seizures is very low with standard treatment protocols and careful monitoring.

Is rTMS covered by insurance?

In Australia, rTMS is not currently covered by Medicare or most private health insurance plans. However, some clinics may offer rTMS as a self-funded treatment option, and some patients may be able to access rTMS through clinical trials or research studies.

Conclusion

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has shown promise as a treatment for depression. While the exact mechanisms of action of rTMS are still not fully understood, it is thought to work by modulating the activity of key brain circuits involved in mood regulation. rTMS is generally considered safe and well-tolerated, with minimal side effects. However, it is not currently covered by Medicare or most private health insurance plans in Australia, and its long-term efficacy and safety still need to be established through further research.

FAQs

What is RTMS?

RTMS stands for repetitive transcranial magnetic stimulation. It is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. The treatment has been proven to be effective in treating depression and other mental health conditions.

How does RTMS work to treat depression?

RTMS is thought to work by stimulating the prefrontal cortex, the part of the brain that is responsible for mood regulation. The treatment increases the activity in this area, which has been shown to improve symptoms of depression.

What are the side effects of RTMS?

The most common side effects of RTMS are mild headaches and scalp discomfort at the site where the magnetic coil is placed. These side effects usually go away on their own and do not require any specific treatment. In rare cases, RTMS can cause seizures, but this is extremely uncommon, and the risk can be minimized with careful treatment planning.


References

1. George, M. S., Lisanby, S. H., Avery, D., McDonald, W. M., Durkalski, V., Pavlicova, M., … & Anderson, B. (2010). Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Archives of general psychiatry, 67(5), 507-516.

2. Fitzgerald, P. B., Hoy, K., Daskalakis, Z. J., & George, M. S. (2016). Repetitive transcranial magnetic stimulation in the treatment of depression: guidelines for effective use. Australian & New Zealand Journal of Psychiatry, 50(7), 632-646.

3. Berlim, M. T., Van den Eynde, F., & Daskalakis, Z. J. (2013). Clinical utility of transcranial direct current stimulation (tDCS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Journal of psychiatric research, 47(1), 1-7.