In this segment, Dr. Judd discusses TMS (Transcranial Magnetic Stimulation) treatment, a non-invasive, FDA approved procedure which utilizes magnetic pulses to stimulate nerve cells in the brain.
Theoretically, these pulses stimulate metabolism and increase the brain’s neurotransmitters, thereby helping to alleviate depression.
The response rate (reduction in depressive symptoms) for TMS is about 70 percent and 50 percent remission rate (returning to a usual level of functioning in absence of depression) compared to 50 percent response and remission rates for medication alone.
Selected Podcast
This is TMS!
Featured Speaker:
Michael Judd, MD
Michael Judd, MD, medical director of Centra Medical Group Piedmont Psychiatric Center and a board certified adult and general psychiatrist, has been practicing in Lynchburg since July, 2001. He received his degree from Ross University School of Medicine and completed his general psychiatry residency at the University of Virginia School of Medicine. His specialty areas include mood and anxiety disorders, bipolar disorder, student mental health and women’s mental health issues, including pregnancy-related mood disorders and premenstrual dysphoric disorder. Transcription:
This is TMS!
Bill Claproth (Host): Depression is a treatable disease, and since 2008, some have found relief in transcranial magnetic stimulation or TMS. It’s a non-invasive, FDA-approved procedure that utilizes magnetic pulses to stimulate nerve cells in the brain. Here to tell us more about this is Dr. Michael Judd, Medical Director of Centra Medical Group Piedmont Psychiatric Center and a board certified adult and general psychiatrist. Dr. Judd, thanks so much for you time today. So, tell us, let’s start at the beginning. How does TMS work?
Dr. Michael Judd (Guest): Well, first of all thanks for having me on the show. TMS is a very interesting modality that we have to treat adults with major depressive disorder. Individuals with depression typically have an underactive left area, left region in their brain called the left prefrontal cortex. So, what this treatment does is it uses a magnetic pulsation and it stimulates that region of the brain and essentially wakes it up so it starts producing the neurochemicals that therefore help improve mood.
Bill: That is fascinating. So, who is a good candidate for TMS?
Dr. Judd: If individuals there listening have struggled with depression or have loved ones that have struggled with depression, typically it’s approved for those individuals that have failed a course of treatment with at least one anti-depressant medication and/or therapy. So, those are -- if you have failed one course of treatment, that would be a reasonable option for them.
Bill: This is outpatient, correct? So what can someone expect? How long are the treatments, and how long do they have to come in to the clinic to get the treatments?
Dr. Judd: That’s a great question. That’s one of the beauties of this particular treatment is that it is 100 percent outpatient. And it’s not like some other modalities that we have, like ECT, which individuals have to undergo anesthesia. This is a completely outpatient procedure. Individuals even come in on their lunchtime. They sit in a chair that’s similar to a dental chair, and they have a magnetic coil applied to the side of their head. And they receive the treatment for about approximately 37 minutes. They’re awake the entire time, they’re chatting with the technician or watching TV or reading a book. They get up and then they return to work or their daily activities. They drive themselves home. So there’s no tip of anesthesia or kind of impairment at the time.
Bill: So, when you say non-invasive, it sounds really non-invasive. And there’s no pain involved, it sounds like.
Dr. Judd: Generally speaking, it’s a very well tolerated procedure. Some individuals after the first treatment or two may have a headache, but that usually subsides, or they can have some discomfort at the site of the treatment, but that usually resolves as well.
Bill: How many times do they have to come for this 37 minutes of treatment?
Dr. Judd: The treatment duration is generally four to six weeks. So, they come to the office Monday through Friday for about 30 or 40 minutes for about four to six weeks, and then we sort of assess where they are at that point. Some people respond early on. Other people take three to four weeks to get a robust response.
Bill: As far as the procedure goes, does it work for everybody, or is there certain varying degrees of success you have with this?
Dr. Judd: Well, like most modalities for treating depression there is some variation in terms of a response. The long-term studies that were done with this modality, people received about a 68 percent response rate. That means of all the individuals that underwent treatment, almost 70 percent of them had at least a 50 percent reduction in their depressive symptoms. If you are a depression sufferer, that’s very significant to have that type of reduction. In fact, 45 percent of those people then actually went into remission and had no depressive symptoms.
Bill: Well, that’s really good news for someone with depression. How long do the results last for then?
Dr. Judd: Another good question. So, the studies that we have to date are a year long, and generally speaking, the numbers that I just cited to you a little while ago have been sustained for the 12-month period. So, a few folks might have a little bit of some recurrence of symptoms, at which point we would just do a retreatment for a week or so, and then their symptoms, we gain control of those symptoms.
Bill: So basically, if after a period of time you start feeling depressed again, the symptoms are coming back, kind of like a maintenance thing, you can go back in, get more treatment to get it taken care of for another period of time.
Dr. Judd: Studies are underway to continue to monitor that, but at this point, that’s kind of what we’re looking at. But it’s actually a very small percentage of people that actually have had to come back in for a retreatment, so to speak.
Bill: And are there any dangerous side effects at all, Dr. Judd?
Dr. Judd: No. The most difficult or troublesome side effect seems to be a headache that some people had just initially, and they usually take Tylenol, or Motrin or whatever they usually take for headaches, and it controls the symptoms. There is a theoretical risk for seizures, but it’s very low risk.
Bill: So for the most part, it’s very safe, it’s very non-invasive. This seems like a procedure that’s been around since 2008 that so far has been very successful.
Dr. Judd: Indeed. I think one of the key points is to note that this is meant to be in addition to other medications or therapy. It’s not meant to necessarily take the place of them. So individuals struggling, they need to know that there is a sense of hope. There are some other modalities available for them.
Bill: Absolutely. So this type of treatment, are there any new treatments say in the works or on the horizon that incorporates this type of treatment that can help people even more or have better results?
Dr. Judd: Currently TMS or transcranial magnetic stimulation is approved for adults over 18 who suffer from major depressive disorder. There are a number of other studies underway looking at treatment of individuals with post-traumatic stress disorder, anxiety disorders, and a number of other conditions. But we don’t have approval for those through the FDA just yet.
Bill: And before administering TMS, is there anything you need to look out for or somebody that may not be a good candidate for this?
Dr. Judd: Individuals that have any type of metal implants within their head would not be a viable candidate. So, individuals that have had any type of neurosurgical procedures or have cochlear implants or metal in their neck, we would not be able to do the procedure with them.
Bill: All right. Dr. Judd, is there anything that we haven’t talked about TMS that you wanted to mention or think it’s important to say?
Dr. Judd: No. I think the key is that we’re very excited to have this modality in Central Virginia that we’re able to offer it to individuals who do struggle with depression. So, if folks have any questions, please don’t hesitate to give us a call.
Bill: Absolutely. And Dr. Judd, why should people come to Centra Health for their mental health needs?
Dr. Judd: Well, we’re a very forward-thinking organization, so we have a lot to offer. We’ve got a wide breadth of services from treatment for adults, children. We’ve got residential treatment programs. We’ve got substance abuse treatment programs. So, a very comprehensive program in Central Virginia.
Bill: All right, Dr. Judd. Thank you so much. We really appreciate it. And for more information on TMS and Centra Health, just visit centrahealth.com. That’s centrahealth.com. This is Centra Healthy Radio. I’m Bill Claproth. Thanks for listening.
This is TMS!
Bill Claproth (Host): Depression is a treatable disease, and since 2008, some have found relief in transcranial magnetic stimulation or TMS. It’s a non-invasive, FDA-approved procedure that utilizes magnetic pulses to stimulate nerve cells in the brain. Here to tell us more about this is Dr. Michael Judd, Medical Director of Centra Medical Group Piedmont Psychiatric Center and a board certified adult and general psychiatrist. Dr. Judd, thanks so much for you time today. So, tell us, let’s start at the beginning. How does TMS work?
Dr. Michael Judd (Guest): Well, first of all thanks for having me on the show. TMS is a very interesting modality that we have to treat adults with major depressive disorder. Individuals with depression typically have an underactive left area, left region in their brain called the left prefrontal cortex. So, what this treatment does is it uses a magnetic pulsation and it stimulates that region of the brain and essentially wakes it up so it starts producing the neurochemicals that therefore help improve mood.
Bill: That is fascinating. So, who is a good candidate for TMS?
Dr. Judd: If individuals there listening have struggled with depression or have loved ones that have struggled with depression, typically it’s approved for those individuals that have failed a course of treatment with at least one anti-depressant medication and/or therapy. So, those are -- if you have failed one course of treatment, that would be a reasonable option for them.
Bill: This is outpatient, correct? So what can someone expect? How long are the treatments, and how long do they have to come in to the clinic to get the treatments?
Dr. Judd: That’s a great question. That’s one of the beauties of this particular treatment is that it is 100 percent outpatient. And it’s not like some other modalities that we have, like ECT, which individuals have to undergo anesthesia. This is a completely outpatient procedure. Individuals even come in on their lunchtime. They sit in a chair that’s similar to a dental chair, and they have a magnetic coil applied to the side of their head. And they receive the treatment for about approximately 37 minutes. They’re awake the entire time, they’re chatting with the technician or watching TV or reading a book. They get up and then they return to work or their daily activities. They drive themselves home. So there’s no tip of anesthesia or kind of impairment at the time.
Bill: So, when you say non-invasive, it sounds really non-invasive. And there’s no pain involved, it sounds like.
Dr. Judd: Generally speaking, it’s a very well tolerated procedure. Some individuals after the first treatment or two may have a headache, but that usually subsides, or they can have some discomfort at the site of the treatment, but that usually resolves as well.
Bill: How many times do they have to come for this 37 minutes of treatment?
Dr. Judd: The treatment duration is generally four to six weeks. So, they come to the office Monday through Friday for about 30 or 40 minutes for about four to six weeks, and then we sort of assess where they are at that point. Some people respond early on. Other people take three to four weeks to get a robust response.
Bill: As far as the procedure goes, does it work for everybody, or is there certain varying degrees of success you have with this?
Dr. Judd: Well, like most modalities for treating depression there is some variation in terms of a response. The long-term studies that were done with this modality, people received about a 68 percent response rate. That means of all the individuals that underwent treatment, almost 70 percent of them had at least a 50 percent reduction in their depressive symptoms. If you are a depression sufferer, that’s very significant to have that type of reduction. In fact, 45 percent of those people then actually went into remission and had no depressive symptoms.
Bill: Well, that’s really good news for someone with depression. How long do the results last for then?
Dr. Judd: Another good question. So, the studies that we have to date are a year long, and generally speaking, the numbers that I just cited to you a little while ago have been sustained for the 12-month period. So, a few folks might have a little bit of some recurrence of symptoms, at which point we would just do a retreatment for a week or so, and then their symptoms, we gain control of those symptoms.
Bill: So basically, if after a period of time you start feeling depressed again, the symptoms are coming back, kind of like a maintenance thing, you can go back in, get more treatment to get it taken care of for another period of time.
Dr. Judd: Studies are underway to continue to monitor that, but at this point, that’s kind of what we’re looking at. But it’s actually a very small percentage of people that actually have had to come back in for a retreatment, so to speak.
Bill: And are there any dangerous side effects at all, Dr. Judd?
Dr. Judd: No. The most difficult or troublesome side effect seems to be a headache that some people had just initially, and they usually take Tylenol, or Motrin or whatever they usually take for headaches, and it controls the symptoms. There is a theoretical risk for seizures, but it’s very low risk.
Bill: So for the most part, it’s very safe, it’s very non-invasive. This seems like a procedure that’s been around since 2008 that so far has been very successful.
Dr. Judd: Indeed. I think one of the key points is to note that this is meant to be in addition to other medications or therapy. It’s not meant to necessarily take the place of them. So individuals struggling, they need to know that there is a sense of hope. There are some other modalities available for them.
Bill: Absolutely. So this type of treatment, are there any new treatments say in the works or on the horizon that incorporates this type of treatment that can help people even more or have better results?
Dr. Judd: Currently TMS or transcranial magnetic stimulation is approved for adults over 18 who suffer from major depressive disorder. There are a number of other studies underway looking at treatment of individuals with post-traumatic stress disorder, anxiety disorders, and a number of other conditions. But we don’t have approval for those through the FDA just yet.
Bill: And before administering TMS, is there anything you need to look out for or somebody that may not be a good candidate for this?
Dr. Judd: Individuals that have any type of metal implants within their head would not be a viable candidate. So, individuals that have had any type of neurosurgical procedures or have cochlear implants or metal in their neck, we would not be able to do the procedure with them.
Bill: All right. Dr. Judd, is there anything that we haven’t talked about TMS that you wanted to mention or think it’s important to say?
Dr. Judd: No. I think the key is that we’re very excited to have this modality in Central Virginia that we’re able to offer it to individuals who do struggle with depression. So, if folks have any questions, please don’t hesitate to give us a call.
Bill: Absolutely. And Dr. Judd, why should people come to Centra Health for their mental health needs?
Dr. Judd: Well, we’re a very forward-thinking organization, so we have a lot to offer. We’ve got a wide breadth of services from treatment for adults, children. We’ve got residential treatment programs. We’ve got substance abuse treatment programs. So, a very comprehensive program in Central Virginia.
Bill: All right, Dr. Judd. Thank you so much. We really appreciate it. And for more information on TMS and Centra Health, just visit centrahealth.com. That’s centrahealth.com. This is Centra Healthy Radio. I’m Bill Claproth. Thanks for listening.