Community Hospital Long Beach has a commitment to provide comprehensive mental health treatment interventions to help adults through their times of crisis.
Transcranial Magnetic Stimulation (TMS) is a treatment Community Hospital Long Beach offers that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
Listen as Dr. Todd Hutton, M.D., medical director, Transcranial Magnetic Stimulation (TMS) Therapy, Community Hospital Long Beach explains who is appropriate for TMS, what are the response rates that he is seeing, what other conditions might this be used for and what is being researched?
The Benefits of Transcranial Magnetic Stimulation
Featured Speaker:
Organization: Community Hospital Long Beach
Dr. Todd Hutton, MD
Todd Hutton, M.D., medical director, Transcranial Magnetic Stimulation (TMS) Therapy, Community Hospital Long Beach, double board-certified in Psychiatry and Geriatric Psychiatry by the American Board of Psychiatry and Neurology.Organization: Community Hospital Long Beach
Transcription:
The Benefits of Transcranial Magnetic Stimulation
Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Todd Hutton. Dr. Hutton is the Medical Director for Transcranial Magnetic Stimulation or TMS therapy at Community Hospital Long Beach. Dr. Hutton is double board certified in psychiatry and geriatric psychiatric by the American Board of Psychiatry and Neurology. Welcome to you, Dr. Hutton.
Dr. Todd Hutton (Guest): Hello.
Deborah: Today we'll be talking about TMS. It sounds like something out of a sci-fi movie, but I'm sure you could break it down for us. What does TMS stand for, and what is it, please?
Dr. Hutton: Well, it does sounds like a sci-fi movie, but TMS, which stands for transcranial magnetic stimulation, is an exciting new treatment for depression that we use that employs magnetic pulses to stimulate areas of the brain that we know are underactive in patients with depression.
Deborah: It sounds fascinating. So how does it work?
Dr. Hutton: Well, it's been known for a long time that in patients with depression, there are areas of the brain, particularly in the left frontal lobe, that are underactive and not functioning properly. We've also known for decades that shock therapy or giving electrical currents to the brain and triggering a seizure has been an effective treatment. People had the idea then if we could stimulate the brain instead with safe magnetic pulses and exercise this underactive part of the brain, we can bring it back to a normal state, and that's see what happens with TMS.
Deborah: Wonderful. So why is TMS so much better than shock therapy, and how do the two differ?
Dr. Hutton: Well, they're both similar in that they use what we call brain stimulation as the therapeutic modalities; that's the thing that gets the brain better. The advantage that TMS has is that it doesn't require any anesthesia, and it doesn't cause any of the memory loss that's typical with ECT or shock therapy.
Deborah: Wow.
Dr. Hutton: With ECT, we use an electrical current to trigger a seizure. That seizure seems to be important for the treatment to work. And it affects the whole brain. With TMS, we actually target just the select part of the brain. We don't have to trigger that whole brain seizure that leads to the memory loss and requires anesthesia for the treatment to happen.
Deborah: That does seem far preferable. So what's a typical course of treatment like?
Dr. Hutton: Well, patients actually come to the clinic five days a week, and they'll sit on a chair underneath the magnet, which is positioned in a very particular spot over their left frontal lobe, and they'll get treatment for 40 to 60 minutes. We do that for five or six weeks, typically, five days a week. In the end, we may have some tapering treatments. So it takes place over a fair amount of weeks, and people come in five days a week. But during the treatment, you're awake, you can watch TV, talk to people, you can listen to music. It's a really easy thing to do.
Deborah: And I'm assuming it's pain-free. What does it actually feel like?
Dr. Hutton: Well, that's interesting. You do experience an intense tapping on your heard. Now, magnetic pulses isn't something we normally feel, but we're using magnetic pulses in a strength that actually make nerve cells fire. And we're aiming at the nerve cells inside your brain, but there's nerve cells in your scalp, which are mostly sensory nerves, and those nerves get fired as well. So you experience a sensation of something tapping on your scalp.
Deborah: Okay. So it's a tap. But again, you can be distracted by TV or talking to people or have some music.
Dr. Hutton: Yes. And we give 40 taps in four seconds that goes, ta-ta-ta-ta-ta.
Deborah: Wow.
Dr. Hutton: Then it rests for maybe 20 seconds, and then we do another four seconds of tapping.
Deborah: Interesting. Who would be an appropriate candidate for TMS?
Dr. Hutton: TMS is currently FDA approved for the treatment of depression. It's typically been reserved for people who've tried and failed four medications. Most insurance companies who are covering it require that people have failed four medications.
Deborah: Wow.
Dr. Hutton: But because it's such a safe treatment, it's appropriate in people who just don't want to take medication.
Deborah: Sure.
Dr. Hutton: That could be pregnant or nursing women, which is a particular focus we have at Community Hospital Long Beach. So anyone with major depression is ultimately a candidate.
Deborah: What are the response rates that you're seeing these days?
Dr. Hutton: Well, this treatment initially has been bringing out people who had highly resistant depression. Now, again, it doesn't have to be reserved for people with highly resistant depression. But people have been coming to us who basically tried a dozen medications. They've been struggling with depression for 10 years. We've been seeing rates of 50 percent of the patients were getting really well, another 25 percent of the patients have a partial response, and probably another 25 percent have a minimal response. But in the really resistant population that we're treating, those are really great statistics.
Deborah: They really are. Do you ever use it in conjunction with medication?
Dr. Hutton: We often do because we've been treating patients who are really, really sick. Also, TMS is designed somewhat as an acute treatment, and we may need a maintenance treatment for people going, and that can be medication.
Deborah: Sure.
Dr. Hutton: Although we have used TMS for maintenance for people who maybe come in once a month for a treatment.
Deborah: Okay. That was my next question. How long do these effects last?
Dr. Hutton: Well, it depends on the patient. Some patients' depression is episodic. For some patients it's chronic. People with episodic depression tend to have a higher rate of getting better and staying well.
Deborah: Okay.
Dr. Hutton: But in general, depression tends to be a condition that can return in the people who've had it, and it could be chronic. So sometimes, if that happens, people will come back, and we will do the maintenance kind of treatment that I discussed.
Deborah: Okay.
Dr. Hutton: There was a study that was done in the original that showed, and the patients who responded, probably 30 percent had some relapse in the first six months, relapse in their symptoms.
Deborah: Okay.
Dr. Hutton: But if they came back and did some more treatments, 85 percent of those, better again.
Deborah: It's almost like a retraining of the brain.
Dr. Hutton: Yes, and we're actually doing something directly to the brain cells to wake them up. And when we stimulate them, they start making new synapses and new connections with the cells around them, and this whole area becomes more active. It's sort of like giving it some lighter fluid and getting the fire going again.
Deborah: Yes. Lovely. Does insurance cover these treatments?
Dr. Hutton: Insurance is beginning to cover this treatment more and more, and we're really excited that Anthem Blue Cross, the nation's largest insurance is covering it; Blue Shield of California, Health Net or MHN is covering it, Magellan, and locally, Chippa, College Health IDA.
Deborah: Wonderful.
Dr. Hutton: So, not every insurance covers it at this point, but more and more.
Deborah: What other conditions might this be used for? Also, what is being researched right now at this time?
Dr. Hutton: Well, now that we have this great tool that's safe and really powerful, people are looking at it for all kinds of different purposes and putting the magnet on the different parts of the brain and using different stimulation protocols. They're looking at it for anxiety disorders and OCD and PTSD. They're looking at it for migraine headaches; they're looking at it for tinnitus or ringing in the ears. One of the applications that I think is really exciting and there's a lot of promise is people with chronic pain. I've had some success in treating these patients with chronic pain. So there's a lot of excitement about what this treatment modality can do and where we can take it in the future.
Deborah: Just wonderful. Well, we want to thank you so much, Dr. Hutton, for taking the time to talk to us today about the benefits of transcranial magnetic stimulation. It's been really inspiring to have you on the show.
Dr. Hutton: Thank you for having me.
Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.
The Benefits of Transcranial Magnetic Stimulation
Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Todd Hutton. Dr. Hutton is the Medical Director for Transcranial Magnetic Stimulation or TMS therapy at Community Hospital Long Beach. Dr. Hutton is double board certified in psychiatry and geriatric psychiatric by the American Board of Psychiatry and Neurology. Welcome to you, Dr. Hutton.
Dr. Todd Hutton (Guest): Hello.
Deborah: Today we'll be talking about TMS. It sounds like something out of a sci-fi movie, but I'm sure you could break it down for us. What does TMS stand for, and what is it, please?
Dr. Hutton: Well, it does sounds like a sci-fi movie, but TMS, which stands for transcranial magnetic stimulation, is an exciting new treatment for depression that we use that employs magnetic pulses to stimulate areas of the brain that we know are underactive in patients with depression.
Deborah: It sounds fascinating. So how does it work?
Dr. Hutton: Well, it's been known for a long time that in patients with depression, there are areas of the brain, particularly in the left frontal lobe, that are underactive and not functioning properly. We've also known for decades that shock therapy or giving electrical currents to the brain and triggering a seizure has been an effective treatment. People had the idea then if we could stimulate the brain instead with safe magnetic pulses and exercise this underactive part of the brain, we can bring it back to a normal state, and that's see what happens with TMS.
Deborah: Wonderful. So why is TMS so much better than shock therapy, and how do the two differ?
Dr. Hutton: Well, they're both similar in that they use what we call brain stimulation as the therapeutic modalities; that's the thing that gets the brain better. The advantage that TMS has is that it doesn't require any anesthesia, and it doesn't cause any of the memory loss that's typical with ECT or shock therapy.
Deborah: Wow.
Dr. Hutton: With ECT, we use an electrical current to trigger a seizure. That seizure seems to be important for the treatment to work. And it affects the whole brain. With TMS, we actually target just the select part of the brain. We don't have to trigger that whole brain seizure that leads to the memory loss and requires anesthesia for the treatment to happen.
Deborah: That does seem far preferable. So what's a typical course of treatment like?
Dr. Hutton: Well, patients actually come to the clinic five days a week, and they'll sit on a chair underneath the magnet, which is positioned in a very particular spot over their left frontal lobe, and they'll get treatment for 40 to 60 minutes. We do that for five or six weeks, typically, five days a week. In the end, we may have some tapering treatments. So it takes place over a fair amount of weeks, and people come in five days a week. But during the treatment, you're awake, you can watch TV, talk to people, you can listen to music. It's a really easy thing to do.
Deborah: And I'm assuming it's pain-free. What does it actually feel like?
Dr. Hutton: Well, that's interesting. You do experience an intense tapping on your heard. Now, magnetic pulses isn't something we normally feel, but we're using magnetic pulses in a strength that actually make nerve cells fire. And we're aiming at the nerve cells inside your brain, but there's nerve cells in your scalp, which are mostly sensory nerves, and those nerves get fired as well. So you experience a sensation of something tapping on your scalp.
Deborah: Okay. So it's a tap. But again, you can be distracted by TV or talking to people or have some music.
Dr. Hutton: Yes. And we give 40 taps in four seconds that goes, ta-ta-ta-ta-ta.
Deborah: Wow.
Dr. Hutton: Then it rests for maybe 20 seconds, and then we do another four seconds of tapping.
Deborah: Interesting. Who would be an appropriate candidate for TMS?
Dr. Hutton: TMS is currently FDA approved for the treatment of depression. It's typically been reserved for people who've tried and failed four medications. Most insurance companies who are covering it require that people have failed four medications.
Deborah: Wow.
Dr. Hutton: But because it's such a safe treatment, it's appropriate in people who just don't want to take medication.
Deborah: Sure.
Dr. Hutton: That could be pregnant or nursing women, which is a particular focus we have at Community Hospital Long Beach. So anyone with major depression is ultimately a candidate.
Deborah: What are the response rates that you're seeing these days?
Dr. Hutton: Well, this treatment initially has been bringing out people who had highly resistant depression. Now, again, it doesn't have to be reserved for people with highly resistant depression. But people have been coming to us who basically tried a dozen medications. They've been struggling with depression for 10 years. We've been seeing rates of 50 percent of the patients were getting really well, another 25 percent of the patients have a partial response, and probably another 25 percent have a minimal response. But in the really resistant population that we're treating, those are really great statistics.
Deborah: They really are. Do you ever use it in conjunction with medication?
Dr. Hutton: We often do because we've been treating patients who are really, really sick. Also, TMS is designed somewhat as an acute treatment, and we may need a maintenance treatment for people going, and that can be medication.
Deborah: Sure.
Dr. Hutton: Although we have used TMS for maintenance for people who maybe come in once a month for a treatment.
Deborah: Okay. That was my next question. How long do these effects last?
Dr. Hutton: Well, it depends on the patient. Some patients' depression is episodic. For some patients it's chronic. People with episodic depression tend to have a higher rate of getting better and staying well.
Deborah: Okay.
Dr. Hutton: But in general, depression tends to be a condition that can return in the people who've had it, and it could be chronic. So sometimes, if that happens, people will come back, and we will do the maintenance kind of treatment that I discussed.
Deborah: Okay.
Dr. Hutton: There was a study that was done in the original that showed, and the patients who responded, probably 30 percent had some relapse in the first six months, relapse in their symptoms.
Deborah: Okay.
Dr. Hutton: But if they came back and did some more treatments, 85 percent of those, better again.
Deborah: It's almost like a retraining of the brain.
Dr. Hutton: Yes, and we're actually doing something directly to the brain cells to wake them up. And when we stimulate them, they start making new synapses and new connections with the cells around them, and this whole area becomes more active. It's sort of like giving it some lighter fluid and getting the fire going again.
Deborah: Yes. Lovely. Does insurance cover these treatments?
Dr. Hutton: Insurance is beginning to cover this treatment more and more, and we're really excited that Anthem Blue Cross, the nation's largest insurance is covering it; Blue Shield of California, Health Net or MHN is covering it, Magellan, and locally, Chippa, College Health IDA.
Deborah: Wonderful.
Dr. Hutton: So, not every insurance covers it at this point, but more and more.
Deborah: What other conditions might this be used for? Also, what is being researched right now at this time?
Dr. Hutton: Well, now that we have this great tool that's safe and really powerful, people are looking at it for all kinds of different purposes and putting the magnet on the different parts of the brain and using different stimulation protocols. They're looking at it for anxiety disorders and OCD and PTSD. They're looking at it for migraine headaches; they're looking at it for tinnitus or ringing in the ears. One of the applications that I think is really exciting and there's a lot of promise is people with chronic pain. I've had some success in treating these patients with chronic pain. So there's a lot of excitement about what this treatment modality can do and where we can take it in the future.
Deborah: Just wonderful. Well, we want to thank you so much, Dr. Hutton, for taking the time to talk to us today about the benefits of transcranial magnetic stimulation. It's been really inspiring to have you on the show.
Dr. Hutton: Thank you for having me.
Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.