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What is TMS Therapy and How Does it Work for Depression?
Depression remains a major problem in our society but now there is a new outpatient treatment for it called Transcranial magnetic stimulation, or TMS, therapy. Dr. Lou Ann Eads discusses TMS therapy and how it can help improve depression.
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Learn more about Lou Ann Eads, MD
Lou Ann Eads, MD
Lou Ann Eads, MD is a Geriatric Psychiatrist.Learn more about Lou Ann Eads, MD
Transcription:
What is TMS Therapy and How Does it Work for Depression?
Joey Wahler (Host): Depression remains a major problem in our society. But now, there's a new outpatient treatment for it called TMS, transcranial magnetic stimulation. So, what is TMS and how does it compare with other ways of addressing depression?
This is a UAMS Health Talk, a podcast sponsored by University of Arkansas for Medical Sciences. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Lou Ann Eads, an the interventional psychiatrist at UAMS. Dr. Eads, thanks for joining us.
Dr Lou Ann Eads: You're welcome.
Joey Wahler (Host): So let's get right into this. TMS, I guess, stimulates certain areas of the brain that are underactive during depression. Am I right?
Dr Lou Ann Eads: Correct.
Joey Wahler (Host): And so how does that work exactly for the uninitiated?
Dr Lou Ann Eads: We know that certain areas of the brain are not performing as well as normal. And in order to help bring them back up to a normal level of performance or functioning, then we use electromagnetic radiation, which is generated through TMS to stimulate a targeted area. And over a period of several weeks, the brain modifies itself and hopefully gets back to a normal level of functioning.
Joey Wahler (Host): And why is it that those areas of the brain in people depressed function that way? Do we know?
Dr Lou Ann Eads: I'm not sure we absolutely know why a certain area is not functioning up in a more normal range. But we have been able to identify specific areas that are underperforming, and that is where we target our treatment.
Joey Wahler (Host): Gotcha. So what exactly does a typical TMS procedure involve for the patient?
Dr Lou Ann Eads: It's five days a week of treatment for six weeks. The patient comes in. The first day, we do what's called mapping or identifying the best location to place our magnet. And subsequent days, we use the coordinates to, set the magnet on those same areas. They're in the chair for about 20 minutes. During this period of time, there is a short burst of pulses of stimulation to the skull that passes into the brain and is translated into electrical activity in the brain. And that's how the nerve cells talk to each other. Then, there is a brief pause followed by another series of stimulations. And this goes on for a 20-minute time period.
Joey Wahler (Host): And so you mentioned, you're actually able to pinpoint what areas need to be addressed specifically, right? That sounds pretty cool.
Dr Lou Ann Eads: We pinpoint a general area that we target with stimulation. We pinpoint what's called the dorsal lateral prefrontal cortex, and that it's been known for a long time that's an area that is not functioning up to par in depression.
Joey Wahler (Host): And you mentioned also, doctor, that you're sitting in a chair. So in terms of the atmosphere overall of what someone can expect, are they in a room that's dark, light? Can you read or be on your phone or do you need to just relax and put everything out of your mind? What's the setting besides sitting there and having this done?
Dr Lou Ann Eads: They're sitting in a chair and there's a helmet that contains the magnet itself that is placed up on the head. The room can be adjusted to patient preference. Most patients prefer a dim-lit room that is calming and relaxing and soothing during the treatment area. We do recommend that you try to have positive thoughts during the treatment time and those kinds of things, but it's more of a relaxing atmosphere.
Joey Wahler (Host): Gotcha. How about how long is a given session?
Dr Lou Ann Eads: It takes probably about three to five minutes to set up everything. Once it's set up, then it's a 20-minute procedure. And then after the procedure is over with, then it takes another three to five minutes to undo what's been set up.
Joey Wahler (Host): And is there a typical length of time that someone would need to continue this procedure?
Dr Lou Ann Eads: A series of treatments usually consist of 30 treatments followed by six tapering, so a total of 36 treatments. Again, the series is usually five days a week for six weeks and then followed by a tapering which is usually one week of three times a week, one week of two times a week and one week one time, for a total of 36.
Joey Wahler (Host): And so would you agree it sounds from the commitment involved as though this is pretty intensive in terms of the commitment on a consistency basis. But then over a relatively short amount of time, hopefully it works, right?
Dr Lou Ann Eads: Well, you're looking at about a six-week commitment, but it takes about us six weeks to really say that you're getting response for a medication or not getting a response from a medication. The positives of TMS is that there's no medications. We don't change medication, so continue on with the same medications that you're on. We're not adding or subtracting medications. So TMS, there's no medication side effects to have to manage. And a lot of people that come to TMS have had a number of medications side effects or not responded. Unlike ECT, you can drive yourself to and from the procedure, and you're not going under anesthesia like you would for ECT. There's not a memory concern with TMS, whereas there's a rare memory risk with ECT.
Joey Wahler (Host): Okay. So a couple of other things. You mentioned the comparison there between TMS and medication, no side effects with TMS, et cetera. How about in terms of comparing their impact? Does this work better at times the medication does? Does It work the same just without the side effects? How would you compare the benefits?
Dr Lou Ann Eads: It is statistically, per literature, it's as good, if not, a little bit better. Efficacy as far as response, it's not a hundred percent, but neither is medications or any other procedure we have to offer.
Joey Wahler (Host): So for the average depressed person, I know this encompasses a wide range of different types of people in terms of what they suffer with depression. You certainly can't paint them all with the same brush to say the very least. I know that. But from your experience with depressed people, taking TMS sessions, what would you say is the main benefit that they would feel getting out of it? What would they notice?
Dr Lou Ann Eads: Well, TMS just like any interventional procedure is targeted towards what we call treatment-resistant depression, meaning depression that has not responded to medications and/or therapy. It is FDA-approved for failure of at least one antidepressant. Most insurances would like to see failure of at least two medications. And we know that each subsequent medication that a person is given, the less likelihood they are to have a response. TMS is FDA-approved for mild to moderate depression. And it can be very helpful for people that have not responded to medications and can help decrease their depression and/or move their depression to more of a remission state.
Joey Wahler (Host): So you just mentioned it's for those that have had medication attempts fail. How about someone that hasn't tried anything for their depression? Would you recommend this over that?
Dr Lou Ann Eads: According to the FDA indication, it's for treatment-resistant depression. So it's recommended that they have at least one trial of medication failure and failure can be either not response or inability to tolerate it. Insurance companies frequently want at least two medication trials.
Joey Wahler (Host): And then, once the six-week period is over and they've completed the allotted number of sessions, let's say in a best case, it works as intended, would you at some point need to go through something along these lines again? And if so, how long thereafter?
Dr Lou Ann Eads: Some people do feel like that they're starting to have a little bit worsening of their depression and will want to come back. Most insurance companies will want at least six to nine months between treatments series.
Joey Wahler (Host): Well, you led me beautifully, doc, into my next question. This is covered by insurance then? At least in terms of covering most of it or some of it, yeah?
Dr Lou Ann Eads: It is covered by insurance as an FDA procedure that's been out since 2008. There is possibly a co-pay that the patient may have to pick up, but that again is insurance-dependent.
Joey Wahler (Host): And then finally, from what I understand, TMS isn't for patients that suffer from certain conditions. So who's not a candidate for this?
Dr Lou Ann Eads: Someone that has any metal in their head, neck, upper chest. Someone that has a tumor, has had a recent stroke, that has had any kind of clips in their brain. Someone that would not be eligible for an MRI because you're using a magnet, so they're pretty similar in restrictions.
Joey Wahler (Host): Well, folks, we trust you're now more familiar with TMS and how it can help with depression. Dr. Lou Ann Eads, thanks so much again.
Dr Lou Ann Eads: You're welcome. Thank you.
Joey Wahler (Host): Now for more information or to schedule an appointment, please call 501-526-8100. That's 501-526-8100. If you found this podcast helpful, please do share it on your social media.
And thanks again for listening to UAMS Health Talk, a podcast sponsored by University of Arkansas for Medical Sciences. Hoping your health is good health, I'm Joey Wahler.
What is TMS Therapy and How Does it Work for Depression?
Joey Wahler (Host): Depression remains a major problem in our society. But now, there's a new outpatient treatment for it called TMS, transcranial magnetic stimulation. So, what is TMS and how does it compare with other ways of addressing depression?
This is a UAMS Health Talk, a podcast sponsored by University of Arkansas for Medical Sciences. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Lou Ann Eads, an the interventional psychiatrist at UAMS. Dr. Eads, thanks for joining us.
Dr Lou Ann Eads: You're welcome.
Joey Wahler (Host): So let's get right into this. TMS, I guess, stimulates certain areas of the brain that are underactive during depression. Am I right?
Dr Lou Ann Eads: Correct.
Joey Wahler (Host): And so how does that work exactly for the uninitiated?
Dr Lou Ann Eads: We know that certain areas of the brain are not performing as well as normal. And in order to help bring them back up to a normal level of performance or functioning, then we use electromagnetic radiation, which is generated through TMS to stimulate a targeted area. And over a period of several weeks, the brain modifies itself and hopefully gets back to a normal level of functioning.
Joey Wahler (Host): And why is it that those areas of the brain in people depressed function that way? Do we know?
Dr Lou Ann Eads: I'm not sure we absolutely know why a certain area is not functioning up in a more normal range. But we have been able to identify specific areas that are underperforming, and that is where we target our treatment.
Joey Wahler (Host): Gotcha. So what exactly does a typical TMS procedure involve for the patient?
Dr Lou Ann Eads: It's five days a week of treatment for six weeks. The patient comes in. The first day, we do what's called mapping or identifying the best location to place our magnet. And subsequent days, we use the coordinates to, set the magnet on those same areas. They're in the chair for about 20 minutes. During this period of time, there is a short burst of pulses of stimulation to the skull that passes into the brain and is translated into electrical activity in the brain. And that's how the nerve cells talk to each other. Then, there is a brief pause followed by another series of stimulations. And this goes on for a 20-minute time period.
Joey Wahler (Host): And so you mentioned, you're actually able to pinpoint what areas need to be addressed specifically, right? That sounds pretty cool.
Dr Lou Ann Eads: We pinpoint a general area that we target with stimulation. We pinpoint what's called the dorsal lateral prefrontal cortex, and that it's been known for a long time that's an area that is not functioning up to par in depression.
Joey Wahler (Host): And you mentioned also, doctor, that you're sitting in a chair. So in terms of the atmosphere overall of what someone can expect, are they in a room that's dark, light? Can you read or be on your phone or do you need to just relax and put everything out of your mind? What's the setting besides sitting there and having this done?
Dr Lou Ann Eads: They're sitting in a chair and there's a helmet that contains the magnet itself that is placed up on the head. The room can be adjusted to patient preference. Most patients prefer a dim-lit room that is calming and relaxing and soothing during the treatment area. We do recommend that you try to have positive thoughts during the treatment time and those kinds of things, but it's more of a relaxing atmosphere.
Joey Wahler (Host): Gotcha. How about how long is a given session?
Dr Lou Ann Eads: It takes probably about three to five minutes to set up everything. Once it's set up, then it's a 20-minute procedure. And then after the procedure is over with, then it takes another three to five minutes to undo what's been set up.
Joey Wahler (Host): And is there a typical length of time that someone would need to continue this procedure?
Dr Lou Ann Eads: A series of treatments usually consist of 30 treatments followed by six tapering, so a total of 36 treatments. Again, the series is usually five days a week for six weeks and then followed by a tapering which is usually one week of three times a week, one week of two times a week and one week one time, for a total of 36.
Joey Wahler (Host): And so would you agree it sounds from the commitment involved as though this is pretty intensive in terms of the commitment on a consistency basis. But then over a relatively short amount of time, hopefully it works, right?
Dr Lou Ann Eads: Well, you're looking at about a six-week commitment, but it takes about us six weeks to really say that you're getting response for a medication or not getting a response from a medication. The positives of TMS is that there's no medications. We don't change medication, so continue on with the same medications that you're on. We're not adding or subtracting medications. So TMS, there's no medication side effects to have to manage. And a lot of people that come to TMS have had a number of medications side effects or not responded. Unlike ECT, you can drive yourself to and from the procedure, and you're not going under anesthesia like you would for ECT. There's not a memory concern with TMS, whereas there's a rare memory risk with ECT.
Joey Wahler (Host): Okay. So a couple of other things. You mentioned the comparison there between TMS and medication, no side effects with TMS, et cetera. How about in terms of comparing their impact? Does this work better at times the medication does? Does It work the same just without the side effects? How would you compare the benefits?
Dr Lou Ann Eads: It is statistically, per literature, it's as good, if not, a little bit better. Efficacy as far as response, it's not a hundred percent, but neither is medications or any other procedure we have to offer.
Joey Wahler (Host): So for the average depressed person, I know this encompasses a wide range of different types of people in terms of what they suffer with depression. You certainly can't paint them all with the same brush to say the very least. I know that. But from your experience with depressed people, taking TMS sessions, what would you say is the main benefit that they would feel getting out of it? What would they notice?
Dr Lou Ann Eads: Well, TMS just like any interventional procedure is targeted towards what we call treatment-resistant depression, meaning depression that has not responded to medications and/or therapy. It is FDA-approved for failure of at least one antidepressant. Most insurances would like to see failure of at least two medications. And we know that each subsequent medication that a person is given, the less likelihood they are to have a response. TMS is FDA-approved for mild to moderate depression. And it can be very helpful for people that have not responded to medications and can help decrease their depression and/or move their depression to more of a remission state.
Joey Wahler (Host): So you just mentioned it's for those that have had medication attempts fail. How about someone that hasn't tried anything for their depression? Would you recommend this over that?
Dr Lou Ann Eads: According to the FDA indication, it's for treatment-resistant depression. So it's recommended that they have at least one trial of medication failure and failure can be either not response or inability to tolerate it. Insurance companies frequently want at least two medication trials.
Joey Wahler (Host): And then, once the six-week period is over and they've completed the allotted number of sessions, let's say in a best case, it works as intended, would you at some point need to go through something along these lines again? And if so, how long thereafter?
Dr Lou Ann Eads: Some people do feel like that they're starting to have a little bit worsening of their depression and will want to come back. Most insurance companies will want at least six to nine months between treatments series.
Joey Wahler (Host): Well, you led me beautifully, doc, into my next question. This is covered by insurance then? At least in terms of covering most of it or some of it, yeah?
Dr Lou Ann Eads: It is covered by insurance as an FDA procedure that's been out since 2008. There is possibly a co-pay that the patient may have to pick up, but that again is insurance-dependent.
Joey Wahler (Host): And then finally, from what I understand, TMS isn't for patients that suffer from certain conditions. So who's not a candidate for this?
Dr Lou Ann Eads: Someone that has any metal in their head, neck, upper chest. Someone that has a tumor, has had a recent stroke, that has had any kind of clips in their brain. Someone that would not be eligible for an MRI because you're using a magnet, so they're pretty similar in restrictions.
Joey Wahler (Host): Well, folks, we trust you're now more familiar with TMS and how it can help with depression. Dr. Lou Ann Eads, thanks so much again.
Dr Lou Ann Eads: You're welcome. Thank you.
Joey Wahler (Host): Now for more information or to schedule an appointment, please call 501-526-8100. That's 501-526-8100. If you found this podcast helpful, please do share it on your social media.
And thanks again for listening to UAMS Health Talk, a podcast sponsored by University of Arkansas for Medical Sciences. Hoping your health is good health, I'm Joey Wahler.