Michael Craig Miller, M.D.

Magnetic stimulation: a new approach to treating depression?

Depression can have enormous depth and staying power. For many people, “talk therapy” and medication can ease this life-sapping condition. But they don’t work for everyone. One relatively new option that might help, and I stress the “might,” uses magnetic fields to stimulate part of the brain. It’s called repetitive transcranial magnetic stimulation (rTMS).

Approved by the FDA in 2008, rTMS treatment centers can be found in more places around the country, though it still isn’t widely available. Keep in mind that it is for people whose depression hasn’t been helped by standard treatments. Experts do not recommend transcranial magnetic stimulation for those with mild depression or newly diagnosed moderate or severe depression.

How rTMS works

Undergoing transcranial magnetic stimulation is relatively easy. You sit in a chair that resembles a dentist’s chair. Your head is gently held in place, and a magnetic coil is positioned on one side of your scalp. Once the clinician is sure the pulses will be delivered to the correct part of your brain, the treatment begins.

The rTMS device produces a series of strong magnetic pulses that are similar in strength to those produced during a magnetic resonance imaging (MRI) scan. It’s a painless procedure—you feel a slight tapping on the head—and the pulses go about an inch into the brain. These pulses create a weak electrical current that can either increase or decrease activity in specific parts of the brain. (If you want to see how the procedure is done, watch this video about transcranial magnetic stimulation from Beth Israel Deaconess Medical Center, one of Harvard Medical School’s teaching hospitals.)

No anesthesia is needed for a transcranial magnetic stimulation treatment, so you can drive home afterwards. The most common side effects of the treatment are a mild to moderate headache or scalp pain below where the device was positioned. Since the magnetic pulses can be loud, some people experience ringing in the ears from the noise of the treatment. Wearing earplugs or earphones helps.

The most serious risk of transcranial magnetic stimulation is a seizure, but this is rare, happening in fewer than 1 person in 1,000. The risk is probably even lower in healthy people who don’t have other seizure risk factors. A careful neurological evaluation can help identify any increased risk.

Typically, transcranial magnetic stimulation treatment involves a 40-minute session, five days a week, for four to six weeks. Some people need less frequent maintenance treatments afterward. The cost can range from $6,000 to $10,000, depending on the clinic and how many sessions are needed. Insurance may not cover the cost of treatment.

Does it work?

The FDA approved rTMS largely on the basis of an industry-sponsored double-blind randomized controlled study. It included 301 men and women, all in the midst of an episode of major depression, none of whom had responded to up to four antidepressants. In this group, one in seven (14%) of those who underwent transcranial magnetic stimulation got relief from their depression by the sixth week, compared with one in 20 (5%) of those who underwent what looked like transcranial magnetic stimulation but wasn’t. A similar trial of 190 men and women with major depression, funded by the National Institutes of Health, found much the same thing.

Is rTMS right for you?

Because rTMS directly stimulates the brain, it is sometimes compared to electroconvulsive therapy (ECT). ECT is one of the oldest treatments for severe depression. It has been extensively studied and is widely held to be effective. But it remains unacceptable to many people, so transcranial magnetic stimulation may be a welcome alternative where it is available. Like ECT, transcranial magnetic stimulation does involve more effort and time than medication. But it avoids the risks and discomforts of anesthesia.

As my colleague, Dr. Anthony Komaroff, wrote recently in his daily Ask Doctor K column, doctors are still learning how best to use transcranial magnetic stimulation. We hope we will someday be able to better identify people who are likely to respond to magnetic stimulation and those who won’t. Improving delivery of the magnetic pulses is also under investigation.

In the meantime, transcranial magnetic stimulation could make a big difference for some men and women with depression that doesn’t respond to medication or psychotherapy.

Related Information: Understanding Depression

Comments:

  1. sue

    Magnets do help control depression

  2. Maria Caillet

    Some people suffering from depression are fortunate to find a good psychiatrist. If they decide to go to a psychiatrist. My people let their pride get in the way or they are just too embarrassed to ask for help. Do not procrastinate– Depression can lead to suicide – do not wait until it is too late. It is better to be safe than sorry. When you suffer, your loved ones suffer. You are not the only one who gets affected. Find a doctor who is well informed on the new developments of treatment. You could even talk to your MD. They could help you too. Everything you tell then is confidential.

  3. James

    Well no doubt that this new method could help mankind in which many of portion are used to be worried unusually. But I doubt that it might has an adverse effect as well. It would be good to introduce this method in the society as soon as possible to test multiple brains and coming up with the best.

    Thanks
    James

  4. PICORELLI-SELLES

    However, several scientific papers and bibliographic items studied from 1980 to 2001, suggest that they are not strong evidence of benefits from the use of transcranial magnetic stimulation to treat depression, but probably due to the limited sample of patients studied

  5. paul hill

    The psychiatric profession is not looking very koshe at the moment allowing Jimmy to slip through the net when he was surrounded by, enmeshed into even, neurology, psychiatry etc. and was SHOUTING ‘I’m gonna go berserk’. So I’d suggest that anybody feeling an overwhelming urge to start blowing people away should perhaps consult their local butcher for help. The most effective way of getting rid of depression is get rid of God as he is the root of ALL psychiatric disorders, especially the very intractable ones. I just felt an overwhelming urge to say all that and that I am making a MASSIVE contribution to the advancement of the pseudo-sciences. Should I consult someone and is it listed in the DSM 5 as a syndrome.

  6. Michael

    Thankfully, my depression is well controlled by medication. But I can imagine the need for this type of treatment for people who are not so fortunate.

    Anything that can help them would be welcome.

    My concern would be the cost of treatment for anyone not on a relatively high income.

    Michael

  7. Paul F Davis

    Thanks for being committed to public health, natural remedies and progressive treatments to get results.

  8. Ern

    If it is better than ECT then probably it should be given a chance.

    Ern