Transcranial Magnetic Stimulation helpful for depression

[David Baxter PhD]

Repetitive Transcranial Magnetic Stimulation Helpful for Depression in Parkinson's Disease
Laurie Barclay, MD

Aug. 13, 2004 — Repetitive transcranial magnetic stimulation (rTMS) is as effective as fluoxetine for the treatment of depression in patients with Parkinson's disease, according to the results of a placebo-controlled trial published in the August issue of the Journal of Neurology, Neurosurgery and Psychiatry.

"[rTMS] is a non-invasive, well tolerated technique for stimulating the brain," write F. Fregni, from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts, and colleagues. "rTMS may have an antidepressant effect by the enhancing the serotoninergic system and increasing monoamine levels. Furthermore, previous studies showed that rTMS applied to the prefrontal area led to an improvement in motor function in patients with Parkinson's disease."

In this double-blind study, 42 patients with Parkinson's disease and depression received active rTMS (15 Hz for 10 days) and oral placebo; or sham rTMS using a specially designed sham coil and 20 mg of fluoxetine per day.

After two weeks of treatment, the Hamilton Rating Scale for Depression and Beck Depression Inventory were similarly improved in both groups (38% and 32% for active rTMS; 41% and 33% for fluoxetine, respectively). At week 8, activities of daily living were improved only in the active rTMS group, and there was a nonsignificant trend for worse scores in the motor function section of the Unified Parkinson's Disease Rating Scale in the fluoxetine group. Although scores on the Mini-Mental State Examination improved with both treatments, it improved faster in the active rTMS group. There were fewer adverse effects with active rTMS than with fluoxetine.

Study limitations include lack of a placebo group due to ethical constraints and possible methodological problems involving the sham coil.

"rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects," the authors write. "The drawbacks of each treatment have to be considered, as rTMS involves higher costs (TMS equipment, trained people to apply) and inconveniences (dislocation to treatment centre), and fluoxetine has some adverse effects, being associated with worsening of the motor symptoms of Parkinson's disease, although this is still controversial."

The authors note that more information is needed concerning optimal stimulation parameters, including number of stimuli per session, number of sessions per week, and optimum length of a course of stimulation. They recommend testing a longer period of rTMS treatment in a similar population.

J Neurol Neurosurg Psychiatry, 2004;75:1171-1174

 

[attical]

I have undergone rtms treatment at St. Joseph's in Hamilton. The first two treatments were research, and my first treatment was a sham treatment, although it was unknown to the doctor or myself. I had no response. The second treatment gave me a few small, but good, responses but they faded in a couple of hours.
They have just acquired new advanced equipment, and I'm half way through treatment with this equipment. My Beck has gone from 33 to 4, and I feel wonderful. Feel free to respond with any questions.

 

[David Baxter PhD]

Hi, attical.

I see you've already also posted in the thread at http://www.psychlinks.ca/phpbb/viewtopic.php?t=1099 -- I knew little about this before Bo posted his experiences and it would be nice to have some additional corroboration from someone else who has tried it. How many treatments have you had so far and when did you start feeling a noticeable benefit? You indicate in the other thread that you've had "no negative side-effects" but what were your subjective experiences of the procedure? Had you previously been treated with medications and/or psychotherapy and if so what were your experiences with more traditional approaches?

 

[attical]

I sshould clarify my previous email. The first round of treatments (10 in total) were sham treatments, and I had no response. The second round (10 in total) gave me a couple of very short positive responses. I'm now half way through a third round (of 15 treatments), with the new advanced equipment, and felt great after the first treatment!! 10 days later, I still feel great.

The current round started with an MRI, and this was translated to a computer program called Brainsight. With a laser system, they located the correct spot on my brain to focus on (the initial rounds weren't as precise, so had limited impact). They check the spot every couple of days to ensure it is exact. I also had a QEEG prior to the first treatment, and will have another at the end...for comparison.

I spent more than a decade working with CAMH tring to find the right medication, and nothing worked, or the side effects were unbearable. I've also spent years working with various therapists, with little in the way of results. I had just about given up hope. For me, rTMS is a miracle.

rTMS treatment at St. Josephs is research, and they only accept patients by referral. It is not covered by OHIP, but there is no charge as it is covered out of research funds.

 

[David Baxter PhD]

Thanks, attical.

I am a natural skeptic and I don't yet know a lot about this therapy but I find it fascinating. I don't know if it will ever replace more traditional therapies but for those who are "treatment resistant", as the psychiatrists put it, this could represent hope where there previously was little or none.

 

[attical]

I don't know a lot about this treatment either, but I felt better in 30 minutes than decades of medicine, psychotherapy and other forms of treatment that didn't work.
Almost every day, there are observers from the Clarke and other hospitals and specialists sitting in on my treatments. I welcome them, as I welcome the readers of this forum.
St. Joseph's has a great leader in Dr. Gary Hasey, and a wonderful, committed team that is delivering relief. One of the doctors observing my treatment said I was making medical history. That's nice, but not as nice as feeling good!

 

[Bo]

Wow Attical, the advanced treatments sound really interesting! My treatments didn't have Brainsight, or any of that, but rTMS itself was a fantastic experience. I had to have 20 sessions, so maybe that made the difference.

I'm glad to hear from another person who has had the treatment, and also benefitted from it. Hopefully this WILL replace more traditional therapies in the future, but for now I'm just happy to have been one of the lucky ones.