Transcranial Magnetic Stimulation: A New Frontier in Depression treatment Gains Traction in the U.S.
October 26, 2024
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is gaining momentum in the United States as a promising option adn adjunct treatment for depression, offering hope for patients who haven’t found relief through customary methods.
What is rTMS and Why is it Important?
Repetitive transcranial magnetic stimulation (rTMS) utilizes magnetic fields to stimulate or inhibit specific areas of the brain. Unlike electroconvulsive therapy (ECT), rTMS is non-invasive and doesn’t require anesthesia.The treatment is personalized to address different pathologies (1). In the U.S., rTMS is primarily used for treatment-resistant depression, obsessive-compulsive disorder (OCD), and, increasingly, for chronic pain management.
Dr. Jean-Luc Bartoli explains its importance, stating, It is a treatment among others which makes it possible to treat early, effectively and not partially depressions to avoid relapses. Classic depression treatments are quite limited, hence the interest of making patients known this more interventional method.
This outlook resonates with manny U.S. psychiatrists who see rTMS as a valuable tool in their arsenal, particularly for patients who haven’t responded well to medication or experience intolerable side effects.
The rising rates of depression in the U.S., coupled with concerns about the side effects of antidepressants, have fueled interest in alternative treatments like rTMS. According to the National Institute of Mental Health (NIMH), an estimated 21 million adults in the United States had at least one major depressive episode in 2020. This underscores the urgent need for innovative and effective treatment options.
A Closer Look at the rTMS Experience
The rTMS procedure usually begins with an initial mapping session that lasts about 45 minutes. During this session, the medical team pinpoints the precise area of the brain to stimulate. Patients wear a cap marked with targets corresponding to these areas. Subsequent daily sessions typically last around 15 minutes,with the total number of sessions varying based on the specific condition being treated.
Dr. Bartoli notes, It is indeed necessary to count thirty in the treatment of depression. it is quite restrictive for the patient who must move every day to the hospital but transport can be taken care of.
while daily hospital visits can be a logistical challenge, especially for those in rural areas or without reliable transportation, many U.S. hospitals and clinics are working to make rTMS more accessible through flexible scheduling and transportation assistance programs.
Contraindications for rTMS are relatively few but important to consider. Patients who have undergone skull surgery or have experienced recent brain problems may not be suitable candidates.Special precautions are also necessary for individuals with unstable epilepsy. It’s essential to have a thorough medical evaluation before starting rTMS therapy.
One of the notable advantages of rTMS over electroconvulsive therapy (ECT) is that it doesn’t require anesthesia and typically has milder side effects. While some patients may experience dizziness,nausea,or headache,these side effects are generally mild and temporary.
Weighing the Advantages: Why rTMS is Gaining Popularity
It is indeed rare that patients do not support RTMS, while a third of them does not tolerate antidepressant treatments, which are not always effective
, according to both psychiatrists. This observation highlights a key advantage of rTMS: its tolerability. Many patients who struggle with the side effects of antidepressant medications find rTMS to be a more manageable and acceptable treatment option.
Dr. Bartoli points out, The problem, estimates Dr. Bartoli, It is indeed that not all patients who do not support antidepressants and for whom RTMS represents an alternative or additional treatment are not sent to us.It is indeed critically important that they can have access to this unique technical platform in the Var department.
this sentiment echoes the situation in the U.S., where access to rTMS remains a challenge for many patients. Despite its growing acceptance, rTMS is not yet widely available, particularly in rural and underserved areas. Furthermore, insurance coverage for rTMS can be inconsistent, making it challenging for some patients to afford the treatment.
Beyond depression, rTMS is also being explored as a treatment for a range of other conditions, including chronic pain, obsessive-compulsive disorder (OCD), and even addiction. Some studies have shown promising results, even though more research is needed to fully understand the potential of rTMS for these conditions.
A 2023 study published in the “Journal of Pain” found that rTMS significantly reduced pain levels in patients with fibromyalgia.While not a cure, rTMS offered a valuable tool for managing chronic pain and improving quality of life.
Future directions: Tailoring rTMS for Anxiety and Depression Subtypes
Ongoing research is focused on refining rTMS techniques to optimize treatment outcomes.One promising area of examination is the use of rTMS to target specific symptoms of depression, such as anxiety.
Dr. Dias-Alves, who conducts the study explains, Anxiety represents a particular problem because it increases suicidal risk, limits the effectiveness of certain treatments and imposes additional drugs. While in the slowed forms of depression, it is the left prefrontal cortex which is stimulated, at high frequencies, it will be a question of studying, in the case of depression with anxious symptoms, low frequency stimulation of the right prefrontal cortex.
This approach, which involves tailoring the type and location of neurostimulation based on individual symptoms, could lead to more effective and personalized rTMS treatments.
For example, a patient with depression characterized by low energy and motivation might benefit from high-frequency stimulation of the left prefrontal cortex, which is associated with positive emotions and goal-directed behavior. In contrast, a patient with depression accompanied by significant anxiety might respond better to low-frequency stimulation of the right prefrontal cortex, which is involved in processing negative emotions.
Such research holds significant implications for the future of mental health treatment in the U.S. By understanding the neural circuits underlying different depression subtypes, clinicians can use rTMS to precisely target and modulate brain activity, leading to more effective and personalized interventions.
