Early Findings Positive for Combination Treatment
Sheppard Pratt is among the early adopters of Transcranial Magnetic Therapy (TMS), offering psychiatrists another tool to treat depression. Dr. Scott Aaronson, director of clinical research programs at Sheppard Pratt and medical director of TMS Services, uses NeuroStar TMS Therapy® for patients who have not responded to other types of depression treatment. It is offered in conjunction with a stay on The Retreat at Sheppard Pratt and on an outpatient basis.
During TMS, magnetic field pulses are generated and aimed at the left dorsal lateral prefrontal cortex, an area of the brain that has been demonstrated to function abnormally in patients with depression. During the clinical trials in which Dr. Aaronson was involved, TMS was used only as a monotherapy for individuals who had failed one to four antidepressant treatments in their lifetime.
Now, Dr. Aaronson is using TMS more frequently as an add-on treatment to antidepressants on patients who are, on average, sicker patients who have failed antidepressant treatment more than what was acceptable for the clinical trial. Dr. Aaronson says the hope is to provide a different paradigm to treat depression, no longer just dealing with serotonin or norepinephrine reuptake inhibitors, but instead offering antidepressant support by electric means.
Outside of the clinical trials, Dr. Aaronson is finding a larger percentage of patients responding to TMS treatment. Whereas it was about 50% of clinical trial subjects responding to TMS monotherapy, now about 60 to 65% of patients show good evidence of response to combination treatment.
Dr. Aaronson cites a 50-year-old male patient who was disabled from his profession because of his depression, and who had not previously responded to aggressive pharmacologic treatment as an outpatient. The man received TMS treatment and is now back to work and functioning again. A woman in her early 30s was able to return to work for the first time in five years after receiving TMS treatments.
A typical course of TMS therapy consists of 20 to 30 consecutive sessions, each lasting about 45 minutes for five days a week. No anesthesia or sedation is needed and there are no cognitive side effects. Currently, only one patient is receiving maintenance treatments, a woman who has failed alternative treatments over the past five years.
The original TMS technology was developed as exploratory means to investigate what different parts of the brain do — a way to activate or slow down areas of the brain through magnetic stimulation. Dr. Aaronson says this is a new tool and sees it as just the beginning of using this new technology. Currently, TMS is used with unipolar depression, but it may also have usefulness in bipolar depression or other illnesses, like schizophrenia.
Additionally, Dr. Aaronson says side effects have been minimal and, generally speaking, most patients have tolerated treatment well. The first few treatments have been uncomfortable for some patients, Dr. Aaronson says, who are sensitive to the tapping sensation at the treatment site. He says patients then get used to the stimulation and it becomes less bothersome as treatment continues.
Although TMS therapy is not currently covered by insurance, the parent company, Neuronetics, is working to get third party payers to support the treatment. Current costs for treatment range from about $6,000 to $9,000. Dr. Aaronson says he believes insurers would be more likely to cover costs once they become aware of the successes that come from using the technology along with antidepressants.
Dr. Aaronson stresses that TMS treatment is not a last chance for patients, but yet another tool for providers to use. He hopes mental health providers accept the technology, and that there will be an increased understanding of its utility for a variety of psychiatric conditions.