Patient Education
More about TMS

The original research articles that have studied TMS showed that over half of patients had improvement in depression and about one-third had remission. In real-world clinical practice -- and certainly in our office -- results are better than that. There are probably many reasons for that, but one that most doctors agree on is that patients who are having some positive results with their meds do not have to stop them -- whereas in the research trials patients had to be off all their meds. Even better, the results seem to last, with longer depression-free periods after TMS than is usually seen with medications.

Here are some patient remarks, and more patient stories are at TheDepressionHopeCenter.com

“I am really very happy with the way things are going.  I have my confidence back – I have not had that in months”      -TMS Therapy patient from
Concord Hospital, NH

“This is the best I have felt in a long time; I really have a future now”      -TMS Therapy patient from
Concord Hospital, NH

“Freedom is a very important work to most Americans and it is a very important word to describe my TMS treatments.  I now have the freedom to think, feel and behave like my friends and family”      -TMS Therapy patient from Advanced Mental healthcare, Inc.  Palm Beach, FL

“The results are startling…spontaneous joy…you get to feeling a certain way…(now) it’s not forced…it’s effortless…it’s like changing a battery.  I had resigned myself that at one point my life would be over and that was a comfort.  There was no joy.  Everything was an effort.  To actually be in a therapy that is working…It works for a person who had given up hope…”  -TMS Therapy patient from Dr. Carl Wahlstrom’s office,  Chicago, IL

“This treatment has really given me my life back”       -TMS Therapy patient from Concord Hospital, NH

In Amarillo's Women in Business, Spring 2010, two women who administer TMS treatments talk about what it's like to see people get better.

Leading research and teaching institutions, including UT Southwestern at Dallas, Stanford (my alma mater!), Massachusetts General Hospital (associated with Harvard), the Mayo Clinic, Walter Reed Army Medical Center, and many other military hospitals and VA's are studying and using TMS.

NAMI, a great force for political advocacy, research support, and family education, is also viewing TMS in a favorable light.

Here are some Case Reports:

51 Year-Old Woman
Patient Description
• Patient is a 51-year-old woman
• She has suffered from recurrent Major Depressive Disorder for over 20 years
Patient Depression Treatment History
• History of non-response to five antidepressants (including SSRIs, SNRIs and Wellbutrin®)
Treatment in Current Episode
• Patient was taking Effexor XR® 300mg at the start of TMS Therapy
• Initial Beck Depression Inventory of 42
NeuroStar TMS Therapy Treatment Course and Results
• Patient treated acutely with 15 TMS Therapy sessions plus 5 taper sessions
• Successfully tapered off Effexor XR
• Patient had a final Beck Depression Inventory of 3 after the 15th treatment session

Case Study: 45-Year-Old Father
Patient Description
• Patient is a 45-year-old man
• Professional, married, with three children
• Patient suffers from Major Depressive Disorder
Patient Depression Treatment History
• Patient started a low dose of Wellbutrin®
• Medication, along with psychotherapy, was effective until 2008
Treatment in Current Episode
• Patient experienced a more severe episode of depression
• Wellbutrin dosage increased to 300mg but was not well tolerated
• Remeron® (30mg) was started – patient experienced partial response
• Patient then inquired about TMS Therapy and began treatment
NeuroStar TMS Therapy Treatment Course and Results
• Patient treated acutely with 34 sessions of TMS Therapy
• Patient returns periodically (approximately every four weeks) for a “booster” TMS Therapy session
• TMS Therapy, in conjunction with regular psychotherapy sessions with psychiatrist, have proven to be successful
Patient Quote:
“I decided to go with (NeuroStar TMS Therapy), and what I noticed was that after about 2-3 weeks, I felt like I was young again. Like 20-years old. Things about my life that were bothering me sort of just unconsciously fade into the background now. I have interest in other things, simple things like picking up a book, actually reading it, and enjoying…rather than just seeing the words on the page and thinking about other things in my life that were bothering me.”

Case Study: 30 Year-Old Woman
Patient Description
• Patient is a 30-year-old white woman
• Patient suffers from severe recurrent Major Depressive Disorder
Patient Depression Treatment History
• Patient started dealing with anxiety issues as a high school student
• First depression occurred in her early 20s after college during initial adult relationship and work difficulties
• Experienced several prior episodes of depression with partial response to antidepressant medication
including: Paxil®, Effexor®, Lexapro®, Pristiq® and also Abilify®
• Other trials included Lamictal®, Xanax® and psychotherapy
• Patient received psychotherapy over 2 to 3 years
Treatment in Current Episode
• Patient currently in a 6 month Major Depressive Disorder episode
• Patient treated with Lamictal® and psychotherapy
• TMS Therapy prescribed based on patient’s non-response to antidepressants administered in previous
episodes
NeuroStar TMS Therapy Treatment Course and Results
• Patient treated acutely with 30 sessions of TMS Therapy plus 6 taper TMS Therapy sessions
• HAM-D scores decreased from 24 to 2

Case Study: 55-Year-Old Woman Professional
Patient Description
• Patient is a 55-year-old woman professional
• Suffers from recurrent Major Depressive Disorder with Seasonal Affective Disorder, and Generalized
Anxiety Disorder
Patient Depression Treatment History
• Patient treated for moderate depression for the past 4-5 years with Prozac (40mg)
• Treatment had a dulling effect but was not effective in improving her mood
• Patient experienced worsening of depression symptoms: increase in sleep, decrease in pleasure, loss of
interest in activities
Treatment in Current Episode
• Patient was taking 40mg of Prozac
• Patient had difficulty tolerating medication and was not adequately benefitting
NeuroStar TMS Therapy Treatment Course and Results
• Patient treated with 32 sessions of TMS Therapy
• Prozac dosage lowered to 10mg at the beginning of treatment
• 7.5 mg of Deplin® added at the beginning of week four of TMS Therapy
• Patient’s Beck Depression Inventory decreased from 20 to 12
• Patient noted improved mood, renewed interest in friends and work at week 2 of TMS Therapy
Patient Quote:
“After years of struggling with depression, anxiety and medications
that didn’t work, I got ‘me’ back with TMS Therapy. My appetite
is back to normal and I’m losing weight… I’m free.”


Other Areas of Interest

Outcomes research -- Alcoholics Anonymous

From the online journal Addiction, February, 2010

People who attended Alcoholics Anonymous meetings drank less -- and less frequently -- than those who did not attend AA, and also were less depressed, according to research based on the federal Project MATCH treatment study.

The Los Angeles Times reported Jan. 28 that a study on AA's impact on drinking and depression, conducted by John F. Kelly of Harvard Medical School and colleagues, also found that AA participants who attended more meetings also drank less.

Abstinent AA attendees had fewer symptoms of depression than the general population, but those who continued to drink did not, the study found.

"Some critics of AA have claimed that the organization's emphasis on 'powerlessness' against alcohol use and the need to work on 'character defects' cultivates a pessimistic world view, but this suggests the opposite is true," said Kelly. "AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn't want that?"


Staying Healthy
   Useful guides to safe medication use /   WebLink     

Consumer information for prescription and over-the-counter medications /   WebLink     

Information about testing and supplementation for neurotransmitters (chemicals that increase or decrease electrical activity in the nervous system) /   WebLink     

Book Recommendations          Drinking and Smoking I haven't read them but books by Allen Carr have helped some of my patients -- "The Easy Way to Stop Drinking" and "The Easy Way to Stop Smoking."  

Something Practical: "Getting Things Done," by David Allen  Something for families: "Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond" by Anne Sheffield     

On Bipolar II disorder:  "Why Am I Still Depressed? Recognizing and Managing the Ups and downs of Bipolar II and Soft Bipolar Disorder," by Jim Phelps, MD. He has a great website, too: http://www.psycheducation.org 

Alternative approaches to mood disorders:  "The Antidepressant Survival Guide" by Robert Hedaya.  

More on Bipolar: Lana Castle's "Finding Your Bipolar Muse: How to Master Depressive Droughts & Manic Floods & Access Your Creative Power." Her previous book is "Bipolar Disorder Demystified: Mastering the Tightrope of Manic Depression."       

Let me know what you think of these and other books on the topic of brain illness and coping strategies.  

Pregnancy and Antidepressants            Two studies in the "New England Journal of Medicine" (June 28, 2007) shed light on of the toughest decisions in psychiatry: how to manage depression during pregnancy.  The studies do not show significant increases in the rate of serious birth defects when women take antidepressants during pregnancy. Nonetheless, there are always concerns about any fetal exposure to medications.      

Unfortunately pregnancy doesn't protect a woman from depression -- any woman has a 10-15% chance of depression. And going off antidepressants during pregnancy results in the time the relapse occurs quickly, in the first trimester.    

At the same time there is evidence of high levels of antidepressants in amniotic fluid and cord blood and an increased rate of heart defects with paroxetine (Paxil). Exposure to SSRI's (Paxil, Prozac, Zoloft, Luvox, Celexa, and Lexapro) is associated with higher-than-average rates of low birth weight, respiratory problems, and SSRI- withdrawal symptoms in newborns.       

Every pregnancy and every woman have unique circumstances that may clearly tilt the balance of risks and benefits in one direction or another. No single formula applies. Read all you can and talk to your doctor if you are facing this question.   

Alcohol Use Guidelines from NIAAA       The National Institute on Alcohol Abuse and Alcoholism has established safe levels of alcohol use for those who do not have a history of alcoholism. For women the limits are 3 drinks in one day and 7 drinks in one week. For mentthe limits are 4 drinks in one day and 14 drinks in one week.   

Good Sleep Habits       If you have insomnia you may have to make some changes in your bedtime behaviors. Here are some ideas. 
• Make your bedroom a refuge -- dark, quiet -- and don't have electronics like TV and computer in the room. 
•Get a comfortable bed. 
•Have a consistent bedtime and a consistent wake-up time.  Have a quiet pre-bed ritual -- reading, bathing, brushing teeth, etc. 
•Avoid exercise within 4 hours of bedtime.  Avoid heavy foods within 6 hours of bedtime.  Eliminate caffeine and alcohol from the diet. 
•Avoid computer use after sunset. 
•Limit fluids after 6 p.m. if nighttime urination is a problem. 
•Don't look at the clock during the night. 
•If you are trying to get to sleep or are waking in the middle of the night and can tell you won't quickly to get back to sleep, then get out of bed. Go to another room and do something with low light, like reading, listening to music, mending, etc. Definitely avoid the computer.  

Drug Abuse Screening       The National Institute On Drug Abuse has a terrific on-line screening tool. It is supposed to be used by medical professionals, but everyone can use it to determine their level of risk (of abuse and dependence) with a number of different drugs.  Go to: http://nida.nih.gov/nidamed/index.php  



 



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