Healthy Living

Major Depressive Disorder is a common disorder affecting about 16 million to 18 million Americans in any one year at a cost of $82 billion. This is a leading cause of disability, and a crippling disease that leads to major disturbances in one’s life — affecting patients in their work, family, and social life.

“Having depression made me feel like I was an awful person. I did not want to leave my house or be with my family or friends. I would not go to work because I could not bring myself to get out of bed in the morning. Sometimes I would only sleep a few hours of the night and wake up repeatedly. When I was awake I could not focus on anything. I felt completely empty; I could not enjoy anything. Food was tasteless and I lost a lot of weight. I was continuously fighting to get through another day.”

This was a quote from a depressed, 55-year-old female patient. This married woman was treated by her primary care provider with Zoloft for months without any improvement. She was then referred to me. The antidepressant was switched to another antidepressant (Effexor XR), and she began psychotherapy.

Her mood improved to some degree but she still complained of lack of motivation, poor energy, inability to enjoy hobbies (crossword puzzles, cooking, and her three grandchildren who previously were her pride and joy).

After a year of treatment with minimal improvement, I suggested Transcranial Magnetic Stimulation (TMS). The patient agreed and within three weeks she was back doing crossword puzzles, and cooking. Within four weeks she was spending a lot more time with her grandchildren — she looked forward to going to work, her concentration was much better, she reconnected with her friends, enjoyed going out to dinner with her family, gained back the weight she had lost and felt her life was meaningful again.

TMS is the latest non-pharmaceutical treatment modality for major depressive disorder that does not respond to other treatments. In a large clinical trial done by the National Institute of Mental Health involving over 4,000 patients, it was found that only 30% of patients treated with antidepressants were totally free of any symptoms of depression.

TMS works by stimulating key neurons in the brain that are believed to be involved in the pathophysiology of depression. Unlike antidepressants that are swallowed and circulate in the body, TMS delivers high intensity focused magnetic pulses that lead to the formation of electrical currents, which are transmitted to deeper structures in the that are also associated with symptoms of depression.

The electric impulses stimulate the neurons to increase neurotransmitters (much like antidepressants) that are lacking in depressed individuals. Unlike medication, TMS does not lead to side effects (weight gain, sexual dysfunction, sedation, gastrointestinal problems) and unlike Electro Convulsive Therapy it does not require anesthesia or muscle relaxants and does not lead to any memory problems. It is an effective treatment that is safe and non-invasive.

Typically the patient will drive to the office, will receive the treatment while lying in a comfortable reclining chair (similar to a dentist chair) will be awake and alert during the session (40 minutes) and can drive back to work or home. The course of treatment is approximately 20-30 sessions and is given five days a week, Monday through Friday. Some patients may require “booster” session after six months and some may need to continue on an antidepressants, but will definitely require less pharmacological intervention than prior to TMS treatment.

Mahmoud Okasha, MD, is a physician with Comprehensive Psychiatric Care of Norwich. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Okasha or any of the Healthy Living columnists at healthyliving@wwbh.org