Evidence is building in favor of using transcranial magnetic stimulation (TMS) ...
early in the course of treatment-resistant depression (TRD) and in other cases, Insomnia.
Jon W. Draud, MD, MS, said in a presentation on TMS that it should be considered after less than a year of treatment and a few medication trials, rather than after many years or courses of several antidepressants.
“There’s a very legitimate argument to be made that this should be introduced sooner rather than later,” said Dr. Draud, who began using TMS in his private practice 2 years ago. “We know for a fact the longer you wait, the less likely anything is to work.”
The brain changes with each successive episode of depression, and depressed people become more likely to discontinue treatment with each new medicine they try, he said.
TMS is FDA-cleared for use in TRD, defined as depression that persists after trials of 2 or more medications. Data shows it is more effective after 2 failed medication attempts than as an original treatment, said Dr. Draud, Clinical Professor of Psychiatry at the University of Tennessee College of Medicine in Memphis. The reasons for the difference in effectiveness are unclear, he noted.
Jon Draud, MD, MS, presents a session on transcranial magnetic stimulation (TMS) at Psych Congress Saturday.
Despite fears and misconceptions to the contrary, Dr. Draud said TMS is very safe, has a low risk of side effects and works as well or better than medications used to treat depression. Furthermore, its benefits may be more durable than benefits from antidepressants, which can become less effective over time, he said.
“At the end of the day, you couldn’t hope for anything more from a treatment for depression,” he told an audience of more than 100 mental health professionals. TMS is also being examined for potentially treating other psychiatric and neurologic disease states, Dr. Draud said.
Brainsway, which manufactures a helmet that delivers TMS treatment, is hoping to have a trial and FDA application for a different disease state for each of the next 5 years, said Pratik Patel, Marketing Director North America of the company. Different types of coils would be used in the helmet for treating different disorders, he said.
In addition, a study published in 2014 found TMS significantly reduced suicidal ideation in a group of 45 inpatients admitted for suicidal thoughts.
The potential use of this is huge,” Dr. Draud said.
What about using TMS for insomnia?
A small pilot study presented at the American Psychiatric Association’s annual meeting suggests bifrontal transcranial magnetic stimulation (TMS) may be an effective treatment for chronic insomnia.
Researchers conducting the prospective, open-label study hypothesized that “low-frequency TMS exerts an inhibitory effect on hyperexcitable cortical state in patients with chronic insomnia and therefore is therapeutic.”
Patients between the ages of 21 and 65 years of age who meet DSM-IV criteria for primary insomnia are being studied, according to the abstract presented at a poster session.
Three men and 3 women, with a mean age of 44 years, have completed the study. Their mean change in sleep duration on actigraphy was 1 hour. The mean change in insomnia severity index (ISI) scores was 15%, and the mean change in sleep efficiency was 10%.
Exclusion criteria included comorbid depression, substance abuse or psychotropic medication changes in the previous 2 weeks, major medical or psychiatric disorders that could cause or contribute to insomnia, and having ferromagnetic material in the head or within 30 cm of the coil.
