From the Desk of Dr. Kent
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― Jennifer Donnelly, Revolution
The earliest known attempts at brain stimulation using electromagnetic stimulation date back as far as 1896 by Jacques-Arsene d'Arsonval of Paris and Silvanus P. Thompson (1910) in London. It wasn’t until 1985 that there was a successful demonstration of transcranial magnetic stimulation (TMS) by Anthony Barker and his colleagues at the Royal Hallamshire Hospital in Sheffield, England. (1) Anthony Barker and associates essentially took a single Faraday coil (invented in1831) to the scalp above the left cerebral motor strip and saw movement in the right hand. They did this on themselves. In the included photo he’s on the right. It immediately garnered widespread excitement and interest in the international research community. This was the first time that electromagnetic stimulation of the brain showed a direct tissue response. Anthony Barker PhD was credited with the discovery of TMS.
What followed was an exponential growth in international research on brain stimulation. Today the field has it’s own scholarly journal aptly named Brain Stimulation. At the 2nd International conference on Brain Stimulation Conference in Barcelona, Spain on 3/6/17, Anthony Barker, PhD was awarded the International Brain Stimulation award. I had the privilege of meeting and talking with Dr. Barker at the conference (see included photo with award). This conference was attended by an estimated 1000 people from all over the world represented by a myriad of disciplines including but not limited to psychiatrists, neurosurgeons, biomedical engineers, neurologists, researchers and industry sponsors. Over the course of 4 days speakers from the international community presented their data and research on various brain stimulation topics ranging from basic TMS to vagus nerve stimulation, electroconvulsive therapy (ECT), effects of ultrasound on brain tissue, deep TMS, invasive brain stimulation and many other topics. Some of the more interesting topics for me were the ones that dealt with the future potential uses or indications for TMS. These included obsessive compulsive disorder, treating addictions such as cocaine, opiates, nicotine and alcohol. There was also research presented that dealt with the potential benefits of TMS for chronic pain sufferers and stroke rehabilitation.
It was exciting to be at a table with researchers and practitioners from Russia and China and many other parts of the world. It was clear from this conference that the field of brain stimulation is here to stay and growing at a rapid rate.
In 1997, TMS was approved by Health Canada, then in 2002 it was approved for treatment resistant depression. In the US, TMS got FDA approval in 2008 with the Neurostar TMS device. In 2013, Brainsway was given FDA approval for it’s novel, patented H-Coil deep TMS device. Intense research ever since has cemented TMS as an effective and safe treatment for resistant major depressive disorder. Mark George, M.D. a psychiatrist at the University of South Carolina Medical school has been a pioneer in the research and application of TMS in the US. He was the co-chair for this international conference. See photo.
Today, TMS, along with other forms of brain stimulation are the focus of widespread research and use. TMS providers continue to expand. I’m told that there is a building in Tokyo, Japan that has roughly 60 TMS machines going daily on one floor of a building.
I’m excited to be a part of this expanding field of brain stimulation and it’s applications to people suffering from various brain disorders. It gives hope that there are safe, alternative treatments.
1. Barker, AT; Jalinous, R; Freeston, IL (1985). “Non-Invasive Magnetic Stimulation of Human Motor Cortex” The Lancet. 325 (8437): 1106-1107. doi: 10, 1016/S0140-6736(85)92413-4. PMID 2860322.
“Happiness is the meaning and purpose of life, the whole aim and end of human existence.”
Transcranial Magnetic Stimulation or TMS uses electromagnetic pulses to stimulate areas of the brain thought to be associated with depression. Electroconvulsive therapy or ECT use electricity to induce a generalized seizure which is thought to be therapeutic. The placement of the ECT pads is relatively strategic to areas of the brain associated with depression, but is not as precisely determined as with TMS.
At the present time, the FDA has approved TMS for major depressive disorder recurrent and obsessive compulsive disorder (Brainsway deep TMS only). Any other use of TMS would be considered off-label or not FDA approved.
What is major depressive disorder?
Major depressive disorder has been extremely well studied and deﬁned. The diagnostic criteria has changed very little since the 1980s. The current criteria states that in order to diagnose someone with major depressive disorder, they must have symptoms that last at least 2 weeks. Those symptoms include low or irritable mood, low energy, loss of interest or anhedonia, sleep difﬁculties, irritability, changes in appetite either higher or lower, feelings of worthlessness, guilt and sometimes hopelessness. The feelings of hopeless tend to be a precursor to thoughts of suicide and a sense that things aren't going to get better. These hopeless thoughts are a predictor of suicide attempts. Untreated depression or refractory depression can become deadly. Suicide is the 2nd leading cause of death for Idahoans age 15-34 and for males age 10-14. (The leading cause of death is accidents.) Idaho is consistently among the states with the highest suicide rates. In 2014 Idaho had the 9th highest suicide rate, 46% higher than the national average (1).
People who struggle with bipolar affective disorder and schizoaffective disorder also experience signiﬁcant depressive episodes. Currently, TMS is not approved by the FDA for these conditions. There is research being conducted world wide to demonstrate whether or not TMS can be used in these disorders.
Major depressive disorder is considered widely as a biological condition. Some individuals may have episodes of depression following certain life crisis that appear to be more situational. There have been a plethora of biological interventions that have come onto the market to treat depression. These include various types of medication, electroconvulsive therapy, light therapy and transcranial magnetic stimulation (TMS). Among the medication options, there are multiple drug classes that are employed to reduce the symptoms of depression and often they are combined. Medications used for depression began in the 1950s with Imipramine, a tricyclic antidepressant. The number of medications used for depression has steadily increased over the years and are in extensive use today. Although antidepressants have been heavily studied, their exact mechanism of action is still not fully understood. Medications are a systemic intervention so they not only affect various parts of the brain, but also hit other receptors in the body such as the gut. This results in undesirable side effects such as weight gain, sexual difficulties (loss of desire, lack of orgasms, impotence) and many others. Antidepressants also can lose their effectiveness with each subsequent medication or with the same medication over time. The American Psychiatric Association recognizes TMS treatment as a viable alternative treatment to medications. They recognize that medication effectiveness drops off with each new antidepressant attempt. Unfortunately, the economics of treatment has favored insurance companies only allowing TMS treatment after multiple medication failures (usually 4) or refractory depression before paying for TMS. Patients who do not have insurance or want to pay out of pocket do not have this constraint. These restrictions may loosen as TMS becomes more widely accepted not only as a second line treatment but a first line approach.
Obsessive Compulsive Disorder although it's less common than Major Depressive Disorder, it is no less disabling. It occurs in approximately 2-3% of the general population. Brainsway deep TMS is currently the only FDA approved transcranial magnetic stimulation on the market. Brainsway reports approximately 55% response rate for OCD.
TMS is showing significant promise for many other brain disorders such as bipolar depression, PTSD, Parkinson's disease, late life memory loss, various addictions and possible post stroke victims.Research is being conducted world wide to determine the range of disorders that may benefit from TMS and other brain stimulation techniques. Some patients may opt to try TMS for off label uses.
The Brainsway deep TMS (transcranial magnetic stimulation) employs a patented H1 coil which differs from all other TMS devices on the market that use a figure 8 coil. This figure 8 coil stimulates the brain more superficially and narrowly. The Brainsway device was developed to reach more broadly and deeper into the brain where many of the structures associated with mood and other brain disorders lie.
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