FDA approves magnetic treatment for depression

From Eugene Register Guard, December 21, 2009

Magnetic stimulation therapy added to psychiatry’s toolbox

Tiffany Marable was taking nine medications a day, and the depression still would not lift.

She could not get out of bed or stop crying. Holding a job was impossible. Just doing the dishes seemed overwhelming.

“I felt doomed,” said Marable, 32.

After years of taking heavy doses of antidepressants, mood stabilizers and other medications at a cost of $3,000 a month, the Aledo, Texas, mother of four agreed to try a new treatment that sounded like something out of a science fiction novel.

Transcranial magnetic stimulation therapy, or TMS, is one of psychiatry’s newest tools in the treatment of severe depression that is unresponsive to medication. It uses short, highly concentrated pulses of magnetic energy to stimulate the part of the brain that is believed to control moods.

The magnetic fields are the same type and strength as those produced by magnetic resonance imaging machines, or an MRI.

The magnetic field is applied above the left prefrontal cortex and does not affect the whole brain, said Dr. Gary Malone, medical director and chief of psychiatry at Baylor All Saints Medical Center.

For 37½ minutes, patients sit in what looks like a dentist’s chair as 8,000 pulses target an area of the brain about the size of a golf ball, he said.

In October 2008, the Food and Drug Administration cleared the device, made by NeuroStar, for the treatment of severe depression. Almost two years earlier, an FDA advisory panel found that the device was safe but questioned its efficacy. Side effects include headaches and lightheadedness.

It could be an alternative to medication for some of the 15 million Americans who have major depression.

For Marable, who was first treated for depression at age 13, the results were life-changing.

“I could do homework with my kids or go to a game and not be afraid to be around people,” she said. “I just felt normal.”

The treatment, given five days a week for six weeks, is effective in 50 percent to 60 percent of patients and is well-tolerated, said Dr. Deborah Kim of the University of Pennsylvania, where she is researching the use of TMS on pregnant women.

About 8 percent of people treated with antidepressants do not respond. Electroconvulsive therapy, also known as shock therapy, is very effective for severe depressive episodes; it has serious side effects and requires hospitalization.

In clinical trials for TMS, half the patients experienced an improvement and a third were able to go off medication, Malone said. Of the three patients he has treated with TMS, all responded within two weeks.

The treatment holds promise for pregnant women because antidepressants are not safe for fetal health, said Kim, a member of the American Psychiatric Association.

It has also been shown to relieve the pain and depression of fibromyalgia, a condition characterized by widespread pain. How long treatment works is unclear because long-term research isn’t available, Kim said.

About 50 percent of patients being treated with TMS at the University of Pennsylvania do maintenance treatment, Kim said. There’s no reason why they cannot repeat the therapy at a later time if necessary.

Still, it’s not for everyone.

“If you’re depressed because you had a fight with your wife or you have addictive issues, this will not help,” Malone said.

For those like Marable whose depression makes it difficult to function, relief comes at a price. The six-week treatment costs about $12,000 and is generally not covered by insurance.