Worries over seizures
The most common side effects of rTMS include transient headache, scalp discomfort and the sensation that something is tapping on the patient's head in time with pulses during sessions. (In contrast, electroshock, which even Neuronetics says is more effective than rTMS, could cause memory problems and diminished mental acuity.)
The side effect that draws the most concern is rare but serious: grand mal seizures. They trigger loss of consciousness and violent muscle contractions. "Seizures do occur, and they should not be brushed off," George says. The rate of seizures is on par with medication therapy, but hard data is difficult to find, he says, adding that no organization tallies these events globally. A show-of-hands survey during an rTMS conference in Italy this year indicated that some are underreporting seizures, according to George, a vocal proponent of rTMS. Still, he estimates that there have been fewer than 50 rTMS-initiated seizures worldwide since the mid-1980s.
Risks can be reduced by carefully vetting rTMS candidates according to the FDA-approved guidelines, says Jon Nilsen, who operates a NeuroStar at the McGrath Clinic in Orland Park, Ill. Nilsen also acknowledges that patients on antidepressants, which themselves carry a risk of seizure, as well as those with a history of seizures are more likely to have an rTMS-related event.
Wassermann says that overly cautious doctors and entrepreneurs are holding back the development of rTMS for depression. He was among the researchers who created laboratory guidelines in 1998 for applying rTMS—guidelines that he says were "cautious" in regard to minimizing the chance of seizures. Those protocols, he says have gone largely unexamined.
"It's asking a lot of a box that you plug into the wall to change your brain and your life" without hobbling its further development with timidity, Wassermann says.
Insuring treatment
It also asks a lot of people's pocketbooks. The McGrath Clinic charges a discounted rate of $265 per single-day session without insurance, Nilsen says, but it charges $300 to $350 per session if health insurance firms reimburse for treatments. Because insurance coverage for rTMS is spotty, some psychiatrists say they sometimes treat severely impacted patients for free.
As of August 3 Aetna health insurance refused to reimburse for rTMS, which it considers "experimental and investigational". Michigan's Priority Health Insurance Co. covers the initial six-week treatment. Priority, however, does not cover "maintenance" sessions used to prolong remissions and treat relapses, saying the efficacy of these regimens has not been proved.
Psychiatrist Denise Lin says the benefits she has seen in some of her severely depressed patients outweigh the risk of seizure. Lin, founder of Advanced Psychiatric Care of Santa Barbara, Calif., bought a NeuroStar in January.
All five people she has treated with rTMS have reported at least some improvement, Lin says. One patient had been assessed before trying rTMS as very severely depressed based on the widely used Hamilton Depression Rating Scale (HAM-D), a series of multiple-choice questionnaires that clinicians use to rate depression severity. After a six-week course the patient was judged to be in remission and rated "normal" on the HAM-D scale, Lin says.
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7 Comments
Add CommentThe article states:
Reply | Report Abuse | Link to this"The prevailing theory is that people with depression do not produce enough of certain neurotransmitters, which include serotonin and dopamine. Electricity (administered in combination with antidepressants) stimulates production of those neurotransmitters."
Based on this explanation, one can only agree with Aetna Insurance, who recently refused to reimburse for rTMS treatment, which it considers "experimental and investigational".
Serious depression is a devastating, debilitating condition, but apparently positive results do not justify unleashing largely experimental treatment methods on the public.
Treatments typically occur five days a week for four to six weeks. FDA guidelines for first-time NeuroStar treatments call for 3,000 magnetic pulses delivered over 37.5 minutes (a rate considered low-frequency) by a figure 8–shaped magnetic coil held to the patient's scalp....
Reply | Report Abuse | Link to thisIn terms of inconvenience and out of pocket cost; not to mention the physiological cost of consuming anti-depressive medication (until the GODS say you can use a simpler BETTER WAY)... is expensive no matter how you slice it.
These dumb-a**es can't even tell if that electromagnet is stimulating "other parts of the brain". Really?... who are these people??? of course they are! just hold a pocket gauss meter under the jaw and you'll find hundreds if not thousands of gauss anywhere you move the sensor.
What a crock of bull-s***. Just another way to charge you up the a** for something that is relatively inexpensive, totally convenient and should be readily available to anyone.
People investingating into the possibilites of rTMS should read the patents and reports related to the research performed by Prof. Risto Ilmoniemi, Aalto University, Helsinki, Finland.
Reply | Report Abuse | Link to thisHis homepage is: http://www.biomag.hus.fi/ilmoniemi.html
and here is a sample of his lectures available as iPod files:
http://www.evicab.eu/bme/08ilmo/ipod/index.htm
This comment was written by Taisto Leinonen, M.Sc.(electronics), who has been involved in TMS for some 30 years while teaching biomedical engineering in Helsinki, Finland, in two universities.
Professor Risto Ilmoniemi, Aalto University, Helsinki, Finland has conducted investigations into rTMS for years and holds several patents. His lectures are available as iPod files here:
Reply | Report Abuse | Link to thishttp://www.evicab.eu/bme/08ilmo/ipod/index.htm
An effective anti depression treatment!! Sign me up!!
Reply | Report Abuse | Link to thisDepression is not caused by chemical imbalance in the brain but by involuntary and on many occasions subconscious recall of traumatic memories from childhood, memories that were never properly emotionally processed by the brain. Recall of these fearful (painful) memories, often during sleep, causes reactivation of strong emotional responses (fight or flight reaction) and release into a bloodstream of fight or flight hormones; adrenaline, noradrenaline and cortisol (See http://en.wikipedia.org/wiki/Fight-or-flight_response). Prolonged circulation of fight or flight hormones in bloodstream causes drop in production of serotonin in a brain of affected individual and loss of brain connectivity ability to recall memories that cause depression. Administration of SSRI antidepressants causes increase in serotonin level and increase in brain connectivity and increase in recall of painful memories worsening emotional turmoil on many occasion leading to murder/suicides. Active neural connections that generate these painful memories have lower electrical resistance than inactive one. ECT treatment applied to both brain hemispheres causes that electric current flows through the brain following path of least resistance permanently frying most active neural connections located in corpus callosum part of the brain that connects brain hemispheres, resulting in loss of memories (loss of good memories that we complain about and loss of bad memories that permanently cures depression).
Reply | Report Abuse | Link to thisrTMS treatment is very similar to ECT as it also fries active neural connections in the brain of an individual affected by depression but it is not as effective as ECT because it fries neural connections generating emotional responses in reaction to recall of traumatic memories.
If you need more info and/or more evidence write to karol_karolak@live.ca
For all the uninformed skeptics out there:
Reply | Report Abuse | Link to thisI suffered from acute and debilitating depression for a few years in my late twenties. I tried everything, all sorts of drugs, read all the books, saw all sorts of therapists, tried meditating... I even got electroshock therapy. The latter helped a bit, but I lost 6 months worth of memory and I was in a daze for months afterwards. I don't recommend it except if it will save one from suicide. At last, I tried rTMS, which was then an experimental treatment. Within 10 sessions, I was back to normal, after 4 years of severe depression. It was unbelievable. It doesn't work for everyone, but it's worth a try. I did this in Canada, where I lived at the time, and I am certain it is cheaper there than in the US. In a few years, I imagine it will be covered, if not by health insurance, then by medication insurance - the math is obvious.
I have been free of depression since (seven years now). If one day I find myself going back, I will get rTMS asap, regardless of cost...