Tuesday, August 24th, 2010
Using magnets to fight the blues
Severe depression cripples the lives of nearly 15 million Americans every year, according to the National Institute of Mental Health. Psychiatrist Randy Pardell, M.D. uses a new technique that he says shows great promise for many patients who suffer from major, treatment-resistant depression.
Transcranial magnetic stimulation, or TMS, uses magnetic fields to stimulate nerve cells in a region of the brain associated with mood regulation and depression. “It’s kind of like a spark plug for the brain,” explains Pardell, who heads the Poughkeepsie-based TMS Center of the Hudson Valley.
Here’s how it works: The magnetic pulses trigger gentle electrical currents in the brain, which stimulate nerve cells in the prefrontal cortex. The nerve cells release chemicals known as neurotransmitters, which affect mood and emotion.
One reason why TMS is an exciting option is because it does double duty, Pardell says: It often improves mental functioning, as well as motivation and energy, in the patient. At the same time, the procedure also appears to calm the anxiety centers of the brain, which are often overactive in people who are depressed. “Also, it’s a noninvasive, nonsystemic technique. When a patient takes a pill, it goes through the entire body. But here, the magnetic pulses are going directly to the area being treated.”
At first glance, a TMS session looks a bit like science fiction. The patient sits in what looks like a dentist’s chair; a small piece of equipment containing an electromagnetic coil is placed near the left side of the forehead. The coil emits pulses of highly concentrated magnetic fields through the skull, about three centimeters down into the brain — in a manner similar to the way an MRI unit works. “In fact, it’s the same level of magnetic intensity as an MRI — which has been used for years with very few negative consequences,” Pardell says. The patient feels a sort of tapping on the head as the magnets pulse. Afterwards, he or she can continue with normal daily activities. Side effects are mild, Pardell says: a few patients experience a mild headache or lightheadedness.
A standard TMS course involves approximately 20 sessions — five days a week for a month. “Each session takes about 37 minutes, during which about 3,000 to 4,000 pulses are given each time,” according to Pardell. The procedure has been government-approved since 2008. “The FDA approved it for use with resistant depression in adults who have tried antidepressant medication for at least a month with no improvement, or for people who have intolerance to antidepressant medication,” Pardell says.
About 200 sites across the nation now use TMS, says Pardell, who has so far treated half a dozen patients in the six months since he first brought the technique to the Valley. A course of treatment costs about $8,000-$10,000; insurance companies consider coverage for it on a case-by-case basis.
TMS is being tested, too, for its effectiveness in treating other conditions including bipolar disorder, schizophrenia, and posttraumatic stress disorder. It’s also being tested in patients suffering from Parkinson’s disease, migraines, and chronic pain.
“Many times, patients who come to us have been on 15 to 20 different medication trials,” Pardell says. “They’ve been in hospitals, sometimes had electroconvulsive [also known as shock] therapy — they’re looking for some other way to help their depression.”
Pardell cautions that TMS shouldn’t be considered a “magic bullet” therapy that eliminates depression on its own. But so far, the numbers look good. “I’ve talked to a lot of psychiatrists across the country who are doing this treatment, and the success rate seems to be somewhere between 65 and 90 percent,” Pardell says. And according to the Mayo Clinic, in cases where TMS is effective, symptoms of depression may improve for days or weeks, or may even subside completely.
“People can continue with their antidepressant medication, if needed, while undergoing TMS,” says Pardell. “And psychotherapy, along with TMS, can give many people their best chance to get well. TMS has been a wonderful adjunct to our practice.”
Randy Pardell, M.D.
Riverview Psychiatric Medicine, 845-471-1807
Friday, August 6th, 2010
(content copied from hotspotz.com) Could magnets make the mind grow stronger? In mice at least, stimulating the brain with a magnetic coil appears to promote the growth of new neurons in areas associated with learning and memory. If the effect is confirmed in humans, it might open up new ways of treating age-related memory decline and diseases like Alzheimer’s.Transcranial magnetic stimulation (TMS) has been used experimentally to treat a range of brain disorders, including depression and schizophrenia, and torehabilitate people after a stroke.
TMS uses a magnetic coil to induce electric fields in the brain tissue – activating or deactivating groups of neurons, although the exact mechanism has remained unknown. One theory was that it aided learning and memory by strengthening brain circuits through a process called long-term potentiation (LTP).To investigate, Fortunato Battaglia at the City University of New York and his colleagues gave mice TMS for five days, then analysed their brains for evidence of LTP or cell proliferation.They confirmed that TMS enhanced LTP in all areas of the braintested, by modifying key glutamate receptors so that they stayed active for longer. The team also saw large increases in the proliferation of stem cells in the dentate gyrus hippocampus. These cells divide throughout life and are now believed to play a crucial role in memory and mood regulation.
posted by southshoretms.com
Tuesday, August 3rd, 2010
Although several therapies exist for people with severe clinical depression, including medication, psychotherapy and electroconvulsive therapy, they don’t all work for everyone.
For many patients with severe depression — characterized by an all-encompassing low mood and loss of interest or pleasure in normally enjoyable activities — who have tried without success to relieve their symptoms with at least one round of medication, there now is a therapy that stimulates the brain, but does so without general anesthesia or lingering aftereffects. Called transcranial magnetic stimulation (TMS), the procedure uses magnetic fields to change the activity in a specific area of the brain thought to influence mood and emotion to improve the symptoms of severe depression, explains Ian Cook, M.D., director of the UCLA Depression Research and Clinic Program.
The procedure is conducted in an office setting; a patient undergoing TMS sits in a chair resembling a recliner, while a large electromagnet is precisely positioned over his or her head to emit targeted electromagnetic pulses. While the patient’s head is gently secured in place, he or she is fully awake during the 45-minute sessions and is able to read, converse, watch videos or listen to music. The therapy is conducted five days a week over four to six weeks.
“Some people like to take a nap. Others like to meditate. All they really experience is the sensation of a tapping on the scalp from the magnetic field, even though nothing is mechanically tapping there,” Dr. Cook says.
Patients wishing to undergo TMS at UCLA are reviewed by a committee, which discusses each case to ensure that the patient is an appropriate candidate. Results from clinical trials have been promising, Dr. Cook points out. After six weeks, about 54 percent of patients reported improvement in their mood, and 33 percent were in remission from their depression.