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Archive for May, 2011

Migraine Sufferers Find Freedom With TMS

Tuesday, May 31st, 2011

A 2010 study suggests that TMS is effective treatment for migraines with aura. The randomized, double blind study included individuals 18-68 years old that had aura followed by a severe headache. The patients were treated with either a hand-held portable TMS machine or a placebo device, and were instructed to treat a maximum of one attack per month for 3 months during the aura stage of the attack. Researchers found that participants using the TMS device found complete freedom from pain after 2 hours and was pain free for up to 48 hours. Researchers believe that TMS is a promising treatment method for migraine patients.

Original Article:

Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Richard B Lipton MD, David W Dodick MD, et al. The Lancet Neurology – 1 April 2010 Vol. 9, Issue 4, Pages 373-380.

Tags: migraine, neuropsychiatry, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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Depression treatment breakthroughs for Mental Health Month

Tuesday, May 17th, 2011

Published May 9th, 2011- Citizens-Times.com

Clinical depression is one of the most common mental health problems, affecting more than 19 million Americans each year.

Depression is scientifically proven to be a brain disorder with decreased brain activity. A PET scan is used to compare brain activity during periods of depression with normal brain activity. Many believe depression is a mood disorder associated with sadness. It is much more than that.

Symptoms include decreased energy, fatigue, low self-esteem, pessimism, difficulty concentrating, lack of motivation, inability to fully enjoy activities and being unusually quiet compared to times when they feel well. Physical complaints may also include generalized aches and pains, abdominal pain, headache, weakness, weight loss or weight gain. People are often hesitant to admit feeling depressed.

Clinical depression is very treatable, with more than two thirds of those who seek treatment showing improvement. Nevertheless, treatment of depression can be challenging. Antidepressants do not offer sufficient relief for a large percentage of patients. Medications need to go to specific areas of the brain. Unfortunately, they go to other areas of the brain and throughout the body, where they can cause significant side effects.

Psychotherapy has value by itself or in combination with antidepressants. Combining the two offers some help, but many patients fail to respond adequately. With each passing month and each trial of antidepressant, the chances of a positive outcome decrease. By the fourth attempt it falls to only 7 percent.

Until recently, electroconvulsive therapy, or ECT, was the next option, offering relief for some 60 percent of the people for whom medications and/or psychotherapy fail. However, side effects with ECT include significant memory impairment in most patients and permanent impairment of memory in some.

With resistant depression, there is now evidence that adding L methyl folate – a form of folic acid not available in foods and most vitamins – may enhance response to other treatments. It is available by prescription.

Transcranial Magnetic Stimulation, or TMS, is a new breakthrough treatment and an excellent option now recommended by the American Psychiatric Association for people who have failed a course of antidepressants. TMS stimulates a major area of the brain that is underactive during depression. The brain then conducts the impulse to deep structures of the brain, resulting in “waking up” the underactive brain.

The treatment can be performed in an office setting without premedication. Treatments take about an hour and can be done during a lunch break. There are no major side effects, other than some initial scalp discomfort or headache. Individuals are able to return to their normal activity immediately after treatment. The good news is that, unlike ECT, the treatment has no adverse effects on memory or cognitive function.

Early treatment is more effective and helps prevent the likelihood of serious recurrences. If you know someone with the symptoms of depression, encourage them to see their doctor for help.

Tags: Anxiety, depression, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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Treat All Dementia as Depression First

Tuesday, May 17th, 2011

Published May 12th, 2011- Foxnews.com

Right now, I believe a million or more Americans who have been diagnosed with dementia (including Alzheimer’s dementia), which is debilitating and incurable, are actually suffering with major depression – and that is completely curable in more than 90 percent of cases. This massive misdiagnosis of Americans has dire effects on families, well-being and productivity.

The symptoms of major depression can perfectly mimic those of dementia. Either condition can be marked by memory loss, profound changes in energy, difficulty concentrating and difficulty making decisions. What’s more, either condition can cause changes in motor function, leading to stumbling. Either condition can even lead to older adults wandering and getting lost. And either condition can lead to irritability, violent behavior or fixed and false beliefs (for example, being robbed or lied to).

Because major depression can so perfectly mimic dementia, I believe that every individual diagnosed with dementia should be treated for major depression, just in case that condition is actually to blame. That may seem like a very bold therapeutic strategy, but there simply is no way to know for sure what percentage of the millions of Americans diagnosed with dementia might have actually been misdiagnosed and might well be completely curable.

Only a brain biopsy after death can prove that dementia was to blame for a person’s cognitive decline.

I would certainly do this for my mother or father if either was diagnosed with dementia (which, thank God, is not the case), so I see no reason not to recommend it to others.

Treating major depression in those diagnosed with depression might include beginning with a low dose of an antidepressant medication with a favorable side-effect profile (such as sertraline or paroxetine), increasing the dose if no effect is obtained (while monitoring for side effects), then adding repetitive transcranial magnetic stimulation (rTMS).

rTMS is a relatively new technology, with no known serious side effects, that rivals or exceeds the antidepressant effects of medication in many patients. The treatment delivers magnetic waves to a particular area of the brain thought to be underactive in depressed individuals. rTMS, combined with an antidepressant, would be a robust treatment strategy for older Americans diagnosed (or misdiagnosed) with dementia.

The idea of “empirically” (without clear evidence) treating dementia as depression would be no different than empirically treating lung cancer with antibiotics were it impossible to know with absolute certainty whether pneumonia might be the real diagnosis. Wouldn’t it make sense to try to cure the patient?

To sum it all up, here’s this psychiatrist’s prescription: If your loved one is diagnosed with dementia, instruct the geriatrician or internist or family physician or neurologist to enlist the aid of a psychiatrist in treating your loved one for major depression. Insist on the use of an antidepressant (one with a side effect profile that is appropriate, given the other clinical facts) and insist on using rTMS at the same time. You might just save your loved one a decade or more of suffering.

Tags: Anxiety, dementia, depression, neuropsychiatry, psychiatrist, tms, transcranial magnetic stimulation
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New Data Show No Negative Long-Term Effect in Cognitive Function in Patients with Major Depressive Disorder Treated with TMS Therapy

Monday, May 16th, 2011

HONOLULU, Hawaii – April 14, 2011 -In an open-label study of patients with major depressive disorder (MDD) who had not benefitted from prior antidepressant medication and were treated with Neuronetics’ NeuroStar Transcranial Magnetic Stimulation (TMS) Therapy, no negative effects in cognitive function were observed following six-month follow-up. The study, conducted in 120 MDD patients, compared the long-term effect of acute treatment with NeuroStar TMS on patients’ cognitive function to the cognitive function of patients given acute sham treatment. The findings were presented on Thursday, April 14, 2011 at the American Academy of Neurology meeting in Honolulu, Hawaii.

“Depression often causes cognitive disturbances in patients. Antidepressant medications can have, as a side effect, an impact that can further worsen patients’ cognition,” said Scott Aaronson, M.D., director of Medical Research Services at Sheppard and Enoch Pratt Hospital in Maryland. “TMS provides an effective treatment option for depression without harm to cognition.”

Results of the six-month follow-up study comparing patients who had received NeuroStar TMS Therapy or sham treatment showed no deterioration on any measure of cognition. In addition, there was no negative effect on cognition in patients who received reintroduction of acute NeuroStar TMS during the six-month period.

“We are pleased with these new results on long-term cognitive function. These data support the growing body of evidence that NeuroStar TMS is a safe option for patients with major depressive disorder,” said Mark A. Demitrack, chief medical officer for Neuronetics. “Neuronetics is committed to continuing our research to find lasting non-pharmaceutical treatments to address this potentially debilitating disease.”

About the Study
Specific measures of global cognition (Mini Mental Status Examination), short-term (Buschke Selective Reminding Test) and long-term (Autobiographical Memory Interview-Short Form) memory were obtained at 24-week follow up from patients with MDD who received acute TMS treatment (N = 99) compared to patients with MDD who were given acute sham treatment (N = 21). These patients had participated in a randomized, controlled study of four to six weeks of acute NeuroStar TMS Therapy (N=155) as compared to sham treatment (N=146)1. In that study, no cognitive effects were reported after acute NeuroStar TMS Therapy.2

About NeuroStar TMS Therapy
Neuronetics’ NeuroStar TMS Therapy system was cleared by the U.S. Food and Drug Administration (FDA) in October 2008 for the treatment of adult patients with Major Depressive Disorder who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly focused MRI-strength magnetic field pulses. The treatment is typically administered daily for four to six weeks.

In clinical trials, patients treated with active NeuroStar TMS Therapy experienced an average reduction in their depression symptom score of 22.1 percent compared to a nine percent reduction in patients receiving inactive treatment. In an open-label clinical trial, which is most like real world clinical practice, approximately one in two patients experienced significant improvement in symptoms, and one in three experienced complete symptom resolution3. There were no systemic side effects such as those experienced with some antidepressant medications. The most common adverse event related to treatment was scalp pain or discomfort at the treatment area during active treatment. There is a rare risk of seizure with TMS Therapy (0.1 percent of patients under general clinical use).

NeuroStar TMS Therapy is contraindicated in patients with non-removable metallic objects in or around the head. It is not indicated or effective for all patients with depression and it is available only upon the prescription of a psychiatrist. For full safety and prescribing information, visit www.NeuroStar.com.

About Major Depressive Disorder
Major depression is a serious medical illness affecting more than 14 million American adults every year. Of those suffering from depression, 6.8 million do not even seek treatment4. Often a debilitating disorder, depression results in a persistent state of sadness that interferes with an individual’s thoughts, behavior, mood, and physical health. It is important to recognize the symptoms and seek treatment as soon as possible.

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