I am enrolling in a clinical trial to have rTMS for my Refractory Major Depressive Disorder. rTMS (rapid Transcranial Magnetic Stimulation) is in the experimental testing/FDA approval process.
Curious if any others in this forum have had it or are also considering it. There are two pdocs that are already doing rTMS off-label if you can not get into one of the 16 trial across the USA.
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rTMS (Transcrainial Magnetic Stimulation)
Started by
Remission
, Aug 01 2004 11:01 AM
11 replies to this topic
#2
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Posted 01 August 2004 - 11:17 AM
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Rapid Transcranial Magnetic Stimulation:
Magnetic Healing of the Brain
While ECT can be an effective means of treating serious depression, its invasive nature has been a longtime source of controversy. Now there is a promising alternative that works on the same principle as ECT, but may be less traumatic. An experimental procedure known as Rapid Transcranial Magnetic Stimulation (RTMS) uses a powerful magnet to deliver an electric jolt to the brain in the same manner as ECT, but without electrical stimulation to unnecessary parts of the brain. Scientists believe that the technique works like a heart defibrillator. The electric voltage that passes through the brain causes its neurons to fire at once and somehow this action seems to reset the rate at which the brain releases its various neurotransmitters.
In clinical trials, some people who have failed to improve by using medication and other therapies have responded to RTMS treatments within six days, while the majority are significantly better after two weeks of twenty-minute treatments. Because of its newness, no one knows if these benefits will last longer than six months, but preliminary indications are promising. Like ECT, RTMS will most likely be used to "jump start" the brain so that other forms of medical care can then be used to maintain the patient's well-being over the long haul. Magnetic therapy has been a viable medical therapy for thousands of years. Having a "gentler" form of ECT available is exciting news for people who suffer from long-term treatment-resistant depression.
Magnetic Healing of the Brain
While ECT can be an effective means of treating serious depression, its invasive nature has been a longtime source of controversy. Now there is a promising alternative that works on the same principle as ECT, but may be less traumatic. An experimental procedure known as Rapid Transcranial Magnetic Stimulation (RTMS) uses a powerful magnet to deliver an electric jolt to the brain in the same manner as ECT, but without electrical stimulation to unnecessary parts of the brain. Scientists believe that the technique works like a heart defibrillator. The electric voltage that passes through the brain causes its neurons to fire at once and somehow this action seems to reset the rate at which the brain releases its various neurotransmitters.
In clinical trials, some people who have failed to improve by using medication and other therapies have responded to RTMS treatments within six days, while the majority are significantly better after two weeks of twenty-minute treatments. Because of its newness, no one knows if these benefits will last longer than six months, but preliminary indications are promising. Like ECT, RTMS will most likely be used to "jump start" the brain so that other forms of medical care can then be used to maintain the patient's well-being over the long haul. Magnetic therapy has been a viable medical therapy for thousands of years. Having a "gentler" form of ECT available is exciting news for people who suffer from long-term treatment-resistant depression.
Quote
Comparison of unlimited numbers of rapid transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode.
Pridmore S, Bruno R, Turnier-Shea Y, Reid P, Rybak M.
Repetitive transcranial magnetic stimulation (rTMS) is a new technology which holds promise as a treatment of psychiatric disorders. Most work to date has been on depression. Superiority to placebo has been indicated in three small blind studies. We compared the antidepressant effects of rTMS and ECT in 32 patients suffering major depressive episode (MDE) who had failed to respond to at least one course of medication. There was no limit to the number of treatment sessions which could be given and treatment was continued until remission occurred or response plateaued. A significant main effect for treatment type was found [Pillai trace = 0.248, F(3,28) = 3.076, p = 0.044; power = 0.656], reflecting an advantage for ECT patients on measures of depression overall, however, rTMS produced comparable results on a number of measures. Blind raters using the 17-item Hamilton Depression Rating Scale (HDRS) found the rate of remission (HDRS = ? 8) was the same (68.8%), and the percentage improvement over the course of treatment of 55.6% (rTMS) and 66.4% (ECT), while favouring ECT, was not significantly different. Significant differences were shown (p & 0.03) in percentage improvement on Beck Depression Inventory ratings (rTMS, 45.5%; ECT, 69.1%), but not for improvement in Visual Analogue ratings of mood (rTMS 42.3%; ECT, 57%). rTMS has antidepressant effects of useful proportions and further studies are indicated.
PMID: 11343589 [PubMed - as supplied by publisher]
Pridmore S, Bruno R, Turnier-Shea Y, Reid P, Rybak M.
Repetitive transcranial magnetic stimulation (rTMS) is a new technology which holds promise as a treatment of psychiatric disorders. Most work to date has been on depression. Superiority to placebo has been indicated in three small blind studies. We compared the antidepressant effects of rTMS and ECT in 32 patients suffering major depressive episode (MDE) who had failed to respond to at least one course of medication. There was no limit to the number of treatment sessions which could be given and treatment was continued until remission occurred or response plateaued. A significant main effect for treatment type was found [Pillai trace = 0.248, F(3,28) = 3.076, p = 0.044; power = 0.656], reflecting an advantage for ECT patients on measures of depression overall, however, rTMS produced comparable results on a number of measures. Blind raters using the 17-item Hamilton Depression Rating Scale (HDRS) found the rate of remission (HDRS = ? 8) was the same (68.8%), and the percentage improvement over the course of treatment of 55.6% (rTMS) and 66.4% (ECT), while favouring ECT, was not significantly different. Significant differences were shown (p & 0.03) in percentage improvement on Beck Depression Inventory ratings (rTMS, 45.5%; ECT, 69.1%), but not for improvement in Visual Analogue ratings of mood (rTMS 42.3%; ECT, 57%). rTMS has antidepressant effects of useful proportions and further studies are indicated.
PMID: 11343589 [PubMed - as supplied by publisher]
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#3
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Posted 01 August 2004 - 11:23 AM
Electromagnetic Stimulation Shows Promise For Treatment-Resistant Depression
Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that uses a powerful electro-magnet placed on the scalp of a person to alter brain activity. Originally developed as a diagnostic tool for mapping brain function, TMS appears promising as a treatment for a variety of complex neuropsychiatric conditions, particularly major depression.
TMS induces an electromagnetic current in the underlying cortical neurons, which may explain its therapeutic effects. Repetitive TMS, using varying frequencies and intensities, can increase or decrease excitability in the cortical area directly targeted by the stimulation. Recent studies combining TMS and neuroimaging techniques, such as magnetic resonance imaging, demonstrate that the effects of TMS are not limited to the cortex but spread to functionally related subcortical structures. This finding provides a basis for using TMS to treat the pathologic neural activity that may underlie neuropsychiatric illness.
At this time, repeated transcranial magnetic stimulation (rTMS) is still experimental and actual clinical use will require much more research.
Clinical Studies: Pilot studies of TMS have reported improvement in major depression, mania, post traumatic stress disorder (PTSD), Parkinson's disease and obsessive compulsive disorder. Major depression has been the most extensively studied of these illnesses, primarily because substantial evidence suggests that the left prefrontal cortex becomes less active during clinical depression and because the prefrontal cortex is easily accessible to TMS stimulation.
Initial case reports and open label trials reported by several groups support the use of TMS as an antidepressant treatment. These promising early results have led to a limited number of controlled trials.
Kolbinger and colleagues reported a semi-blinded study in which 15 patients were divided into a placebo group and two treatment groups that received high and low frequency TMS. Using the Hamilton Depression Rating Scale (HDRS), results indicated no change in the placebo group and a reduction of symptoms in the treatment groups; however, the changes in the treatment groups did not reach statistical significance.
A few studies have looked at patients refractory (resistant) to traditional treatments. Pascual-Leone and colleagues reported significant antidepressant effects in 11 out of 17 medication-resistant depressed patients treated with TMS to the left dorsolateral prefrontal cortex for five days. George and colleagues treated 12 medication-resistant patients with TMS for two weeks and with placebo treatment for two weeks, using a cross-over design. The researchers found an average decrease in HDRS of five points during active treatment and an average decrease of three points during placebo treatment. Similarly, Figiel and colleagues reported that 21 out of 50 patients with refractory depression had an antidepressant response to TMS. Their data also suggest that younger patients may respond to TMS better than elderly patients.
Grisaru and colleagues also studied the use of TMS in treating acute mania. They randomly assigned patients to stimulation of either the right or left prefrontal cortex for 10 consecutive days. Patients receiving right-sided stimulation showed a statistically significant decrease in manic symptoms at the end of the trial.
To date, there have been two published reports on the use of TMS in PTSD patients. Grisaru and colleagues applied TMS (one session of 30 pulses) to 10 patients and reported improvement in avoidance, anxiety and somatization symptoms, as well as general clinical improvement as measured by the Clinical Global Impression Scale. McCann and colleagues reported on two PTSD patients treated with low frequency TMS who showed a reduction in symptoms during treatment but whose symptoms returned within one month after ending treatment.
Initial reports using TMS for Parkinson's disease are very limited and focus on the use of TMS as a probe of cortical function rather than a treatment. Pascual-Leone and colleagues demonstrated decreased reaction times, as well as decreased movement time, in Parkinson patients treated with TMS.
Side Effects: To date, the most serious side effect of TMS has been the induction of grand mal seizures in seven subjects. Five of the seizures occurred prior to the introduction of safety guidelines in 1993. These guidelines subsequently were revised in 1996. Other reported side effects include headache. In addition, 3 percent of patients reported a nonspecific sense of discomfort experienced during treatment that usually resolved after the first few treatment sessions.
Conclusions: TMS appears to be a promising potential tool for modulating the activity of cortical neurons. Until additional convincing evidence of its clinical efficacy and safety is available, TMS remains an experimental intervention. Because it is very difficult to blind the placebo condition fully and because depression is an illness with a high placebo response rate, the few controlled studies now in the literature must be interpreted cautiously. Nonetheless, results of these initial studies are encouraging. Additional studies need to be performed to determine the optimal use of TMS and whether the technique ultimately will merit inclusion in the broadening array of treatments for neuropsychiatric disorders.
Additional Reading
Pascual-Leone A, Rubio B; Pallardo F; Catala, MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996; 348:233-237.
George, MS; Wasserman, EM; Kimbrell, TA; Little, JT; Williams, WE; Danielson, AL; Greenberg, BD; Hallett, M: Post, RM. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled cross-over trial. Am J Psychiatry 1997; 154:1752-1756.
Wasserman, EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol 1998; 108:1-16.
Figiel, GS; Epstein, C; McDonald, WM; Amazon-Leece, J; Figiel, L; Saldiva, A; Glover, S. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neurosci 1998; 10:20-25.
This article was submitted by Michael Henry, MD, director of McLean Hospital's ECT Service; A. Pascual-Leone, MD, PhD, director of the Laboratory for Magnetic Brain Stimulation at Beth Israel Deaconess Medical Center; and Jonathan Cole, MD, director of McLean Hospital's Psychopharmacology Research Program, senior consultant to McLean's Depression and Anxiety Disorders Outpatient Service and professor of psychiatry at Harvard Medical School.
Thank you for posting about this new treatment, Remission! We did some researching around about rTMS (Transcrainial Magnetic Stimulation) and came up with the above.
Best wishes to you on your trial treatment, sweetie and please keep posting so we know how your doing.
Hugs,
~Lindsay, Forum Admin
Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that uses a powerful electro-magnet placed on the scalp of a person to alter brain activity. Originally developed as a diagnostic tool for mapping brain function, TMS appears promising as a treatment for a variety of complex neuropsychiatric conditions, particularly major depression.
TMS induces an electromagnetic current in the underlying cortical neurons, which may explain its therapeutic effects. Repetitive TMS, using varying frequencies and intensities, can increase or decrease excitability in the cortical area directly targeted by the stimulation. Recent studies combining TMS and neuroimaging techniques, such as magnetic resonance imaging, demonstrate that the effects of TMS are not limited to the cortex but spread to functionally related subcortical structures. This finding provides a basis for using TMS to treat the pathologic neural activity that may underlie neuropsychiatric illness.
At this time, repeated transcranial magnetic stimulation (rTMS) is still experimental and actual clinical use will require much more research.
Clinical Studies: Pilot studies of TMS have reported improvement in major depression, mania, post traumatic stress disorder (PTSD), Parkinson's disease and obsessive compulsive disorder. Major depression has been the most extensively studied of these illnesses, primarily because substantial evidence suggests that the left prefrontal cortex becomes less active during clinical depression and because the prefrontal cortex is easily accessible to TMS stimulation.
Initial case reports and open label trials reported by several groups support the use of TMS as an antidepressant treatment. These promising early results have led to a limited number of controlled trials.
Kolbinger and colleagues reported a semi-blinded study in which 15 patients were divided into a placebo group and two treatment groups that received high and low frequency TMS. Using the Hamilton Depression Rating Scale (HDRS), results indicated no change in the placebo group and a reduction of symptoms in the treatment groups; however, the changes in the treatment groups did not reach statistical significance.
A few studies have looked at patients refractory (resistant) to traditional treatments. Pascual-Leone and colleagues reported significant antidepressant effects in 11 out of 17 medication-resistant depressed patients treated with TMS to the left dorsolateral prefrontal cortex for five days. George and colleagues treated 12 medication-resistant patients with TMS for two weeks and with placebo treatment for two weeks, using a cross-over design. The researchers found an average decrease in HDRS of five points during active treatment and an average decrease of three points during placebo treatment. Similarly, Figiel and colleagues reported that 21 out of 50 patients with refractory depression had an antidepressant response to TMS. Their data also suggest that younger patients may respond to TMS better than elderly patients.
Grisaru and colleagues also studied the use of TMS in treating acute mania. They randomly assigned patients to stimulation of either the right or left prefrontal cortex for 10 consecutive days. Patients receiving right-sided stimulation showed a statistically significant decrease in manic symptoms at the end of the trial.
To date, there have been two published reports on the use of TMS in PTSD patients. Grisaru and colleagues applied TMS (one session of 30 pulses) to 10 patients and reported improvement in avoidance, anxiety and somatization symptoms, as well as general clinical improvement as measured by the Clinical Global Impression Scale. McCann and colleagues reported on two PTSD patients treated with low frequency TMS who showed a reduction in symptoms during treatment but whose symptoms returned within one month after ending treatment.
Initial reports using TMS for Parkinson's disease are very limited and focus on the use of TMS as a probe of cortical function rather than a treatment. Pascual-Leone and colleagues demonstrated decreased reaction times, as well as decreased movement time, in Parkinson patients treated with TMS.
Side Effects: To date, the most serious side effect of TMS has been the induction of grand mal seizures in seven subjects. Five of the seizures occurred prior to the introduction of safety guidelines in 1993. These guidelines subsequently were revised in 1996. Other reported side effects include headache. In addition, 3 percent of patients reported a nonspecific sense of discomfort experienced during treatment that usually resolved after the first few treatment sessions.
Conclusions: TMS appears to be a promising potential tool for modulating the activity of cortical neurons. Until additional convincing evidence of its clinical efficacy and safety is available, TMS remains an experimental intervention. Because it is very difficult to blind the placebo condition fully and because depression is an illness with a high placebo response rate, the few controlled studies now in the literature must be interpreted cautiously. Nonetheless, results of these initial studies are encouraging. Additional studies need to be performed to determine the optimal use of TMS and whether the technique ultimately will merit inclusion in the broadening array of treatments for neuropsychiatric disorders.
Additional Reading
Pascual-Leone A, Rubio B; Pallardo F; Catala, MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996; 348:233-237.
George, MS; Wasserman, EM; Kimbrell, TA; Little, JT; Williams, WE; Danielson, AL; Greenberg, BD; Hallett, M: Post, RM. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled cross-over trial. Am J Psychiatry 1997; 154:1752-1756.
Wasserman, EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol 1998; 108:1-16.
Figiel, GS; Epstein, C; McDonald, WM; Amazon-Leece, J; Figiel, L; Saldiva, A; Glover, S. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neurosci 1998; 10:20-25.
This article was submitted by Michael Henry, MD, director of McLean Hospital's ECT Service; A. Pascual-Leone, MD, PhD, director of the Laboratory for Magnetic Brain Stimulation at Beth Israel Deaconess Medical Center; and Jonathan Cole, MD, director of McLean Hospital's Psychopharmacology Research Program, senior consultant to McLean's Depression and Anxiety Disorders Outpatient Service and professor of psychiatry at Harvard Medical School.
Thank you for posting about this new treatment, Remission! We did some researching around about rTMS (Transcrainial Magnetic Stimulation) and came up with the above.
Best wishes to you on your trial treatment, sweetie and please keep posting so we know how your doing.
Hugs,
~Lindsay, Forum Admin
~Lindsay ღ
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"One person can make a difference through their seemingly small actions" ~Unknown
"To know even one life has breathed easier because you have lived". ~ Bessie Stanley
Depression Forums are PG rated and we comply with Health on the Net's HONcode
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#4
Ocracoker16
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Posted 01 August 2004 - 05:04 PM
This sounds like a pretty promising treatment to me. It would be nice to achieve effects similar to those of ECT without leaving the pdoc's office. It is so much more specific than ECT so the chance of it messing with other parts of your brain are much less. It is neat that you are participating in the study. They have already looked at 1500 people since 1995 and having data on more patients should help. Tell us how it goes.
Katie :sleepy:
Katie :sleepy:
Katie
#5
ados
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Posted 02 August 2004 - 01:27 AM
Good luck, Remission! It sounds like this could be really exciting. We'll be anxious to hear back from you.
Karen
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Original DF join date: October 25, 2001
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#6
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Posted 15 August 2004 - 09:55 AM
(((((((((((Remission)))))))))))))))
What wonderful news! I am so glad this treatment is working for you!
Please continue to share!
~Lindsay
What wonderful news! I am so glad this treatment is working for you!
Please continue to share!
~Lindsay
~Lindsay ღ
Forum Super Administrator, Founder
"One person can make a difference through their seemingly small actions" ~Unknown
"To know even one life has breathed easier because you have lived". ~ Bessie Stanley
Depression Forums are PG rated and we comply with Health on the Net's HONcode
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#7
Remission
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Posted 14 August 2004 - 09:20 PM
Thank you for all the info and everyone™s wishes for good luck. I think it helped.
I started rTMS last Wednesday. It is rather painless and less difficult than finding the energy to take a shower when you are extremely depressed.
I felt no different after day 1 or day 2. However, on Friday about 2 hours after I had the 3rd session, while I was driving 3 hours back home, it hit me like a ton of bricks. For 4 hours I felt better than I have felt in over 10 years of this horrible illness. :idea3: This just might work!!!
It faded in about 4 hours, but I am still better than my baseline prior to starting rTMS.
I am very excited because I had such a strong response in such a short period of time and so few sessions so far. I have 6 more weeks of session 5 days per week.
I can't wait to get back there and get a full week of this stuff and maybe the response will build upon itself and provide full remission. Like ECT, they don't know how long rTMS lasts with those that respond. I would have no problems getting this done on a monthly maintenance basis, if that is what it takes. It takes less time than a visit to a psychologist.
Keeping my fingers crossed and you can be sure I will be staying in this study for the full 6 weeks of daily treatments.
Regards,
Remission!!!!
I started rTMS last Wednesday. It is rather painless and less difficult than finding the energy to take a shower when you are extremely depressed.
I felt no different after day 1 or day 2. However, on Friday about 2 hours after I had the 3rd session, while I was driving 3 hours back home, it hit me like a ton of bricks. For 4 hours I felt better than I have felt in over 10 years of this horrible illness. :idea3: This just might work!!!
It faded in about 4 hours, but I am still better than my baseline prior to starting rTMS.
I am very excited because I had such a strong response in such a short period of time and so few sessions so far. I have 6 more weeks of session 5 days per week.
I can't wait to get back there and get a full week of this stuff and maybe the response will build upon itself and provide full remission. Like ECT, they don't know how long rTMS lasts with those that respond. I would have no problems getting this done on a monthly maintenance basis, if that is what it takes. It takes less time than a visit to a psychologist.
Keeping my fingers crossed and you can be sure I will be staying in this study for the full 6 weeks of daily treatments.
Regards,
Remission!!!!
#8
Kaitrin
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Posted 18 August 2004 - 04:28 PM
I am so glad that it's helping you, Remission. It's great that you were able to get into this trial. I hope the treatment ends up becoming a helpful one for lots of us depressed folks!
#9
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Posted 19 September 2004 - 05:09 PM
I am sorry to hear that it didn't work out for you. Scientists are still fine tuning the treatment so maybe data from trials like the one you participated in will help them improve the efficacy. It may be true too that like you said there needs to be some augmentation with an antidepressant. Good luck with the Cymbalta.
Katie
Katie
Katie
#10
Remission
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Posted 19 September 2004 - 11:25 AM
Bad news for rTMS and me. I was switched over to the active treatment (no sham), and still did not get better. Actually, it was a mutual decision for me to stop, as I scored worse in all the depression rating tests after rTMS, than my baseline scores. rTMS really sent my anxiety to the roof. I had never had to go to the ER before, but during rTMS I had 3 visits. I would get extreme restlessness and started to have panic symptoms. I did not have either of these problems prior to the study.
Since it is a clinical trial, there are very little modifications to the treatment that were available. Perhaps TMS works best as an augmentation with meds. I had to be meds free in order to participate. Also, it is possible that 6 weeks (5 days a week) was too much stimulation for my biology. In addition, their is a chance that my test site did not have proper training (I was the 2nd subject) and they were not doing things just the right way.
I still hope that it gets approved, so that they can get more experience with it and possibly find more benefit for others.
Remission
Since it is a clinical trial, there are very little modifications to the treatment that were available. Perhaps TMS works best as an augmentation with meds. I had to be meds free in order to participate. Also, it is possible that 6 weeks (5 days a week) was too much stimulation for my biology. In addition, their is a chance that my test site did not have proper training (I was the 2nd subject) and they were not doing things just the right way.
I still hope that it gets approved, so that they can get more experience with it and possibly find more benefit for others.
Remission
#11
Remission
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Posted 08 September 2004 - 09:33 PM
My rTMS update. After 4 weeks, besides the initial boost, I have been going back downhill and at a level below baseline before starting rTMS. It is important to remember that I am in a randomized, double blind trial, meaning that me, the study coordinators and my attending doc are blind and do not know if I am getting the active for fake (sham) treatments.
Since I have not yet responded, I have been switched over to the open label trial. So from now on, there is no question that I will be getting real rTMS.
Here we go again for another 6 - 9 weeks. If it helps, it will be worth all the time and expense to do it.
Wish me luck with the for sure thing now.
Remission
Since I have not yet responded, I have been switched over to the open label trial. So from now on, there is no question that I will be getting real rTMS.
Here we go again for another 6 - 9 weeks. If it helps, it will be worth all the time and expense to do it.
Wish me luck with the for sure thing now.
Remission
#12
Ocracoker16
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Posted 09 September 2004 - 06:33 AM
Well, I hope that you were in the sham group and you will get better when you get the real treatment. It sounds so promising since it seems to be a simple, short procedure and promises to not ruin your memory. Thanks for checking in.
Katie :;):
Katie :;):
Katie
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