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Highlands Hospital Using Technology-Based Program for Depression Treatment
By Daniel Casciato

Highlands Hospital is now using a technology-based treatment for depression as an alternative to traditional methods that have been ineffective for some patients.

Transcranial magnetic stimulation (TMS) is a non-Invasive procedure that delivers magnetic energy to areas of the brain known to be underactive in depression, near the left side of one's forehead. Since the magnetic energy does not reach further than two inches into the brain, the treating physician can target the precise portion of the brain to treat. This also lessens the chance for side effects that may occur with other procedures.

“This procedure helps turn on these areas and thus reconnect the areas of the brain leading to depression,” says Crystal Clevenger, TMS coordinator for Highlands Hospital. “Patients can drive themselves to and from the office with an average treatment time of twenty minutes per day.”

This procedure is performed while the patient is awake and seated in a chair. An ideal candidate for TMS is someone who has tried antidepressant medications in the past and either could not tolerate the side effects or could not sustain benefit from the drugs.

“This is known as being medication-resistant which is roughly 33% of the population who struggles with depression,” explains Clevenger. “It is FDA approved since 2008 for depression though we have over 20 different protocols for various conditions of the brain including OCD, PTSD, tinnitus, migraines, chronic pain, fibromyalgia, and many more.”

The most common side effect is discomfort near the treatment site. These events are transient meaning they only occur during the TMS treatment itself. Most patients do not experience this discomfort after the first week, notes Clevenger.

“Every patient is different,” she says. “Treatments are administered for twenty minutes a day, five days a week for three to four weeks, although it could work at treatment 4, 10, 20, even after treatment has completed. A patient completes 30 sessions.”

Dr. Ryan WakimTMS will not affect any current medications and the patient may be on medications when they start. Some patients may be able to successfully come off medications with TMS therapy.

“TMS has a response rate of nearly 70% which is ten times that of medications in the same patient population,” says Clevenger. “Many patients’ depression symptoms significantly improve [response] or completely go away [remission] after four to six weeks of treatment.”

STAR*D (Sequenced Treatment Alternatives to Relieve Depression) was a collaborative study on the treatment of depression, funded by the National Institute of Mental Health. The study showed the likelihood of achieving remission declines with each successive successful treatment attempt, side effects and discontinuation from medications increases with each attempt after three failed medications remission rate goes to 6.9%.

Print to TMS approval, a nurse practitioner will schedule you for a psychiatric evaluation to discuss your depression. At Highlands Hospital, Dr. Ryan Wakim performs the psychiatric evaluations.

Currently, insurances only cover TMS for major depressive disorder, adds Clevenger.

“However there is a plethora of off label treatments that it can be used for that are being researched for the FDA,” she says.

For more information, visit www.highlandshospital.org

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