TMS IS A NON-INVASIVE
MEDICAL PROCEDURE
AND IS AN APPROVED
TREATMENT FOR
DEPRESSION IN AUSTRALIA.
hile there was once only one further treatment option for these
patients in the form of Electroconvulsive Therapy (ECT), there
is now a new treatment available to drug resistant patients –
W
Transcranial Magnetic Stimulation (TMS).
The Southport Private Hospital along with a number of other Ramsay Health
Care facilities have begun offering this new treatment to patients admitted
into its mental health wards.
TMS is a non-invasive medical procedure and is an approved treatment for
depression in Australia. It involves the use of magnetic pulses to stimulate
nerve cells in the cerebral hemisphere and frontal lobe (the part of the
brain responsible for emotional expression, problem solving, memory,
judgement, language and sexual behaviours). This stimulation in turn
causes brain plasticity over time resulting in recovery from depression
in 37 percent of treatment-resistant patients according to the American
Psychiatric Association.
The TMS procedure involves an electromagnetic coil being placed against
the patients scalp creating a magnetic field that stimulates certain areas of the
brain. The electromagnet painlessly delivers a magnetic pulse that stimulates
nerve cells in the region of the brain affecting mood control and depression.
The treatment is performed in a specialised treatment room, with the patient
being fully awake and feeling minimal discomfort, making sedation or
anaesthesia unnecessary.
The treating Psychiatrist will undertake a thorough psychiatric assessment of
the patient before prescribing the treatment, which is usually administered in
15 minute to 45 minute daily sessions over a five day period for two to three
weeks. Generally patients will be admitted to a mental health ward at an
approved facility, and under the care of the treating Psychiatrist, along with a
highly skilled team of mental health nurses and other support staff.
While ECT is still the gold standard treatment for the most severe drug-resistant
depression, TMS offers a safe, effective choice for treatment-resistant
patients who either don’t want to have ECT or can’t have ECT due
to the possible risks involved such as anaesthetic side effects or transient
memory disturbance.
TMS was developed in 1985 and has been available since the early 1990’s,
but only recently has its efficacy been definitively proven in patients where
other treatments had failed.
In one study released in 2016 from the Monash Alfred Psychiatry Research
Centre in Melbourne, around 500 out of 1,100 depressed patients reported
improvement in their condition after undergoing TMS, according to data
pooled over 10 years.
Response rates in treatment-resistant patients were between 45 percent and
60 percent and remission rates were between 30 percent and 40 percent in
various studies.
While according to recent studies most patients who respond maintain
clinical improvement 12 months later, there is variability in the duration
of response. The best strategies to sustain the antidepressant effect of TMS
remain undefined, but long term psychiatric treatment with medication and
psychological therapy is advised to prevent relapses after TMS.
Repeat courses of TMS over time may be necessary in some patients in order
to prevent relapse, especially if they cannot take medications due to side
effects or if their other psychiatric treatment is ineffective.
Given the enormous burden of treatment-resistant depression to patients,
society and the economy – recently estimated at around $12.6 billion dollars
to the Australian economy alone annually – establishing effective, long term
treatment strategies such as TMS are of the upmost importance. This is why
this safe and effective treatment is now an important adjunct therapy for state-of-
the-art mental health facilities such as The Southport Private Hospital.
Depression treatment success rates
According to Ramsay Health’s Dr Jon Steinberg, Psychiatrist, the following
relates to treatments for depression:
ECT – Electroconvulsive Therapy has between a 80 to 90 percent success
rate in treatment-resistant patients. ECT of the past was depicted in 1950s
movies like One Flew over the Cuckoo’s Nest as a painful and torturous
process which led to misconceptions about ECT. In reality ECT in modern
times is a safe and painless treatment with mainly only temporary side
effects such as short term mild memory loss, jaw pain and extremely rarely,
cardiovascular issues. Other extremely rare risks include those typically
associated with having anaesthesia – i.e. stroke or death.
TMS – 30 to 40 percent of the general population who suffer with depressive
illness will be treated successfully with TMS which is virtually side-effect
free; but they may need to supplement with medication down the track. A
good option for people who cannot tolerate medications or ECT; but follow
up TMS sessions may be required if they cannot take medication.
MEDICATION – Around 40 to 60 percent of people notice improvement
in symptoms within two months; however side effects such as nausea,
dizziness and headaches can make medications difficult to tolerate for one
third of people.
EXERCISE – Has anti-depressant properties for mild depression in the
general population; also a good adjunct treatment for severe depression.
However exercise alone is not a successful treatment for severe depression.
NO TREATMENT – The lifetime risk of suicide from untreated depression
is 2.2 to 15 percent and people with depression generally are 25 times more
likely to commit suicide than the general population.
TMS treatment is not currently covered by Medicare, but is covered by a
range of health insurance companies for patients with policies that include
psychiatric services. An out-of-pocket fee is generally paid per treatment, but
you should check with your hospital and health insurance provider before
making any decisions.
34 Pindara Magazine ISSUE 14 | 2018