New Procedure Gives Hope for Depression Patients
By Carrie A. Moore
Deseret News
Published: Saturday, Aug. 7, 2010 10:46 p.m. MDT
SALT LAKE CITY — Jeanne Pudoff-Oyen has been depressed for more than a decade. Not the “I wish I’d been a better (fill-in-the-blank),” kind of depression, but the “living inside this black cloud I want to kill myself” kind of chronic depression that doesn’t respond to traditional therapy or medication.
But a new treatment now available at the University of Utah Neuropsychiatric Institute looks to provide new hope for patients like Pudoff-Oyen, who haven’t found relief from their depression using medication.
In fact, Pudoff-Oyen says that transcranial magnetic stimulation “literally saved my life,” after she had tried every medication and dosage available, to no avail.
TMS was approved for treating depression by the Food and Drug Administration in 2008, according to Dr. Howard Weeks, a psychiatrist who is believed to be the first in the state to employ the technology.
The treatment is done in what looks like a dental chair. Patients sit while Weeks strategically places an extension of the TMS machine against the side of their head, much as dental assistants position the arm of an X-ray machine.
The machine “generates an MRI-strength magnetic field” inside the patient’s head, which provides an electrical current to a small area of the brain, he said.
“We’re targeting it over an area called the dorsolateral prefrontal cortex, which is the part of the brain that affects depression.”
The process stimulates the release of nerve chemicals into a deeper region of the brain in a way that hasn’t previously been possible, Weeks said, and the result for many is a marked lessening of depressive symptoms.
The catch for many patients is that TMS requires multiple treatments before any benefit is detected, he said, noting insurance companies may be reluctant to pay when other treatment options are available, even if they’re not as effective.
Research presented in May to the American Psychiatric Association shows relapse rates for patients using TMS were much lower than those for patients who used only drugs or electroconvulsive therapy.
Two separate studies showed only 10 percent to 12 percent of patients who were able to achieve an initial remission of symptoms suffered a relapse after undergoing TMS. Relapse rates for those using medications or ECT have been about 40 percent.
As the most common form of mental illness with nearly 15 million adult sufferers, “major depressive disorder” is the leading cause of disability in the U.S. for people ages 15 to 44, according the National Institutes of Mental Health. While it can develop at any age, the median age at onset is 33, and the condition is more prevalent in women than in men.
Weeks said the TMS equipment turns the magnetic field on and off “for about four seconds, then off for 26 seconds, and it’s pulsing at about 20 cycles per second. Treatments last about 40 minutes, and patients get about 3000 pulses” per treatment.
Patients report feeling that “someone is tapping on your skull” as the pulses enter the brain, he said. “It can be a little uncomfortable, but it’s not painful.” Possible side effects are headache and scalp discomfort, but patients are awake and alert during the procedure.
About a dozen patients have undergone TMS treatment at UNI to date; they get 25 to 30 treatments each, he said.
Pudoff-Oyen’s treatments began in January 2007, when she learned about the new procedure from her psychiatrist and researched it, then traveled to Vancouver, B.C., to be treated.
She and her husband, who live in Ketchum, Idaho, rented a condo there so she could receive two treatments per day, five days a week, for three weeks. “They said I should see change within two weeks, but we decided before we left that I’d do all three weeks. It was the very end of the second week when I woke up that I felt a shift in mood.”
Pudoff-Oyen is in Salt Lake City this week for follow-up treatments at UNI, and is scheduled for multiple TMS sessions through the end of the week.
Remembering her first trip to Canada, she recalls being “suicidal when I went up there, crying all the time and very depressed. I felt I was in a dark cloud and it felt when I woke up that the cloud had lifted. The heaviness with it was lifted as well. Things just felt lighter.”
e-mail: carrie@desnews.com