I chose the patient with MDD who had transcranial magnetic stimulation (TMS) treatment six months ago because such cases are new to me. To be able to develop effective care plans in the future, I would like to delve into the topic of TMS. Particular questions that are of concern include its effectiveness, reoccurrence rates of depression after TMS, its adverse effects, and contraindications.
Effectiveness/reoccurrence of depression
TMS involves a non-invasive stimulation of the brain by sending short magnetic impulses to some of its areas. Given that TMS does not require surgical interventions, the method is widely used in the United States for both diagnostic purposes and the treatment of neurological and psychiatric disorders (Becker, Maley, Shultz, & Taylor, 2016; Luber et al., 2017). Nowadays, prefrontal TMS is approved by the FDA as a method of treating MDD in adults since its effectiveness for mood stabilization has been demonstrated in a variety of randomized controlled trials (Perera et al., 2016).
For instance, the sham-controlled RCTs conducted by O’Reardon et al. in 2007 and George et al. in 2010 show that TMS at 120% motor threshold and 10 Hz frequency provides “clinically meaningful antidepressant effects” (Perera et al., 2016, p. 340). However, its effectiveness compared to other treatment options for MDD remains an open question.
TMS is regarded as a promising treatment for patients with MDD who do not show a positive response to treatment with mood-stabilizing drugs (Perera et al., 2016). Concerning the reoccurrence of depression after the use of TMS, in 2015, Levkovitz et al. found that in individuals receiving the 4-week TMS therapy preventing the relapse of acute depressive episodes, about one-third of patients achieved remission, and the majority of them did not relapse during the next three months (Perera et al., 2016).
Adverse effects of TMS
Despite being effective for patients who do not benefit from mood stabilizers, TMS is associated with a variety of adverse effects. Among the most frequent unwanted effects of repetitive TMS, there are changes in hearing. For instance, there are cases of temporary hearing impairments or loss after its use for depression and anxiety (Tarannum, Alam, Khan, Parveen, & Mullick, 2015). Moreover, the therapy can lead to the limited use of short-term memory and cognitive changes, both of which are temporary (Tarannum et al., 2015).
Additionally, the use of TMS sometimes causes brief episodes of abnormal elevation (hypomania) or induces pain or discomfort in the head (Tarannum et al., 2015). At the same time, the most dangerous effects such as temporary insensibility or seizures are relatively rare (Tarannum et al., 2015). Thus, the majority of side-effects are not long-term, and it explains a relatively small number of contraindications.
Contraindications
Contraindications for TMS in patients with depression relate both to medical history and current health condition. Due to the use of magnetic coils, the most important factor is the absence of metallic implants in the body (Tarannum et al., 2015). Moreover, TMS should not be used in stroke survivors or epileptic patients, as well as in individuals taking drugs that impact the convulsive threshold (Tarannum et al., 2015). Similar to other therapies, TMS is not recommended to people with life-threatening cardiovascular conditions, brain tumors or traumas, pregnant/breastfeeding women, and underage patients (Tarannum et al., 2015).
Summary
In the end, there are mixed views on the long-term effectiveness of TMS in patients with MDD, which has implications for the chosen case. The information about the outcomes of TMS reported by the patient aligns with modern researchers’ findings when it comes to the therapy’s unwanted outcomes such as headache and short-term antidepressant effects. The fact that the patient has complaints related to depressive mood six months after TMS therapy may indicate the need for other treatment options.
References
Becker, J. E., Maley, C., Shultz, E., & Taylor, W. D. (2016). Update on transcranial magnetic stimulation for depression and other neuropsychiatric illnesses. Psychiatric Annals, 46(11), 637-641.
Luber, B. M., Davis, S., Bernhardt, E., Neacsiu, A., Kwapil, L., Lisanby, S. H., & Strauman, T. J. (2017). Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm for imaging-guided intervention. Neuroimage, 148, 1-7.
Perera, T., George, M. S., Grammer, G., Janicak, P. G., Pascual-Leone, A., & Wirecki, T. S. (2016). The clinical TMS society consensus review and treatment recommendations for TMS therapy for major depressive disorder. Brain Stimulation, 9(3), 336-346.
Tarannum, S., Alam, M. S., Khan, N. M., Parveen, S., & Mullick, M. S. I. (2015). Transcranial magnetic stimultation: Scientific and modern technology for treatment of psychiatric and neurological disorders. Bangladesh Journal of Psychiatry, 29(1), 41-43.