Noe Padilla and Xander Apicella
A new method of therapy uses the physics of electromagnetism to alter brain activity. Known as transcranial magnetic stimulation (TMS), it is being used by a company in Santa Barbara, Pulse TMS, as a treatment for depression.
Depression is one of the most common disorders in America, and it is a constant battle that many have to fight against on a daily basis.
The current practices that physicists use to combat depression are psychotherapy, antidepressants, or electroconvulsive therapy (ECT). These practices may not be able to help every patient. Studies show that around 40 to 60 percent of patients see an improvement regarding their symptoms when taking antidepressants, but this is not the case for all patients.
For patients who don’t respond to antidepressants, ECT is another option. A study from 2011, however, shows that only about 16 percent of patients diagnosed with depression received ECT treatment. This could be a result of the public stigma behind ECT treatment, or from hesitance to recommend it.
Over a decade ago, the FDA approved TMS — a new, innovative treatment. Over the past few years, TMS has started to leave the realm of research and become more accessible.
Earlier this year, Pulse TMS opened up in Santa Barbara. Pulse TMS’ goal is to showcase the benefits of TMS and innovate the practice as a whole.
“If you think about what we can do in psychiatry … most people would be familiar with talk therapy, and most people would be familiar with medications,” said Dr. Dustin Sanchez, Medical Director for Pulse TMS, in an interview with The Bottom Line. “There’s another class of treatments that most people are probably not familiar with … neural modulation.”
Neural modulation is the performance of interventions (via various methods) in the brain itself that alter its function. The brain is an organ that runs on electricity — the neurons within use electricity to communicate.
TMS is a non-invasive form of neural modulation that uses an electric field to stimulate or inhibit different parts of the brain. This is done via a small coil, placed against the patient’s forehead.
Electricity (or current) runs in pulses through the coil. The spiraling current, as per the laws of electromagnetism (and Maxwell’s equations, which describe them), generates a magnetic field.
The electricity’s magnitude changes — to pulse is to go from zero current to non zero current, and back again — and so the magnetic field it generates is changing, as well. Maxwell’s equations tell us that a changing magnetic field, in turn, makes an electric field (the whole process is somewhat cyclic in nature). This electric field is tunable and can be made to target specific structures in the brain.
ECT is an older, more common form of neural modulation. It stimulates the brain with electricity directly, rather than creating a magnetic system (and subsequent electric field).
ECT requires a lot of electricity to get through the skull and tissue surrounding the brain, resulting in the requirement that the patients go to the hospital and take general anesthetic. It essentially induces a seizure in the patient, firing neurons all throughout the brain.
“If the person wasn’t under anesthesia it would be extremely painful,” Dr. Sanchez said. “TMS is a way that we can generate an electric field and kind of bypass the skull so we can stimulate parts of the brain without needing somebody to go to the hospital or take anesthesia … it’s a treatment that most people tolerate … with very minimal discomfort.”
TMS targets specific regions on the cortex, or surface, of the brain. In stimulating the brain’s outside, it affects the brain’s inside (subcortical) structures that share the same network. In this way, the electric field can alter the activity of a small region while only targeting the cortex.
The electric currents travel to the brain in a helmet like the device. At most, a patient might feel a tapping gesture on their head, and the procedure takes around 20 minutes to complete. Generally, patients will receive treatment five times a week, over the span of four to six weeks.
One way that Pulse TMS is trying to innovate is by implementing talk therapy in conjunction with TMS treatment. They have patients visit a psychiatrist at their collaborating facility, Mission Harbor Behavioral Health, during their treatment of TMS. Although remission rates after TMS treatment are about 51 percent, Pulse TMS believes that this new style of care will help lower them.
The team at Pulse TMS describes how they want to help out individuals who are spiraling into depression and are unable to go through the normal process of care.
“What I would say to a patient who can’t get up and jog: We know exercise is a really powerful antidepressant. TMS is going to get you to the point where you can get up and jog in the morning. So that you can treat your own depression by doing the things we know are natural antidepressants,” said Dr. Sanchez.
Although TMS is another way of treating depression, Dr. Sanchez stressed that it should not be used as an alternative means of care. TMS is meant to be used as an option by patients who are unable to find a sense of relief through normal means of care.
Although TMS is a new form of treatment of depression, it has the potential to help treat other disorders like obsessive compulsive disorder (OCD).
For anyone who is interested in TMS treatment, a representative from Pulse TMS is willing to help you out. You can get a hold of them by calling 805-225-6488 or visit their website at www.Pulsetms.com.