Traverse City Record-Eagle

March 9, 2013

New magnetic treatment for depression

By ANNE STANTON astanton@record-eagle.com
Traverse City Record-Eagle

---- — TRAVERSE CITY — For some people, depression has no good reason to arrive, and less reason to linger.

“For eight or nine years, I’ve been walking around with my head in my shoe, and I don’t know why it was there to begin with,” said Tom, an area businessman.

Tom, 57, said the depression caught him off guard because, by all accounts, his life is perfect. He loves his “congenitally cheerful” wife, raves about their bright 16-year-old daughter and earns a good income.

Tom, who didn’t want his last name used, talked recently about his inexplicable depression in the office of Luis Oxholm. The Traverse City psychiatrist is one of two in town to use transcranial magnetic simulation — the strange-sounding therapy that helped Tom finally beat the depression back.

“At the moment, my depression is pretty much completely in remission,” Tom said. “I am no longer consumed by how bad I feel.”

Approved by the FDA in 2008, TMS is based on the 19th century research of Michael Faraday, who found that a moving magnetic coil creates an electric field. The Neurostar machine generates magnetic pulses to “wake up” underactive neurons in the brain that release mood-affecting neurotransmitters, such as serotonin, said psychiatrist Marilyn “Lyn” Conlon.

Conlon was the first in the area to use TMS in what she terms a “leap of faith.” She bought the $87,000 TMS machine in October of 2011 when the treatment was still coded as experimental. She has no doubts now. Of the 36 people she’s treated, 84 percent are in remission and an additional 12 percent reported some positive response.

“Add it up,” she said. “That beats what the literature says.”

Oxholm said only two of his 15 patients have not responded to TMS. Both psychiatrists said that their toughest patients are those with the deepest, most resistant depression.

There are no side effects from TMS except headaches, particularly early on. Some are also sensitive to the Woody Woodpecker tapping of the magnetic pulses.

On the downside, TMS treatment costs about $10,000 and insurance coverage is iffy. It’s also a gamble. Like all therapies for depression, there is no guarantee of success.

In the only industry-independent study, 190 patients received three weeks of TMS treatment. About one in seven patients went into remission compared to the sham treatment result of one in 20. The second part of the study evaluated patients who responded positively in the first phase. Of those, one-third went into remission, according to a 2010 National Institute of Mental Health article.

David Brock, medical director at Neurostar manufacturer Neuronetics, said data from all 800 patients studied show that half of patients had a significant clinical response and one in three went into remission.

Stan Walat, 66, of Alpena, said Conlon didn’t make promises.

“She wasn’t a used car salesman,” he said. “She said it might not work.”

But he was willing to pay the price to overcome a profound depression that medication couldn’t touch. He attempted suicide many times and went on disability in 1986. Since 2003, Walat’s undergone 221 treatments of electro-convulsive therapy. It’s not the scary shock therapy of old days. ECT is administered to patients under general anesthesia. An electronic current is sent briefly through the brain to intentionally cause a brief seizure.

ECT gave Walat some relief, but only for about a week. He’d begin his emotional plummet the second week. By week three, his depression would sink to an unbearable level. Then he’d get another treatment.

Walat suspects the ECT treatments scoured his brain of a lifetime of memories, although he knows he blocked his most terrifying childhood memories long ago.

When Stan and Sandy, his wife of 38 years, heard of TMS, they didn’t hesitate.

“I knew it couldn’t be any worse than I was feeling,” he said.

His stepdaughter, Pam Geyer, 48, of Traverse City, considers TMS a “miracle.” Her stepdad now smiles. He is outgoing, engaged and involved with her kids for the first time, she said.

“With everything he’s been through, so many years, the number of treatments, the number of drugs, going from psychiatric ward to psychiatric ward, suicide attempts galore,” Geyer said. “And now that’s all gone. Done.”

“It’s like starting over,” said Walat with a grin.

TREATMENT

A typical TMS regimen lasts five weeks, five days a week, with the number of treatments tapering off in the sixth week. Patients sit in a reclining chair and have a magnetic coil, covered by a padded headpiece, attached to the left side of the forehead. The coil delivers 40 signals in 10 seconds with a sensation similar to a thwacking rubber band. The signal subsides for 26 seconds before the next 10-second round. The treatment of about 3,000 pulses takes about 40 minutes.

After the initial six weeks, a patient typically requires a couple of “refresher” treatments anywhere from six months to a year, Oxholm said.

TMS is far less expensive than ECS, and, unlike ECS, doesn’t carry the potential for memory loss. Yet unlike ECS, Medicare doesn’t pay for TMS treatment in the Midwest, although it does on both coasts, said Conlon, who is lobbying for change. Blue Cross/Blue Shield may initiate coverage in April. Priority Heath covers TMS now, she said.

Although TMS is approved for depression, psychiatrists can legally use it for other symptoms, such as anxiety. One of Conlon’s patients was “on all kinds of opiates” after getting hit by a car. She was riding a motorcycle when a car hit her and stopped right on top of her crushed body, Conlon said.

“She injured her pelvis, legs, abdominal ribs and she had a head injury,” Conlon said. “We got her feeling less anxious and depressed, and off her opiates.”

Social worker Dawn Davenport works with Conlon and operates the Neurostar. She believes it’s time for people to regard depression like they would diabetes — a medical condition.

“I think it’s ignorant to tell a person to pull yourself together,” said Davenport, who said her own depression disappeared with TMS. “Who would ever choose to feel this way?”