Do a google search on “drug free depression treatment” and a million web sites will come up including google ads touting the problems with antidepressants and ways to beat depression without taking medications. Some of these sites talk about TMS therapy for depression. Neuronetic’s site states that its treatment is for “patients trapped by depression and its treatment side effects.” Many patient testimonies about TMS include extensive histories of medication trials that did not work, or in fact made the person worse. Taken as whole TMS would appear to be a great treatment option for depression for patients who do not want to try medication or who have not responded to medication or suffered from medication side effects.

So is TMS really a medication free approach to treat depression?

In short yes and no.

TMS is a brain treatment that uses magnetic pulses to stimulate a specific part of the brain associated with depression, the left prefrontal cortex. It is not a treatment that works by ingesting a chemical that gets to the brain by absorption into the blood stream and then crossing the blood-brain barrier. In this way TMS is truly a drug-free method of treating the brain.

TMS does not cure the brain of depression. This means that we have no data to suggest that if a person responds to a course of TMS therapy that they will not have depression in the future. In fact we do not have a treatment modality that seems to cure depression in the majority of patients, especially patients who have had 2 or more depressive episodes. This goes for other drug-free treatments, including ECT and psychotherapy.

Since we don’t have a cure for depression we have to ask “once the depression is treated how do we maintain remission?” When treating patients with severe depression or multiple episodes patients do better with a maintenance therapy (they have less depression and depressive relapses). So once we have completed TMS therapy for depression we have to look at maintenance treatment to keep the patient in remission. This treatment can include medications, continuation TMS or psychotherapy. Certainly, combinations of these treatments can help patients maintain the results from TMS.

At Sacramento TMS we can offer a truly medication-free approach to treat depression. We offer TMS for the acute phase of treatment and once the depression is in remission we offer continuation treatment with TMS. We also offer cognitive-behaioral therapy and mindfulness meditation approaches to maintaining remission as these methods have both been found to improve remission rates from depression.

Antidepressant medications are also very effective in helping patients maintain remission. For those patients who do not have treatment side effects from antidepressant medications, they are very effective at reducing relapse rates.

Sacramento TMS is pleased to announce the opening of a second treatment center in Sacramento beginning the first week of December. Our second office is located in the Campus Commons area (Howe and Hwy. 50) at 350 University Avenue, Suite 101, Sacramento California. Now TMS therapy for depression is close and accessible to the following Sacramento communities: Davis, West Sacramento, Natomas, Elk Grove, Fair Oaks, Carmichael, and Roseville.

Sacramento TMS offers specialized treatments for major depression in the Sacramento region. Sacramento TMS is the first provider of TMS therapy (transcranial magnetic stimulation), a FDA approved treatment for patients with depression who not have responded to antidepressant medication. Sacramento TMS began treating patients with transcranial magnetic stimulation in 2010 in El Dorado Hills. This center brings TMS therapy to patients and is conveniently located near the Sacramento communities of Folsom, Granite Bay, Cameron Park, and Placerville.

To learn more about TMS therapy for depression in Sacramento California contact our TMS program coordinator at (916) 932-0375. Sacramento psychiatrists and Sacramento psychologists who want to learn more about transcranial magnetic stimulation in the Sacramento region can call and consult our TMS psychiatrist.

Results presented at the 2011 American Psychiatric Association (APA) meeting and published in the journal The Lancet, show that agomelatine is an effective antidepressant equal to many traditional antidepressants prescribed today (Hickie, 2011).

Agomelatine is a potent oral agonist of melatonin receptors as well as an antagonist at serotonin-2C (5-HT_2C), receptors. This compound was initially investigated to treat circadian sleep disturbances.  However, with the discovery of the 5-HT_2c antagonist activity research has shifted to investigating its anxiolytic and antidepressant effects.

In the short-term, agomelatine has similar antidepressant efficacy to venlafaxine, fluoxetine, and sertraline and, in the longer term, fewer patients on agomelatine relapse (23·9%) than do those receiving placebo (50·0%). Patients with depression treated with agomelatine report improved sleep quality and reduced waking after sleep onset. Patients taking agomelatine tend not to have many side effects associated with antidepressants including nausea, diarrhea, or sexual side effects. This is because the compound does not raise serotonin levels. These results confirm other studies, which have shown this compound has efficacy in the treatment of depressed patients that extends beyond simply treating their sleep disturbances. In another article published in International Clinical Pharmacology, investigators showed that agomelatine was superior to fluoxetine in an 8 week, double-blinded, randomized, controlled study (Hale, 2010).

Agomelatine is not available in the United States. The French pharmaceutical company, Servier, manufactures it. In 2009 it was approved for the treatment of Major Depression in Europe. It is expected to reach the United States sometime in 2013 and is expected to become a new leader in the treatment of depression given its efficacy and favorable side effect profile.

Should we start prescribing exogenous melatonin or the US available melatonin analog Rozerem (ramelteon) to our patients? The effects of these two compounds on depression have not been studied to date and receptor binding studies indicate that agomelatine’s antagonist activity at the 5-HT_2c is unique compared with Rozerem and exogenous melatonin.

References:

Hale A, Corral RM, Mencacci C, Ruiz JS, Severo CA, Gentil V. Superior antidepressant efficacy results of agomelatine versus fluoxetine in severe MDD patients: a randomized, double-blind study. Int Clin Psychopharmacol. 2010 Nov;25(6):305-14.

Hickie IB, Rogers NL. Novel melatonin-based therapies: potential advances in the treatment of major depression. The Lancet published online 18 May 2011.

Three recent financial developments suggest that TMS is becoming a mainstream technique for neurological rehabilitation and treatment. In other words, TMS has received a healthy round of funding and vote of confidence from investors in the last month.

Brainsway is a medical device company that has developed a “Deep TMS” system. The company proposes on its web site that with a unique technology the Brainsway Deep TMS System enables direct non-invasive activation of deep brain structures. Standard TMS typically stimulates cortical structures 1.5 to 2 cm deep in the brain. Brainsway clinical research has focused on treating bipolar depression and major depression. In April, Brainsway filed plans with the SEC to sell up to $30 million in ordinary shares to raise money to fund manufacturing, and ongoing and future clinical research.

Nexstim markets, manufactures, and develops navigated brain stimulation devices (navigated TMS). Nexstim has a system that combines the power of neuroimaging and TMS that maps the cortex so that brain tumors can be successfully resected with little to no permanent worsening of brain function post-operatively. The company also appears to be developing a product for stroke rehabilitation. In the last month according to a company press release, Nexstim has acquired additional equity financing of EUR 13.4 million. To date, Nexstim has raised over EUR 30 million.

Today Neuronetics the maker of the NeuroStar TMS Therapy System for Depression, announced that it had secured $30 million in additional funding from Polaris Venture Partners and Pfizer Venture Investments. Neuronetics has been marketing the NeuroStar TMS system for the treatment of major depression for patients who have not adequately benefited from prior antidepressant medication since it was cleared by the FDA in October 2008.

Sacramento TMS was the first psychiatric practice in the Sacramento region to acquire the NeuroStar system. We began treating patients with this system in March 2010.

This financing seen with three leaders of TMS technology represents a tremendous vote of confidence for TMS.

“How much does TMS cost?” A year ago (April 2010) I posted this blog entry and it is by far the most visited post to date. “How much does TMS cost?” is still the most common question we get when we get an inquiry- whether it is from another provider referring a potential client or a potential client asking about the treatment.

A year ago all of our clients who underwent TMS for depression paid “out of pocket” for the TMS. That is, they considered the cost of TMS versus the cost of their depression and made the decision to pay for the treatment. In 2011 we have seen a completely different landscape in reimbursement for TMS. The majority of our clients at Sacramento TMS are getting commercial insurance to cover their TMS treatment. Currently we have clients receiving coverage from Cigna, MHN (Managed Health Network, a subsidiary of Health Net), Magellan (provides behavioral health coverage for Western Health Advantage members in Sacramento),  the Blue Shield/Blue Cross Federal Program, Blue Shield of California, and Anthem Blue Cross.

With each of these clients the path to securing coverage has been quite different. Some of these authorizations were quite simple requiring some basic paperwork to be completed while other authorizations took months, requiring extensive appeals.

At Sacramento TMS we are committed to the reimbursement process. Our goal is to reduce any costs or barriers you face when deciding if TMS is the appropriate treatment for you.