TMS is the newest approach for treatment resistant depression to emerge in 50 years.Researchers are developing an ever-increasing number of ways to stimulate the brain using electromagnetic fields. This is expanding the treatment options for patients suffering from a variety of medication resistant disorders.TMS is a noninvasive, non-pharmacologic way of stimulating the brain using electromagnetic fields. TMS targets a specific part of the brain, the left prefrontal cortex, which is known for its role in regulating mood. It has been studied since 1985 and the Neurostar TMS device received FDA approval in 2008 for the treatment of depression.Here's how it works:When a person receives TMS, it is important to know that you are awake. There is no use of anesthesia. A magnetic coil, one of many found in an MRI scanner, is placed on a targeted region of the prefrontal cortex on the left side of the brain.The treatment is noninvasive. A magnetic field is applied steadily over 37 min. This is done with a magnetic coil which is placed in a precise position upon your head. You hear a clicking noise and feel a light tapping on your head where the magnet is placedTreatment sessions take place five times a week, Monday to Friday over a 4 to 6 week period of time. You can safely drive yourself to and from treatment and can return immediately to work or other regular activities. There is no memory loss, as there is with electroconvulsive treatment, (ECT), which electrifies the entire brain and requires anesthesia, along with someone else to drive you to and from treatment.Some patients will feel discomfort at the site of the magnet, and a possible mild headache, which both diminish over the first week of treatment. No medicine related side effects such as nausea, dizziness, sexual dysfunction, or weight gain are seen with TMS therapy.Initial response is usually seen after about two weeks. Overall TMS works as well or better than medicine, especially if the patient has failed on one or two antidepressants. Treatment effect is believed by many to be comparable to that of ECT.Neurostar TMS therapy represents the beginning of a growing number of brain stimulation technologies, giving us greater opportunities to treat a number of serious psychiatric disorders.
Biology: Illness, Treatment, and Neurodevelopment
Until recently, our understanding of mentall illness has been one of abnormalities that derive from "chemical imbalances". The implication was that these were "static" disorders: you either had them or not and once you developed one, it would likely be wiith you for life. Medical tretment would "manage" these conditions by impacting on the relative activity of various neurotransmitters, thereby restoring balance and, hence, normal emotions and behavior.
In the last several years, however, some very exciting discoveries have been made that have shifted our understanding towards a "dynamic" view of psychiatric illness. These disorders are "neurodevelopmental disorders" that change brain structure and function over time.
Our brains are "in motion", that is to say that neurons change in response to the interaction of genetics and environment. They can modify their shape and make or break connections with other cells, thus shifiting the pattern of electrical activity in various regions of the brain. This is referered to as plasticity.
Neurons can also shrink, or die altogether. This neuronalatrophy can occur as a natural process or result from abnormal conditions impacting on the expression of genes in these cells.
Most interesting is the discovery that neurogenesis, the development of new brain cells also occurs naturally and in response to pathological factors.
Recovery: Changing the Course of Illness
Insofar as the adolescent brain is rapidly changing, medications that treat psychiatric illnesses can arrest the development of these disorders. This means not just the ongoing "managment" of symptoms. the hope of complete recovery from illness.
