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TMS may become a preferred treatment for Postpartum Depression (PPD)

Posted on January 24th, 2013 by | 1 views
TMS Center - Edward B. Mohns MD
8950 Villa La Jolla Dr. Suite C112 La Jolla, CA 92037 858-452-2551 ph, 858-452-2641 fax

“Treatment response was rapid, robust and durable” is how psychiatrist Dr Keith Garcia of Washington University School of Medicine in St Louis summarises his research on a novel approach to the treatment of postpartum depression. His project had been designed to assess three questions; was TMS - transcranial magnetic stimulation - effective in bringing about a rapid improvement in patient mood, how long did any beneficial effect last and did it have a positive effect on maternal bonding.


Dr Garcia believes that this new approach could bring mothers with PPD an effective treatment that side-steps the possibility of drug side effects, both in patients and their infants. Additionally, it brings a bonus ofimproving mother-infant bonding. “We believe TMS may become a preferred treatment for PPD”, he writes in the conclusion of his research report.


TMS had its origins in the mid 1980s as an exercise in scientific curiosity. A medical scientist in England had discovered that a strong magnetic pulse directed into a brain (his own) evoked a striking effect on his body - it made his thumb ‘twitch’ involuntarily. This vivid demonstration of the interaction of magnetism and brain tissue quickly got the attention of psychiatrists: they foresaw in the technique, a benign way to stimulate parts of the brain involved in mental illnesses such as depression to improve patients’ health.


The twenty years of clinical research since then lead to TMS - the use of trains of multiple magnetic pulses to stimulate the brains of people with psychiatric disorders. Across the world, TMS is now used as an effective treatment for depression.


The regions targeted by the TMS therapist lie within the brain’s frontal cortex - regions that underlie the hairline at the top of the forehead. Studies on people with depression have shown that this region, about the size of a quarter, in the left hemisphere has unusually low activity: the equivalent zone in the right hemisphere shows the opposite - an overactivity. The TMS therapist’s goal is to restore a healthier state by boosting left-side activity and diminishing right-side activity.


The magnetic pulses interact with the nerve circuits in the target area and promote an increase in blood flow and alteration of neurotransmitter behavior. These changes in the target zones are communicated to deeper structures within the brain - notably the limbic system, a key region for mood control - and exert there, a sustained effect that lifts mood.


Patients need neither sedation nor anesthesia for the treatment. They sit in a comfortable reclining chair and the therapist positions a magnetic coil over the area to be treated (picture) and delivers the series of magnetic pulses to the brain: many patients feel a “pecking like” sensation over the nearby eyebrow (it is the consequence of the face’s muscles responding to the magnetic stimulus) but soon most are able to ignore it. 10% of patients have a mild headache after the session: apart from these two, TMS seems remarkably free of side effects, much less so than anti-depressant drugs. Each treatment session lasts about 45 minutes.


The response to TMS treatment can be very rapid - some patients feel their mood begin to lift during the first two weeks of treatments. Dr Keith Garcia’s research group found that the majority of women in his pilot study were restored to their former sense of well being by the end of two weeks of daily TMS sessions.


At the TMS Center in La Jolla, we have specialised so far in treating patients who have had their depression for many years – all had failed to respond adequately to any course of medication. Even among patients with this level of intractable illness, TMS is proving remarkably effective. 60% of our patients have shown substantial clinical improvement – many have gone into remission.


The clinical research done so far in the USA, Australia and Brazil suggests strongly that TMS could be an effective form of treatment for PPD. Unlike medications used in the treatment of depression, which bring the possibility of transfer to the infant during nursing, TMS’s few side effects such as a mild headache are limited solely to the patient.

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