Monday February 27th 2017

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Transcranial Magnetic Stimulation (TMS) in the treatment of depression and addiction

Are you in the midst of depression and searching for help?

Increasingly, treatment professionals have noted that an underlying moderate to severe depressive disorder can co-occur as you address addiction. This mood disorder requires attention, as thoughts and feelings can snowball and lead to difficulties in recovery.

However, is it possible for magnets to help a person address depression? Here, we learn more about Transcranial Magnetic Stimulation (TMS), a method used for mood regulation. Continue reading and find out how you can reset your brain after getting sober.

Transcranial Magnetic Stimulation to treat depression

Today, we speak with Dr. Michael Genovese, MD, JD and Chief Medical Officer at Arizona-based Sierra Tucson on this very topic. He’ll share with us the importance of treating depression during an addiction treatment and ways to successfully manage this mental disorder. We’ll learn more about how Sierra Tucson has been using Transcranial Magnetic Stimulation (TMS) treatment method for depression relief…and how depression and addiction are related.

At the end of this interview, if you have any additional questions regarding the appliance of this method, please use the section at the bottom of the page. We try to respond to all questions or comments with a personal, prompt reply.

ADDICTION BLOG: Dr. Genovese, thanks for joining us! Can you first explain to our readers how clinical depression affects people in addiction recovery?

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DR. MICHAEL GENOVESE, MD, JD: Depression will exacerbate the symptoms of patients who are presenting with addiction. Their mood will be lower, they will feel even more hopeless and cravings will be worse. They will be less resilient and have a lower capacity to work on their addiction. It’s important to treat these depressive symptoms simultaneously when people are seeking help for addiction. We need to address all issues—mood, anxiety, anything they report—as all of these things affect the success we have in treating patients with addiction.

ADDICTION BLOG: Why is it important to treat depression while treating addiction? And should treatment ideally be co-occurring or can depression treatment come AFTER addiction treatment?

DR. MICHAEL GENOVESE, MD, JD: It’s important to treat the whole patient and not just the diagnosis. When we are treating real patients they do not fall very neatly into categories like “Addictions” or “Trauma”. Most patients have co-occurring diagnoses, all of which must be addressed if we are to optimize the patient’s health.

ADDICTION BLOG: Can you briefly introduce us to TMS? What does this method involve in treating depression? How is it applied and what is its aim?

DR. MICHAEL GENOVESE, MD, JD: Transcranial magnetic stimulation (TMS) has been cleared by the Food and Drug Administration (FDA) to treat major depressive disorder. The treatment utilizes a MRI strength magnet to treat the brain directly. The brain is an electrochemical organ, which means that it uses both electrical and chemical activity to function and the two are related.

The magnet involved in TMS therapy is applied directly to the patient’s scalp—directly above the part of the brain implicated in depression. The treatment magnet is turned on and off rapidly, 10 times per second, by a computer. When you oscillate a magnet that powerful and rapidly it induces a perpendicular electromagnetic field. That field causes changes in the brain cells (neurons) and it causes them to release chemicals like serotonin, norepinephrine, as well as dopamine which are all involved in mood, specifically in depression.

One of the great things about TMS is that we can treat the brain directly so for patients who have not benefited from medication or have had negative side effects from medication effectively without adverse effects.

ADDICTION BLOG: How long does the treatment with Transcranial Magnetic Stimulation (TMS) last? Is it intended for an inpatient or an outpatient setting?

DR. MICHAEL GENOVESE, MD, JD: The treatment itself takes 37.5 minutes to perform. It occurs over time, typically five days per week over the course of four to six weeks. It can be done on an inpatient or outpatient setting.

One of the beauties of having it done in a residential setting is that we have patient there and we are able to observe them onsite. The patient is already in a therapeutic setting so there’s no need to leave work or modify their regular daily schedule.

ADDICTION BLOG: What is a TMS session like?

DR. MICHAEL GENOVESE, MD, JD: It’s a relatively straightforward procedure. It is safe, noninvasive and there is no anesthesia required. The patient sits down, the provider performs the treatment and then the patient leaves and goes about their day.

ADDICTION BLOG: Can TMS be used concurrently with prescription medications such as SSRIs during therapy?

DR. MICHAEL GENOVESE, MD, JD: Absolutely!
In the clinical trials researchers used TMS by itself to see how it would address the symptoms of major depressive disorder. In clinical practice, we want to do everything we can for the patients so we will often combine both medication and therapy to achieve the best possible health improved outcomes. We want to address our patients’ maladies with every necessary tool in our tool box.

ADDICTION BLOG: Are there any side effects from using this method while treating depression? Do you recommend it for everyone?

DR. MICHAEL GENOVESE, MD, JD: The most common side effect is a mild headache. This often occurs within the first couple sessions. The headache is generally reported as mild, temporary and tends to go away.

No, we can’t recommend it for everyone because no one treatment is the same for every patient. Like any other treatment modality, the doctor has to exercise their best judgement on whether or not to use the therapy for a patient. For example, a patient with a non-removable ferromagnetic implant in their skull, like a shunt, would not be a TMS candidate.

ADDICTION BLOG: Compared to other methods, what makes TMS unique? How is it different than other methods?

DR. MICHAEL GENOVESE, MD, JD: One of the most common questions I get is, “What is the difference between TMS and Electroconvulsive therapy (ECT)?” ECT is still a very good form of antidepressant therapy for patients; however, with ECT anesthesia is required, patients are induced into a seizure and there are certain side effects—such as memory loss—which can be a problem for patients.

TMS is a great treatment in that it is very effective in treating depression without causing side effects. As I mentioned, there are significant side effects which are sometimes associated with electro convulsive therapy. Medications can also confer adverse effects such as weight gain, sedation or sexual side effects. Since TMS is targeted directly to the brain, we avoid such side effects when employing it.

ADDICTION BLOG: What are the main benefits of using Transcranial Magnetic Stimulation for the treatment of depression?

DR. MICHAEL GENOVESE, MD, JD: It’s particularly helpful for patients who have not benefited from medication treatment. Some people based on their genetics are unable to metabolize medication appropriately or just never seem to accrue adequate benefits from medication. We consider it another tool in our tool box. If one method doesn’t work, then we have another one to go and we are always striving to find innovative ways to treat depression.

ADDICTION BLOG: What are the success rates of using TMS? Has it proven effective in helping people relieve depression?

DR. MICHAEL GENOVESE, MD, JD: TMS is effective enough to receive clearance from the FDA. So we know that it serves as an effective form of treatment because the clinical trials have received clearance. In a residential setting we have found it to be even more effective. See the graph I’ve provided which offers a glance of a small sample of how it has benefited patients at Sierra Tucson.

Graph TMS

ADDICTION BLOG: Do you have anything else that you would like to add for our readers?

DR. MICHAEL GENOVESE, MD, JD: TMS is a relatively young science proven to help with depression. We are also looking for other disease states in which the therapy can be helpful. For example, we are already treating patients with TMS for conditions such as anxiety and those craving substances. TMS is not a magic bullet or the answer to every clinical dilemma but it is representative of the innovation that will be necessary if we are going to adequately address mental health and the epidemic of addiction in the United States.

Photo credit: NeuroStar

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