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Prof. Dr. Cengiz BAHADIR

Hemiplegia Treatment

Transcranial Magnetic Stimulation (TMS) in Depression Treatment

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Depression is a condition of sadness, melancholia at the level to affect the person’s social life, daily activities and communication with others. It usually progresses with seizures. The most common symptoms of depression are the feelings of unhappiness and sadness, loss of interest in life and in things once pleasurable, indifference, sleeping too much or insomnia, fatigue, restlessness, loss or gain of weight, trouble concentrating, low self esteem, and suicidal thoughts in severe cases. In the presence of the majority of these symptoms, major depression is considered while in the presence of just a couple of these symptoms, minor depression is considered. The incidence of minor depression is much higher.
Genetic, environmental and hormonal factors may play a role in the development of depression. Primarily, medicinal therapy is recommended for depression treatment. Mechanism of action for these medicines called antidepressants relies on the normalization of the level of brain hormones. Tricyclic antidepressants, widely used medications with many adverse effects, have been replaced with selective serotonin reuptake inhibitors (SSRI). These medications are frequently used in depression treatment for long terms. Many adverse effects occur with long term use. The treatment fails to provide benefit in some patients and depression attacks make it all unbearable for the patient. Electro convulsive therapy (ECT) is another choice for severe cases. This method also brings some adverse effects. All these treatments may still fail to provide any solution to the depression attacks or the attacks may relapse. Transcranial magnetic stimulation (TMS) therapy is a promising choice for drug-resistant cases.

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TMS therapy relies on stimulating the relevant areas in the brain with the help of the magnetic field. Brain stimulation is achieved with a magnetic stimulation device and a connected coil (illustration). Different parts of the brain cen be stimulated on a certain frequency with TMS coil.
Dorsolateral prefrontal cortex of the brain is stimulated for the depression treatment. This stimulation technique makes it possible to stimulate or suppress this part of the brain. Low frequency currents (1 or less stimulation per second) suppress this part of the brain while high frequency currents stimulate. A stimulating high frequency current is delivered to -usually- the left hemisphere (dominant part) of the brain for depression treatment. However, in some cases suppressive low frequency current is delivered to the right hemisphere of the brain to indirectly increase the activity of the left hemisphere. TMS therapy usually consists of 20 sessions with two days of intervals on the weekends and takes approximately 1 month. 600 to 1200 stimulation can be delivered in each session based on the protocol. It has been reported that TMS therapy provides high success rate in patients with drug resistance. Maintenance therapy might be administered with intervals for some patients.
The patient does not feel any pain during the TMS therapy. There may be a slight discomfort during the stimulation. The therapy includes near zero side effects. Some patients may experience temporary headache or dizziness. In very rare cases (1/30,000) non-permanent epilepsy attacks have been observed. Thanks to all these benefits, TMS therapy is highly superior to electroshock therapy. TMS therapy is an FDA approved treatment choice covered by private and public health authorities for drug resistant depression treatment in USA and many European countries. There are hundreds of centers providing TMS therapy in the USA. It’s efficacy and benefits for brain disorders other than depression are currently evaluated and so far, very promising results have been achieved.