Brand Story - How transcranial magnetic stimulation offers hope for treatment-resistant depression.
Patients with severe depression arrive at Active Recovery TMS for Transcranial Magnetic Stimulation (TMS) as a last-ditch effort to relieve their suffering. At the end of a 6 to 8-week treatment program, nearly one third will be symptom free and 70 percent will see improvement.
Medications and psychotherapy fail for 45 percent of the major depressive disorder (MDD) population. Since its FDA clearance in 2008, TMS brings hope and, more importantly, consistent results to these individuals suffering from treatment-resistant depression. At Active Recovery TMS, 79 percent of patients show at least a 25 percent reduction in PHQ-9 depression scores.
TMS is a non-invasive treatment that uses magnetic pulses (similar to an MRI) to stimulate activity in the area of the brain that affects mood. The treatment consists of 36 20-minute sessions: five days a week for six weeks and then six tapering sessions. While free of any serious side effects, for some, the tapping sensation can cause minor headaches. Patients can drive themselves to and from each session.
“There has been nothing in my entire career in medicine or psychiatry where you watch people’s lives transform in such a short period of time: six to eight weeks,” says Dr. Y. Pritham Raj, Chief Medical Officer of Active Recovery TMS. “It’s pretty remarkable.”
Dr. Y. Pritham Raj, Chief Medical Officer of Active Recovery TMS.
TMS is covered by most insurance plans, including Medicare and Medicaid. Insurance requires that individuals try one to four antidepressant prescriptions before qualifying for TMS treatment. So, by default, the clinic serves patients with treatment resistant depression—a group with a relapse rate of up to 80 percent when treated with medication and psychotherapy alone. Tragically, members of this group are twice as likely to attempt suicide than their treatment-responsive peers.
According to the STAR*D trials, the world’s largest study on depression, the rate of recovery is just seven percent for patients who have failed to achieve remission after trying three medications. TMS gives that same population a remission rate six times that figure.
TMS is FDA cleared for OCD and anxious depression. Advocates imagine the numbers they could achieve if given the opportunity to treat patients earlier.
“We take people who have failed all other options, and 70 percent get some measure of benefit, which is incredible,” explains Dr. Raj, who is also an internist teaching at OHSU. “Most of us in this field are arguing that it should be a first-line agent because it’s so effective. But I think we’re just so accustomed to medications that we’ve been detracted from innovative alternatives. Would you prefer a lifetime of medications or fixing the problem using TMS over six weeks?”
Active Recovery TMS has six locations in the Portland Metro area, including Clackamas
A patient’s TMS story
Anne Dunlop had been suffering from depression off and on for 17 years when her doctor referred her to Active Recovery TMS, reuniting her with Dr. Raj, whom she had met during her time at his Emotional Wellness Center at Adventist Health Portland.
With the arrival of the pandemic, Dunlop found herself struggling again. Since the onset of social distancing, one out of 10 adults in the US have reported symptoms of anxiety and depression, significantly higher than pre-pandemic MDD rates of 6.7 percent for Americans 18 and older.
“It was the first time I couldn’t pull myself out of it. I didn’t understand how people got things done because I just couldn’t,” recalls Dunlop, Founder & Executive Directive of nonprofit Chronic Illness Grit & Grace. “I’d been on five different medications and they kept upping them. I’d been to talk therapy for many years. When you’ve struggled with depression for a long time, you almost don’t believe anything is going to work. This is just the way life is going to be. So, I went into it thinking, ‘It can’t hurt. I’ll try anything I can at this point.’”
During the first appointment, the team maps the patient’s brain to target the depression center.
TMS machines create a magnetic field that transfers rapidly alternating magnetic pulses to the left dorsal lateral prefrontal cortex. This stimulates increased nerve activity in an area of the brain connected to depression, improving its functioning.
TMS is sometimes mistaken for electroconvulsive therapy (ECT), which induces seizures and triggers a cascade that resets the brain, also causing side effects like short-term memory loss.
“TMS doesn’t reset the brain. It’s an upgrade of the software,” Dr. Raj explains. “People often don’t recognize what depression is actually doing to their brain. It has a deleterious effect. It shrinks the brain and causes it to atrophy.”
In 2014, research based on six years of TMS usage revealed that patients were still doing well a year after treatment, if not better.
TMS Vancouver location
“I didn’t see results until probably the last week. One day I woke up and got out of bed and was ready to do stuff. I hadn’t felt like that in years,” recalls Dunlop, who lives with chronic illness. “A big one for me personally is that when I have days where my pain is high, I don’t fall into a depression. I just think, ‘Well, I hurt today, but I’m still going to do from bed the things I can do.’”
TMS transformations like Dunlop’s are common, prompting rising demand for the treatment across the US. In response, Active Recovery TMS is expanding with new locations in the Puget Sound region. With six offices already in the Portland metro area, the team looks forward to bringing this lifechanging treatment to more people.
Additionally, the clinic now offers short-term psychotherapy and Spravato (esketamine) for treatment-resistant patients, allowing it to accompany patients as they explore every option on their unique recovery journeys.
“I was shut down in a little bubble and TMS brought me out of it. As the world is opening up from the pandemic, I feel like I can take part in it,” Dunlop concludes. Her message to others considering TMS? “It doesn’t hurt to try. It could be the thing that brings you back.”
Brand stories are paid content articles that allow Oregon Business advertisers to share news about their organizations and engage with readers on business and public policy issues. The stories are produced in house by the Oregon Business marketing department. For more information, contact associate publisher Courtney Kutzman.