Treating depression: Pulses provide pluses

Web-posted Wednesday, February 24, 2010

Amarillo psychiatrist Michael Jenkins had a troublesome patient with severe depression who wasn't responding to medication.

The patient, in his early 20s, hadn't left his house in a year.

Then Jenkins provided a form of therapy new to Amarillo, in which short magnetic pulses are delivered to the part of the brain that controls mood.

"And this kid is now applying for a job," said Jenkins, medical director for Texas Panhandle Mental Health Mental Retardation. "The results of it are pretty dramatic."

Since November, Jenkins and psychiatrists at the Texas Neuropsychiatric Institute in Amarillo have treated depressive patients with a machine slowly making its way across the country.

It's called NeuroStar TMS Therapy and it seeks to help patients with major depression who aren't benefiting from medication as treatment.

Jenkins explained that depression is the result of cells in the area of the brain responsible for mood that no longer communicate with one another.

"What it does is it takes the brain and makes it very active in that area," said Jenkins, chairman of the psychiatry department at the Texas Tech School of Medicine in Amarillo. "Each pulse kind of makes those cells talk."

Ten percent to 12 percent of the U.S. population suffers from severe depression, Jenkins said, and of that number, 30 percent to 40 percent don't respond to medication.

"Depression is anywhere from the eighth to 12th leading cause of death because of suicide," Jenkins said.

The NeuroStar machine delivers short magnetic pulses to the area of the brain where depression is thought to originate. Ten pulses are delivered in a four-second burst before it takes a 27-second break, then starts again. Patients undergo five treatment sessions a week for about six weeks. Each session lasts about 30 minutes and costs $350 to $375. With 30 sessions, treatment can cost about $11,000.

"With that, you are likely going to be off all medication," Jenkins said.

He said a person can spend upward of $1,000 a month on medication to control depression.

Insurance coverage for TMS - transcranial magnetic stimulation - treatment is minimal at this point, Jenkins said, but is growing.

According to clinical trials by Neuronetics, the manufacturer of the NeuroStar, about half the patients experienced "significant improvement" in their depression symptoms. Of those who showed improvement, about two-thirds had total symptom resolution.

The Texas Neuropsychiatric Institute has treated 20 to 25 patients since November, and there's a two- to four-week waiting list for the procedure.

"All but two have done extremely well," Jenkins said. "By well, I mean very, very close to remission or zero symptoms."

There are two common side effects from treatment: headaches and a tingling sensation around the area of the head that's targeted. The headaches occur in 25 percent to 30 percent of patients and can be treated with over-the-counter medication.

"Most people have found those side effects are very easy to tolerate," said Mark Demitrack, chief medical officer for Pennsylvania-based Neuronetics.

The technology can be found in Wichita Falls, Oklahoma City and Santa Fe, N.M.

"There's a waiting list to get this set up and into a city," Jenkins said. "For us to get it in here is pretty remarkable."

TMS technology has been around since the 1980s, Demitrack said. Other makers of medical devices have used it for treatment.

"They're very, very cumbersome to use," said Demitrack, a psychiatrist.

The technology has been in use in Canada since 2002, but the U.S. Food and Drug Administration approved it for use in the states in late 2008.

"An effective treatment really has great value over the long term, when it's proven to work," Demitrack said.