“In TMS, the current that’s induced in the brain is strong enough to actually … activate the neurons … The way that TMS is activating the brain is very different and probably much stronger than the other two devices.”
TMS is not covered by Medicare or most insurance companies, he said.
There are many other brain stimulation options as well, including the well-known electroconvulsive therapy. This therapy uses a machine to deliver energy to electrodes that are attached to the head in order to stimulate the brain.
““It’s actually a reasonably safe treatment the way we do it today, not necessarily the way it was done in the 1950s or earlier,” Holtzheimer said. “It remains the most effective treatment for a depressive episode. If you want to get somebody who’s depressed out of their depression, the most effective way to do it would be to give them ECT. It’s better than medication probably and it’s better than no treatment at all.”
Although it’s effective and safe, there are still lingering fears over past abuse.
“The reason we don’t use it probably more is that a lot of patients are afraid of it because they’ve seen “One Flew Over the Cuckoo’s Nest” or heard horror stories about other patients who had ECT,” he said “The other reason is that you have to come in two to three times a week for an ECT treatment. You’re under general anesthesia, so there’s a recovery period so it’s almost impossible to work while you’re getting the treatment.”
The treatment happens over three to four weeks. Also, there can be cognitive side effects, like short-term memory problems and confusion, that usually don’t last long for most patients, he said. However, because of the above, this treatment is usually saved for patients who have resistance to other treatments.
In patients with more severe depression, where they are suicidal and stop eating, ECT can be a first option.
“We will sometimes use ECT sooner than [for] … another patient because we really want to get them out of that depressive episode for their own safety as quickly as possible,” Holtzheimer said.