Your Good Health: Magnetic stimulation may help bipolar patient

Dear Dr. Roach: After reading your recent column regarding psilocybin for depression, I looked online and found information on transcranial magnetic stimulation.

I had three rounds of electroconvulsive therapy and had to stop the last two because the amnesia and reactions to anesthesia were so bad.

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Can you give me your input on TMS as a treatment for depression? I am bipolar, but have suffered debilitating depression for many months. Changes in medication either haven’t helped or have caused uncomfortable side-effects. Over the years, I have tried just about everything, and I’m at a standstill.

P.S.

Depression, whether by itself (unipolar) or as part of bipolar disease, can be challenging to treat when the usual treatments fail, which is far too common. In addition to novel medication treatments, such as psilocybin (derived from hallucinogenic mushrooms) and ketamine, there are therapies designed to directly stimulate the brain.

Electroconvulsive therapy is one of these. It is often tried in people who have a poor response to both medication and psychotherapy. Since its side-effects were so bad for you, I think it very reasonable to consider another treatment that has increasingly become accepted — transcranial magnetic stimulation.

TMS has been used mostly for people with “ordinary” depression, but it has been studied for people with depression as part of bipolar disease — bipolar disease must include at least one episode of too much energy, referred to technically as mania — and is about as effective as it is in unipolar depression. Some experts recommend TMS in people with bipolar disease, while others await more data.

It is known that strong magnetic fields can depolarize neurons in certain areas of the brain, but the exact mechanism as to how this can treat depression is not understood.

In two comprehensive studies, subjects were randomized to getting “real” TMS or “sham” TMS. About 25% of people getting the sham treatment (with no actual magnetic stimulation) had a response, while 45-50% of those getting active TMS had a response.

In bipolar disease, the treatments are often given weekly. Most studies looked at TMS in addition to, not instead of, medication. No factors to help predict who might respond were identified. The major side-effect was seizure at the time of stimulation, with less than 1% of people experiencing this.

I think TMS is an option to consider for a person who has had poor response to other treatments, certainly in people with unipolar depression, and possibly in those with bipolar depression.

Dr. Roach is unable to answer individual letters, but will incorporate them in the column when possible. Email questions to ToYourGoodHealth@med.cornell.edu.

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