rTMS Therapy for Depression

Dr Ajay Nihalani,MD,MRCPsych

www.drnihalanipsychiatristdelhi.in

• What is magnet Therapy?• How does it work?• What are the side effects?• Does it work?• Magnet therapy in the media.• Tips are MANDATORY

What is Magnet Therapy?

Is it the Application of Magnets this way?

rTMS

• Repetitive Transcranial Magnetic Stimulation

What is involved in Therapy?

How does rTMS work?

• Magnetic stimulation leads to either an increase or decrease in brain activity in targeted brain area.

Left Front End of Brain

Brain Perfusion SPECT.

Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229

Copyright © 2010 Elsevier B.V.

Fig. 1 Normalized glucose metabolism between medication-resistant depressives (MRD) and healthy controls (HC) under P< 0.05 corrected for multiple comparisons, suggesting a reciprocal limbic-cortical dysregulation in MRD even after depressed symptoms were under control. 

Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229

Copyright © 2010 Elsevier B.V.

Comparisons of normalized baseline glucose metabolism between rTMS responders and non-responders under a voxel-level uncorrected P< 0.05 (Upper left: Responders > Non-responders; Upper right: Responders < Non-responders; Lower: Responders > Non-Responders [in red], Responders < Non-Responders [in blue], with transverse slices in Axis- Z of − 40 to 40), suggesting patients with less impaired limbic-cortical dysregulation responded better to rTMS. 

Fig. 2 Normalized baseline glucose metabolism between rTMS responders and non-responders, with blue crossings showing an individual global maximum cluster under a cluster-level uncorrected P< 0.05 (Upper: Responders > Non-responders [2756 voxels, P= 0.009, global maximum at Talairach ( xyz) coordinates of 6, 46, 14]; Lower: Responders < Non-responders [1011 voxels, P= 0.087, global maximum at Talairach ( xyz) coordinates of − 34, − 28, − 10]). 

Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229

Copyright ©  2010   Elsevier B.V.

Fig. 4 Pretreatment glucose metabolism relating to depressive symptom improvement following a 2-week add-on rTMS treatment, with blue crossings showing individual global maximum cluster under P< 0.05 corrected for multiple comparisons (Upper, positive correlation [1070 voxels, P= 0.029, global maximum at Talairach ( xyz) coordinates of − 2, 38, 12]; Lower: negative correlation [3751 voxels, P= 0.001, global maximum at Talairach ( xyz) coordinates of − 24, − 44, − 

14]). Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229

Copyright ©  2010   Elsevier B.V.

Fig. 1. Bottom row: Representative consecutive transaxial slices at the level of the basal ganglia parallel to the cantho-meatal line of pre-rTMS treatment neuroSPECT. The pre-treatment study demonstrates decreased perfusion in the right temporal and bilateral infero-frontal regions, as well as non-homogeneous uptake in the caudate nuclei. TOP row: Representative consecutive transaxial slices at the same level of the basal ganglia as the previous study of post-rTMS treatment neuroSPECT. Following treatment, the neuroSPECT study demonstrates marked, general improvement in brain perfusion, including frontal, infero-frontal, and temporal regions, and an increased uptake in the left thalamus.

Right prefrontal rTMS treatment for refractory auditory command hallucinations – a neuroSPECT assisted case studyPsychiatry Research: NeuroimagingVolume 116, Issues 1–2, 30 November 2002, Pages 113–117

Side effects?

• APA conference-37% remission•                            -58% positive response

Magnetic Therapy in Media

• Magnet Treatment for Depression Works for Some

• Rigorous Study Finds rTMS Magnet Therapy Can Relieve Depression With Few Side Effects

• May 4, 2010 -- A controversial new treatment for depression, rTMS, helps some patients, a rigorous government-funded study finds

• Attractive Therapy: Magnetic Brain Stimulation Gaining Favor as Treatment for Depression

• More doctors are turning to repetitive transcranial magnetic stimulation (rTMS) of their patient's brains

• Aug 30 2010

• Magnetic therapy works where pills fail in major depression

• Malathy Iyer, TNN Sep 9, 2012, 05.31AM IST• (The therapy, which won the…)• MUMBAI: Six months ago, south Mumbai-based executive

Ramesh Joshi's behaviour started worrying his family. He would take two hours to finish a meal. While walking, he would suddenly freeze at a spot. He would stammer if he had to speak more than a couple of lines. The medical diagnosis — major depressive disorder — stunned his

• Wednesday 10 October 2012News updated at 2:19 AM IST

• Magnetic therapy for depression• London, May 10, 2012, PTI:• Scientists have found a new magnetic therapy

for depression which they claim could soon spell the end for brain-altering, anti-depressant drugs.

• End of anti-depressants? Magnetic pulse therapy eases depression in third of patients

• By Claire Bates• PUBLISHED: 11:29 GMT, 9 May 2012 | UPDATED:

14:25 GMT, 9 May 2012 • Depression affects one in four of us at some point of

our lives, but controversy still reigns over how to best treat the debilitating condition.

• Now scientists have found that a type of 'magnetic therapy' - which involves no brain-altering drugs or invasive procedures - could be a potent new treatment.

• Magnetic pulses draw good reviews from doctors treating depression

• Therapy shows positive results for those getting treatment

• April 11, 2012|By Janice Neumann, Special to the Tribune