Many people with depression will eventually find out that their symptoms are resistant to treatment. In these cases, many interventions that typically yield positive results for sufferers of depression, including diet and exercise changes, medications, and talk therapy, are not effective in diminishing depressive symptoms.
Though there is clinically proven efficacy for using TMS (transcranial magnetic stimulation) to treat major depressive disorder, there are evolving new strategies for the augmentation of TMS to achieve even better results.
What is TMS?
TMS for depression involves using magnetic pulses to stimulate the left dorsolateral prefrontal cortex (DLPFC), the region of the brain with less activity in patients with depression. In a standard session, a high-frequency left-sided treatment (HFL) consisting of 10 Hz of stimulation is transmitted to the DLPFC. A session typically lasts 20 minutes and is non-invasive. Patients remain conscious for the duration of the procedure.
TMS Augmentation Strategies
With other forms of treatment for Major Depression, a failed, delayed, otherwise lack of response to the treatment often leads to an increase of that treatment in some way. If, for instance, a patient is struggling to find relief during talk therapy sessions, additional sessions may be recommended to give them an opportunity to do so. Similarly, if a patient’s depressive symptoms are unresponsive to one form of antidepressant medication, another one is often recommended to supplement the one that was prescribed initially.
Likewise, augmentation of TMS may have similar beneficial results. To augment TMS in individuals who have an initially limited response, additional forms of stimulation used during the HFL treatment can be introduced. A recent study focused on two particular forms of treatment augmentation: bilateral TMS and intermittent theta-burst priming of left DLPFC (iTBS-P), both of which we utilize at Mid City TMS as strategies to enhance outcomes for patients who fail to achieve a robust response after 15-20 sessions.
More information about these augmentation strategies and the entire study can be found here. In summary, this study found that individuals who initially had blunted response to TMS for treatment-resistant MDD did better following augmented forms of TMS. Importantly, eighty percent of individuals who experienced 20% better results from augmented TMS sessions, saw those benefits after only ten augmented sessions.
Additionally, the aforementioned study found that standard HFL TMS augmented using iTBS-P was more effective and less time-consuming than augmenting with Bilateral TMS. Researchers concluded that over six hours of “found time“ results during a TMS course when iTBS-P is employed as the chosen augmentation strategy instead of BL treatment because BL treatments are longer.
Health insurance plans, including Medicare, limit the number of TMS sessions an individual can receive, meaning that adding more sessions beyond the standard TMS course (usually 36 sessions) may not be an option. Inadequate response to TMS treatment early on can negatively impact long-term success. This is one reason that strategies of augmentation to enhance clinical benefits are sought. Another strategy involves increasing the number of stimulations delivered during each session. At Mid City TMS, we often increase from 3000 pulses/session to 5,000 pulses/session for patients who have not had an adequate response after 15-20 sessions.
Learn More about Using Transcranial Magnetic Stimulation to Treat Major Depressive Disorder with Mid City TMS
Mid City TMS is at the cutting edge of all treatment methods for depressive disorders, including using, when appropriate, the three augmentation protocols (iTBS, Bilateral TMS, and increasing from 3000 to 5000 pulses/session) discussed above. If you aren’t having adequate results with your current treatment, call Mid City TMS today or visit our website to get more information on how TMS can help you.