For many, depression and comorbid psychiatric conditions go hand in hand. According to Joseph Kaizer in a review paper titled “Approaches to Use of rTMS for treatment of MDD with Comorbid Psychiatric Illnesses”, many researchers have pondered if Transcranial magnetic stimulation (TMS), a proven, painless method to relieve depression symptoms, would affect these conditions in either positive or negative ways.
Oftentimes, an individual can have a conflicting diagnosis. Medication that helps one condition may make another worse, and the struggle of finding the correct combination of medications to soothe their various conditions can often take years. If TMS was equally effective for depression and comorbid psychiatric conditions, it could be life-changing for those who suffer from multiple mental illnesses.
What Are Comorbid Psychiatric Conditions?
Psychiatric comorbidity occurs when an individual has two or more psychiatric disorders. It’s a commonly accepted fact that people treated for one mental disorder are at increased risk to develop others. Individuals with Major Depressive Disorder (MDD) will often have at least one other condition such as anxiety, posttraumatic stress disorder, panic disorder, or a substance use disorder. Some people are genetically more likely to develop mental illnesses, and sometimes these conditions form as a result of a traumatic event or unhealthy home life.
The existence of multiple psychiatric conditions over a lifetime greatly affects how that individual navigates the world. In most cases, the conditions are akin to chronic illness, meaning that the individual will cope with symptoms over their entire lifetimes. They will often deal with physical pain brought on by their symptoms, high healthcare costs, and decreased length and quality of life. They also must deal with the social aspect of their conditions, either dealing directly or indirectly with stigmas against mental illnesses or convincing friends, family, and other health professionals to believe their conditions are real. Living with comorbid psychiatric conditions can be a full-time job, so there is a lot of incentive for researchers to find effective treatments.
How Do Comorbidities Affect Depression?
The term “comorbidity” implies that the interactions between the illnesses can often worsen one another. For example, depression can lead people to substance abuse. Depression manifests itself by feelings of hopelessness, sadness, and isolation. Many cope with these symptoms by using drugs or alcohol. This addiction can make depressive moods worsen in an endless loop.
While therapy and medication are often efficient ways to cope with mental illness, treatment is often not that easy. It can be difficult to find a medication regimen that treats all comorbid conditions without the medications negatively reacting to one another. Even if that perfect regimen is found, there is no guarantee that the combination will work throughout a lifetime. Bodies can build a tolerance to medications over time, and while doses can usually be adjusted, every medication has a limited quantity that is safe to consume at once.
Evaluating TMS Effects on Other Psychiatric Conditions
While it is known that many adults diagnosed with MDD have additional psychiatric conditions, few studies have been done on if these conditions can affect TMS treatment. Since other psychiatric conditions, such as Borderline Personality Disorder, have been demonstrated to be effectively treated with TMS, there is a foundation to test the technique on other conditions.
One recent review article summarizes how effectively TMS treats depression symptoms with subjects with anxiety disorders, PTSD, and substance abuse disorders. In one small pilot study mentioned in this review article, thirteen patients with MDD and generalized anxiety disorder (GAD) were treated with bilateral TMS (a protocol we frequently use at Mid City TMS) that targeted the right and left dorsolateral prefrontal cortex (DLPFC), the main sections of the brain that regulate mood and executive functioning. Subjects received 1000 pulses of low frequency (1 Hz) TMS to the right DLPFC and high frequency (10 Hz) TMS to the left DLPFC each day for about 5-6 weeks. Overall the patients experienced a 65% decrease in depression symptoms and a 75% decrease in anxiety.
Another trial that studied the efficacy of TMS for the treatment of Panic Disorder with comorbid MDD demonstrated significantly better improvement in panic symptoms after low-frequency TMS to the right DLPFC after 4 weeks and significant improvement in both panic and depressive symptoms after 8 weeks.
While the nature of PTSD is complex and there are no well-proven specific protocols, several randomized trials suggest that right-sided, high-frequency TMS and Intermittent theta-burst stimulation (iTBS), a shorter duration protocol of TMS, could be effective treatments for the condition when depressive symptoms are highly prevalent.
In addition, an article that examined results for several studies involving TMS for substance abuse disorders (SUD) concluded that the usual protocol we use for MDD– high-frequency TMS applied to the DLPFC–reduced cravings for smoking, alcohol, and cocaine and that point out that further study would make it a promising treatment for MDD comorbid with substance use disorders.
Seeking Relief from Depression? Call Mid City TMS
Mid City TMS specializes in TMS for depression and has extensive experience and expertise in treating depression with comorbid conditions. . We offer compassionate and attentive care and extended hours, so patients can prioritize relief with any schedule. We can coordinate care with your current psychiatrist, therapist, or primary care provider to enhance the benefits of TMS to suit your specific needs. We will update your doctor regularly on your progress and provide a written report at the end of the TMS treatment course. If you’d like to learn more about our services, contact us today.