TMS for Traumatic Brain Injury and Depression

TMS for Traumatic Brain Injury and Depression

Traumatic brain injury (TBI) can result from a violent blow or jolt to the head or body. An object, such as a bullet or piece of skull, that pierces brain tissue can also cause  traumatic brain injury. The effects of a traumatic brain injury can lead to big life changes that may leave a person needing long term care.

Effects of Traumatic Brain Injury

TBI can have wide-ranging physical and psychological effects, which may appear immediately after the traumatic event, while others may appear days or weeks later. The cognitive, behavioral, and sensorimotor disabilities that result from TBI often dramatically decrease quality of life. TBI can cause irritability, anxiety, insomnia, and depression. Depression after a TBI is characterized by:

  • Persistent sadness and anxiety
  • Anhedonia (lack of pleasure)
  • Feelings of worthlessness
  • Hopelessness
  • Loss of interest in work and family activities
  • Poor motivation
  • Decreased social contact
  • Suicidal thoughts

Frequency and Risk Factors for Depression after Traumatic Brain Injury

Mood disorders like depression are common after a traumatic brain injury. Most experts estimate first-year post-TBI depression frequency in the range of 25-50% and lifetime rates of 26-64%.

Genetic, demographic, developmental and psychosocial factors, as well as their complex interactions, influence the risk of depression following TBI. People who have a history of mood and anxiety disorders as well as poor social functioning are more likely to develop major depression after a TBI.

Alcohol misuse can also play a big role in developing depression after a TBI. Jorge and Arciniegas followed 158 people, some of whom misused alcohol, for a year after their TBI. Of the 55 TBI patients with a history of alcohol misuse, 33 (60%) developed a mood disorder during the first year of follow-up compared with 38 (36.9%) of 103 patients without a history of alcohol misuse.

Other factors which likely contribute to the development of TBI depression include injury severity, injury to the left dorsolateral frontal part of the brain, persistence of physical symptoms following TBI, and poor social support.

How TMS May Help Traumatic Brain Injury and Depression

It is difficult to treat post-TBI depression due to the nature of the injury. The research on using antidepressant medications for post TBI depression has been inconsistent in showing any significant effectiveness.

Conventional rehabilitation methods are not as effective when treating a traumatic brain injury, partially because of the dual nature of the injury, meaning they cause both diffuse and focal damage. Therefore, there is a great need for improved therapeutic strategies for post-TBI depression to provide optimal functional recovery.

There are some beneficial reported effects of TMS (transcranial magnetic stimulation) in patients with TBI such as relieving a post-traumatic headache but other results are varied. There are several studies on animal models that seem to show enhanced neuroprotection and recovery from TMS after a TBI.

There are limited published studies on the use of TMS for treating post-TBI depression. A case report by Fitzgerald et al., a case report by Nielson et al., and a randomized trial by He et al. comparing TMS and a tricyclic antidepressant with a tricyclic antidepressant alone all reported positive effects of TMS on depressive symptoms.

Research published in 2019 in the Journal of Neurotrauma, found that TMS was safe and well tolerated in post-TBI depression.  This study also demonstrated that it was effective in helping cognition, specifically working memory and executive functioning, in patients who had post-TBI depression. Twenty-one patients with a current episode of major depression subsequent to a TBI participated in a randomized double-blind placebo-controlled trial of TMS. Sequential bilateral TMS (to the left and right dorsolateral prefrontal cortex) was provided in 20 treatments over a period of 4 weeks. Patients were randomly allocated to receive either active or sham stimulation. There was no significant effect of TMS on post-TBI depression, with all patients showing a significant improvement in depressive symptoms irrespective of their treatment group. This study was flawed because it provided only 20 treatment sessions, which is significantly less than the amount (usually around 36) of sessions we provide to patients in real world clinical practice, including at Mid City TMS.  A greater number of sessions would have more likely have produced more significant improvement in depressive symptoms in the patients in this study.

More research needs to be conducted to discover how TMS can best be used to treat post-TBI depression. New studies will need to have larger research groups with improved design and better TMS protocols.

Consider TMS for Your Traumatic Brain Injury and Depression

Transcranial magnetic stimulation (TMS) is a proven depression treatment option. There are some potential advantages of using TMS over medications in treating post-TBI depression; specifically, TMS may lend itself to the neuropathology of TBI more than medications since TMS is known to induce widespread neuromodulation and strengthen connections between synapses in the brain.

If you’ve suffered from a traumatic brain injury and have depression and are wondering if TMS can help you, contact us and we’ll help you figure out the best plan for you.

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