TMS For Depression Making Inroads Into Mainstream

Insurers are starting to cover TMS for depression (after determining that SSRIs or other medications aren’t working for the patient). A full course, 24-36 treatments, of TMS can cost well over $10k. Though this is purely conjecture on my part, one way tDCS might make it into the mainstream is as a method to ‘top up’ post-TMS treatment as effects begin to fade.

Published on Jun 19, 2017 | YouTube UCLA
As the number of people suffering from depression rises, doctors are looking for new, more targeted ways to treat it. One approach used by doctors at UCLA and a handful of other centers nationwide is to beam magnetic pulses deep into patients’ brains, a therapy known as transcranial magnetic stimulation (TMS). The therapy is time-consuming, and only a few hospitals or clinics offer it, but its ability to work in a fundamentally different way from medications is also what makes it so promising for people not helped by drugs.

Sooma tDCS

Finnish company Sooma manufactures and supports a tDCS device for the treatment of depression (in Europe). They recently added clearance to treat pain in Canada, and I would assume, are aggressively working towards clearing their device for the treatment of depression in Canada and the U.S.

I would recommend muting the sound (captioned so not necessary) in these next two.

Treating Depression With tDCS | IEEE Spectrum

Excellent article on the state of prescribed tDCS for depression.
Full article: Treating Depression With tDCS: Startup Ybrain Aims for the Mainstream

In South Korea, Ybrain is betting that these benefits and its slick consumer-friendly design will speed adoption of its device. “It’s designed for home use,” says Ybrain CEO Lee, “so physician can electronically prescribe the device and patients can bring it to their homes.”

Zapping the brain really does seem to improve depression | New Scientist

Analysing these high-standard studies revealed that tDCS seems to reliably improve the symptoms of depression, addiction and craving, and fibromyalgia. It also uncovered that the technique does not work for tinnitus, and that the evidence for using tDCS for stroke rehabilitation was not as strong as many had thought.

Full article: Zapping the brain really does seem to improve depression

Full Paper: Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)

 

I intentionally electrocuted my brain. Here’s why… | BBC

BBC Three's Nick Arnold takes the Focus Sports for a test drive.

BBC Three’s Nick Arnold takes the Focus Sports for a test drive.

I contacted a few people using tDCS to cure their depression via social media. Mario, 32 from Mexico, told me it was working for him.

“I think it is great. You can see a lot of improvements in your mood. The more you use it the better you feel.”

Another user, eagee, wrote, “I suffered from depression for almost 25 years, and after I started applying tDCS I’ve had two years so far without it.”

If tDCS really can be so life changing for depression patients, why isn’t it more widely available?

According to Dr. Williams, “the equipment is so simple that it cannot be patented in the US. And if no one can own the rights to tDCS, no one can make a profit on it.”

That’s why, according to its supporters, tCDS is being ignored by major drug companies.

Brendan Morgan Omni Stimulator (For Depression) Review

Stumbled upon this device today, the Omni Stimulator, which seems to be mostly sold in Australia. That lead to this video where Brendan Morgan makes the case for the use of tDCS in the treatment of his depression. Again, I am not advocating the use of tDCS for the self-treatment of your depression. I’m simply collecting evidence, clinical and anecdotal, and making it available. That said, I know that if I myself were experiencing depression, I would be experimenting with tDCS. Especially in light of the fact that the efficacy of treatment of depression with SRRIs remains controversial, tDCS would definitely seem to be worth a try. [Highly recommended, Science VS podcast episode #11 Antidepressants.]

Cloud-Based tDCS Device For Remotely-Supervised Trials

Our ~6 min video about the project! Featuring & ‘s Prof Colleen Loo.

We developed a cellular brain stimulation device as part of our ELEC5622 Sensors, Signals & Health assessment at the University of Sydney. The technique, known as transcranial direct current stimulation (tDCS), uses weak electrical currents to modulate ongoing brain activity, and is a promising treatment for a range of neurological and psychiatric diseases. As the feasibility of administering tDCS at home has recently become an emerging area of research, there is a substantial need for a tDCS device which send data to the clinician in real time.

[Update 11/7/16 The video mentioned has been deleted.]

TMS & Depression In The News

Now that TMS has been approved for the treatment of depression we’re seeing a lot more stories in the news. Naturally this is in part due to the marketing efforts of the four device makers currently FDA approved: Brainsway, Magstim, Magvita, and Neurostar. No doubt patients and doctors are eager to try an alternative where antidepressants didn’t work!

I will update this post as I find new and interesting news stories related to TMS and depression.

tdcsmagnetstms

Magnets cured my depression
New symptom-free treatment helps depression, reduce military suicides

University of British Columbia Explores tDCS With Yoga in Treatment of Depression

Fidel Vila-Rodriguez, an Assistant Professor of Psychiatry at the University of British Columbia, is exploring the effects of transcranial direct current stimulation combined with yoga, to see if it can be used to treat depression.

From UBC: Harnessing electricity to treat depression – in a kinder, gentler way

Why DIY?

Market forces, the for-profit bias that imbues every aspect of health care in America, skew R&D towards solutions and products that are highly profitable. That’s one of the reasons I was so curious about tDCS. You can do it at home. It doesn’t cost a fortune. My initial curiosity was inspired by research papers that seemed to indicate the potential for cognitive enhancement, primarily memory and learning. Many papers later, I’m not so sure, but where it comes to tDCS and depression I’m much more confident. There does seem to be an overwhelming amount of both research and anecdotal evidence to support the use of tDCS in depression. If that were better known, perhaps someone like the woman featured in this NBC news clip would have had somewhere to turn when she was denied coverage for continuing TMS treatment for depression.

Injured Workers Face Stacked Deck During Workers’ Comp Appeals Process, Critics Say

How TMS and Genome Testing Pulled Me Out of a Severe Depression | Toby Wachter

No mention of tDCS in his journey to find relief from severe depression, but some new to me and interesting information about treating his depression with Transcranial Magnetic Stimulation. Especially interesting is that a genome test recommended by his psychiatrist led to the awareness that many of the drugs typically used to treat depression would most likely be overwhelming to his system. Also that his insurer, Anthem Blue Cross (through the ACA, Obamacare) covered his TMS treatment. Links below to full article.

Transcranial Magnetic Stimulation, or TMS, is a depression treatment that was approved by the FDA in 2008. It involves placing a magnetic coil on the patient’s head, and stimulating neurons in a specific part of the brain known to be underactive in depression (the dorsolateral prefrontal cortex). Best of all, it has very few side effects: only some uncomfortable tapping on the head where treatment is applied. There are none of the standard side effects we’ve come to associate with medications.

How Transcranial Magnetic Stimulation and Genome Testing Pulled Me Out of a Severe Depression

Self-Administered Domiciliary tDCS Treatment for Tinnitus | Sooma Medical

Unfortunately the study found little to no benefit (no more than sham) using tDCS with two different montages to treat tinnitus. What is very interesting however, is that the study allowed participants to administer tDCS at home.

A Sooma tDCSTM device (Sooma Oy, Helsinki, Finland) was used in the study. The device is designed and approved for patient use with pre-programmed treatment parameters and hardware-level safety limits. Patients were given a package consisting of the stimulator unit and stimulation electrodes (consisting leads and pads) along with three pairs of sponge pouches for the electrode pads, a head cap with openings for the electrodes (Fig 1), a chinstrap and 0.9% saline solution.

tdcsElectrodePouchCap

In Europe, Sooma depression solution was approved for depression treatment in 2014.

tdcsSoomaMedical2

Download the Sooma brochure (pdf)

tdcsSoomaMedical

 

tDCS Depression Montage

Marom Bikson (no less!) demonstrating depression montage using the Soterix EasyStrap.

From a recent Marom Bikson slide deck.

From a recent Marom Bikson slide deck (pdf).

Low Field Magnetic Stimulation

All roads LFMS lead to the Harvard Low Field Magnetic Stimulation Lab. But please follow along with what led me here in the story below.

Harvard's Low Field Magnetic Stimulation Lab

Harvard’s Low Field Magnetic Stimulation Lab

I came across Low Field Magnetic Stimulation, or LFMS, in a recent panel talk from SXSW: Superbugs, Magnets & More: Medicine’s Comeback Kids – SXSW Interactive 2015. The conversation is particularly interesting considering panelist Dr. Bennett Shapiro’s background. At Merck he led research that developed over 25 drugs and vaccines. (The panel touches on magnets, phage therapy and fecal transplants, for example.)

Dr. Shapiro’s company (he is the co-founder and non-executive director), Pure Tech Health created Tal Medical, to develop an LFMS treatment/device.
This is most likely the nexus for looking into LFMS in the first place:

Anecdotal reports have suggested mood improvement in patients with bipolar disorder immediately after they underwent an echo-planar magnetic resonance spectroscopic imaging (EP-MRSI)… Low-Field Magnetic Stimulation in Bipolar Depression Using an MRI-Based Stimulator  (Found on the Tal Medical publications page.)

The panel discusses TMS, which has recently been approved by the FDA for treatment of depression. But Dr. Shapiro goes on to discuss LFMS, which (to my readers anyway) is especially interesting because it uses so little power to achieve its effects. (As opposed to TMS which is too complicated and powerful to ever become part of the DIY community. Never say never!)

In 2013, Tal received initial proof-of-concept data from a randomized, double-blind, sham-controlled trial in patients with major depressive and bipolar disorders conducted by McLean Hospital, a leading psychiatric research hospital affiliated with Harvard Medical School. In the study, a single 20-minute treatment demonstrated rapid onset of action, substantial effect size, and a strong safety profile. Given this unique, rapid effect of LFMS treatment, the National Institute of Mental Health has selected LFMS for a multi-site clinical trial. The trial is examining the efficacy and durability of the treatment over an extended period of time in patients with major depressive disorder.

Researching possible patents led to Michael Rohan, Ph.D. and the Harvard Low Field Magnetic Stimulation Lab. I assume there is a partnership between the Harvard Lab, McLean Hospital and Tal Medical, though I could not find any formal announcement. Click through the lab link to do a deeper dive into ongoing research they are presently involved with, including clinical trials.