TMS – Effective New Treatment for Depression

“Seven months ago I was so depressed I wasn’t able to function. After six weeks of Nashville TMS Therapy, I was back to work feeling great! I was enjoying my kids again and I got my life back.” – Craig, 38 years young

TMS (Transcranial Magnetic Stimulation) is a new therapy that involves no drugs and is proven safe and effective – for treatment-resistant depression! TMS is free of the negative side effects often associated with taking antidepressants.

Nashville TMS BLOG

Struggling With Dерrеѕѕiоn?

Depression

You May Nоt Bе Gеtting Аll Thе Infоrmаtiоn You Need


If уоu nееd hеlр mаnаging your dерrеѕѕiоn аnd dоn't know where tо turn, it may be that you don’t have all the information you need! A first-of-its-kind study by researchers at The Dartmouth Institute for Health Policy & Clinical Practice reveals an eye-opening disconnect between the priorities of patients and those of clinicians, when it comes to the information needed to make decisions about treatment options for depression.

According to the study report, only 18% of respondents reported a high level of perceived shared decision making with their clinician, while the majority perceived a lower level of shared decision making.  While this has raised the issue for clinicians to try to improve communication, it is still important for patients to conduct as much research as possible prior to making any decisions.

Types of Treatment for Depression


Thе more options уоu hаvе, the better your сhаnсеѕ оf ѕuссееding аnd leading thе kind оf lifе you’ve аlwауѕ wanted - happy аnd healthy, fillеd with jоу аnd ѕuссеѕѕ.

Remember: No two people are affected the same way by depression. There is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

HOSPITAL CARE

A person with severe depression may need to be given care in a hospital to prevent harm to himself, herself, or others; to monitor medicines; and/or to adjust medical therapy.

PHARMACEUTICAL

Many medications exist for the treatment of depressive disorders. These medications, known as antidepressants, work by affecting neurotransmitters, especially serotonin and norepinephrine. These medications fall into a number of classes including:

SSRIs -These medicines alter serotonin, a chemical in the brain that affects mood, sleep, appetite, etc. There are many brand name and generic forms.

SNRIs -These medicines alter serotonin and another brain chemical called norepinephrine.

NDRIs -These medicines alter norephinphrine and another brain chemical called dopamine.

Tricyclic antidepressants (TCAs) -These medicines alter serotonin and another brain chemical.

MAOIs -Persons who take MAOIs must follow a special diet. This is needed because some foods, if taken with MAOIs, can cause a high blood pressure crisis. Examples are aged cheeses and red wine. Because of this and other reasons, MAOIs are not used often.

Lithium -This is used to treat bipolar disorder. Lithium reduces both manic and depressive episodes. When episodes occur, they are less severe in most persons who take lithium.

Other Medicines used to treat acute mania in bipolar disorder.

Over-the-counter herbal remedies, such as:

  • SAMe

  • John’s Wort


There are numerous forms of medication across these classes and each has different side effects. People sometimes need to try different medications to find a medication that relieves their depression and has tolerable side effects.

HERBAL AND COMPLEMENTARY

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health  website.

COUNSELING

Psychotherapy, or "talk therapy", is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors.

People with a depressive disorder often benefit from seeing a psychiatrist, psychologist, or other mental health counselor. If medication is needed, the person must see a psychiatrist or other healthcare professional with prescribing privileges. Interpersonal therapy, a form of behavioral therapy, is a short-term treatment option that aims to help people work through troubled relationships that may be affecting their condition.

Most mental health practitioners practice one of six types of psychotherapy:

  • Supportive psychotherapy

  • Psychoanalysis 

  • Psychodynamic psychotherapy

  • Cognitive therapy 

  • Behavioral therapy 

  • Interpersonal therapy 


BRAIN STIMULATION THERAPIES:

When treatments such as medication and therapy aren’t able to relieve the symptoms of depression or another mental health condition, there are other options available. Brain stimulation therapies involve stimulating or touching the brain directly with electricity, magnets or implants.

  1. Electroconvulsive Therapy (ECT) - Electrodes are attached to the head, and while the person is sedated, a series of electrical shocks are delivered to the brain to induce a brief seizure. Side effects of ECT may include:



  • Physical effects, such as headaches, muscle pain, nausea

  • Confusion following treatment, which may last a few minutes or hours

  • Memory loss, which can range from forgetting conversations or events right before and after a treatment, forgetting things from weeks or months before treatment, and less commonly, from years before



  1. Magnetic Stimulation (TMS) - TMS is a procedure that creates magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. With TMS, a large electromagnetic coil is placed on a person’s forehead and short pulses are directed into an area of the brain believed to control moods. TMS does not deliver the risk of negative side effects experienced by other pharmaceutical and non-pharmaceutical treatments.



  1. Vagus Nerve Stimulation (VNS) - VNS uses a pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses. VNS can be used to treat depression, as well as other medical conditions including epilepsy. Side effects of VNS may include:



  • Voice changes or hoarseness

  • Cough or sore throat

  • Difficulty swallowing

  • Neck pain

  • Discomfort in the area where the generator is located

  • Breathing problems when exercising



  1. Deep Brain Stimulation (DBS) - Originally developed to reduce tremors from Parkinson’s disease, the FDA approved DBS for use in treating obsessive-compulsive disorder (OCD). DBS is currently being studied as treatment for Tourette’s syndrome and major depression. The use of DBS for mental health, however, is largely experimental and its safety and effectiveness are unknown.


Treatment-Resistant Depression


For some, depression саn bе mаnаgеd thrоugh antidepressants. Although ѕоmе реорlе аrе hеѕitаnt tо tаkе these because оf thе роѕѕiblе nеgаtivе side-effects, they hаvе рrоvеn tо help.

But if you have tried one or more antidepressants, and still feel depressed, you may be ‘Treatment Resistant’. To be sure, make an appointment with уоur physician, who саn help уоu dесidе whеthеr or nоt thiѕ is thе саѕе with you. Then consider TMS, proven effective with treatment-resistant depression.

About Nashville TMS:
In April of 2010, Dr. Scott West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe Major Depressive Disorder has not responded to multiple courses of antidepressant medications and/or other depression treatments. Dr. West and the Nashville TMS Team has successfully treated over 500 patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida, and Alabama. Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Resource: Social Media

Policy Coverage Resources for Health Insurance and Mental Health Services


Mental Health Services Help - MentalHealthorgHealth Care Coverage Information


Many of our patients ask us to help them determine their insurance benefits for TMS (Transcranial Magnetic Stimulation). At Nashville TMS, payment by healthcare insurers is an important part of the service we provide new patients.

Our goal is to reduce as much stress as we can prior to starting treatment. We’ve helped individuals find out about all relevant policy coverage details. Then work to help everyone involved understand all applicable policy limitations, patient responsibilities and payment terms. Then we proceed to operate within the agreed terms.

 

If You Need Help Determining Health Care Payment Coverages


Not all treatment providers have the ability to do this for each and every patient. If you don’t have access to this kind of help for your mental health treatment coverage determinations, you can tap into resources offered by the US Government.

Many times, our patients’ questions involve the Affordable Care Act, the health insurance marketplace, private policy insurance, coverages, Medicare and Medicaid. And when we are not at work, just out and about in conversation, we get these questions from friends and acquaintances.

Many people need answers in this new age of health care coverage. So we assembled these answers; presented by the experts at Centers for Disease Control (CDC) and MentalHealth.gov.

We offer the Q&As below to help people find these valuable and much needed resources. If this information assists even a few individuals to obtain coverage for mental health services, then we will be quite happy. Best wishes to you!

 

Q: How does the Affordable Care Act help people with mental health issues?


A:  The Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges. These new protections build on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provisions to expand mental health and substance use disorder benefits and federal parity protections to an estimated 62 million Americans.

Because of the law, most health plans must now cover preventive services, like depression screening for adults and behavioral assessments for children, at no additional cost. And, as of 2014, most plans cannot deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.

 

Q: Does the Affordable Care Act require insurance plans to cover mental health benefits?


A:   As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. Another is rehabilitative and habilitative services. Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in MHPAEA, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.

 

Q: How do I find out if my health insurance plan is supposed to be covering mental health or substance use disorder services in parity with medical and surgical benefits? What do I do if I think my plan is not meeting parity requirements?


A:   In general, for those in large employer plans, if mental health or substance use disorder services are offered, they are subject to the parity protections required under MHPAEA. And, as of 2014, for most small employer and individual plans, mental health and substance use disorder services must meet MHPAEA requirements.

If you have questions about your insurance plan, we recommend you first look at your plan’s enrollment materials, or any other information you have on the plan, to see what the coverage levels are for all benefits. Because of the Affordable Care Act, health insurers are required to provide you with an easy-to-understand summary about your benefits including mental health benefits, which should make it easier to see what your coverage is. More information also may be available with your state Consumer Assistance Program (CAP).

 

Q: Does Medicaid cover mental health or substance use disorder services?


A:   All state Medicaid programs  provide some mental health services and some offer substance use disorder services to beneficiaries, and Children’s Health Insurance Program (CHIP) beneficiaries receive a full service array. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. While states determine which of these services to cover for adults, Medicaid and CHIP requires that children enrolled in Medicaid receive a wide range of medically necessary services, including mental health services. In addition, coverage for the new Medicaid adult expansion populations is required to include essential health benefits, including mental health and substance use disorder benefits, and must meet mental health and substance abuse parity requirements under MHPAEA in the same manner as health plans. For high level regulatory information and guidance on navigating the system for availability of certain services:

Pathways for Covering Mental Health and Substance Use Disorder Services (Dated 22-9-15)

For additional information on Medicaid and mental health and substance use disorder services, visit:http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Mental-Health-Services.html

 

Q: Does Medicare cover mental health or substance use disorder services?


A:  Yes, Medicare covers a wide range of mental health services.

Medicare Part A (Hospital Insurance)  covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.

Medicare Part B (Medical Insurance)  helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.

Medicare Part D (Prescription Drug )  helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs  .

If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials or call the plan for details about how to get your mental health benefits.

If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit Medicare & Your Mental Health Benefits . To see if a particular test, item or service is covered, please visit the Medicare Coverage Database .

 

Q: What can I do if I think I need mental health or substance use disorder services for myself or family members?


A:  Here are three steps you can take right now:

  1. Learn more about how you, your friends, and your family can obtain health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting gov.

  2. Share this infographicwith your friends, family, and colleagues so more people know about the mental health benefits accessible under the Affordable Care Act.

  3. Find out more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm



Q: What is the Health Insurance Marketplace?


A:  The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. The Marketplace Can Help You:

  • Look for and compare private health plans.

  • Get answers to questions about your health coverage options.

  • Get reduced costs, if you’re eligible.

  • Enroll in a health plan that meets your needs.


Learn more at HealthCare.gov.

 

Q: Where Do I Find Help for Depression?


A:  If you or someone you care about is in crisis, please seek help immediately.

  • Call 911

  • Visit a nearby emergency department or your health care provider's office

  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor


Improving mental health is part of CDC's overall public health mission. For more research on depression, anxiety, and other chronic conditions, read Preventing Chronic Disease. Specific articles on depression and anxiety include:


More Information:



 

About Nashville TMS:
In April of 2010, Dr. Scott West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe Major Depressive Disorder has not responded to multiple courses of antidepressant medications and/or other depression treatments. Dr. West and the Nashville TMS Team has successfully treated over 500 patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida, and Alabama. Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Written by: Lisa Chapman

Depression Drug Now Labelled ‘Inadequate’ by Researchers

One More Failure for Many Patients with Treatment Resistant Depression


Metryapone Antidepressant Deemed Ineffective

How many people do you know have tried one or more treatments for depression? It’s quite a common occurrence, unfortunately. Researchers all over the globe are in a race for solutions.

Depression affects a significant proportion of the population, with 1-year and lifetime prevalence of: 3-5% and 10-30%, respectively. Full remission is achieved in only a third of patients following treatment with first-line antidepressant.

Drug research – new options for depression?


Researching drugs that treat the debilitating symptoms of major depression is a continuing process, in which drug companies believe that trials will produce an option more effective than is currently available. Much research focuses on finding effective drugs for people who suffer from depression, but haven’t found an option that works. These new drugs often inhibit certain functions of the brain and/or the body.

The drug Metryapone, however, appears to be just one more failure for many patients with treatment resistant depression. But research has gone on for decades and will continue, as long as treatment resistance is a widespread problem and enormous sums of money can be made by pharmaceutical companies.

What is Metyrapone and how does it work?


Metyrapone has been prescribed by doctors and used by depression sufferers who have not had a positive response to at least two conventional antidepressant drugs. Metyrapone works by blocking the production of the hormone cortisol. This hormone is naturally produced in the body and high levels have been linked to depression. In fact many depression sufferers have a high level of cortisol, which has been labelled as the stress hormone. Thus, Metyrapone is given to patients with the belief that it will combat the effects of depression by inhibiting the production of cortisol.

Study - The effects of Metyrapone


The University of Newcastle in England studied patients with depression who were being treated by medical professionals. The patients were part of trials that involved the use of Metyrapone or a placebo. These studies concluded that Metyrapone proved inadequate for the treatment of depression. The drug clearly doesn’t have the desired effects on depressed patients that the University researchers were looking for.  The head of the study stated that the use of the drug to treat a wide population of patients for depression was inadequate. As for individual cases with particularly high levels of cortisol, he said that a clinical trial would ultimately be the way to find out if Metyrapone could actually help.

Depression - A complex condition


The problem of depression is pervasive. Depression affects one in ten people at some stage of their life, so a proliferation of drugs is definitely not the ideal solution. As trials and studies continue, inadequate solutions should be ruled out and new alternatives researched.

The University of Newcastle study supports the belief that depression is much more than a simple chemical process that produces more of a certain hormone. Cortisol is present in higher levels with those that suffer from depression but that doesn’t automatically mean that reducing the production of cortisol will solve the problem itself. Depression is too pervasive a problem to be limited to treatment with single drugs, especially when the drug is pronounced ‘inadequate’.

Many patients wait for a new drug treatment, but don’t realize that a non-drug treatment has proven to be effective.

TMS Therapy for treatment resistant depression


TMS (Transcranial Magnetic Stimulation) is a new therapy that involves no drugs and is proven safe and effective – for treatment-resistant depression! TMS is free of the negative side effects often associated with taking antidepressants.

TMS technology is similar to that of magnetic resonance imaging (MRI). TMS Therapy uses highly focused magnetic pulses to stimulate the Prefrontal Cortex – to restore it to normal function and lift your depression.

  • NeuroStar TMS Therapy has been proven safe and effective in the treatment of depression, as documented in clinical studies as well as a long history of patient experiences.

  • Because it does not use depressing drugs, TMS Therapy is free of side effects typically experienced with antidepressant medications.


After a thorough evaluation and intake process, TMS Therapy is prescribed by a psychiatrist and delivered in an outpatient setting.

About Nashville TMS:
In April of 2010, Dr. Scott West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe Major Depressive Disorder has not responded to multiple courses of antidepressant medications and/or other depression treatments. Dr. West and the Nashville TMS Team has successfully treated over 500 patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida, and Alabama. Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Written by: Lisa Chapman

 



‘Normal’ Depression vs ‘Clinical’ Depression. What’s the difference? Download the complimentary guide.

Patients Talk About TMS

What is Depression?


Video 4:28

About Scott West, MD

Dr. Scott West has dedicated his professional career to helping people overcome clinical depression. He has practiced psychiatry in Nashville Tennessee since 1986, when he finished his residency in psychiatry at Vanderbilt University Medical Center.

Prior to that, he graduated Magna Cum Laude from the University of Tennessee, Knoxville and received his medical degree from the University of Tennessee Medical Center in Memphis. He is a Diplomate of The American Board of Psychiatry and Neurology in the specialty of Psychiatry and a Distinguished Fellow of the American Psychiatric Association.

More about Scott West, MD