Chapter 34: Transcranial Magnetic Stimulation

 

 

 

My psychiatrist at the Amen Clinic believes I would be a good candidate for Transcranial Magnetic Stimulation.  My brain scans showed decreased activity in the left and right inferior orbital prefrontal cortex on both studies (concentration & rest), more severe at rest.  SIDE NOTE:  When there is decreased activity in the inferior orbital prefrontal cortex during a resting state and it improves with concentration, it is often associated with depressive disorders, and may be responsive to antidepressant medication.

Transcranial Magnetic Stimulation reaches the prefrontal cortex areas of the brain very well.  It does not stimulate the deeper areas of the brain.  That is why my doctor believes I would be a good candidate.  I also have problems with activity in deeper parts of my brain.  If you are interested in seeing my brain scans, go to Chapters 11 & 13.

My medical insurance company believes TMS is experimental and will not help pay for the therapy.  The Neuropsychiatric Institute near the city where I live offers TMS treatment and have had the necessary equipment since January 2010.  I know they have a patient assistance program and I would need to get the details to see if I could afford the therapy at this time.  I think doing the research for this blog chapter will help me decide if I could make this treatment happen!

NEUROSTAR TMS DEPRESSION THERAPY SYSTEM 

FIRST TO BE GIVEN FDA APPROVAL

  

Sean Fallon, author of this post, at GIZMODO

"Last year, Neuronetics' NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system became the first device of its kind to be cleared by the FDA for treating depression. Although, the similarity to a dentist chair was probably not a great idea.

Nonetheless, trials on 164 patients with unipolar, non-psychotic major depressive disorder using the device proved that treatment with short magnetic field pulses to the left prefrontal cortex can be a viable alternative to medication. After 30 40-minute daily sessions, half of the patients in the trial experienced significant improvement, while a third reported complete resolution. Plus, the only statistically significant side effect was mild discomfort in the treatment area. Currently, patients can receive NeuroStar treatments in a psychiatrist's office while remaining completely awake and alert.

Given all of the uncertainty and danger surrounding many psychiatric drugs, NeuroStar seems like it's worth a shot for people suffering from serious bouts of depression. It could also be a sign of things to come. Perhaps technology like this will one day be implanted directly into our brains—making us feel awesome all the time."

http://gizmodo.com/5403423/neurostar-tms-depression-therapy-system-first-to-be-given-fda-approval

Transcranial Magnetic Stimulation requires the following:

1. Prescription by a Psychiatrist
2. 20-30 Outpatient Treatments, Usually Daily
3. Treatment for 4-6 Weeks
4. 37-40 Minute Sessions
5. Patient is Awake, No Anesthesia or Sedation
6. Usually $325.00 or More For Each Session (Depends on the treatment facility) 

This is the link to the NeuroStar TMS Therapy website.  It will give you more detailed information about the treatment:

http://www.neurostartms.com/Patient/Home.aspx

I thought the video on the NeuroStar website was educational and encouraging.  To watch it, go to this link:  (Sorry it was not possible to embed the video)

http://www.neurostartms.com/NeurostarTMSTherapyforDepression/NeurostarTMS-Video.aspx

GOOD BASIC INFORMATION ON TRANSCRANIAL MAGNETIC STIMULATION 

FROM THE MAYO CLINIC

By Mayo Clinic Staff

RISKS
Transcranial magnetic stimulation is the least invasive of the brain-stimulation procedures used for depression. Unlike vagus nerve stimulation or deep brain stimulation, transcranial magnetic stimulation doesn't require surgery or implantation of electrodes. And, unlike electroconvulsive therapy, it doesn't require seizures or complete sedation with anesthesia. However, transcranial magnetic stimulation does have some risks and can cause some side effects.

Common side effects
Transcranial magnetic stimulation often causes minor short-term side effects. These side effects are generally mild and typically improve after the first week or two of treatment. They can include:

• Headache
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
• Lightheadedness
• Discomfort from noise during treatment

Uncommon side effects
Serious side effects are rare. They can include:

• Seizures
• Mania, particularly in people with bipolar disorder
• Hearing loss due to inadequate ear protection during treatment

More study is needed to determine whether transcranial magnetic stimulation may have any long-term side effects.

  

HOW YOU PREPARE

Before having the procedure, you may need a medical examination to make sure it's safe and a good option for you. You may be asked a number of questions about your depression. Tell your doctor or health provider if:

• You're pregnant or thinking of becoming pregnant.
• You have any metal or implanted medical devices in your body. Transcranial magnetic stimulation usually isn't recommended if this is the case.
• You're taking any medications, including over-the-counter medications, herbal supplements or vitamins. Bring a list of what you're taking to your doctor's appointment and include dosages and how often you take them.
• You have a history of seizures or mania. Tell your doctor about any past injuries or surgeries and about any other physical or mental health problems you have.

Little preparation is needed. Transcranial magnetic stimulation isn't invasive, doesn't require anesthesia and can be performed in a doctor's office. You don't need to arrange for someone to drive you home after treatment. Before considering treatment, however, check with your health insurance company to see whether transcranial magnetic stimulation is covered. Your policy may not cover it. 

 

WHAT YOU CAN EXPECT

Transcranial

Your first treatment
Before treatment can begin, your doctor will need to identify the best place to put the magnets on your head and will need to find the best dose of magnetic energy for you.

This is what will most likely occur during your first appointment:

• You'll be taken to a treatment room. You'll be asked to sit in a reclining chair, and you'll be given earplugs to wear during the procedure.
• An electromagnetic coil is placed against your head. The electromagnetic coil is switched off and on repeatedly, up to 10 times a second to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a light tapping sensation on your forehead. This part of the process is called mapping.
• The amount of magnetic energy needed is determined. Your doctor will increase the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed depending on your symptoms and side effects.
• Once the coil placement and dose are identified, you're ready to begin. The treatment itself will last about 40 minutes. The entire appointment typically lasts about one to two hours.

During transcranial magnetic stimulation
Here's what to expect during each treatment:

• You'll sit in a comfortable chair. The magnetic coil is placed against your head.
• The machine is turned on. You'll hear clicking sounds and feel tapping on your forehead.
• Each treatment session lasts about 40 minutes. You'll remain awake and alert.
• After treatment, you can return to your normal daily activities.

There are different ways to perform the procedure. Techniques may change as more is learned about the most effective ways to perform treatments.

  

RESULTS

Some research showed that transcranial magnetic stimulation improved depression symptoms, while in other studies it didn't seem to help. If transcranial magnetic stimulation works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

Transcranial magnetic stimulation may be less likely to work if:

• Your mental illness causes detachment from reality (psychosis)
• Your depression has lasted for four or more years
• Electroconvulsive therapy (ECT) has not worked to improve depression symptoms

It's not yet known if transcranial magnetic stimulation can be used to treat depression for the long term, or whether you can have periodic maintenance treatments to prevent depression symptoms from returning. The effectiveness of transcranial magnetic stimulation may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate. 

http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185

If you are interested in reading a more in depth article on the background, development, practical implementation, and applications of TMS go to:  

http://www.scholarpedia.org/article/Transcranial_magnetic_stimulation

I am also considering going to Newport Beach (Amen Clinic) to have TMS done.  The doctor there does one TMS treatment and an EEG on the brain.  There needs to be a day in between, and then another TMS treatment is performed and another EEG on the brain.  The EEG's results give the doctor information to help him predict if TMS is going to be effective for that particular patient.  I will find out if this procedure is still being used, and if it is used at the Neuropsychiatric Institute near my home.

I think affordable medical treatment should be available to anyone who might benefit from it!

Chapter 33: Endorphins - Natural Morphine

I had my tonsils removed in August of 1977 when I was 24 years old.  I was teaching first grade students at the time, and was getting repeated upper respiratory infections with a painful sore throat.  I was so frustrated with being sick, I told my doctor the surgery would be worth it to me if there was any chance it would end the infections.

I had some people tell me the pain I would feel after surgery might not be as bad as the pain I felt with the sore throats.  Well, for me the pain after surgery was millions of times worse!  I was in the hospital for a few days, a tonsillectomy was not an outpatient surgery 33 years ago.  While I was in the hospital I was given morphine, by injection, which made the pain bearable.  

After I left the hospital I was given a prescription for a pain killer, I don't remember which drug it was, but it was definitely not as effective as morphine!  I slowly recovered from the surgery and fortunately soon after the repeated infections stopped.  After that experience I knew morphine would be by drug of choice if I was in pain, and in the hospital!

Part of my treatment plan from the Amen Clinic is to do aerobic exercise everyday for 30-40 minutes.  The positive effects of endorphins last for 24 hours, so my doctor recommended I replenish them every day.  Some patients are encouraged to workout at least 5 times per week.

These are my exercise instructions from my treatment plan:  "The health benefit from physical exercise is truly amazing.  Solid research has shown that regular exercise helps protect brain cells against toxins, including free radicals and excess glutamate; helps repair damaged DNA; reduces the risk of cognitive impairment, heart disease and stroke; improves cholesterol and fat metabolism, plus improving blood, oxygen and glucose delivery to tissues; reduces risk of diabetes, osteoporosis, depression , colon and breast cancer.  Regular exercise is one of the best natural treatments for ADD and depression.  I recommend you exercise 30 minutes a day 5 times a week.  In order for the exercise to be aerobic you must have a sustained increased heart rate."

I was doing regular aerobic exercise before I went to the Amen Clinic.  I know I feel better when I work out, but it has been hard for me to be consistent in exercising every day!  I decided I would do some research on endorphins, hoping this will help me start on a daily exercise habit.

CTER - Endorphins

http://wik.ed.uiuc.edu/index.php/Endorphins

"According to Rathus and Nevid, the word endorphin comes from the words endogenous morphine. Endogenous means developing from within. Endorphins are similar to the narcotic morphine in their functions, and we produce them in our own bodies. They occur naturally in the brain and bloodstream.

According to the Houghton Mifflin Dictionary, an endorphin is any of a group of peptide hormones that bind to opiate receptors and are found mainly in the brain. Endorphins reduce the sensation of pain and affect emotions.

According to the 2001 Columbia House Encyclopedia, Sixth Edition, endorphins are neurotransmitters found in the brain that have pain-relieving properties similar to morphine. There are three major types of endorphins: beta endorphins, enkephalins, and dynorphin. Beta endorphins are found primarily in the pituitary gland, and enkephalins and dynorphin are both distributed throughout the nervous system. Endorphins interact with opiate receptor neurons to reduce the intensity of pain. Among individuals afflicted with chronic pain disorders, endorphins are often found in high numbers. Many painkilling drugs, such as morphine and codeine, act like endorphins and actually activate opiate receptors. Besides behaving as a pain regulator, endorphins are also thought to be connected to physiological processes including euphoric feelings, appetite modulation, and the release of sex hormones. Prolonged, continuous exercise contributes to an increased production and release of endorphins, resulting in a sense of euphoria that has been popularly labeled "runner's high."

       Types of Endorphins

• Beta-endorphins are produced by the pituitary gland and are believed to produce a greater "high" than the other types of endorphins. The beta-endorphin is generally believed to provide a considerable amount of natural pain relief. Some scientists believe it is due to beta-endorphins that some people who experience a traumatic injury, such as the loss of a limb, experience little or no immediate pain.

• Alpha-endorphins have been studied since the 1970's, but little is known about how they affect the body. Some research suggests that alpha-endorphins may stimulate the brain in ways similar to amphetamines and others claim that they may help treat anaphylactic shock and similar conditions.

• Gamma-endorphins have also been researched since the 1970's, but most of the information on how the substance affects the body is pure speculation. Some studies show that they have antipsychotic effects on patients suffering from disorders such as schizophrenia, while others show that they may help regulate blood pressure.

How Do Endorphins Work?

Endorphins act by locking into receptors in the nervous system for chemicals that transmit pain messages to the brain. Once the endorphin, or the "key", is in the "lock," pain causing chemicals are prevented from transmitting their messages (Rathus and Nevid 2003). Endorphins interact with the opiate receptors in the brain to reduce our perception of pain, similar to the drugs morphine and codeine. The body's release of endorphins, however, does not lead to addiction like morphine and codeine might. 

              RELEASING ENDORPHINS

The release of endorphins is different based on each individual. Certain foods such as chocolate and chili peppers can lead to enhanced production of endorphins. Laughter is thought to release endorphins into the brain. Strenuous exercise, exposure to ultraviolet light, massage therapy, and acupuncture can also activate endorphin production. 

Okay, morphine is still my drug of choice for pain even after trying Oxycodone and Lortab years later after other surgeries. =)  Endorphins are like morphine in their functions and I produce them in my own body.  They occur naturally in my brain and bloodstream.  Yes, this is motivating for me to work out more often even if I don't take advantage of the endorphin "runners high" every day!  I like to do aerobic exercise on an Elliptical Cross Trainer in my basement.  I do not have the excuse that working out is inconvenient.

How endorphins were discovered:

COLIN BLAKEMORE and SHELIA JENNETT. "endorphins." The Oxford Companion to the Body. 2001. Encyclopedia.com. (December 4, 2010). http://www.encyclopedia.com/doc/1O128-endorphins.html

© The Oxford Companion to the Body 2001, originally published by Oxford University Press 2001. 

endorphins During the 1960s and early 1970s, it became apparent that opioid drugs such as morphine and heroin produced their profound actions in the body by interacting with specific receptors on the outer membrane of nerve cells. This raised the intriguing question of why the body goes to the trouble of synthesizing such receptor proteins. Surely it was not just on the off chance that a drug such as morphine might be administered. In 1975 the group in Aberdeen, Scotland led by Hans Kosterlitz and John Hughes, isolated from the pig brain two related molecules, the enkephalins, which bind to and activate opioid receptors. These enkephalins are short peptides, each comprising five amino acids. Although at first glance the enkephalins did not look similar in chemical composition to morphine, they proved to have a crucial component in common. We now know that the brain contains as many as thirteen such endogenous (internally generated) opioid peptides, which have come to be referred to collectively as ‘endorphins’. 

Well, I definitely believe adding more aerobic workouts to my schedule will help my depression symptoms.  The hard part is depression symptoms make me not want to do anything.  This is what I need to push through and workout anyway.

If you are interested in reading more about endorphins, this website is a good one.  It has photos expressing the molecular structure of different kinds of endorphins, called the Endorphin Collection.  It also has good information.

http://microscopy.fsu.edu/micro/gallery/endorphin/endorphins.html