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QuestionsandAnswersAboutTMS(TranscranialMagnetic

Stimulation)

ByLouisB.Cady,M.D.founderandCEO,CadyWellnessInstitutewww.indianatms-cadywellness.com

www.cadywellness.com

@LouisCadyMD@TMS4depressionCadyWellnessInstituteFanpagewww.facebook.com/cadywellness

1. WhatisTMS?

a. TMSisarguablythebestandmosteffectivetreatmentformajorclinicaldepressionanditworkswithminimalsideeffectsandno

medicationswhichhavetobetakenintoyourbody.

b. ItwasFDAapprovedthreeyearsago,andisindicatedforuseafteronefailedtrialofanadequateantidepressant.

i. Theadvantageofstartingafteronefailedtrialsisthatdepressioncanberesistanttotreat,andthebettingoddsare

thatforeveryonechangeofmedicationfromthefirstone,

youroddsofsuccessgodown

1. (Odds:a. 27.5%cureforfirsttreatmentb. 21.2%afterfirsttreatmentc. 16.2%aftersecondtreatmentd. 6.9%afterthreeprevioutreatments)

2. Howdoesitwork.a.

TMSworkslikechargingacordlesstoothbrush,usingamagneticfieldinthetreatmentheadofthedevice(likethechargingbaseofthe

electrictoothbrush)toinduceanelectriccurrenttoflowinyourbrain

cellsrightundertheskull(orlikeelectricityflowingtothebatteryin

thehandleofthetoothbrush).

i. ThisusesMichaelFaradaysprincipleofelectromagneticinduction.

b. Thesmallcurrentflowthatisinducedinbraincellscausesalocalreleaseofneurotransmittersparticularlyserotonin,andalsohas

effectsatmoredistantlocationsinthebrainviarelaystations.

c. Inthisway,themagnetonthesideofthepatientsheadhasimmediate,localeffects,aswellasdeepbraineffects.d. Itisthelocalanddistantreleaseofneurotransmittersthatcausesthetreatmenteffect.

3. Howlongdothetreatmentstake:a. AfullcourseofTMS,doneaspertheFDAlastfor30treatments,

givenM-F,sixweeksinarow.

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b. Eachstandardtreatmentlasts37minutes.

4. Aretheresideeffects?a. Therearenosignificantsideeffects.Inthefirstweek,thereisa

littlelocalscalppainandirritation,aswellasthesensationofa

headacheunderthetreatmentcoilallofwhichresolvebythesecondweekoftreatment.

b. Therearenosideeffectsinthebody,suchasbeingdopedup,havingadrymouth,orhavingsexualdysfunctionallcommon

sideeffectsofantidepressants.

5. Howwelldoesitwork?a. TMSappearstobeaseffectiveasthebesttreatmentin

psychiatry,withnoneofthesideeffects.Itdoestakelongerto

work,however.

6. Howsoondopeopleseeresults?a. Somepeopleseeresultsinaslittleas12weeks.b. Mostpeoplefeelsomethingby23weeks.c. Almosteveryoneisfeelingbetterbythefourthweekoftreatment.

7. WhenshouldTMSbeused?a. Thelabelingisafteronefailedtrialofanantidepressant.Inpractice,

becauseoftheexpenseofthetreatment,itshouldbeconsideredafter

23failedtrialsofantidepressantswheretheyeitherhavent

worked,orhavestoppedworking.

8. DoyoudoitdifferentlyatCadyWellnessInstitutethanintheclinicaltrials,andifso,why?

a. Yes.b. Theclinicaltrialsweredonetoestablishthatthistreatmentworked

betterthanplacebo,orfaketreatment.Assuch,theonlythingthat

wascaredaboutwassettingituptotellthetwodifferenttreatmentsapart.

i. Tothisend,allantidepressantswerestoppedtotallybeforethetrialbegan(puttingthepatientsatriskofslippingevenfurtherintodepressionbeforetheclinicaltrialbegan).

ii. Further,thetreaterwasforbideentotalktothepatientforfearofcontaminatingtheeffectsofthetreatment.Theonlyrequirementwasthatthepatienthadtostayaway.

c. Howwedoit:i. IkeepthepatientonbaselinemedicationwhilestartingTMSto

avoidslippagepriortotreatment.

ii. Thepatientisengagedinvigoroustalktherapybythetreatingstaffwhilereceivingtreatments.Thistakesadvantageofthe

extra-receptivestateofthebrainduringtreatments.

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iii. Wealsopayattentiontothyroid,adrenal,andsexhormonesaswellasallmedicalissues,andeitherstabilizethemorreferthe

patientforstabilizationbeforeandduringtreatment.

iv. Inthisway,weareusingafullcourtpresswhereliterallyeverythingthatcanbedoneforthepatientisbeingdone.

9. Whyistreatingdepressionimportant?

a. Misery:i. Patientstellmeitslikebeinginthepit.ii. Theveryfactofexistenceistremendouslypainful.iii. Patientslosetheirfamilies,theirjobs,andtheirlives.iv. Theycanbecomemiserablepeoplesunkintothemselves.

b. Tragedy:i. Depressionisrelativelyeasytotreatwiththemedicationswehavenowandastepbystepplantogetpeoplebetter.

c. Stats/economic:i. ProjectedtobeleadingcauseofdisabilityinUSii. Amongthetopthreeworkplaceproblemsiii. FirstChicagoCorporationstudydepressionaccountedfor

morethanhalfofallmedicalplandollarspaidformentalhealth.

iv. Indianaranks39outof51states(39thfromthebestorleastdepressed,11fromthebottom).

d. (suicideand7rule):i. 7%ofthepopulationwillhavedepressioneachyearii. 1outof7previously(now1outof6)peoplewill

experiencedepressionatsomepointintheirlivs(National

instituteofMentalHealthStudy)iii. 1out7withRECURRENTmajordepressioncommitsuicideiv. 70%ofsuicideshavedepressionv. 70%ofsuicidesseetheirprimaryMDswithin6weeksof

theirsuicide.

FormoreinformationcontactthestaffatCadyWellnessInstituteat

frontdesk@cadywellness.comorvisittheirwebsites.TheTMSwebsiteiswww.indianatms-cadywellness.com.Thanksforreading!