TMS Improving Symptoms in People With Treatment-Resistant Depression

For people being treated for serious depression, a sense of hopelessness can develop if symptoms don’t improve over months or years. Today, use of transcranial magnetic stimulation (TMS), which delivers magnetic pulses to stimulate areas of the brain, at Lehigh Valley Hospital (LVH)–Muhlenberg and LVH–Cedar Crest is showing promising results in people with treatment resistant major depressive disorder, according to Zahid Islam, MD, attending psychiatrist at Lehigh Valley Health Network (LVHN).

“So far, TMS has had a fantastic response. Most of the literature shows that it’s working, and I’ve noticed significant results in my own patients,” Dr. Islam says.

TMS, a noninvasive procedure first approved by the FDA in 2008, has been used at LVHN since 2018. The typical course of treatment is five days a week for six weeks. After an initial one-hour brain mapping, each TMS treatment – applied using NeuroStar technology – takes about 20 minutes total.

“The magnetic field causes stimulation of part of the brain in the frontal lobe that’s responsible for emotions. This, at the end of the day, increases the serotonin level of the brain,” Dr. Islam explains. Unlike medications used to treat depression that enter the bloodstream, TMS provides few, if any, side effects for people diagnosed with major depressive disorder without psychotic features. Occasionally, mild headache or discomfort occurs. TMS is not indicated for people with bipolar depression.

“Most of the patients I treat with TMS have been suffering from depression and taking a medication – or multiple medications – for a long time. They are not experiencing a full recovery, or there is only a partial response with the medication,” Dr. Islam explains. “Patients really like [TMS] because there are no side effects.” 

While some people see TMS as an alternative to medication, it does not require cessation of pharmacological treatment. In fact, TMS seems to make the brain more sensitive, Dr. Islam says, so medication can actually become more effective in treating depressive symptoms during a TMS regimen.

Before and every week throughout treatment, LVHN psychiatrists apply the Patient Health Questionnaire-9 (PHQ-9) to measure initial severity of depression – which is often defined as “severe” with scores in the 20s – and the response.

“We have found that 70 to 80 percent of patients see good benefit, with [PHQ-9] scores somewhere between 0 and 10, which indicates no/minimal depression or mild depression,” Dr. Islam reports.

“My TMS patients have been dealing with depression for a long, long time and finally, they tell me they have gotten their life back again.”