New brain stimulation therapy offers fresh hope for depression treatment

New hope in the form of Repetitive Transcranial Magnetic Stimulation (rTMS), has arrived for people suffering from various forms of mental disorders.

The procedure is in fact expected to change the landscape of treatment of depression and other mental disorders, to go by proponent Dr Mark Xuereb, a psychiatrist.

The therapy, currently offered in a handful of institutions worldwide, including the Mayo Clinic, Butler Hospital in the US, Harley Street Clinic in London, and a small number of facilities in Italy and Australia, is locally being spearheaded by Crisis Resolution Malta.

“Malta is in fact one of the first countries to offer this treatment, and we hope that the country will become a stronghold in the treatment of mental disorders through the introduction of this therapy,” Xuereb added.  

The revolutionary procedure has been a long time in the making, with the first successful TMS study performed by Anthony Barker and his colleagues at the Royal Hallamshire Hospital in Sheffield, in the UK in 1985. The Food and Drug Administration (FDA) approved the treatment back in 2008, and defined it as “a treatment to alleviate symptoms of depression”.

Studies have since perfected the technique and suggested it as a possible treatment for a number of other disorders, such as anxiety, schizophrenia, pain, stroke, and amyotrophic lateral sclerosis (ALS) among others. 

Xuereb said that anxiety and depression were the most common mental disorders in the world, and the World Health Organization estimated that by 2020, the disorders would be among the heaviest burdens for society; at par with cancer and heart disease. 

“10 to 12% of the Maltese population have suffered from depression at some point in their lifetimes, which essentially means that there could be some 50,000 sufferers at any given moment,” Xuereb said, stressing the need to find ways to cure or alleviate symptoms of depression. 

“Depression and other psychological disorders are a result of imbalances of chemicals in the brain, or of some sort of irregularity in the nerve connections or brain activity,” Xuereb said. 

He added that scientists had studied how magnets could be used to affect brain activity ever since the Renaissance, given that physics reveals that magnetism exists wherever there is an electric current, which the brain naturally generates.

“In the past there were many gimmicks of the kind, but the 1985 discovery has been truly revolutionary,” Xuereb explained, stressing the validity of rTMS. 

The Mayo Clinic website explains that a large electromagnetic coil is placed against the scalp near the forehead for the treatment, to stimulate nerve cells in the region of the brain thought to be involved in mood control and depression. 

“The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan,” the US’s National Institute of mental health website adds. 

The website also adds that the magnetic pulse easily passes through the skull, but that it does not generally reach further than two inches into the brain which allows scientists to select which parts of the brain will be affected and which will not be.

“The therapy affects the left dorsolateral pre-frontal cortex and the limbic system, which control the person’s mood, and are therefore the core of depressive tendencies.”

Xuereb explained that according to studies, a depressed brain has low levels of oxygen. 

“The therapy works precisely by addressing this shortage,” he said. “It coaxes the brain to restore oxygen levels and it jump starts the brain to rebalance chemicals and enhance connections.”

The treatment has been termed “promising” by many, with research presented at the 12th Congress of Biological Psychiatry in Athens even confirming that the treatment is so localized and focused that it can be used on pregnant women, for whom medication is out of the question. 

Xuereb also explained that TMS, with its 70% success rate, was also much more effective against fighting mental conditions than traditional methods, such as psychotherapy, medications and Electroconvulsive therapy (ECT), with their 40%, 40% and 60% success rates respectively. 

Xuereb explained that TMS was being compared to ECT, with the added benefit of it being painless, non invasive, completely natural, and that patients would not be anaesthetised for the duration of the process. 

“The only side effect that has been recorded is a slight tingling headache, but this has only affected some 1% of those who took the therapy,” he added, explaining that the only contraindication for the treatment was epilepsy. 

The therapy is administered on a daily basis for five days a week, and the number of weeks depends on the severity of the condition, according to reports, and while effects are permanent, a top-up every six months was recommended.

“Results have been visible some two weeks after the courses started and it has so far been tested on depression, Obsessive Compulsive Disorder and even Fibromyalgia,” he added, stressing that the treatment was ‘the next big thing’ in psychiatry. 

While inviting those interested in the therapy to get in touch with Crisis Resolution Malta and visit the organisation’s Facebook page, Xuereb also emphasised the importance of never stopping medication without consulting doctors first.