January 2020 - Promises Healthcare
ENQUIRY
Alternative Depression Treatment: Transcranial Magnetic Stimulation

Alternative Depression Treatment: Transcranial Magnetic Stimulation

by | Jan 31, 2020 | Articles, TMS - Transcranial Magnetic Stimulation

Non-Medication, FDA Approved Depression Treatment

Targeted magnetic pulses stimulate brain regions implicated in depression

Depression is a complex and nebulous beast. More than 264 million people worldwide are afflicted with the disease, and you or a loved one might be experiencing the crippling dysfunction of depression. Here’s where TMS comes in. It’s a technology which employs magnetic stimulation of brain activity to treat physiological and neurological conditions, borne out of a need to more effectively treat depression.

Over a decade ago, the United States Food and Drug Administration approved the use of transcranial magnetic stimulation to treat depression.1 Since then, TMS has become the most widely adopted method for brain stimulation, overtaking electroconvulsive therapy and deep brain stimulation. In 2012, a study demonstrated that regardless of the number of antidepressant medications that failed depressed clinical subjects, TMS delivered a consistent rate of response at 60%, and a remission rate of 40%.2 Even if you’ve been disappointed by numerous rounds of antidepressants, there is hope for you yet.

TMS delivers targeted magnetic pulses to the left dorsolateral prefrontal cortex – an area of the brain responsible for establishing positive feelings and inhibiting negative emotions generated by limbic structures such as the amygdalae. In depressed people, it is this part of the brain that shows the greatest sign of weakness or under-activity. Essentially, the precept of TMS is to stimulate neuronal activity by inducing an electric current in the prefrontal cortex.

So, you might well think of TMS as exercise for your brain – helping it achieve ‘balance’. During TMS therapy, which lasts for forty minutes a session every weekday for four to six weeks, there’s very little you actually have to do. The clinician might ask that you do some questionnaires to help him gauge the efficacy of the treatment and the extent of your depression, but that’s about it. All you have to do is sit in a chair alert and awake, and possibly make some small talk – if you are so inclined. When the electromagnetic coil fires, you’ll hear a series of clicks and there’s a small chance you may experience slight discomfort (think mild headache), but your clinician will have some aspirin ready.

As TMS is a non-invasive, non-drug therapy, you won’t have to muddle through the litany of possible side effects that come with antidepressant medication. Nor will you have to subject yourself to electroconvulsive therapy (inducing a medically controlled seizure while you’re under general anaesthesia). TMS is a remarkably well-tolerated procedure with benign side effects. In fact, it’s safer than current antidepressant medication – the seizure rate of TMS is 0.001%, compared to antidepressants’ 0.1% (a conservative estimate). You’d be a hundred times safer. Treating depression with medication is often an inexact science – trial-and-error, hit-or-miss. Drugs interact with your entire physiology. Unintended consequences and attendant side effects are part of the territory. In contrast, TMS interacts with the targeted area of your brain only, tapping into the network of its electrical circuitry. The markedly low number of side effects3 which can occur during TMS compared with drug therapy means it is a rational, sensible choice if your antidepressant medication isn’t working – there’s no need to complicate your mental health journey with another stressful round of antidepressants and their consequences.

 

The side effects of anti-depressants are numerous.

TMS isn’t just used to treat depression. Since the pulses can target different areas of the brain and the configuration of those pulses adjustable (scientists have discovered that modulating pulse frequencies has an effect on the change in neuronal activity), it stands to reason that it will show promise for treating other physiological or neurological conditions. In fact, TMS has catalysed a wave of clinical trials around the world that explore its efficacy in diverse disease states including autism, epilepsy, migraine, tinnitus, stroke recovery, schizophrenia, insomnia, Parkinson’s and Alzheimer’s disease.

If you’re considering TMS therapy, our experienced clinicians will work with you to formulate a holistic treatment plan with your values and goals in mind. You can discover more information about TMS therapy and if it’s a right fit for you over at the TMS Singapore website.

1More, A. (2019, August 28). Transcranial Magnetic Stimulator Industry 2019 Global Market Growth, Size, Demand, Trends, Insights and Forecast 2024. Retrieved from https://www.marketwatch.com/press-release/transcranial-magnetic-stimulator-industry-2019-global-market-growth-size-demand-trends-insights-and-forecast-2024-2019-08-28

2Carpenter LL, et al. (2012). Transcranial Magnetic Stimulation (TMS) for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice. Depression & Anxiety 29(7):587–596.

3Janicak, P.G and Dokucu, M.E. (June 2015). Transcranial magnetic stimulation for the treatment of major depression. Neuropsychiatric Disease and Treatment. 2015:11, pp 1549-1560

From The Cradle To The Grave: A Mother’s Enduring Love

From The Cradle To The Grave: A Mother’s Enduring Love

by | Jan 20, 2020 | Articles, Dr Terence Leong

Written & Translated by: Dr Terence Leong, Senior Consultant Psychiatrist

First published on Wan Bao Fu Kan on 19 Jan 2020 in Mandarin

 

Many years ago, whilst I was a trainee, I used to work in the Institute of Mental Health. One night, while I was on duty in the emergency room, an old lady in her 90s brought her 60-year-old daughter to the clinic. With a calm and friendly smile, she told me that her daughter had relapsed. It turned out that her daughter had been suffering from schizophrenia for many years, with frequent relapses that required innumerable hospitalizations. At the age of 16, she started to suffer from hallucinations and paranoid delusions. She became suspicious of others, and her temper became extremely volatile. In the early days, she resisted taking medication, resulting in a rapid deterioration in her condition. Within a few months, she was forced to drop out of school. Subsequently, she did try to work, but was unable to hold on to a job. Without a stable income, she was unable to support herself and was unable to lead an independent life. Moreover, her psychotic symptoms worsened, impacting on her self-care. She had to stay at home near-daily, relying on her mother to care for her. 

The old lady was a senior nursing officer in our country before her retirement. She made many important contributions to our country’s healthcare system and she was a pioneering leader in the nursing profession. Unfortunately, her husband passed away early on, and she had to raise all their three children by herself. Her eldest son went abroad to start a business and now has a successful trading company in the United States. Her second child also did well in her studies. After getting her master’s degree, she taught at the university for several years but decided to become a housewife after getting married. The third child was originally the smartest and most sensible amongst the three children. She studied hard since young, and did well academically, with excellent grades every year. She was a filial child, who would always help her mother with housework. In short, she was never a trouble to her parents.

Unfortunately, she fell ill during the first year of junior college, resulting in a dramatic change in her personality and behaviour. Formerly a cheerful, vivacious and enthusiastic young lady, she became irritable and impulsive. Her paranoia resulted in her isolating herself from her friends and loved ones. The old lady took care of her with infinite love and silently accepted this difficult mission. But the eldest brother and the second sister refused to associate with her, and did not welcome their visits even during the Lunar New Year.

The years gradually passed. The old lady is now retired and the frailties of age took a toll on her physical health. In her twilight years, she sincerely begged her two elder children to take care of their sister. But they both adamantly refused to accept this burden. After asking several times, and after having the door literally closed on them on the 2 older children, the old lady finally understood. She courageously continued her lifelong mission and patiently looked after her daughter. By then, she was in her early 90s, and her daughter was in her 60s. That night, she quietly told me: “I’m actually tired, but I cannot die. Because she still needs me.”

That night, I truly understood the greatness and self-sacrificing nature of a mother’s love. 

Schizophrenia is a serious, long-term disease. The support of family members is very important to the patient’s recovery. Without the help of family members, even if you take the best medicine and see the best doctor, it will be to no avail.