Robert D. McMullen, MD on New Depression Treatment
…I’m a psychiatrist and I specialize in treatment-resistant depression. I went to medical school at Georgetown University and I did my residency in Psychiatry at Columbia Presbyterian. For 36 years, I’ve been specializing mainly in the treatment of difficult psychiatric cases, depression as well as other illnesses and especially treatment-resistant depression.
In the last 5 years, I have used a new modality called TMS (trans-cranial magnetic stimulation) and I’ll get back to this but I want to mention a few other things that are new that help treatment-resistant depression. One thing is very low dose Lithium like only 150 milligrams a day whereas somebody with manic depression might be on 1200 and to our surprise this low dose often helps people with depression in a week or two. I have 36 people I’ve collected in the last two years that had a significant antidepressant effect within two weeks. Another thing that is somewhat new is taking vitamin D.
We make this (it’s a hormone it’s not actually a vitamin, it’s a steroid hormone)… we make this in our skin, at least we make one step of making it, when the sun hits the skin. So all of us are low on this since we no longer are farmers, we are [Inaudible 01:55] and we work in offices and we [Inaudible 01:58] and people should take about 5000 IU once a day and there’s a small but significant proportion of people that they are being low on vitamin D is contributing to their depression.
Another new modality is trans-cranial direct-current stimulation- that’s a long name, but it means running a little electricity from say the shoulder over to the left forehead and this small amount of electricity has an effect on the brain which is been shown to help depression and I have used it in dozens and dozens of people and sometimes it has been successful. It’s not as successful as the TMS.
The TMS is really a revolution in psychiatry. The first machine got FDA approved in 2008 and I obtained the machine in 2010. What it consists of is a giant magnet and the magnet is caused by running electricity through a copper coil and your pulse, enormous amount of electricity through this coil and that causes the magnet to go briefly on and briefly off. So if you put this magnet over the brain you can either stimulate a certain area of the brain, usually when you stimulate the left fore head, which is the left dorso-lateral prefrontal cortex technically or we do an inhibitory treatment on the right side of the brain and if it’s excitatory, it makes the neurons easier to discharge, if it’s inhibitory it calms down the neurons and make them less easy to discharge and somehow this causes the depression to remit over about 2 or 3 weeks you’ll see good benefits and then by 6 weeks you hope that at least half the people that their depression would be completely gone.
Anam Sacum is a famous researcher in shock treatment ECT and in one of his lectures he said that TMS is much better than shock treatment because it’s safer, you don’t have to be under anesthesia, you don’t go unconscious, it’s usually painless in fact you usually come in and have the treatment and half an hour later you go to your job. And he said that besides that it’s more durable, once somebody gets shock treatment for a major depression frequently, six months or a year later they are in the same depression again and they need another treatment whereas the TMS seems to be much longer lasting that people sometimes go for a few years without relapse and when they do relapse, you won’t need another 30 treatments sometimes just a few treatment or 5/6 treatment will be enough to bring you back to a normal mood.
Another interesting thing he said was that he said this magnetic pulse that we get into the brain is really a homeopathic dose, it’s a very small dose of magnetic energy just going in few centimeters into the brain and then the brain remains a little bit activated for 45 minutes after the treatment and then everything is back to normal. You can’t find anything different in metabolism or EEG, everything is back to normal after 45 minutes. But after 2 or 3 weeks, the person’s depression is lifting and he says what’s happening is the depression… the brain is curing itself of depression. And this makes a lot of sense to me because why else would having 30 treatment in 6 weeks bring somebody all the way to a normal mood when they’ve never been in a normal mood their whole life. And then this benefit last for 3 years or more except that the brain wanted to get better and the TMS is enabling it. There’s a reason with more than one reason that the TMS would be enabling it, it increases a hormone called BD-NF and that hormone increases plasticity in the brain and allows the brain to change.
So basically, the TMS increases the ability of the brain to change and adapt and it adapts in the right direction.
It seems almost impossible to harm anybody with this TMS, the only risk is of causing seizure which happens only in about 1 out of 10,000 treatments. You do have to be careful if the person is very bipolar because if you do the regular excitatory left-sided treatment, you can cause the person to cycle and have a manic episode or to have more depressions, the same risk you have with standard anti-depressants. I have a lot of experience with bipolar depression and we treat them with a low intensity inhibitory treatment on the right and we haven’t caused anyone to cycle and it’s been just as effective for depression as the left-sided treatment but without the risk of making them worse. This really is one of the most exciting thing that’s happened in psychiatry. There’s been a few big revolution in psychiatry since I’ve been practicing; one was the modern anti-depressants started with Prozac and the other was the modern atypical anti-psychotics, started with [Inaudible 09:10] but they are much safer and they have an anti-depressant part, the old anti-psychotics actually made you more depressed. Lamictal which is an anti-seizure medication originally but it turns out to work extremely well for depression in many people and has very low side effects.
A fourth revolution from my point of view is this TMS and we are all hoping that eventually we’ll have smaller devices to do the trans-cranial direct-current stimulation to treat depression at home so it would be much more convenient. But so far, we haven’t developed the best parameters to make it really effective and to treat high proportion of people successfully.
For further information call me on 212-362-9635 or visit our website.
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[…] Transcranial magnetic stimulation (TMS) is a non-invasive method of stimulating the brain. A coil of wire, insulated in plastic, is put on the head like a big spoon. Each TMS pulse then produces a magnetic field that stimulates the surface of the brain beneath the coil. Since magnetic fields do not hurt, this process is not painful. This is a growing and exciting concept, the therapeutic effect of TMS upon psychiatric practice is exemplified by the fact that hundreds of clinics in the United States now use an FDA-approved TMS system to treat depression. Though not yet FDA approved, double blind studies have shown the efficacy of TMS in treating Tourette’s syndrome, improved and complete rehabilitation of Stroke patients, Seizure control, Parkinson’s disease is a slowly progressive neurodegenerative disorder characterized by typical motor deficits, which result from the depletion of the neurotransmitter dopamine. The characteristic motor deficits of Parkinson’s disease include a slowing of physical movement, muscle rigidity, involuntary resting tremor, postural instability and gait disturbances. Although the motor symptoms of Parkinson’s are mainly treated with drugs, the clinical utility of these medications tends to become limited over the years, often due to adverse effects such as dyskinesias. Invasive brain stimulation for PD, such the DBS technique and minimally invasive cortical stimulation have reduced the surgical risks but are still costly and invasive. Therefore, non-invasive forms of brain stimulation are desirable. Repetitive Transcranial Magnetic Stimulation (rTMS) has been used in PD patients and has been suggested as possible therapeutic tool. Dr. Robert D. McMullen, MD. Psychiatrist, is specialized in neuropharmacology to treat neurodegenerative disorders via drugs. Though hesitant to diversify into procedural treatments for neurological disorders, the amazing results observed with TMS in treating various conditions led him to try this in patients with advanced PD. One particular patient’s treatment consisted of excitatory stimulation of the brain in 15-20 sessions. The improvement was visibly dramatic. Her parkinsonian score went form a 70 to under 35. Another patient showed a drop in the score from 32 to under 16, with improved speech and motor function and could even drive a car. Through repetitive magnetic impulses, TMS appears to improve the neuroplasticity of the brain.TMS can enhance or decrease cortical excitability and thus potentiate or modulate neuroplastic processes. This application of TMS might be capable of speeding up recovery from stroke reducing the consequences of immobilization or enhancing acquisition of new skills. Long-term rTMS significantly stimulates the expression of BDNF in distinct areas of brain, as has been reported to occur after antidepressant drug treatment. With TMS, you can intervene in the brain in exactly the parts that are not functioning well. We now have a non-invasive way in which we can actually target the part of the brain that has to do with movement, and will hopefully be able to improve people’s lives. […]
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My son is bipolar. He is taking Aripiperazol and Depakore. He do lots of shopping and had big amount of credit and having a very bad time He is 46 year old and his Bipolar started when he was 20 year old. I am his mother.
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