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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.