New Developments in TMS For 2019
In this video, we introduce Robert D. McMullen, MD who is a psychiatrist in NYC who has been performing psychopharmacology for over 30 years, the last 10 of which includes transcranial magnetic stimulation(TMS). Today, he will discuss some recent developments in research regarding TMS in 2019.
There were recently two conferences held in Vancouver, Canada regarding TMS research. The first was a 2-day conference held by the Clinical Society of TMS, which is the U.S organization for TMS research that has been around for 10 years. The second is the three day International Brain Stimulation conference which occurs every 2 years. Out of these two conferences came new developments in TMS for 2019.
TMS treatments are historically left excitatory on the left dorsolateral prefrontal cortex. It was then observed that if you performed inhibitory treatment on the right side it worked as well. Afterward, many started doing bilateral treatments. Recent studies suggest that all those forms of treatment work equally as well, although, for some, bilateral treatment might work better.
Theta burst stimulation is another breakthrough impacting TMS in recent years. It shortens the length of treatment on both sides of the brain(40 seconds on the right and 3 minutes and 8 seconds on the left side).
Recent findings from the conferences suggest that doing 2 TMS treatments per day increases the odds of patients responding to TMS treatments. One recent study shows that people who receive 2 treatments per day for 15 days did just as well as people who did 1 treatment per day for 30 days. Using theta bursts significantly lowers the length of the treatment. As a result, you can now perform multiple treatments in one day. Ideally, each treatment should be 15 minutes apart for optimal effect.
Another finding that came from the conferences is that if you treat on the dorsomedial prefrontal cortex, it has a significant antidepressant effect on the patient. This seems to work better on people who have impulse control problems. Their impulsiveness usually decreases significantly right after the treatment. In addition, it also works well on people who have a borderline personality disorder(BPD). Those who have various mood swings throughout the day could benefit from the antidepressant effects of the treatment to regulate their mood throughout the day.
In addition, treating the right orbitofrontal cortex can help with depression. One case that supports this claim is when a person, who was battling severe depression, shot themselves in the head. The person was able to survive the injury, and furthermore, it was found that their depression had subsided. After taking x-rays of the person, doctors discovered that they had blown away their right orbitofrontal cortex. This had caused an inhibitory effect on them further proving that treating this area can help with those suffering from depression.
Furthermore, treatment of the right orbitofrontal cortex(OFC) seems to work better for certain personalities. Someone who is conservative will benefit from this kind of treatment due to the fact that the orbitofrontal cortex has a restraining effect on overly emotional responses. However, those who have no cognitive distortions will not respond to TMS treatment. Those who battle depression suffer from certain distortions such as feelings of inferiority, low-self esteem, and feeling excessively guilty. People who don’t suffer from these distortions usually will not respond to treatment. However, one case shows that treating these type of people on their right OFC might help with their depression symptoms.
Lastly, another breakthrough in TMS is with left excitatory treatments. If you add an inhibitory treatment on the preSMA while performing the left excitatory treatment, it adds to the antidepressant effect of the treatment. Furthermore, theta bursts reduce the length of the treatment which will significantly make treatments more affordable and easier to carry out.
These are just a few of the developments that came from the conferences. Although TMS research is still ongoing, the future is looking bright for this method of treatment.
To learn more:
Psychiatrist Robert D. McMullen – NYC – Depression Specialist – TMS BrainCare
Location 1: 171 W 79th St #2, New York, NY 10024
Location 2: 344 Main St, Mt Kisco, NY 10549