Behavioral Health Immediate Care Program seeks to fill gaps in access to care
Transcranial magnetic stimulation and vagus nerve stimulation show positive results
When medicines and cognitive behavioral therapy aren’t working to improve symptoms of advanced depression, transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are alternative therapies approved by the U.S. Food & Drug Administration (FDA) that offer hope for a better quality of life.
Psychiatrists at The Ohio State University Wexner Medical Center are using both with good results and advocate earlier referral for better outcomes. They are conducting research to expand and confirm applications.
Transcranial magnetic stimulation
TMS uses magnetic pulses to stimulate areas of the brain that influence mood. Overactive brain areas can be slowed and underactive areas can be stimulated with TMS.
About half to two-thirds of patients who receive TMS treatments experience noticeable improvements in depressive symptoms. Nearly 40% of patients see their symptoms totally resolve with TMS. Positive effects often persist for months—years, in some cases—and the treatment can be repeated over time.
Candidates for the procedure are those who have not benefited from one or more antidepressant medications at full doses taken for more than six weeks. Patients receive treatments five days a week for approximately six weeks and often see improvement beginning in as few as seven to 10 treatment sessions.
Psychiatrists take individual measurements of the head and place an electromagnetic coil against the scalp near the forehead to correspond to a particular brain area.
“TMS is a very safe, very good early treatment,” says Kevin Reeves, MD, a psychiatrist at the Ohio State Wexner Medical Center. He adds that it may be safe even for women who are pregnant, because it has no effect on other organs.
Dr. Reeves is currently working on research that examines how patients with early life trauma experience benefits from TMS. He and his colleagues also are exploring novel treatment protocols with TMS.
Vagus nerve stimulation
VNS delivers an electric current in continuous cycles to change brain wave patterns and help reduce or eliminate depression symptoms. It was approved by the FDA in 2005 for treatment-resistant depression for patients who had not found relief after trying at least four antidepressants. It also is an important treatment option for people with bipolar disorder, who often experience depression as their predominant mood change.
“Many patients find that treatments are effective in the short term but not in the long term—for a year or more,” Dr. Reeves says.“VNS is a long-term solution that offers the possibility of having something always on and working for an individual day and night. It’s the closest thing to a cure that we have at the moment.”
Psychiatrists at the Ohio State Wexner Medical Center are part of the national conversation on depressive disorders and regularly help shape national standards of care. The medical center is currently Ohio’s only investigational site for a Centers for Medicare and Medicaid Services RECOVER multicenter clinical trial to further evaluate VNS safety and efficacy.
The vagus nerve regulates heart rate and gastric acid secretion. It carries sensory and motor information to and from the brain. To administer vagus nerve stimulation, physicians must first implant a pulse generator, similar to a pacemaker, in the chest. It connects to a wire that is threaded beneath the skin and wound around the left vagus nerve, which runs from the brain stem at the base of the neck down to the chest. The pulse generator is programmed to deliver small electrical signals in a timing pattern that is adjusted to optimize the patient’s response.
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