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Q: Rapid Transcranial Magnetic Stimulation
About 1 yr ago, my psychiatrist was seriously considering recommending me as a
patient to a study for trans magnetic stimulation --the closest location for me
was at Emory. Unfortunately at that time I did not qualify, but may now.
Do you know if such studies are still ongoing & if their results are as positive
as they initially had indicated?
Dear Ms. C' --
As is often the case, the first reports were extremely encouraging, and then as
time has gone on, things don't look quite as impressive -- but still
impressive, nonetheless. A recent report compared rTMS (officially
"rapid transcranial magnetic stimulation") to electroconvulsive
therapy (ECT). ECT is the gold standard of antidepressants, mind you; so
anything that works as well as ECT is darn good.
In a group of patients who were randomly assigned to
either rTMS or ECT, improvement rates were the same. Somewhat
surprisingly, as initially it didn't look like rTMS effects would last all that
long, they found that the "relapse rate" -- how quickly does a patient
slip back into being symptomatic -- was identical between the two groups of
patients (ECT and rTMS). Here's that
report
summary.
As soon as rTMS is approved by the FDA, I hope to be
positioned to deliver it. It looks a lot more satisfactory as a doc' to
give that treatment compared to ECT. The vagus nerve stimulation (VNS)
data is coming along nicely as well (e.g. this summary by Dr.
Mark
George, who's been very closely involved in both rTMS and VNS
research).
However, note that only ECT has clearly been shown to
have anti-manic effects. rTMS has caused mania, especially at first
before they started tinkering with the frequency of the pulses and their
size. There is still some hope, as of last I heard, that by getting the
frequency/intensity relationships right, rTMS might be able to have anti-manic
effects as well.
Meanwhile, VNS has also caused mania or hypomania in
several patients. So it has the problem of being able to solve one side of
the problem but not control the other, again unlike ECT.
Dr. Phelps
Published January, 2003
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