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Transcranial Magnetic Stimulation Offers Promising Alternative to Electroconvulsive Therapy July 6, 1998 In the not-too-distant future, transcranial magnetic stimulation, or TMS, just might replace electroconvulsive therapy (ECT) - popularly known as "shock" therapy - in treating severe depression. A study under way at the University of Pennsylvania Medical Center is comparing the two, and preliminary results look promising. TMS delivers a mild, magnetic pulse that jump-starts the part of the brain responsible for severe depression. Severe, long-term depression affects some 35 million Americans, many of whom do not respond to treatment, such as medication and psychotherapy. With TMS, patients are given a much less physiologically challenging option than ECT. "So far, patients have responded well to five-to-ten TMS treatments over a one-to-two week period," says Marty Szuba, M.D., an assistant professor of psychiatry who directs the ECT Program and the Laboratory for Transcranial Stimulation at the University of Pennsylvania Medical Center. "Afterwards, there is no fatigue and no memory loss, which usually occurs with ECT. If anything, we've seen an increase in memory for some patients. The only complaint we've had is of a mild headache which can easily be treated with acetophetamen or ibuprofen." The differences between TMS and ECT are apparent immediately. "ECT is still the most effective treatment for severe depression that is unresponsive to anything else," says Szuba. "ECT is now an extremely safe treatment, as opposed to 20 years ago. However, it requires a tremendous amount of preparation to make it that way." ECT must be conducted in a specialty-care unit with a psychiatrist, anesthesiologist and nursing staff. Since ECT induces a seizure which causes convulsions, the patient is put under general anesthesia, and given a short-term paralyzing drug to prevent muscle strains and broken bones. Once the treatments are completed, the patient has to recover from general anesthesia. Sedation, vomiting, and memory loss are common after-effects. TMS is much less involved, Szuba says. Patients are treated in an outpatient exam room while sitting in a comfortable recliner. They are awake and alert and require no medication. "Many patients do not want to be on anti-depressants indefinitely, and TMS looks promising as an effective therapeutic alternative for those individuals," notes Szuba. "While its permanent niche remains to be defined, TMS definitely will have a place in the treatment of severe depression. With this study, we are not looking to completely replace ECT, but to find another treatment option. For now, TMS could be the answer for patients with a long course of depression who simply cannot tolerate anything else." Before he begins a TMS treatment, Szuba demonstrates it on his own forearm. The pulse causes his hand to twitch, but only a bit, and that's much more of a reaction than what occurs on the scalp. When patients see just how mild the magnetic pulse is, they feel reassured. To locate the right spot of the brain to be stimulated by the magnetic coil, the physician must find the part of the brain where depression occurs, called the dorsal lateral pre-frontal cortex. This area is slightly above the temple and behind the forehead. Source: University of Pennsylvania news release Depression.com is a registered trademark of NetHealth, a division of Epicenter Communications, Inc. Copyright MCMXCVIII by NetHealth. <http://www.depression.com/news/news_980706.htm> ------------------------------------------------------------ janet paterson 52 now 41 dx 37 onset [log in to unmask] 613-256-8340 PO Box 171 Almonte Ontario K0A 1A0 Canada a new voice <http://www.geocities.com/SoHo/Village/6263/> ------------------------------------------------------------