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Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.1
What is major depression?
What causes depression?
How prevalent is depression?
Is depression a serious disease?
Is there a depression cure?
Are some people more likely to become depressed than others?
What are the symptoms of depression?
What are the current approved treatments for depression?
What is transcranial magnetic stimulation?
Is transcranial magnetic stimulation (TMS) therapy safe?
When is transcranial magnetic stimulation (TMS) not a treatment option?
Depression is a serious medical illness affecting more than 14 million Americans each year.1 It is a condition which lasts two or more weeks and interferes with a person’s ability to carry out daily tasks and enjoyed activities that previously brought pleasure.
The exact cause of depression is not known, but the leading scientific theory is that depression is caused by an imbalance in the brain’s neurotransmitters. Neurotransmitters are chemical messengers that send signals between brain cells. A person’s genetic make-up and life history may also determine a person’s tendency to become depressed.
A 2003 a study conducted by the Department of Health Care Policy at Harvard Medical School, reported that major depressive disorder will affect approximately 14.8 million American adults (about 6.7 percent of the US population) in a given year.1
Yes. The National Institute of Mental Health maintains that, “Depressive illness can often interfere with normal functioning and cause pain and suffering not only to those who have the disorder, but to those who care about them. Serious depression can destroy family life as well as the life of the ill person.”
A national study of depression found that nearly all the respondents who reported a major depressive disorder also reported that their social and/or work lives were negatively affected by their illness.1 In 2000, the economic burden of depression was estimated at $83.1 billion in the US2 and researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide.3 Depression can also be a lethal disease. Each year in the US, over 30,000 people die by suicide, 60% of whom had been diagnosed with major depression.4
There is no known cure for depression, but with effective treatment many patients can remain symptom free.
Yes, depression is known to be hereditary so depression may occur in some people who have a particular genetic makeup that make them more likely to develop depression. However, the exact nature of these genetic characteristics is not known. Other factors may contribute to an individual’s likelihood of experiencing depression. Some of these risk factors include:
- Individuals suffering from certain medical illnesses such as stroke, heart attack, cancer, Parkinson’s disease, and hormonal disorders
- Individuals experiencing a serious loss, difficult relationship, financial problem, or any stressful change in life pattern
- Individuals taking certain medications that may increase vulnerability to depression
According to the standard diagnosis guide (DSM-IV-TR)5, depression is diagnosed when an individual is experiencing either a depressed mood or a loss of interest or pleasure plus four or more of the following:
- Significant weight loss (when not dieting) or weight gain (a change of more than five percent of body weight in a month)
- Significant increase or decrease in appetite
- Excessive sleepiness or insomnia
- Agitation and restlessness
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive and inappropriate guilt nearly every day
- Diminished ability to think, concentrate, or make decisions
- Recurrent thoughts of death or suicide
If you feel you are experiencing any of these depression symptoms, contact your doctor and speak with them about your depression treatment options.
Depression is most often treated with psychotherapy (talk-therapy) and antidepressant medications administered together. Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, since antidepressants are typically taken by mouth, they circulate in the bloodstream throughout the body, often resulting in unwanted side effects.
More than 4 million patients do not receive adequate benefit from antidepressant medications and/or cannot tolerate the side effects caused by them.6 For these patients, non-drug treatments are available. Some of these treatments include: electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and transcranial magnetic stimulation (TMS).
During electroconvulsive therapy (ECT) the patient’s brain is electrically stimulated to cause an intentional seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.
Patients receiving vagus nerve stimulation (VNS) are required to have a medical device implanted within their chest. Through a wire, this device is attached to the vagus nerve in the neck. Electrical pulses sent from the device travel up the vagus nerve to the brain. Some risks associated with VNS include persistent voice alteration and potential nerve paralysis. Also, since VNS is an implanted device, patients face surgical risks when choosing to undergo treatment.
Transcranial magnetic stimulation (TMS) therapy uses a pulsed magnetic field to non-invasively stimulate the area of the brain thought to control mood. TMS is administered without medication in a physician’s office while the patient remains awake and alert. TMS is delivered in 37 minute treatment sessions given daily over 4 to 6 weeks. The most common side effects associated with TMS treatment are scalp pain or discomfort at the treatment site —generally mild to moderate and occurring less frequently after the first week of treatment. There is a remote risk of seizure with TMS, occurring in approximately 0.1% of patients.
Transcranial magnetic stimulation (TMS) uses short pulses of magnetic fields to stimulate nerve cells in the area of the brain thought to control mood. These pulsed magnetic fields may have a positive effect on the brain’s neurotransmitters levels. TMS Therapy® may be a treatment option for those who have not benefitted from prior antidepressant medication.*
TMS Therapy is well tolerated and has been proven to be safe in clinical trials. Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect related to treatment was scalp pain or discomfort at the treatment sitee during treatment sessions. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. Less than 5% of patients treated with TMS Therapy discontinued treatment due to side effects.
There is a small risk of seizure with TMS Therapy. No seizures were reported in clinical trials using the Neuronetics TMS system. The estimated risk of seizure under ordinary clinical use is approximately 1 in 1000 patients (0.1% of patients). This risk is similar to what has been observed with certain antidepressant medications.
While NeuroStar TMS Therapy has been proven effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.
TMS Therapy should not be used (is contraindicated) in patients with implanted metallic devices or non-removable metallic objects within 30cm of the treatment coil.
TMS should be used with caution in patients who have an implanted device that is activated or controlled in any way by physiologic signals such as pacemakers and implantable cardioverter defibrillators (ICDs).