Treatment of Depression: A Brief History

Transcription

1 nd Place Urbandale, Ia Treatment of Depression: A Brief History 1960 s to Present Community Based Services SSRI Antidepressants SNRI Antidepressants 1970 s to present 20% of patients do not respond to medication and other traditional treatments 1

2 IN A MULTICENTER RANDOMIZED CONTROLLED TRIAL USING BRAINSWAY DEEP TMS, PUBLISHED (BY LEVKOVITZ, ET AL) FEBRUARY 2015 IN WORLD PSYCHIATRY, 71% OF SUBJECTS RECEIVING ACTIVE TREATMENT RESPONDED OR REMITTED AT FIVE WEEKS AS MEASURED CHANGES IN HDRS-21 SCORES. AT SIXTEEN WEEKS 76.1 % EITHER RESPONDED OR REMITTED. 5 Weeks 16 Weeks Response Other Remission Response Other Remission Brainsway Deep TMS Brainsway Deep dtms is a non-invasive FDA approved treatment which stimulates the brain regions responsible for depression and obsessive-compulsive disorder. It is a safe, convenient, outpatient procedure done at Compass Clinical Associates. 2

3 ELECTROMAGNETIC COIL INSIDE A PADDED HELMET. THE H1 COIL IS CAPABLE OF STIMULATING BRAIN REGIONS UP TO SIX CENTIMETERS BELOW THE SCALP. How TMS works. dtms provides neuromodulation which directly stimulates neurons in the area of the brain where depression lives. dtms provides neuromodulation which directly stimulates neurons in the area of the brain where Obsessive-compulsive disorder lives Electromagnetic pulses Helmet based enclosure keeps the magnetic coil in place 3

4 FARADAY S LAW LIKE AN ELECTRIC MOTOR OR GENERATOR ELECTRICAL CURRENT IS GENERATED IN AN ELECTRIC CIRCUIT ADJACENT TO A PULSED MAGNETIC FIELD ELECTRIC CURRENT IS INDUCED IN TARGETED AREA OF NEURONS IN THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC). THE PREFRONTAL CORTEX IS SHOWN IN GREEN ON THE DIAGRAM BELOW. THE BRAIN IS BOTH A CHEMICAL AND ELECTRICAL SYSTEM: CHEMICALS ARE THE MESSENGERS BETWEEN NEURONS. ELECTRICAL IMPULSES (OR ACTION POTENTIALS) ARE THE MESSAGE. LIKE MORSE CODE, THE MESSAGE IS RELAYED BY THE FREQUENCY OF THE ELECTRICAL IMPULSES. HIGHER FREQUENCIES ARE EXCITATORY. LOWER FREQUENCIES ARE INHIBITORY. THE BRAINSWAY DEEP TMS PROTOCOL FOR MAJOR DEPRESSION IS HIGH FREQUENCY (18 HZ), TELLING THE UNDERACTIVE PART OF THE BRAIN TO STEP UP ITS GAME. 4

5 The dorsolateral prefrontal cortex has neural connections to the underlying cingulate gyrus which connects to the rest of the limbic system. Abnormalities in the limbic system are correlated with MDD. THE BRAIN REWIRES ITSELF TO LEARN A NEW SKILL. A CONCERT CELLIST S BRAIN HAS PHYSICALLY CHANGED TO ACQUIRE THIS SKILL. BY STIMULATING THE UNDERACTIVE PART OF THE BRAIN RESPONSIBLE FOR DEPRESSION, THE BRAIN LEARNS TO BECOME MORE ACTIVE IN THIS REGION. 5

6 ELECTROCONVULSIVE THERAPY ELECTRICALLY INDUCED SEIZURE IMPACTS THE ENTIRE BRAIN AND CNS COGNITIVE AND MEMORY DYSFUNCTION ALTERATIONS IN BLOOD PRESSURE PAIN AND DISCOMFORT SEVERAL HOURS, INCLUDING ANESTHESIA AND RECOVERY HOURS TO DAYS FOR RECOVERY OFTEN REQUIRES PARTIAL HOSPITALIZATION (DAY HOSPITAL) DEEP TMS STIMULATES THE SPECIFIC AREA OF THE BRAIN IMPLICATED IN DEPRESSION (LEFT DLPFC) TEMPORARY FATIGUE MILD DISCOMFORT OR HEADACHE 0.2% CHANCE OF SEIZURE 6

7 SSRIS/SNRIS: IMPACTS NON TARGETED BRAIN REGIONS/FUNCTIONS AND OTHER ORGANS NAUSEA NERVOUSNESS, AGITATION OR RESTLESSNESS DIZZINESS REDUCED SEXUAL DESIRE OR DIFFICULTY REACHING ORGASM OR INABILITY TO MAINTAIN AN ERECTION DROWSINESS INSOMNIA WEIGHT GAIN OR LOSS HEADACHE DRY MOUTH VOMITING DIARRHEA DEEP TMS STIMULATES THE SPECIFIC AREA OF THE BRAIN ASSOCIATED WITH DEPRESSION (LEFT DLPFC) TEMPORARY FATIGUE MILD DISCOMFORT OR HEADACHE 0.2% CHANCE OF SEIZURE. 7

8 Cortical mapping and motor threshold determination Non-invasive Takes about an hour Includes first dtms treatment Treatment sessions Six weeks Five days a week Sessions are twenty minutes Follow up appointments with Dr. Barlow every three weeks Depression scales weekly (PHQ-9) Maintenance or tapering (twice a week for 3 weeks) Cortical mapping and motor threshold determination Non-invasive Takes about an hour Includes first dtms treatment Treatment sessions 29 sessions within 6 weeks Five days a week Sessions are thirty minutes Follow up appointments with Dr. Barlow every three weeks Yale-Brown Obsessive Compulsive Scale (YBOCS) score, 8

9 Brainsway dtms is indicated for the treatment of depressive episodes in adult patients suffering from Major Depressive Disorder or OCD who have failed to achieve satisfactory improvement from previous anti-depressant medication or OCD medications. If you are suffering from depression and have had several anti-depressants, fail you, this may be a good treatment option for you. Patients with history of seizure disorder, patients with cardiac pacemakers or any metal implants around the head or neck that are not MRI safe. Wellbutrin (Patients would need to taper off this medication before treatment starts). Patients with concurrent alcohol usage. 9

10 Just about all insurance companies cover TMS if the patient meets the criteria. Some of plans that cover: Wellmark and all other BCBS plans United Health Care (United Behavioral Health) Aetna Cigna Health Partners Medicare Diagnosis of MDD At least 4 trials of failed antidepressants in 2 different classes or 3 trials of failed antidepressants and 1 augmentation. No history of seizures No metal implants from the chest above that are not MRI safe At least 18 years old 10

11 Eric Barlow, MD, Psychiatrist Medical Director Compass Clinical Associates, PLLC 11