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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Brain Neuroplasticity and Treatment Resistant Depression

Allan Schwartz, LCSW, Ph.D. Updated: Aug 24th 2009

On August 14 2009 I posted an enthusiastic article about the latest findings in brain research. That article can be found here:

/poc/view_index.php?idx=119&d=1&w=5&e=29804

One reader correctly pointed out that we have lots of articles that encourage us to be enthusiastic about having hope for treatment resistant depression. We can now cross from hope into reality.

There are a significant number of people who do not get any benefit from psychotherapy of any type, or from any of the anti depressant medications or from any combination of medications. Even when electro convulsive therapy is used these patients may feel temporarily better but return to their depressive state 6 months to a year later. Truly, these are people whose depression is treatment resistant.

Last week I wrote about the amazing plasticity of the human brain. In fact, it is so amazing that stroke patients are being returned to normal functioning as a result of medical science using the newly discovered ability of the brain to repair itself.

Now, these discoveries are being used to help those with treatment resistant depression to recover and live normal lives. Here is how it works:

Thanks to fMRI pictures of the human brain, medical researchers learned that in some people with depression, large parts of the Prefrontal Cortex are turned off. In other words, the neurons in that part of the brain are under-functioning.

A non invasive type of brain stimulation is being used at the University of Michigan Department of Psychiatry to turn those prefrontal brain neurons back on and help patients become free of their resistant depression.

The non-invasive stimulation is called TMS. TMS stands for Transcranial Magnetic Stimulation. The magnetic current from this machine travels into the neurons of the brain and stimulate the underactive nerve cells. This is achieved without any surgery at all. In order to make certain that the newly awakened brain cells remain awake, an rTMS is used. This is stands for repetitive Transcranial Magnetic Stimulation.

The research at the University of Michigan included 10,000 patients. It was found that the treatment was well tolerated by patients, did not have any of the uncomfortable side effects that go with medications, such as dry mouth and lowered libido, and was successful in relieving depression for people who formerly could get no relief. In addition, it has been found to be a safe.
 
What Should You Do?

If you are one of the people with a history of depression that has been resistant to any other treatment, you should consult your psychiatrist about rTMS.

The only caution that I am alerting everyone to is that I do not know when this new treatment will become readily available. In fact, it may be but I doubt that. I would also assume that, when it is ready for the public, the treatment would be done on an ooutpatient basis at the hospital, at least, that is my guess.

Conclusion:

This is not "pie in the sky" meaningless hope. It is merely a matter of time before this treatment is easily availabe for the public. This is just one example of the extraordinary work being done to help people with all tyes of disabilities.

Your comments, questions and your experiences with depression are welcome and encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    An option? - Linda - Oct 24th 2010

    Allan, I had just private messaged you asking what your thoughts of this new treatmnet were, so interesting timing...

    I have had no luck with medications or ECT in these last 4 years since diagnosis. I have a diagnosis of Bipolar and as of now, FDA in the US does not approve the TMS therapy for that, only depression. And only the Neuro star machine is FDA approved. So beware if there is another machine other then Neuro star doing the therapy.

    I think the length of daily treatment being 4-6 weeks is a hinderance to the patient. I find it totally impractical for me to travel almost an hour each each way, each day to try another treatment that will require maintenance of usually another drug. And the cost is definately a hinderance for almost any of us especially since insurance may or may not cover it and for a bipolar diagnosis, it will not....

    But, I tried all medications and have had very negative effects from ECT. I will always recommend to everyone to try whatever they can. I have seen ECT work on other just as I have seen medications work as well.

    Maybe when this is covered by insurance, I will try this therapy, but for now I will have to wait and continue being on no medications and hope that therapy will somehow help me....

    rTMS - my experience - K. Wilson - Oct 24th 2010

    I have been attending the Vancouver Mindcare Centre for almost 7 years now - and it has been worth every trip, every penny.  I suffer from severe, treatment-resistant depression, and have tried every classification of medication (more than one in each classification) - without success.  Wellbutrin worked the best, but even that was only a partial remission.  

    rTMS uses no drugs, nothing invasive.  You don't have to wean off a medication prior to treatment.  To me, this was a big selling point.

    I am considered an "early responder" - I knew very soon into my treatment that I was feeling better, and that rTMS was working for me.  My biggest hurdle has been funding - it has taken me all this time to finally have Veterans Affairs cover the cost of my treatment (my depression has been directly related to circumstances related to injuries sustained while a member of the Canadian Forces).

    My advice is, if you can, try it.  Try any and everything that might help - you never know if you don't try.  My attitude was, if I don't try, I'll always wonder.  I am so glad I tried.  And managed to finance it - my thanks to everyone who made treatment possible - especially my husband.

     

    RTMS useless - - Jun 11th 2010

    I had the same experience with rtms therapy from mindcare in vancouver.  I tried the full package in 2008 and got no results whatsoever.  Buyer beware.

    FDA approved - sidran - Jan 8th 2010

    In my research, I found that the FDA approved TMS in September of 2008. Insurance does not cover it in the US - yet.  I'm keeping my fingers crossed that i'll be able to try it. Something has GOT to work...

    Buyer Beware - Allan N. Schwartz, PhD - Oct 15th 2009

    Hi Magneto,

    I regret the fact that the treatment you tried was not successful. I certainly agree with you about not endorsing a  new treatment. However, if you read the article carefully, I did not endorse as much as I reported with the caution that this is new, and should be discussed with your psychiatrist or physician. I have no way of knowing your case but I get the impression that you acted on your own. I could be completely wrong about this. Also, I do not know if this treatment is available in the U. S. but I have the impression it is not. Again, I could be wrong.

    Yes, new research is being done and new technology being invented that will help but I fully agree with you: Buyer Beware.

    Dr. Schwartz

    Buyer Beware - RTMS - Magneto - Oct 15th 2009

    I came across this article while I was conducting an internet search for depression and neuroplasticity.  This was the second link to Dr. Schwartz's blog. 

    I too have suffered from treatment resistant major depression for some time.  I came across rtms therapy in my research in early 2008 and found out that it was being offered at a clinic (Mind Care Centres) in Vancouver for between $5000 and $10000 depending if one had 2 or three weeks of treatment and whether one treated for depression or anxiety or both. I am a Canadian citizen, although the clinic accepts customers from outside Canada. 

    I had the full package.  I, like many of you reading this, wanted hope for a better life and since the procedure was non-invasive I jumped.  Let me be clear that the treatment DID NOT help my depression in any measurable way, either just after it was performed or now a year and a half later.  I'm not saying that it wouldn't work for anyone.  This is my case. It had no adverse side effects so if you have the cash and the time to spend in Vancouver you can give it a try but don't walk in thinking that this is a proven cure and do your homework. 

    I think Dr. Shwartz has to take these new alternative treatments with a grain of salt rather then endorse them as the next miracle cure with no experience.  Just my too cents.    

    A Glimmer Of Hope - - Sep 23rd 2009

    Once again, just a glimmer of hope.  No definite date when this will be available.  For those of us who deal EVERY day with the illness and with people wondering why you don't just snap out of it, we're waiting for the miracle cure.  For myself, it's been 30 years with no significant relief from any medications.   

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