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To Your Good Health: TMS Can Be Alternative Treatment for Depression



Sunday, December 15, 2013
Dear Dr. Roach: “TMS” stands for “Transcranial Magnetic Stimulation” and is done for four to five weeks daily and takes about 30 to 40 minutes per treatment in the doctor’s office, with the doctor overseeing it and a trained technician doing the treatment.

Do you know how successful this newest noninvasive treatment for depression is (for those who cannot tolerate antidepressant side effects, or for whom these medications just don’t work)? Is it, to your knowledge, successful, and advised for older people too? It’s been successful for some, according to the research I’ve done, but I wanted to get your input.

I understand that it is not covered yet by Medicare, so for those whose primary insurance is Medicare, that means the secondary doesn’t cover it, either!

It is being recognized in some areas and gradually being covered by some insurance plans. I just wondered if you have had any patients who have had the treatment and if you feel it is a viable alternative treatment for the abovementioned health issues.? — J.S.C.

Answer: I had not heard of this treatment before your letter, and was surprised to find that there is good evidence to support its use. It is more effective than placebo treatment, but only about 25 percent of people — all of whom had poor response to at least one medication — had a good response to treatment. The major side effect in treatment is seizures, but only in less than 1 percent of cases.

Due to differences in brain structure, the elderly may require a higher intensity of magnetic stimulation.

This treatment appears to be a useful alternative therapy. However, other antidepressant medications, electroconvulsive therapy and especially non-pharmacologic treatments such as cognitive behavioral techniques may be effective in a larger number of people than TMS.

Dear Dr. Roach: What is the difference between a CT scan and an MRI? — B.

Answer: A CT (computerized tomography) scan uses X-rays to create an image that looks like a slice through the body, head or a limb. The quality of the picture is excellent, but it has much more radiation than a regular X-ray. An MRI uses powerful magnetic waves to create an image that also looks like a slice. It uses no radiation. CT scans are cheaper and faster, in general. One isn’t necessarily “better” than the other. MRI tends to be better for looking at soft tissues, like the brain, and CT usually is better for looking at bones.

Your doctor, or the consulting radiologist, can tell you which is more likely to be better in your individual situation.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.