Edward Fruitman, MD
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Hudson Valley Magazine reports on TMS

BY DALE MCKNIGHT PUBLISHED AUGUST 16, 2010 AT 04:15 PM

Severe depression cripples the lives of nearly 15 million Americans every year, according to the National Institute of Mental Health. PsychiatristRandy Pardell, M.D. uses a new technique that he says shows great promise for many patients who suffer from major, treatment-resistant depression.Using magnets to fight the blues

Transcranial magnetic stimulation, or TMS, uses magnetic fields to stimulate nerve cells in a region of the brain associated with mood regulation and depression. “It’s kind of like a spark plug for the brain,” explains Pardell, who heads the Poughkeepsie-based TMS Center of the Hudson Valley.

Here’s how it works: The magnetic pulses trigger gentle electrical currents in the brain, which stimulate nerve cells in the prefrontal cortex. The nerve cells release chemicals known as neurotransmitters, which affect mood and emotion.

One reason why TMS is an exciting option is because it does double duty, Pardell says: It often improves mental functioning, as well as motivation and energy, in the patient. At the same time, the procedure also appears to calm the anxiety centers of the brain, which are often overactive in people who are depressed. “Also, it’s a noninvasive, nonsystemic technique. When a patient takes a pill, it goes through the entire body. But here, the magnetic pulses are going directly to the area being treated.”

At first glance, a TMS session looks a bit like science fiction. The patient sits in what looks like a dentist’s chair; a small piece of equipment containing an electromagnetic coil is placed near the left side of the forehead. The coil emits pulses of highly concentrated magnetic fields through the skull, about three centimeters down into the brain — in a manner similar to the way an MRI unit works. “In fact, it’s the same level of magnetic intensity as an MRI — which has been used for years with very few negative consequences,” Pardell says. The patient feels a sort of tapping on the head as the magnets pulse. Afterwards, he or she can continue with normal daily activities. Side effects are mild, Pardell says: a few patients experience a mild headache or lightheadedness.

A standard TMS course involves approximately 20 sessions — five days a week for a month. “Each session takes about 37 minutes, during which about 3,000 to 4,000 pulses are given each time,” according to Pardell. The procedure has been government-approved since 2008. “The FDA approved it for use with resistant depression in adults who have tried antidepressant medication for at least a month with no improvement, or for people who have intolerance to antidepressant medication,” Pardell says.

At first glance, a TMS session looks a bit like science fiction. The patient sits in what looks like a dentist’s chair; a small piece of equipment containing an electromagnetic coil is placed near the left side of the forehead

About 200 sites across the nation now use TMS, says Pardell, who has so far treated half a dozen patients in the six months since he first brought the technique to the Valley. A course of treatment costs about $8,000-$10,000; insurance companies consider coverage for it on a case-by-case basis.

TMS is being tested, too, for its effectiveness in treating other conditions including bipolar disorder, schizophrenia, and posttraumatic stress disorder. It’s also being tested in patients suffering from Parkinson’s disease, migraines, and chronic pain.

“Many times, patients who come to us have been on 15 to 20 different medication trials,” Pardell says. “They’ve been in hospitals, sometimes had electroconvulsive [also known as shock] therapy — they’re looking for some other way to help their depression.”

Pardell cautions that TMS shouldn’t be considered a “magic bullet” therapy that eliminates depression on its own. But so far, the numbers look good. “I’ve talked to a lot of psychiatrists across the country who are doing this treatment, and the success rate seems to be somewhere between 65 and 90 percent,” Pardell says. And according to the Mayo Clinic, in cases where TMS is effective, symptoms of depression may improve for days or weeks, or may even subside completely.

“People can continue with their antidepressant medication, if needed, while undergoing TMS,” says Pardell. “And psychotherapy, along with TMS, can give many people their best chance to get well. TMS has been a wonderful adjunct to our practice.”

Randy Pardell, M.D.
Riverview Psychiatric Medicine, 845-471-1807

 

(http://www.hvmag.com/Hudson-Valley-Magazine/September-2010/Medical-Breakthroughs/index.php?cparticle=2&siarticle=1.html)

About the Author
Dr. Edward Fruitman graduated from the University of Michigan with a Bachelor of Science degree in Biology and Bachelor of Arts in Psychology. He went on to receive his Doctor of Medicine (MD) degree from Michigan State University, College of Human Medicine. Dr. Fruitman completed his residency at Einstein/Montefiore. He is a Diplomate of the American Board of Psychiatry and Neurology.