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Q:  Rapid Transcranial Magnetic Stimulation

About 1 yr ago, my psychiatrist was seriously considering recommending me as a patient to a study for trans magnetic stimulation --the closest location for me was at Emory. Unfortunately at that time I did not qualify, but may now.  Do you know if such studies are still ongoing & if their results are as positive as they initially had indicated?


Dear Ms. C' -- 
As is often the case, the first reports were extremely encouraging, and then as time has gone on, things don't look quite as impressive -- but still impressive, nonetheless.  A recent report compared rTMS (officially "rapid transcranial magnetic stimulation") to electroconvulsive therapy (ECT).  ECT is the gold standard of antidepressants, mind you; so anything that works as well as ECT is darn good.   

In a group of patients who were randomly assigned to either rTMS or ECT, improvement rates were the same. Somewhat surprisingly, as initially it didn't look like rTMS effects would last all that long, they found that the "relapse rate" -- how quickly does a patient slip back into being symptomatic -- was identical between the two groups of patients (ECT and rTMS).  Here's that report summary

As soon as rTMS is approved by the FDA, I hope to be positioned to deliver it.  It looks a lot more satisfactory as a doc' to give that treatment compared to ECT.  The vagus nerve stimulation (VNS) data is coming along nicely as well (e.g. this summary by Dr. Mark George, who's been very closely involved in both rTMS and VNS research). 

However, note that only ECT has clearly been shown to have anti-manic effects.  rTMS has caused mania, especially at first before they started tinkering with the frequency of the pulses and their size.  There is still some hope, as of last I heard, that by getting the frequency/intensity relationships right, rTMS might be able to have anti-manic effects as well.  

Meanwhile, VNS has also caused mania or hypomania in several patients.  So it has the problem of being able to solve one side of the problem but not control the other, again unlike ECT. 

Dr. Phelps

Published January, 2003 


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