Magnetic Stimulation Can Effectively Treat Severe Depression January 9, 2025 Severe depression is a common mental health condition, affecting millions of adults and adolescents in the United States, according to the National Institute of Mental Health. For many people with major depressive disorder, a combination of medication and psychotherapy (also called talk therapy) can keep symptoms in check. For some however, these traditional treatments are not enough. “Nationally, about 30% of people with major depressive disorder are resistant to treatment, meaning that traditional treatment does not work for them,” said Psychiatrist Kyle Cothran, MD, with Samaritan Mental Health – Corvallis. “A person is treatment resistant if they’ve tried two medications for depression without easing symptoms.” For these people, interventional psychiatry can offer a larger psychiatric toolbox of treatment options. What Is Interventional Psychiatry? Interventional psychiatry is an emerging medical subspecialty that uses technology to identify and treat problems in the brain that can cause psychiatric disorders. Procedures use different methods and technologies to stimulate the brain in areas which are causing a person’s mental health disorders. While transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and deep brain stimulation (DBS) are the more common interventions used to help patients, only TMS is currently available at Samaritan. How TMS Works At a basic level, the brain uses chemicals and electrical impulses to communicate with itself and the rest of the body. For those with depression, the brain acts differently than the typical brain. “Imaging studies have shown that in people who have major depressive disorder, a part of the brain called the left dorsolateral prefrontal cortex is less active than it should be. Transcranial magnetic stimulation is used to ‘wake up’ that part of the brain to get it functioning better again,” said Dr. Cothran. TMS uses magnetic fields to stimulate nerve cells in the brain. “The way TMS works is by pulsing electricity through a device that is held against the head. The electricity does not go into the brain but creates a fluctuating magnetic field in the brain in a very targeted location. That magnetic field induces the brain’s natural electrical signals in the neurons,” said Dr. Cothran. The procedure is non-invasive, meaning the procedure is done without surgery or cutting of the skin. While TMS can also be used to treat some cases of obsessive compulsive disorder (OCD), its primary use is for depression in those ages 15 and older. “Roughly 70% of people treated with TMS have at least a 50% reduction in depression, and about 30% of people reach remission,” Dr. Cothran noted. What Does the Procedure Feel Like? TMS treatment begins by mapping the individual’s brain to find the spot that needs treatment. Once located, the device is placed over that area and begins pulsing. “The patient will feel a tapping sensation on the scalp. There is no part of the device actually tapping on the scalp, but it truly feels like it,” explained Dr. Cothran. “For the first couple weeks of treatment, the patient usually feels some tenderness of the scalp and sometimes a headache after each daily treatment. Both side effects usually resolve each day, or with assistance from over-the-counter pain relievers if needed.” Typical TMS treatment takes 36 treatments of about 30 minutes each. Over time the treatment may need to be repeated, but not always. TMS is generally covered by most insurances after some qualifications have been met, such as adequate trials of at least two medications and at least six weeks of psychotherapy. Patient Skepticism Is Common While TMS has been in use since its approval by the FDA in 2008, it is still not widely known by those outside the medical field, so it is natural for a patient to feel skeptical, noted Dr. Cothran. “Patients are used to doctors recommending a medication, vaccine, imaging studies or surgery, but when I tell a patient that I am going to turn an electrified coil into a magnet next to their head and their depression will get better, many are skeptical or nervous. I understand that reaction,” Dr. Cothran said. “However, we have lots of evidence and research to support that TMS works well, even when other treatments fail,” he said. In most cases, patients do not feel pain during or after treatment beyond scalp sensitivity and some headaches. In rare instances — fewer than 0.1% of cases — a seizure can occur during treatment. “TMS has been shown to be a safe procedure. It is rewarding to me to see people who have been in pain for so long start to feel joy and hope again,” said Dr. Cothran. Results Are Noticeable It can take about four weeks before patients notice differences, Dr. Cothran said. “While patients do not often notice much change during the first four weeks often the people around them, such as a significant other or their therapist, do. For example, they do not feel different, but they have picked up their guitar and played it for the first time in six years, something small like that,” Dr. Cothran explained. After four weeks, changes will be more noticeable. “Patients have told me this treatment changed their lives. They can get back to work and do the things they enjoy again,” said Dr. Cothran. “One patient with young children told me her kids could see her smiling again, and as a father of three small kids myself, her comment really hit home for me.” “I am proud to be a part of Samaritan, which had the first TMS chair in Oregon. We continue to find ways to increase access to these treatments that can provide so much relief for those struggling with treatment-resistant psychiatric disorders. We need our community’s help in getting rid of the stigma of mental illness and encouraging each other to reach out for help if we are struggling,” Dr. Cothran said. “Life is so short, and TMS and other interventional psychiatry procedures have helped people get back to connecting with others and finding meaning in their lives. Depression no longer needs to cloud the picture for people for so long,” he said. To learn whether transcranial magnetic stimulation can help you, talk with your primary care provider. Psychiatrist Kyle Cothran, MD, sees patients at Samaritan Mental Health – Corvallis. To reach him call 541-812-5235.
