Deep transcranial magnetic stimulation is also called repetitive transcranial magnetic stimulation. DTMS is a non-invasive and non-drug treatment that is now highly used by the doctors for the treatment of depression and anxiety. We will see How Deep Transcranial Magnetic Stimulation Can Treat Depression and Anxiety.
In this type of treatment, brain stimulation is done by generating a magnetic field that produces the electric current at a specific part of the brain through electromagnetic induction. Or we can say that there is a coil that is placed on the scalp.
Through this coil, the current is passed which activates the neural circuits at the specific areas in the brain which as a result, improvement of the symptoms occurs.
In India, DTMS is present in selected hospitals for the treatment of psychiatric patients. The names of the hospitals are AIIMS, NIMHANS, and PGI-Chandigarh.
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What Is Deep Transcranial Magnetic Stimulation (DTMS) or TMS Therapy?
In DTMS special combinations of coils are used which has the capability to penetrate the skull up to 4 cm in length, these coils are known as H coils. So, in DTMS different coils are designed in such a way that they can target different areas of the skull.
DTMS is used in those patients of depression and anxiety, especially those who are taken lots of medication in treatment and yet no relief in the symptoms occur.
As the DTMS H1 coil is FDA approved so it is considered as the safest treatment for depression and anxiety with fewer side effects in treatment-resistant patients.
Today DTMS along with depression and anxiety. It is used in other diseases for the treatment like:-
- Parkinson’s disease
- Alzheimer’s disease
- Bipolar disorder
- Major depression
- Post-traumatic stress disorder
- Chronic pain
- Multiple sclerosis
- Smoking cessation
- Obsessive compulsion disorder
- Negative symptoms of schizophrenia
- Stroke rehabilitation
- Mild cognitive impairment
How Transcranial Magnetic Stimulation (TMS) Can Help?
For the patients who are diagnosed with depression and anxiety, your psychiatric doctor will first evaluate all your symptoms whether you need the DTMS treatment or not before he/she recommends this treatment to you.
Patient’s recommendation for the treatment of DTMS is based on-
- The history of the patient
- Patient previous medications
- Any risk for the procedure regarding with patient’s personal health.
After taking the above all, if the patient needed the treatment doctor will then approve with determining the frequency, duration, and location for the treatment.
For the treatment of DTMS, no anesthesia is required to the patient nor hospitalization is done, as this method is non-invasive and non-drug in nature. The patient during the treatment is awake and is alert.
How to collect the psychiatric history of a patient?
Psychiatric history is a record of the patient’s life.
The doctor should communicate empathy and respect to the patient. Collect demographic details of the patient such as age, sex, marital status, occupation, and religion.
It also includes a source of information and reliability. The chief complaint states the reason why the patient is consulting a psychiatrist.
History of present illness is most helpful in making a diagnosis. The nature of the onset of the symptoms, whether it is acute or gradual; the presence or absence of precipitating events; the course and duration of the illness (fluctuating, continuous or episodic); and the impact of the illness on the patient’s personal, occupational and social life.
The details of the nature of behavioral changes (e.g. irritability, bizarre behavior) and the presence of physical (headache, vomiting, and fever) and psychological symptoms (forgetfulness, personality changes, confusion) suggestive of organic brain damage should be looked into.
History of substance abuse or excessive consumption of prescription drugs (pain killers, cough syrup, etc.) should always be asked for.
Past both psychiatric and medical illnesses. Inquire into the previous history of similar episodes, hospitalization, medication, suicide attempts, and substance use.
General medical history like injury or trauma, reproductive history, history of neurological disorders, drug allergies and sensitivities.
A personal history to include the nature of delivery, milestones, presence of neurotic traits in childhood (thumb-sucking, nail-biting, bed-wetting), personality as a child, and behavior during schools should be asked for; behavior during adolescence, sexual knowledge and practices, history of sexual abuse, marital history, other sexual relationships and occupational history.
Time Needed for The DTMS Treatment
Patients who are under the treatment of DTMS need to have five sessions daily for 20 minutes each for four to six weeks. Patient treatment can be integrated well with the patient’s daily routine so that the timing for treatment should not clash with the patient’s other work.
Once the patient session is over, he/she can go to their home/office or even the patient can drive their car for going home/office to resume their daily work.
Along with the treatment you need to undergo the weekly follow up to your doctor with a daily assessment of any side effects by the technician in order to know whether you are improving with your symptoms or not.
What Can Be Probable Adverse Effects of DTMS Treatment?
Every treatment has its advantages and disadvantages. DTMS is considered as the safest method for the treatment in depression and anxiety, but this method also produces adverse effects if the magnetic stimulation frequency is higher than the normal.
The adverse effects can be seen in the form of:-
- Brief episodes of hypomania
- Cognitive changes
- Hearing loss
- Impaired working memory
- Changes in the induction of cardiac pacemakers in the heart
Procedure Of DTMS
For the treatment of this procedure, the magnetic coil has been placed on the head of the patient where the anatomical marking is done on the skull for receiving the magnetic stimulation. The coil is then attached to the pulse generator or the stimulator which transmits the electric current to the coil.
Types of Coils Used in The Treatment Of DTMS
The coil which is used for DTMS is mostly in the shape of figure eight. The choice of this shape of the coil is because it will easily transmit the shallow magnetic fields which can affect the superficial neurons present in the brain.
DTMS for Anxiety
When you are normal your brain controls and regulates the emotions, impulses and all the behavior through the limbic system (controls emotion) in the brain. But when there is anxiety state all these states become hyperactive and you will be more worrying.
Through DTMS all the symptoms of anxiety can be controlled by giving magnetic stimulation to the brain through the magnetic coil from which the electromagnetic pulses are delivered. It has been seen that the patient who are in anxiety state and after taking this treatment their symptoms get relieved.
If the anxiety is more which cannot be controlled by anti-anxiety medications, DTMS for anxiety disorder has been supported by researchers for the improvement of the symptoms.
This treatment may not eradicate anxiety from your body but will improve the anxiety condition which disturbs you from doing your daily activity or routine work.
Symptoms of Anxiety Which Are Improved by DTMS Treatment
Symptoms of anxiety differ from patient to patient. But with DTMS treatment patient can see the relieve in the following symptoms: –
- Shortness of breath
- Disturbance in sleep
- Muscle tension
- Blurred vision
- Difficulty in concentration
- Increased sweat
- Digestion problem
Many kinds of research on DTMS treatment has shown that relapse of the symptoms of anxiety and depression can occur even after the treatment is over. The relapse of the symptoms can be seen over a period of six months of time.
After completion of the sessions of DTMS treatment, the patient is advised to go to the doctor for the psychotherapy and medication for the standard care for the depression and anxiety patient.
After taken the DTMS treatment the symptoms are not present now and the patient feels good but after few months if the patient feels again the same problem than the patient can again go with the DTMS treatment under the consultation of the doctor.
Diseases came in society along with advanced modernization.
The brain, spinal cord, and peripheral nerves constitute an organ that is responsible for the perception of the environment, a person’s behavior within it, and the maintenance of the body’s internal environment to get ready for this behavior.
Most of the population today consult their doctors each year with any neurological symptoms or any neurological disorders. In which about one-fifth of the acute admissions and a large amount of chronic physical disabilities are found.
Psychiatric disorders may occur from disturbances of one or more of the following interrelated factors like: –
- Biological factors
- Learned behavior
- Psychological adaptation
- Social and environmental conditions
Subjective reports of the patient and other informants from the cornerstone for psychiatric diagnosis and management. There may be no demonstrable physical signs for diagnosis. Proper diagnosis can be reached only through accurate history taking, mental status examination, and physical examination.
What is Anxiety?
Anxiety is the commonest psychiatric symptom in clinical practice and anxiety disorders are one of the commonest psychiatric disorders.
Anxiety is a normal phenomenon which can be present due to a state of apprehension or any unease arising due to anticipation of danger. Anxiety is different from fear, as fear is the reflection of state due to apprehension in response to external danger, while in anxiety the danger is unknown.
Normal anxiety becomes pathological when it causes significant subjective distress and/or impairment in the functioning of the individual.
Anxiety can be categorized under two: –
Trait anxiety: – This is a habitual tendency to be anxious in general. For example- ‘I often feel anxious’.
State anxiety: – This is the anxiety which the patient felt now. For example- ‘I am feeling anxious now’.
What are the symptoms of Anxiety?
Symptoms of anxiety can be divided into two: –
Physical symptoms: –
- Muscles twitches
- Fearful facial expression
- Dry mouth
- Frequency and hesitancy of urination
Psychic symptoms: –
- Poor concentration
- A vague sense of apprehension
- Inability to relax
- The feeling of impending death (when severe)
Anxiety is a cardinal feature of almost all psychiatric disorders, it is important to exclude another diagnosis. The most important differential diagnosis is from depressive disorders.
What is Depression?
The lifetime risk of depression in males is 8-12% and in females is 20-30%, though the lifetime risk of major depression or depressive episode of about 8%.
The depression can be categorized by the following features: –
Depressed mood: –
The most important feature is the sadness of the mood or loss of interest and pleasure in almost all activities present throughout the day. The depressed mood varies little from day to day and is often not responsive to environmental stimuli. The patient lost interest in daily activities which results in-
- Social withdrawal
- Decreased ability to function in occupational and interpersonal areas
- Decreased involvement in previously pleasurable activities.
- Severe depression may result in an inability to experience a pleasure.
Depressive ideation: –
The sadness of mood usually associated with pessimism (always expecting that some bad things will happen). As a result, the patient has three common types of depressive ideas-
- Hopelessness (no hope for the future)
- Helplessness (no help even if possible)
- Worthlessness (feeling of inferiority)
Psychomotor activity: –
This form is seen in both younger and older patients with different symptoms. In younger patients, there is slowed thinking and activity decreased energy and a monotonous voice.
While in older patent there is anger which is more common than anxiety, restlessness which can be seen in form of inability to sit still; hand-wriggling; picking at body parts or any other objects, and unease.
- Physical symptoms: – Many physical symptoms are found few of which are-
- Heaviness of head
- Body ache
- Reduced energy
- Easy tired
- Biological symptoms: – This includes symptoms like-
- No proper sleep
- Loss of appetite
- Losing weight
- Loss of sexual drive
Psychotic features: –
About 20-30% of depressive patients have delusions, hallucinations, delusions of guilt, the delusion of poverty and stupor, the delusion of control.
Suicidal ideas came in the depressive patient than it should be taken seriously. Although there is a risk of suicide in every depressed patient with suicidal ideation with the presence of certain factors increases the risk of suicide.
General Treatment used to treat Anxiety and Depression
Most of the patients are treated with antidepressant medications and a variety of medicines are available in the market. Though the side effects are present of every drug which are given to the patient.
The next choice of treatment goes with lithium which is currently the drug of choice for treatment. Other mood stabilizers are given to the patient.
But now deep transcranial magnetic stimulation is getting more popular with good results shown in cases of anxiety and depressive patients. Let us know the detail of it.
“How Deep Transcranial Magnetic Stimulation Can Treat Depression and Anxiety” we have chosen this topic because it is quite not possible to live life with anxiety and depression. If the condition gets worsen the patient has the tendency for suicide as they think there is nothing left in the life for which they should live.
For these patients, if medication and counseling don’t give any result, then DTMS can give hope to the patient that they can live their life normal and happy just with few sessions of treatment for 4-6 weeks.
In India, it has been found that about 5% of the population is taking DTMS treatment and their reports are also very good till now. No side effects have been noticed after the treatment. But due to its high-cost people not able to afford this treatment.
The cost of the DTMS package in India is about 60,000 to 75,000 rupees which an ordinary person cannot afford. But to solve this problem few companies provide insurance which covers DTMS treatment for depression and anxiety.
DTMS has about a 70-80% success rate. While about 45-50% of the success rate is when the patient is given repeated DTMS treatment for depression and anxiety. Many of the doctors from India and from out of India has recommended DTMS treatment besides going for brain surgery.
It can later produce brain lesions in any part of the brain which can even lead to death. It is the duty of the psychiatric doctor to diagnose the patient properly and make them aware of what they are suffering from and why they need the treatment and how this treatment will help them to overcome their problems.
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