Depression

Condition

Depression is a common, serious medical illness affecting more than 1.5 million adults in the UK at any point in time. 

It is defined as a persistent state of sadness that may interfere with an individual’s thoughts, behaviour, mood, and physical health.

Symptoms

Symptoms may include:

  • Persistent low mood.
  • Lack of interest in usual activities or an inability to experience pleasure
  • Difficulties with thinking, memory or concentrating and decision making
  • Feelings of worthlessness, hopelessness, helplessness, or guilt
  • Changes in sleep habits and decreased energy
  • Loss of appetite or significant weight gain or weight loss
  • Thoughts of death or suicide
  • Negative outlook, self-perception and self-critical thoughts

Problems

Problems caused by depression may include:

  • Diminished personal relationships with family and friends.
  • Physical health problems including increased pain.
  • Side effects from antidepressant medication.
  • Inability to participate in hobbies and activities
  • Limited motivation and desire to do anything.
  • Limited ability to work, missed promotion and career opportunities.

Causes/Triggers

While the exact cause of depression is not known, it is known that depression is characterised by an imbalance of the brain’s neurotransmitters, as well as decreased activity in the frontal lobes of the brain. Neurotransmitters are chemical messengers that send signals between brain cells.

Video: What causes depression?

Dr Leigh Neal explains:

Are you suffering from Clinical Depression?

The PHQ-9 is a questionnaire for diagnosing clinical depression, which is often used by General Practitioners in the UK. A score of 10 or more indicates you may be suffering from clinical depression and you should seek medical advice. The PHQ-9 test can be downloaded from here: PHQ-9 Test.

Conventional Treatments

Depression can be treated with psychological therapy such as Cognitive Behaviour therapy, but this is not suitable for everyone.

Depression can also be treated with antidepressant medication.  It is believed that antidepressant medication works by increasing the levels of neurotransmitters in the brain. Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, antidepressant medication circulates in the bloodstream throughout the body, and can result in unwanted side effects such as: feeling detached, weight gain, decreased sex drive, nausea, sleepiness, and dry mouth.

Millions of patients do not receive adequate benefit from antidepressants and/or cannot tolerate the side effects caused by them. In addition, anti-depressants in pregnancy can lead to complications and they are not usually recommended when breast feeding.

More infrequently persistent or more severe forms of depression can be treated in specialised centres in the UK with Electro-Convulsive Therapy (ECT), which requires the patient to be anaesthetised and paralysed in an operating theatre and can cause memory impairment.

rTMS Treatment for Depression

NICE Approved Treatment of Depression with rTMS

NICE approved rTMS as a safe and effective treatment for depression in December 2015 (NICE Guidelines, 2015). 

The rTMS treatment for depression stimulates the pre-frontal cortex area of the brain.  This area controls mood, motivation, and social skills.  In particular, the left side of the pre-frontal cortex is associated with positive feelings.  It is this area of the brain that is stimulated by rTMS. Stimulation of the pre-frontal cortex by rTMS in depressed patients can lead to complete remission from depression with patients reporting that they feel much more positive; they are more sociable, motivated and talkative.

References:

NICE Guidelines (2015) https://www.nice.org.uk/guidance/ipg542.

Further Evidence, Research and Studies

rTMS for Depression Research

Bakkert et al (2015) identified 185 patients with medication-resistant major depressive episode who underwent 20-30 sessions of rTMS.  98 patients were given the standard depression treatment over 30 minutes and 87 patients were given theta burst treatment over 6 minutes.  A total 7912 runs of rTMS were administered, without any seizures or other serious adverse events.  Recovery rates did not differ significantly between the two groups.  Complete recovery rates from the depressive illness were between 35% with both treatments.  On measures of severity there was no significant difference between the treatment groups in post-treatment severity scores, or percentage improvement. 

Both the standard depression treatment and theta burst treatment appeared safe and tolerable.  The effectiveness of 6 minute theta burst and the standard depression protocol appeared comparable.

Depression in Pregnancy

Hizli et l (2014 ) showed that when 30 depressed pregnant patients received rTMS over the left prefrontal cortex for 6 days in a week, for 3 weeks.  After the treatment period, 40 % of the study group demonstrated significant mood improvements as indexed by a reduction of more than 50% on measures of depression and 20 % recovered completely from the depressive illness.  The treatment was well tolerated, and no significant adverse effects were reported.  rTMS was found to be statistically and clinically effective in pregnant patients with treatment-resistant depression.

References

Bakker et al (2015)  rTMS of the dorsomedial prefrontal cortex for major depression: safety, tolerability, effectiveness, and outcome predictors for 10 Hz versus intermittent theta-burst stimulation. Brain Stimul. 8(2):208-15.

Hızlı et al (2014) Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health. (4):311-5.

rTMS at The Smart Clinics in London

Transcranial Magnetic Stimulation therapy treatment for depression is available at Smart TMS, based at The Smart Clinics, Brompton Cross, London.

Treatment Protocol

At Smart TMS we provide the standard rTMS depression treatment. Each treatment session takes 40 minutes.  We also provide Theta Burst rTMS treatment for depression, if preferred, which takes 6 minutes per session.

The treatment protocol as outlined by NICE is typically 2-6 weeks.  Patients will receive five treatment sessions per week and progress will be assessed over the course of treatment to monitor the effect.  The actual length of the treatment will vary dependent on how quickly a reduction in depression level is seen.

Depression During Pregnancy

There are potentially harmful effects from drugs crossing the placenta during pregnancy. Avoiding the use of drugs in the treatment of depression in pregnancy is desirable because of the risk to the developing and growing foetus.

For these reasons TMS may be a suitable treatment for depression during pregnancy, which you can discuss with your doctor.

Postnatal Depression/Breastfeeding

Breastfeeding

Postnatal depression is a very common illness affecting more than 1 in every 10 women within a year of giving birth. However, medication for depression may contaminate the mother’s milk.

TMS may be a suitable treatment for depression while breast-feeding, during the postnatal period and is probably a preferable form of treatment to taking drugs for depression.

What our patients say

“I have been on and off medication for about 25 years now, but in the short space of a month TMS has given me back something immeasurable.”

AnnaLondonRead full testimonial