Device helps long-term depression sufferers
Published: Wednesday, November 7, 2012 at 1:45 p.m.
Last Modified: Wednesday, November 7, 2012 at 1:45 p.m.
Elizabeth Bate used to go to bed at night praying she wouldn't wake up in the morning.
Bate has suffered from depression since 1974, the year her daughter was born, which threw Bate into postpartum depression.
"She cried, and I would cry. She got colic, and I had colic of the brain," Bate said.
For the past three decades, Bate, now 62, has been what she calls "a functional depressive." She took medications — as many as four at a time — that kept her suicidal thoughts at bay but did little else.
Sometimes to distract herself from her depressive thoughts, she stayed in bed all day, reading or watching "crap TV," she said, without remembering anything about the shows or books.
"I would see my grandkids and feel sad because I didn't feel joy," Bate said.
But in May, Bate began to reclaim her life with a treatment called TMS, which stands for transcranial magnetic stimulation. Electric pulses to the brain reactivate what Bate's doctor, psychiatrist Michael Johnson, calls the brain's "emotional circuitry," which connects such functions as thoughts, mood and appetite.
"When you trigger one part of it, the current flows through the whole circuit," Johnson said. In other words, TMS normalizes the neurotransmitters such as serotonin and dopamine, which affect everything as diverse as mood, memory and sex drive. In depressed patients, the malfunctioning circuitry allows negative emotions to take over.
The FDA approved TMS in 2008 for patients who already had at least one medication fail. Patients who don't want to deal with the side effects of antidepressants also are opting for TMS.
"Medications can affect the entire body. You can have side effects such as nausea, vomiting, weight loss, weight gain, sexual side effects," said Dr. Richard Holbert, a psychiatrist and professor at the University of Florida and Shands. TMS instead is "very focused treatment," Holbert continued, careful to distinguish it from electroconvulsive therapy (ECT), in which "you're actually put to sleep and made to have a seizure so the entire brain is affected."
Bate tried ECT but said she suffered memory loss, a common side effect. She also can attest to the negative side effects of antidepressants, which gave her night and day sweats and made her gain weight.
"Gaining 32 pounds in one year will definitely add to your depression," she said.
TMS sessions last about 45 minutes and are typically done Monday through Friday for a maximum of six weeks. "People come in on their lunch breaks," Johnson said.
"We've treated a number of doctors, nurses, and attorneys, and it's nice for them," Holbert added.
Johnson and Holbert are the only psychiatrists using TMS in Gainesville, with about a dozen clinics offering the treatment statewide, according to the manufacturer.
The biggest barrier to the treatment so far is its cost. The full six-week treatment costs about $10,000, and most insurance plans don't cover it, Johnson said. Medicare is starting to cover it in some states, and "that's a good sign," said Holbert, adding that were it not for the cost, he would have treated eight to 10 times the number of patients.
Most patients' depression goes into remission after the six-week treatment, research has shown, with some requiring repeated sessions.
Afterward, patients can receive maintenance therapy in the form of therapy sessions.
ECT is much more expensive than TMS, but insurance covers it. Medications also are generally covered in part by insurance, with co-pays running $25 to $75 a month.
The fraction of Johnson's patients who are able to afford TMS are paying for it in installments, much like making car payments, he said.
For Bate, she says the treatment was worth the cost.
"It gave me my life back," said Bate, correcting herself. "It gave me my life."
A former physical education instructor who stopped working out during her depression, Bate said she now walks every morning and does Qigong, a Chinese exercise using meditation, four nights a week. She said she loves spending time with her grandchildren and wakes up in the morning happy to be alive.
"She's basically had complete recovery," said Johnson, adding that TMS "is not just another me-too drug." Studies suggest the effects might last longer than other depression treatments and essentially put patients into remission. Sometimes, they repeat TMS once a month to prevent relapse, or more often, they start therapy.
Holbert said that depression "is the most disabling condition in the world, much more than heart disease. It's imperative that we get patients into remission."
Last year, more people died from suicide than from motor vehicle accidents in the U.S., Johnson added.
He compares depression to cancer: The earlier you catch it, the greater your chances of survival.
"It's a fatal illness," he said. "Not everyone kills themselves, but it kills your life."
Kristine Crane is a Gainesville Sun staff writer.
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