By Sharan Mujoo
One of the reasons medicine has advanced is due to the rapid leaps technology has made in the last few decades. Nonetheless, there are some diseases as well which have kept pace with technology. And one of those diseases is the largest cause of disability in the world according to the WHO. Commonly known as depression, this ailment affects and disrupts the lives of approximately 300 million people globally. And from 2005 up until 2015, the instances of this disorder have shot up by 18%.
Traditionally, procedures such as Cognitive Behavioural Therapy and Antidepressants classified SSRI (Serotonin Selective Reuptake Inhibitors) and Tricyclics have been used to deal with all kinds of depression. Nevertheless, the efficacy of these methods is still found lacking in plenty of cases, not to mention the side effects, particularly in the case of anti-depressants.
Transcranial Magnetic Stimulation
Off late though, a new technique is proving to be increasingly effective, especially when it comes to dealing with Major Depressive Disorder. Known as Transcranial Magnetic Stimulation, the technique involves the stimulation of neurons in the brain with the help of magnetic induction. Introduced in 1985 by Anthony Baker at the University of Sheffield in England, TMS was designed to be a neurodiagnostic tool used to stimulate muscle movement by activating relevant motor areas of the brain.
Mechanism and action
It is important to understand that the brain consists of electrochemical pathways or circuits which conduct electricity. In order for various parts of the brain to communicate, information must travel across these circuits. Therefore, for the appropriate functioning of the brain, it is imperative that these circuits function appropriately. During a depression, certain chemical messengers responsible for positive or regular moods, such as dopamine, serotonin and norepinephrine are not released in appropriate quantities. Moreover, the release of these chemicals or neurotransmitters is a function of the appropriate stimulation of neurons comprising the circuitry. This is where Transcranial Magnetic Stimulation is able to edge other treatments. Typically, the treatment using TMS involves sittings for 20-40 minutes for 4-6 weeks. Patients are usually made to sit on a chair like that of a dentist and given pulses using a rod with a coil at the end which induces currents in the brain using principles of induction.
Till late, the long-term efficacy of TMS was largely inconclusive due to lack of appropriate trials and studies, even though it was successful for acute cases. The FDA, on this basis, granted approval to this treatment in 2008. However, in 2013, research by Linda Carpenter from Brown University showed the efficacy of TMS for Treatment-Resistant Major Depressive Disorder. “This is the first study to examine 12-month outcomes of TMS in a large dataset in a real-life setting. We have data on 257 patients that got all the way through the long-term follow-up, and we found that 68% improved and 45% had complete remission at 1-year follow-up,” Linda was recorded sharing with Medscape, an online health news provider.
Since then, the US FDA has also granted approval to single pulse TMS for the treatment of a migraine. TMS does have its side effects though. Some of which include fainting, seizures, hypomania, transient hearing loss et al. Companies such as Neurostar have been one of the firsts to pioneer this technology. With 775 systems across the US, they’ve already performed more than a million treatments. TMS has come under the insurance cover as well in countries like the UK and US.
Depression as a disease
While new and improved treatments may keep arriving, it is important to understand that depression is as much a disease as any other. Concern arises when the responsibility of care is assumed to be solely that of the victim. The barrier of social stigma still prevents people from accessing proper care for this disease.
We are living in times of increasingly high uncertainty and complexity which makes it a perfect breeding ground for stress. It comes as no surprise then, that trends of mindfulness and emotional intelligence make their way into modern-day lifestyles of millennials.
Sigmund Freud came up with the insight that depression is aggression turned inwards. It is difficult to translate this into science, however, we understand by now that stress lies at the intersection between psychology and the neurobiology of depression. Depression has biological underpinnings in the brain and modern-day treatments are a testament to this.
Featured Image Source: Visual Hunt
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