Transcranial Magnetic Stimulation: A Different Approach for Mental Disorders
With nearly8％的美国成年人(nearly 20 million people) living with depression, data suggests thatmedication and talk therapy are only effective in treating around two-thirds of depressive patients, underscoring a concerning gap of people left without relief. In clinical terms, this group of people who are unable to find sufficient benefit through medication is deemed “treatment-resistant”, leaving them feeling without answers or help. However, an alternative type of FDA-cleared treatment is on the rise.
Transcranial magnetic stimulation或“ TMS”是一种非侵入性脑刺激方法，使用放置在头皮上的绝缘线圈依赖电磁诱导，重点是被认为在情绪调节中起作用的大脑区域。线圈会产生简短的磁脉冲，这些脉冲轻松地通过头骨进入大脑。产生的脉冲与磁共振成像（MRI）机产生的脉冲具有相同的类型和强度。由于其高疗效和安全性，这种方法是获得令人难以置信的牵引力和接受作为抗治疗抑郁症的有效疗法 - 除了没有全身性副作用的患者之外。
围绕新型TMS的持续创新继续给数百万患有精神疾病的人带来希望，越来越多的患者大声疾呼，表明精神卫生行业的转变令人鼓舞。
TMS的历史及其运作方式
While the concept of using magnetic pulses to stimulate the human brain and other parts of the body in an attempt to treat diseases can be traced back to more than 100 years ago, the first modern TMS device was introduced in 1985 by安东尼·巴克博士。His device and studies proved the influence of magnetic stimulation on the motor cortex to alter the brain’s electrical signals with the use of magnetic fields. At present, devices for repetitive electromagnetic induction have been developed such that different parameters, including the ability to increase or decrease the excitability of cortical areas, can be modified to research neurological and psychological conditions.
Traditional TMS uses a figure-eight shaped coil that sends out an electromagnetic field with the ability to safely reach brain structures involved in depression. By influencing these structures, TMS is able to safely regulate their neural activity, thereby facilitating symptom alleviation and contributing to the patient’s well-being.
Emerging TMS technology enables deeper and broader penetration of electromagnetic stimulation, resulting in more neurons being activated in the target brain regions. This helps maintain the field’s effectiveness without needing to increase the intensity to a level that risks causing undesirable side effects. The deeper, broader field also enhances targeting of the correct brain region, eliminating the need for complex neuronavigation equipment.
While the magnetic pulses activated by standard rTMS only reach a depth of 0.27” (0.7cm) beneath the cortex, new TMS technology can reach up to 1.25” (3.2cm) beneath the cortex,which uniquely enables the ability to safely and directly stimulate both deeper and wider ranges of the brain to treat a number of mental health and addiction conditions。
TMS vs traditional treatment methods
A number of antidepressant medications have been FDA-approved to treat major depressive disorder (MDD). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are usually prescribed as first-line treatments. However, despite their relatively high remission rates,over 40% of patients with MDD remain unresponsive to antidepressants并被认为是耐药的。药物也可能具有难以溶解的副作用，from insomnia to appetite changes, weight gain and sexual dysfunction。
药物的副作用主要与进入血液并影响整个身体的抗抑郁药的系统性有关，并可以防止患者维持药物治疗方案。抗抑郁药随着时间的流逝而失去功效也很常见，有时甚至没有病人就知道发生了。连续药物通过连续的药物减少了临床益处，这突显了TMS在精神病实践中服务的关键补充，为不需要药物的有效方法提供了一种有效的心理健康疾病方法，尤其是对于耐治疗的人。
As a non-invasive form of treatment, TMS can bring about significant and beneficial change in one’s well-being that can be introduced as a standalone treatment or in combination with other forms of therapy, including medication and psychotherapy. Depression is one of the leading causes of disability in the developed world and treatment-resistant depression affects more than 5 million patients a year in the United States.
Second-line treatments in the outpatient arena have a 21% chance of efficacy in achieving remission和第四线治疗有13％的机会达到缓解的机会。通过多次不成功的药物试验来抗击严重抑郁症的患者，或发现治疗的副作用是无法忍受的，无法继续尝试，可以从无创的治疗方案（例如TMS）中受益匪浅。尽管没有治疗抑郁症可以保证永久治愈，但TMS治疗过程的积极影响已显示出明显的耐用性，通常一年或更长时间。当救济开始减少时，可以进行后续治疗。
TMS moving forward
Overall, findings continue to support the efficacy of TMS for treatment-resistant mental disorders. Clinical research continues to expand the use of TMS to new indications, and is allowing practitioners to optimize protocols, including stimulation parameters, treatment targets and TMS delivery schedules. Ongoing research using neuroimaging and electroencephalography (EEG) is laying the foundation for a deeper understanding of treatment-resistant depression and therapeutic mechanisms of TMS.
We will continue to see an evolution of technology as more and more mental diseases will be able to be treated. As more psychiatric practices continue to offer innovative TMS technology, more patient needs will be met through the treatment of MDD, OCD and smoking cessation.
最终，TMS将继续是一种至关重要的非侵入性支柱，作为治疗各种精神病，神经和成瘾性疾病的一种方法。
关于作者
Aron Tendler博士是Brainsway, developers of Deep Transcranial Magnetic Stimulation (Deep TMS™), the only TMS treatment that is FDA-cleared to treat four indications: depression, anxious depression, OCD and smoking addiction. As CMO, a medical doctor, and a psychiatrist with decades of experience, Dr. Tendler’s research has been published in numerous peer-reviewed journals.
