What if treatment resistance to depression didn't exist?
Depression is the leading cause of disability in the United States among people ages 15 to 44.The most common treatment modalities for major depression have generally been medication and counseling or psychotherapy. However, traditional psychiatric medication is not suitable for everyone, and psychotherapy is not always accessible. About two-thirds of people with depression don't get adequate relief from the first antidepressant they try. After two months of treatment, at least some symptoms will remain for these individuals, and each subsequent medication tried is less likely to help than the one before (Stern 2020). People can become more overwhelmed the longer symptoms persist without adequate relief.
There are only so many medications available, and nothing has significantly changed the SSRI market since Prozac came out in the 90s. So, what can people with depression do when they do not respond to first-line treatments? For several decades, electroconvulsive therapy (ECT) was the solution for treatment-resistant depression. However, ECT or "shock therapy" is an invasive procedure that requires anesthesia and is accompanied by side effects such as memory and cognition impairment, making it less desirable to many people.
What if what had not been considered was that depression is not inherently treatment-resistant, but only resistant to the known treatment modalities? Reframing this thought has helped researchers think outside the box. By learning more about where depression manifests, we can find innovative ways to treat it and potentially make treatment resistance a thing of the past.
Enter the magnets.
Transcranial Magnetic Stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression. It's called a "noninvasive" procedure because it's done without surgery or cutting the skin. During TMS treatment, a small coil is placed on the patient’s head, and painless magnetic pulses are sent to the targeted area of the brain. This coil delivers magnetic pulses that stimulate nerve cells in the region of the brain involved in mood control and depression. It's thought to activate regions of the brain that have decreased activity during depression.
Visualize.
Imagine, for a moment, that you are stuck in a place with someone who will not stop yelling at you or barking orders. What do you do? Maybe you yell back at first, but eventually, you run out of energy. You cannot leave, and you must figure out how to survive. So, you slowly disassociate; you shut down and try to shut out the yelling.
Now imagine the yelling was not a person, but a feeling inside you. This is what depression is like for many people. The “yelling” is feeling sad, worthless, overwhelmed, hopeless; it is having low energy, sleeping too much or not enough; being unable to “get over it” and even feeling paralyzed at times. Depression slowly but surely causes a person to shut down because they cannot escape it or even minimize the effects if the front-line treatments have not worked. Where positive feelings should exist, depression has taken over and put that part of the brain to sleep to survive. Medication tried to pound through, but ultimately the brain was like Teflon, and it just bounced right out.
TMS uses brain mapping to pinpoint the exact location of the depression. Once the location has been determined, the magnet gently taps the part of the brain that has gone into hibernation trying to survive depression. The soothing but powerful magnetic pulses tap consistently on the brain like a knock at the door saying, “It is time to wake up.” For the first few weeks of TMS, the brain is slowly awakening, but by the end of treatment, it has been recharged.
What is the treatment process?
Pivot has an integrative team of healthcare professionals. Therapists and psychiatric providers collaborate in the TMS process to help you gain access to care.
Schedule a TMS Consultation with any clinical provider at Pivot.
Complete a Psychiatric Evaluation with a psychiatrist at Pivot.
Eligible patients will work with the Pivot administration team to obtain prior authorization approval from insurance since this is not a regularly covered procedure and can be quite expensive.
Once approved, patients will attend their initial brain-mapping session where the treatment location will be determined.
Patients attend 5 sessions per week at 19 minutes per session for a period of 6 weeks.
Follow-up appointments need to be attended as recommended.
The Pivot Promise
At Pivot, our goal is to redefine the concept of treatment resistance by reimagining mental health treatment. While we cannot guarantee that TMS is the solution, we can assure you that we will relentlessly strive to discover the remedy that brings you relief.
We rely on science and evidence-based practices to guide our treatment methodologies. Our team is proficient in highly innovative modalities, so while we cannot promise specific outcomes, we can enhance your chances of success. Our objective is to utilize our clinical expertise to collaborate with you, as the expert on your life and symptoms, to develop a tailored solution for your needs.