repetitive transcranial magnetic stimulation for depression

1. rTMS Therapy for Depression
Dr Ajay Nihalani,MD,MRCPsych
www.drnihalanipsychiatristdelhi.in

2. • What is magnet Therapy?
• How does it work?
• What are the side effects?
• Does it work?
• Magnet therapy in the media.
• Tips are MANDATORY

3. What is Magnet Therapy?

4. Is it the Application of Magnets this
way?

5. rTMS
• Repetitive Transcranial Magnetic Stimulation

6. What is involved in Therapy?

9. How does rTMS work?

10. • Magnetic stimulation leads to either an
increase or decrease in brain activity in
targeted brain area.

11. Left Front End of Brain

12. Brain Perfusion SPECT.

13. Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose
metabolism
Li, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
Fig. 1 Normalized glucose metabolism between medication-resistant depressives (MRD) and healthy controls (HC) under P< 0.05
corrected for multiple comparisons, suggesting a reciprocal limbic-cortical dysregulation in MRD even after depressed symptoms
were under control.

14. Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolism
Li, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
Comparisons of normalized baseline glucose metabolism between rTMS responders and non-responders under a voxel-level
uncorrected P< 0.05 (Upper left: Responders > Non-responders; Upper right: Responders < Non-responders; Lower: Responders >
Non-Responders [in red], Responders < Non-Responders [in blue], with transverse slices in Axis- Z of − 40 to 40), suggesting patients
with less impaired limbic-cortical dysregulation responded better to rTMS.

15. Fig. 2 Normalized baseline glucose metabolism between rTMS responders and non-responders, with blue crossings showing an individu
global maximum cluster under a cluster-level uncorrected P< 0.05 (Upper: Responders > Non-responders [2756 voxels, P= 0.009, global
maximum at Talairach ( xyz) coordinates of 6, 46, 14]; Lower: Responders < Non-responders [1011 voxels, P= 0.087, global maximum at
Talairach ( xyz) coordinates of − 34, − 28, − 10]).
Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolism
Li, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.

16. Fig. 4 Pretreatment glucose metabolism relating to depressive symptom improvement following a 2-week add-on rTMS treatment, with blue cross
individual global maximum cluster under P< 0.05 corrected for multiple comparisons (Upper, positive correlation [1070 voxels, P= 0.029, global ma
Talairach ( xyz) coordinates of − 2, 38, 12]; Lower: negative correlation [3751 voxels, P= 0.001, global maximum at Talairach ( xyz) coordinates of −
14]).
Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolism
Li, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.

17. Fig. 1. Bottom row: Representative consecutive transaxial slices at the level of the basal
ganglia parallel to the cantho-meatal line of pre-rTMS treatment neuroSPECT. The pre-
treatment study demonstrates decreased perfusion in the right temporal and bilateral
infero-frontal regions, as well as non-homogeneous uptake in the caudate nuclei. TOP row:
Representative consecutive transaxial slices at the same level of the basal ganglia as the
previous study of post-rTMS treatment neuroSPECT. Following treatment, the neuroSPECT
study demonstrates marked, general improvement in brain perfusion, including frontal,
infero-frontal, and temporal regions, and an increased uptake in the left thalamus.
Right prefrontal rTMS treatment for refractory auditory command hallucinations – a neuroSPECT ass
Psychiatry Research:
Neuroimaging
Volume 116, Issues 1–2, 30 November 2002, Pages 113–117

18. Side effects?

20. • APA conference-37% remission
• -58% positive response

21. Magnetic Therapy in Media

22. • Magnet Treatment for Depression Works for
Some
• Rigorous Study Finds rTMS Magnet Therapy
Can Relieve Depression With Few Side Effects
• May 4, 2010 -- A controversial new treatment
for depression, rTMS, helps some patients, a
rigorous government-funded study finds

23. • Attractive Therapy: Magnetic Brain
Stimulation Gaining Favor as Treatment for
Depression
• More doctors are turning to repetitive
transcranial magnetic stimulation (rTMS) of
their patient's brains
• Aug 30 2010

24. • Magnetic therapy works where pills fail in major
depression
• Malathy Iyer, TNN Sep 9, 2012, 05.31AM IST
• (The therapy, which won the…)
• MUMBAI: Six months ago, south Mumbai-based executive
Ramesh Joshi's behaviour started worrying his family. He
would take two hours to finish a meal. While walking, he
would suddenly freeze at a spot. He would stammer if he
had to speak more than a couple of lines. The medical
diagnosis — major depressive disorder — stunned his

25. • Wednesday 10 October 2012
News updated at 2:19 AM IST
• Magnetic therapy for depression
• London, May 10, 2012, PTI:
• Scientists have found a new magnetic therapy
for depression which they claim could soon spell
the end for brain-altering, anti-depressant
drugs.

26. • End of anti-depressants? Magnetic pulse therapy
eases depression in third of patients
• By Claire Bates
• PUBLISHED: 11:29 GMT, 9 May 2012 | UPDATED:
14:25 GMT, 9 May 2012
• Depression affects one in four of us at some point of
our lives, but controversy still reigns over how to best
treat the debilitating condition.
• Now scientists have found that a type of 'magnetic
therapy' - which involves no brain-altering drugs or
invasive procedures - could be a potent new
treatment.

27. • Magnetic pulses draw good reviews from
doctors treating depression
• Therapy shows positive results for those
getting treatment
• April 11, 2012|By Janice Neumann, Special to
the Tribune