UAB Offers New Treatment for Depression: First In State With Cutting-Edge Technology

By Dale Short In ancient times the devastating brain disorder we now know as major depressive disorder, or clinical depression, was so mysterious and allencompassing that it could only be described metaphorically, as a force of nature. Physicians first named it melancholia, which is Greek for black bile. Even today, author and depression sufferer Andrew Solomon titled his award-winning memoir The Noonday Demon: An Atlas of Depression. Not until the mid 20th century would effective pharmaceutical treatments be developed for the chemical imbalances in the brain. And when drugs and psychotherapy both failed, the last resort was to directly, and violently, stimulate the affected brain cells with a jolt of electricity, known as Electro-Convulsive Therapy, or ECT. Now, there's a new alternative. The University of Alabama at Birmingham is the first medical center in Alabama to offer a treatment for depression called Repetitive Transcranial Magnetic Stimulation, or rTMS. As the name suggests, rTMS delivers focused magnetic pulsesat about the strength of an MRIto the part of the brain most involved in depression.

The area is called the left dorsolateral prefrontal cortex, says Bates Redwine, M.D., an assistant professor in the UAB Department of Psychiatry and Behavioral Neurobiology, and it's known to have decreased activity in depressed patients. The magnetic pulses pass through the scalp and skull to the brain, where they cause these brain cells to activate. The rTMS seems to 'wake up' those neurons, stimulating them to fire and become more active. Repeated stimulation over a series of weeks causes sustained activation of this specific area of the brain, that results in significant improvements in depressive symptoms. The more treatments you have, the more sustained the effect." The rTMS device is attached to a flexible arm, as with a dentist's chair. Sessions are generally 40 minutes, five times a week, and patients typically start showing improvement within four to six weeks. A main advantage of the treatment is that it's non-invasive, says Redwine: Patients sit in the chair with the magnet positioned in the appropriate spot, where it delivers the focused magnetic pulse. They hear a clicking sound while the device is pulsing, but there are no significant sideeffects. Most patients watch TV, or even nap, during the procedure. There's no sedation required, and no sedating effect, so it's a lot less involved than many other inpatient procedures, and there are no major side effects. For a lot of people, that's a big dealnot to have side effects, and not to have to take medication. (The most common side-effect reported is a mild headache afterward. But this may be a function of the noise the machine produces, which Redwine says is somewhat reminiscent of the clacking of old IBM Selectric typewriters.) Medications are wonderful, and psychotherapy is wonderful, but many people don't respond to those. So it's always good to have something else that we can use to treat depression. In clinical trials, more than half of rTMS patients showed significant improvement of their condition, and a third of them experienced complete remission. The depression connection first came up in a related field of study, when PET and MRI scans of stroke patients showing decreased metabolism in the left dorsolateral prefrontal cortex. People recovering from strokes that have occurred in this area of their brain have far higher rates of depression than those with different types of strokes. Though not all health insurance plans cover rTMS treatments, there's a movement in the industry to include themespecially since Redwine says that in the long run, rTMS may prove to be more economical than current alternatives.

More information about UAB's rTMS therapy is available at (205) 996-7431. # # #