Boosting your mood
By Katia Savchuk Special to the Miami Herald
Ryan Jones, 29, a patient at the Chrysalis Transcranial Magnetic Stimulant (TMS) Institute in Miami, is getting treated for post-traumatic stress disorder resulting from his service in Iraq. Doctors are increasingly using TMS to treat depression and PTSD. Alex M Sanchez / For the Miami Herald
Doctors are increasingly using Transcranial Magnetic Stimulation (TMS) to treat depression and post-traumatic stress disorder. Dr. Gregory Marsella, right, who recently opened an office at the University of Miami Life Science & Technology Park, was one of the first doctors in South Florida, and in the country, to offer this treatment after the FDA approved the device in 2008. He is treating Ryan Jones, an Iraqi war veteran from Lighthouse Point, who suffers from PTSD. Alex M. Sanchez / For the Miami Herald
German Ortiz, a Transcranial Magnetic Stimulation technician, gets Ryan Jones, 29, a patient at the Chrysalis TMS Institute in Miami, ready for treatment. Jones, an Iraqi war veteran, is being treated for post-traumatic stress disorder. Alex M. Sanchez / For the Miami Herald
The young man reclined in what looked like a dentist’s chair. A strip of white tape strapped a plastic contraption to his head. As he watched a documentary on conga drums, bursts of electromagnetic pulses tapped his scalp like an invisible woodpecker. They were hitting him 20 times a second, but he didn’t even flinch.
Ryan Jones, 29, was getting transcranial magnetic stimulation at a clinic in downtown Miami. TMS is the latest form of brain stimulation therapy — a safer, less invasive form of electroshock. It’s been gaining popularity in South Florida and across the country as a treatment for depression and other ailments. The expensive therapy is likely to become more mainstream now that Florida’s Medicare provider last month approved it as a treatment for depression.
Jones, an Iraqi war veteran from Lighthouse Point, decided to try TMS after a cocktail of medications failed to lift him from the grip of PTSD. He did two tours as an Apache helicopter crew chief before leaving the U.S. Army in 2009. Back home, he had to withdraw from college and couldn’t hold down a job.
“I was a wreck,” recalled Jones after his most recent appointment. His eyes were hidden behind dark sunglasses, and he held a cigarette between chewed fingernails. “I was having a very hard time transitioning back to civilian life. I couldn’t do it anymore on my own.”
While staying on his medication, he decided to try TMS after seeing a poster for the treatment in his psychiatrist’s office.
“I was apprehensive because it just seemed too good to be true,” he said.
Five days a week for a month, he traveled to the Chrysalis TMS Institute, a Boca Raton-based practice that opened an office in Miami earlier this year. For about half an hour, a metallic coil delivered 3,000 targeted pulses to his skull. This created a magnetic field that stimulated his prefrontal cortex, which controls neurotransmitters linked with mood. In the case of PTSD, the goal was to calm his rapidly firing neurons.
“It’s a little uncomfortable when it’s happening, but you don’t feel different,” he said. “It feels like someone’s tapping you on the head with small hammer really, really fast.”
At first, nothing changed. For a while Jones felt even more agitated. But after about three weeks, he noticed his mood gradually improving.
“Things just got brighter. I could actually get out of bed in the morning,” he said. “It gave me some hope that I could get better, live my life, not live under a dark cloud for the rest of my days.”
Jones’ psychiatrist, Dr. Gregory Marsella, said TMS works for the vast majority of his patients. He was one of the first doctors in the country to offer the therapy after the Food and Drug Administration approved the first TMS device, made by Pennsylvania-based Neuronetics Inc., in 2008. He was also among the earliest to adopt a second machine that reaches deeper sections of the brain after the FDA gave it a green light in January.
Marsella, 60, is thin with wide eyes and a beak-like nose. His unbuttoned white lab coat and black hair streaked with white give him the air of a mad scientist.
Originally from Providence, Marsella studied English at Harvard and medicine at the University of Pennsylvania. In 1987, he moved to Florida to run an adolescent facility in Delray Beach. It was the dawn of the Prozac revolution.
“The reception was so wonderful that people were thinking maybe the whole world should be on Prozac,’’ Marsella said. “But it was quite ineffective for a small amount of the population.”
After Marsella went into private practice in 1992, he increasingly grew frustrated by the side effects that medication produced in many patients. When TMS came along, he was thrilled at the prospect of a targeted treatment with apparently few risks worse than a headache. It could be a godsend for people who didn’t respond to medication or those who couldn’t take many pills, like pregnant women or the elderly.
“It’s a dream that continuing pills is going to be a continually developing panacea. Every time you take a medication it gets disseminated to every tissue in your body. The future is going to be targeted medicine,” Marsella said.
Before TMS, electroconvulsive therapy was the only option for depressed patients who didn’t react to pills. Despite its bad rap, ECT is still the most popular form of brain stimulation therapy and the most effective for intractable depression. But ECT, which requires full sedation and an induced seizure, is much riskier and has been shown to cause memory loss and long-term cognitive damage.
Studies so far suggest that TMS is much safer. In rare cases, it has caused seizures and hearing loss, but typically nothing more than slight discomfort or lightheadedness.
“The consensus opinion that’s coming down the pike is that TMS doesn’t have far to go before it matches and perhaps exceeds the success rates of shock therapy. When that happens, there’s going to be a groundswell in psychiatry,” Marsella said.
Several large trials have shown that TMS improves the mood of patients who didn’t respond to an anti-depressant. Studies have shown promising results in treating PTSD, schizophrenia and bipolar disorder. Marsella, who performs clinical trials, said he’s also used TMS to treat seizures, Tourette syndrome, insomnia and chronic pain.
But questions remain about how effective the treatment is. Dr. Charles Nemeroff, chair of psychiatry at the University of Miami Miller School of Medicine, said more research is needed to determine whether TMS really works.
“The availability of data from which clinicians can judge its efficacy is meager,” he said. “The bottom line is we don’t have a treasure trove of evidence.”
Nemeroff said he’s recommended TMS to depressed patients who haven’t responded to other treatments.
“Do I personally think it works? That’s a belief, not science. I think it works for some patients and not others,” he said.
Dr. Martin Strassnig, a psychiatry professor who directs the brain stimulation clinic at the University of Miami, said treating PTSD, anxiety and other conditions with TMS is still experimental.
“Before recommending TMS for any of these indications, I think there needs to be more studies done,” he said. “It’s not been validated —there’s no solid evidence.”
Researchers also know very little about TMS in the long-term —whether positive effects last or other side effects emerge. Nearly 500 doctors across the country offer TMS treatment today, according to the manufacturer Neuronetics. Marsella, who opened an office at the University of Miami Life Science & Technology Park in August, is one of the only providers in Miami-Dade. Until recently, the $400 per session cost has been prohibitively expensive for many.
That may soon change. On Oct. 7, Florida’s Medicare provider joined more than a dozen other states in approving coverage of TMS as a treatment for major depression. As other insurance plans follow, it’s likely that TMS will become more widespread — and less expensive.
Even if the science on TMS as a PTSD treatment is still inchoate, Jones said his experience is proof that it can help. After the treatment, he eventually stopped taking medication, began socializing more with friends and started a document management job at a law firm.
“Things started to get better and better and better, and I haven’t felt this good since before I was in the military,” he said. “I still have bad days and good days, but it’s not just depressed for no reason.”
But Jones questions whether the benefits will last.
“Sometimes I wonder if things will keep going this way or if I’m looking at slipping back into depression.”