There’s a New Way to Treat Your Depression

Depression is considered one of the more common—and persistent—mental health disorders. The symptoms associated with this condition are diverse and go beyond the more commonly attributed feeling of sadness. Among the available depression treatment options is transcranial magnetic stimulation (TMS), a non-invasive medical device therapy that has been gaining professional recognition and popularity. So how does TMS treatment work? What makes TMS effective in treating depression? And how does TMS affect symptoms? Read on to find out.

Depression: Definition and Possible Causes

The American Psychiatric Association (APA) defines depression, or major depressive disorder (MDD), as a mood disorder marked by a decrease in well-being which is linked  to a reduction of positive emotion (more on that in a moment). Depression has been shown to affect roughly about one in 15 adults, or 6.7% of the adult population. 17.3 million adults (or 7.1%) have experienced one or more depressive episodes during their lifetime.

Reflecting its deficit of beneficial attributes, depression is characterized by a sense of lacking that can manifest in a number of life arenas:

• On an emotional level, depression often includes feelings of sadness, loneliness, emptiness, a lack of hope that things will improve, an inability to feel happiness or pleasure (also known as anhedonia), worthlessness, guilt, or a general sense of mourning without it necessarily consciously associated with a particular loss.
• On a cognitive level, depression is linked to difficulty concentrating, indecisiveness, and at times suicidal ideation.
• On a behavioral level, symptoms of depression can include crying, agitation, and restlessness.
• On a physical level, depression can manifest in feelings of fatigue, low energy, drastic weight changes when not dieting, impaired psychomotor skills, or disrupted sleep patterns.
• On an interpersonal level, depression often has a negative effect on different relationships, causing distress or impairment in the individual’s familial, social, occupational, or romantic spheres.

Possible Causes for Depression

Major depressive disorder has been linked to several possible contributing factors. Among them are:

• Genetics. MDD heritability is around 40%, while having a first-degree relative with this condition also significantly increases the risk of developing depression.
• One’s Childhood Environment. Living through a diverse array of adverse childhood experiences have been shown to contribute to the likelihood of developing depression.
• Life Events. Stressful life events beyond childhood have also been linked to this condition.
• Temperamental Inclination. Neuroticism—the enduring inclination to experience negative emotional states—has been linked to the appearance of depression. More plainly, an individual with a more pessimistic, agitated, or high-strung personality is more likely to develop this condition.
• The Existence of Additional Health Conditions. Generally speaking, dealing with other non-mood disorders increases the likelihood of developing depression. This can include physical ailments such as diabetes, obesity, or cardiovascular disease, which have all have been linked to increased rates of depression. Non-mood mental health disorders, such as borderline personality disorder, anxiety disorders,  and substance abuse, have also been associated with the appearance of this condition.

Types of Depressive States: MDD and Other Depressive Disorders

Major depressive disorder is considered the central depressive disorder included in the APA’s Diagnostic and Statistical Manual’s fifth edition (DSM-V). An MDD diagnosis can be considered after at least two weeks of symptomatology. Furthermore, MDD is not usually associated with instances of depression that continue beyond one year in children and two years in adults.

The DSM-V does, however, recognize several other depressive disorders beyond MDD. The common thread among them is the centrality of sadness, emptiness, or irritability to the individual’s mood, together with physical and cognitive changes that significantly affect their ability to function. They differ from one another in terms of duration, timing, or presumed causation.

In addition to MDD, depressive categories that describe instances of substance abuse and cases that do not meet the official requirements for any specific depressive disorder, the depressive disorders family includes:

• Disruptive Mood Dysregulation Disorder: A childhood disorder defined by anger and irritability. This disorder includes temper outbursts that do not meet the diagnostic criteria of either a manic episode or conditions belonging to the bipolar disorders family. Disruptive mood dysregulation disorder was included in the depressive disorders chapter, since research has shown that as they grow into adulthood, children with this disorder are more likely to develop depressive or anxiety disorders, rather than bipolar disorders.
• Persistent Depressive Disorder (Dysthymia): Referring to the most persistent or chronic forms of depression, this diagnosis should be considered in cases where sufficient depressive symptoms are present for longer than one year for children and adolescents, or two years for adults.
• Premenstrual Dysphoric Disorder: Based on over two decades of research, the majority of cases where this diagnosis applies include marked affective lability, irritability, and anxious or depressed mood during the final week before the onset of menstruation. Those affected by this condition usually report experiencing an improvement and eventually an absence of symptoms in the days following menstruation.

Sadness, Grief and Bipolar Disorders: How They Differ from Depression

Despite certain common traits, MDD is distinct from several other adverse states. Three mental health issues that are commonly confused with depression are sadness, grief, and bipolar disorders.

• Sadness. A natural part of life, sadness refers to an emotional pain that, like depression, is defined by a longing or lacking. The difference between them lies in the fact that sadness normally does not severely disrupt the individual’s daily functioning. Sadness also tends to pass much quicker than depression.
• Grief. In addition to other depressive disorders, major depressive disorder also differs from grief, which is not considered a disorder but rather a normal reaction to a specific, painful loss. The grieving process is also more likely than depression to include balancing, positive elements, such as humor.
• Bipolar Disorders. Another important distinction is between MDD and bipolar disorders. Specifically, cases where one or more manic episodes of extremely elevated, easily irritated, and often exhaustive mood have been reported will not be diagnosed as MDD. They may, however, warrant a diagnosis belonging to the bipolar disorder family.

Who can Diagnose Depression?

Different states and countries define which mental health professionals are allowed to diagnose major depressive disorder according to their own parameters. However, a general consensus is that psychiatrists possess the knowhow and professional status to legally be permitted to diagnose depression. Many countries also list licensed psychologists among those allowed to diagnose this and other mental health conditions. Such professionals often offer depression treatments, as well as the possibility of a diagnosis.

How to Treat Depression

Following an initial diagnosis of depression, patients often seek out mental health professionals who can offer them a viable treatment option for their condition. In addition to first-line treatments such as psychopharmacology and psychodynamic therapy, the more recently developed transcranial magnetic stimulation (TMS), has been gaining recognition among mental health professionals.

TMS: Quick Overview

Transcranial magnetic stimulation was first developed in 1985 as a medical device treatment option for various mental health conditions. The treatment utilizes electromagnetic fields to safely and effectively regulate the neural activity of brain structures found to be associated with the condition targeted. With depression, one of these structures is the bilateral prefrontal cortex.

TMS is an FDA-cleared, non-invasive treatment, and as such does not require anesthesia, an extended recovery period, or a chaperon to and from each session. It generally does not cause any long-lasting or significant side effects, with the most common one being a passing headache during initial sessions.

Due to its non-invasive nature, TMS can be incorporated with other treatments for depression, including medication, to increase their overall efficacy.

There are currently two kinds of TMS treatments available on the market: traditional TMS and Deep TMS:

Traditional TMS has been FDA-cleared since 2008 to treat depression. It uses a handheld device that focuses on a relatively small area of the brain. As a result, traditional TMS can encounter targeting issues, with treatment sessions sometimes missing the sought-after structure. To avoid this, some traditional TMS providers incorporate neuronavigational equipment into treatment sessions, to better identify and reach the targeted area.

Deep TMS has been FDA-cleared to treat depression since 2013. It utilizes its own patented H-Coil technology, which is held inside a cushioned helmet. The helmet is fitted onto the patient’s head, allowing the projected electromagnetic pulses to simultaneously reach wider areas of the brain. At the same time these pulses are directly regulating the neural activity of brain structures located within the brain’s deeper regions. This in turn helps it avoid the targeting issues raised with traditional TMS, while maintaining a high safety standard that does not induce significant side effects.

How does TMS Help Treat Depression?

TMS has been shown to specifically alleviate symptoms of depression. The benefits of this treatment are expressed in two central ways:

Symptom Severity: The overwhelming and debilitating severity of major depression symptoms have repeatedly been shown to decrease following TMS treatment.

Symptom Duration: The pervasive nature of depressive symptoms, which can gradually erode the individual’s sense of well-being, has also been shown to be mitigated due to TMS treatment.

Other Conditions TMS can Treat

In addition to treating depression, TMS has been recognized for its ability to offer symptom relief of other mental health and neurological conditions. While traditional TMS has been FDA-cleared to treat migraine headaches and obsessive-compulsive disorder (OCD), Deep TMS has been FDA-cleared to treat OCD and smoking cessation. Deep TMS has additionally been CE-marked in Europe to treat a number of other conditions.