“Turning a miss into a hit”: the benefits of rTMS

Emphatically presenting on the benefits of brain stimulation in the treatment of mental illness, Dr. Jonathan Downar suggests that rTMS and neuroimaging is making inroads.

At the latest Grand Rounds session at Ontario Shores Centre for Mental Health Sciences (Ontario Shores), Dr. Downar from the University Health Network shared that one of the most frequently asked questions by patients is “Why can’t I find a Psychiatrist?".

To truly provide universal healthcare, Dr. Downar says that by 2030, each psychiatrist would need to be seeing at least 1600 patients.

“We know that effective care is to present care to more people and to identify the best ways to get this done,” says Dr. Downar.

Specifically there is a subset of individuals who need particular help.   There are about 275,000 people living with treatment resistant depression out of the 640,000 individuals that are living with depression.

Of this group of individuals living with treatment resistant depression, about 10-15 percent is helped with medication.  They also have need for an intensive program of therapy to change thought patterns as well as the need to remove external stressors, which may affect their individual recovery.

The remaining percentage in the group still needs help.

“About 1,600 of the 275,000 get help with electroconvulsive therapy or ECT.  This number is greatly affected by the stigma that is associated with it,” says Dr. Downar.

An alternative is repetitive transcranial magnetic stimulation, or rTMS, which is a non-invasive brain stimulation used in the treatment of major depression and which has reduced symptoms by 50%.  rTMS involves placing a magnetic coil on the scalp and using it to stimulate the brain’s electrical circuits. Over or under-active parts of the brain can be calmed down or jump-started.

Considered to be safe, rTMS has been approved by the FDA in 2008 with its main disadvantage being inconvenience, as patients have to make regular visits to complete a course of treatment.

“There are no known long term adverse effects with the use of rTMS therapeutic brain stimulation. This treatment has also been able to get symptoms down by half with a remission rate of 30-35 percent,” adds Dr. Downar.

While the use of rTMS is not always successful and the brain does not always respond in a predictable way to the stimulation, this treatment can be very successful and cost effective. 

“With 10 – 15 minute appointments and with 25-50 sessions per day seeing up to 200 patients per year per device is feasible.  This means that one medical doctor and five technicians can see about 1,000 patients per year,” Dr. Downar explains. 

This brings us much closer to true universal healthcare.