Columbus psychiatrist Kevin McPherson has patients suffering from depression for whom neither talk therapy nor medication management is providing the desired relief.
He has begun offering another option.
"I had nothing else to offer them but now I do," McPherson said.
It is called transcranial magnetic stimulation, and he has been using it at his office on Brookstone Centre Parkway for about a year.
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McPherson explained that TMS uses magnetic fields to stimulate nerve cells in the region of the brain that research has demonstrated to be associated with depression.
With the NeuroStar system used by McPherson, a treatment coil sits on the scalp of the patient above the left prefrontal cortex, the part of the brain involved with mood regulation.
As the magnetic fields enter the brain, they release tiny electrical currents that stimulate cells called neurons, which are thought to release neurotransmitters such as serotonin, dopamin and norepinephrine. Since depression is thought to be the result of an imbalance of these chemicals in the brain, TMS can help restore that balance.
"It restarts circuitry that is not working. It's like cranking an engine," McPherson said.
The National Institute of Mental Health says that most likely depression is caused by a combination of genetic, biological, environmental and psychological factors.
Brain imaging technologies have shown the brains of people with depression look different from those who don't.
McPherson said TMS is not the same as electroconvulsive therapy, which is better known as electroshock treatment. With that procedure, electrical currents are sent into the brain that intentionally trigger a seizure. The change in brain chemistry caused by the currents may relieve symptoms for some people with particular mental disorders.
"ECT is still used today and can be effective in certain situations," McPherson said.
McPherson said TMS was approved by the U.S. Food and Drug Administration in 2008. He did a lot of research into the procedure before investing about $70,000 in a NeuroStar system.
"It was a leap of faith on my part," he said.
McPherson said he has done the procedure on about 20 patients and has seen success. He said some patients have seen improvement soon after treatments begin.
"They start sleeping better," McPherson said.
TMS is noninvasive. McPherson said the patient is awake and alert during the procedure.
"The patients can talk to me," he said.
No anesthesia is involved. There is only minor discomfort as some people suffer some scalp irritation.
A patient comes for treatment five days a week for six weeks. Each session is about 37 minutes.
While sitting in a large, comfortable chair, the patient hears a clicking sound and feels nothing more than a light tapping sensation on the head.
"Think of a woodpecker," McPherson said.
The tapping goes on for four seconds. There is then a break of 26 seconds.
McPherson said a person receives 10 magnetic pulses per second and 4,000 overall in a session.
"Medicine uses chemicals to get to the wiring. This goes straight to the wiring," McPherson said.
There are few side possible effects, including headaches or lightheadedness.
Asked about TMS causing a seizure. McPherson replied that the chances of that are extremely rare, like one in 30,000.
He said TMS is approved only for depression and not for people with bipolar disorder.
TMS, also in use at the Bradley Center in Columbus, is not cheap. The treatments run $10,000 to $12,000. He said many insurances do not cover it, but he believes that number will grow.
Since it is so new, the long-term effectiveness of TMS is still unknown. "We don't know about 10 or 15 years. We know it helps in the short term," McPherson said.
McPherson has been in practice locally for three years. The Virginia native has a degree from Brown University and graduated from the University of Tennessee Health Science Center. He completed his residency at Walter Reed Army Medical Center. He was a major in the U.S. Army, seeing two tours of duty in Iraq and was stationed at Fort Benning.
According to the Centers for Disease Control and Prevention, 1 in 10 adults has depression.
Symptoms include fatigue, diminished ability to concentrate, recurrent thoughts of suicide, feelings of worthlessness, insomnia and irritability.
"Depression is a serious illness that is still misunderstood by many," McPherson said. "Everybody likely has a friend or family member with depression."