TMS Vs ECT

  

Depression and Neurological treatment through TMS and ECT

 

   Ghulam Mohyud Din & Aimen Akbar

 

Depression: 

The Diagnostic and Statistical Manual of Mental Disorders (DSM V) states that depression is a major mood disorder or clinical disorder common which is common and serious mood disorder. It ranges from mild to severe level. It is a complicated illness and effects everyone differently.

According to International Classification of Diseases (ICD11) depression is a series of continua in the area of mood disorders: those between ‘normal sadness’ and depression; between ‘normal elation and hypomania; between a ‘pure’ depressive episode and a ’pure’ manic episode; between unipolar depression and bipolar disorder; between ‘mood disorders and psychotic disorder.’ Patients experience periods of intense emotions changing in sleep patterns and activity levels, a characteristic behavior—often without recognizing their likely harmful or undesirable effects. Bipolar disorders are also called ‘mood episodes.

Depression occurs in every decade of life in all communities of the world. Biological; social pressures or economic burden are the leading cause of depression. Mind and brain are two ways of looking at the same thing.

Depression is not an easy area of research because a lot of depression treatment takes place in private office practice, a confidential setting and documentation is not publicly available. Excessive sadness or blue mood is depressive illness.

Successful management of depression is typically achieved by using a multiple-pronged and the ‘come at it from all angels. Change in lifestyle, limiting alcohol intake, making time for fun, medication, antidepressant, TMS’s, ECT.

Neurostar Transcranial Magnetic Stimulation (TMS)

It is a type of noninvasive deep brain stimulation that may be used to treat severe depression or obsessive-compulsive disorders (OCD) when other treatments are not available. Therapists do not restrict to a specific technique and use eclectic approach. Thirty-six sessions, five times a week and then tapering off to three sessions per week for the final three weeks. During a typical TMS session, a helmet is placed on the patient’s head and magnetic pulses are delivered to stimulate the nerve cells in precise areas of the brain associated with mood control. Many patients describe the feeling of TMS as a tapping sensation on their head, feel sleepy, muscle tightness. Not used as a primary treatment

Types of TMS

It is predecessor of dTMS and is a relatively non-invasive procedure that involves placing procedure that involves placing a small device directly on the skull. This sealed device directly on the skull. This sealed device contains a coil of wire that carries electricity and generates a magnetic field. It is called repetitive because it pulses rather than remaining steady.

The flow of electricity through the device stimulates cells in the brain called neurons, changing their activity levels. The activity level of neurons has been linked to symptoms of mental illness like OCD. The number of treatments depends on the treatment protocol.

It also uses coil placed directly on the skull, which creates a magnetic field penetrating the brain .The biggest difference between two types are that coil used for dTMS , called H-coil allows the pulse to

Cost 230US$-330 per session.

Well tolerated and safe.

Side effect is scalp discomfort.

TMS has received considerable attention as a possible alternative for certain conditions.

Reasons to try TMS.

Very effective to patients resisting OCD, severe depression, bipolar disorders combined with medication

 

Electroconvulsive Therapy (ECT)

A patient is sedated, then the electrodes are placed on their scalp to deliver an electric current to the brain to induce a small seizure. It quickly reduces the symptoms of depression as well as maniain those who struggle with mood disorders. Direct electric currents to patient’s head while they are sedated and immobilized, intentionally causing a ‘therapeutic seizure’ to reset the brain. Short term cognitive effect but not always preclude independent living during the period of time ECT  as delivered changes in heartbeat, blood pressure, transient deficits although rare  ECT is also used in bipolar depression, mania, catatonia and schizophrenia.

ECT extremely acute and dangerous cases of depression which either have not responded to or do not have the time to respond.

A patient is sedated, then the electrodes are placed on their scalp to deliver an electric current to the brain to induce a small seizure. It quickly reduces the symptoms of depression as well as maniain those who struggle with mood disorders. Direct electric currents to patient’s head while they are sedated and immobilized, intentionally causing a ‘therapeutic seizure’ to reset the brain. Short term cognitive effect but not always preclude independent living during the period of time ECT  as delivered changes in heartbeat, blood pressure, transient deficits although rare  ECT is also used in bipolar depression, mania, catatonia and schizophrenia.

ECT extremely acute and dangerous cases of depression which either have not respondes to or do not have the time to respond.

Effectiveness and effectiveness of treatment

ECT can be useful to address treatment-resistant depression, bipolar disorder,etc.Mental Health won’t just go back to normal when Pandemic is over.

 

Comparison between TSM and ECT

 

Both procedures are vastly different. Both are effective. There are many differences in safety and tolerability. Both affect the brain of patient. Both ultimately cause changes in neurotransmitter levels and receptors, as well as increased levels of healing proteins such as brain derived neurotropic factorThe pre-frontal lobe activity and connectivity with deep brain structures. Access to ETC was limited by precautionary measures to limit exposure to the Covid19 virus. Some patients who did not respond to ECT responded TMS.

Neurostar TMS patients sit in the chair for 19-37 minutes. No sedation. No hospitalization. Patients can transport through to and fro from treatment place. No effect on memory system, no seizures. Perform daily chores. Individualized and personalized treatment system. Patients are encouraged to engage in reading, watching videos, light discussions, listening to the music etc.

In ECT electric shock is given to the patient. It is also personalized treatment. Sedation is necessary. Short term loss of memory and confusion. Seizure occurs after shock. Monitoring is required after shock. Recovery occurs slowly. It is not at all first, second or third priority of treatment. It is only administered to save life or to reduce resistant depression or in extremely violent behaviors. It has led to a spike in anxiety, depression, stress, and other mental health issues. Heavy caseloads and long wait lists.

 

Deciding Between TMS and ECT

ECT practice is ceased in pandemic Covid-19 so there is no way it can be done now a days all over the globe. ECT always been considered a last resort to stabilize a patient with depression. There is oversimplification and stigmatization of ECT by the media had led treatment-resistant and severely depressed patients to reject it. Even if positive response is 80 to 90% patients are still reluctant to adapt

Patients who did not respond to ECT, Neurostar TMS may be administered.

Why TSM?

Not enough improvement from standard treatment. Uses latest technology to improve symptoms of mental health disorders without the use of medication.

Feels like tapping sensation, and headache which subsides within the first week of treatment.

A slight tingling sensation on the scalp; facial twitching

No nausea, dry mouth, infomania, dizziness, fatigue and sexual problems reported.

Patients remain aware entire time, so there is no risk of anesthesia.

No Psychotherapy and other treatments have not done enough to relieve patients. Although have not received Federal Food and Drug Administration (FDA) approval but studies show that TMS is:

Extremely helpful in pandemic Covid 19. Patients eligible forTMS are:

Effective in childhood depression

Post-Traumatic Stress Disorder (PTSD)

Smoking cessation

ADHD

Anxiety

Autism

Bipolar disorder

Chronic pain

Eating disorder

Multi Scleroses (MS)

Schizophrenia

Stroke rehabilitation

Substance abuse disorders

Fibromyalgia

Tinnitus

Infect TMS, has used in Europe to the above and other disorders.

Do not use TMS if:

Patients have metal fragments in any part of body.

Many Insurance Providers cover it.